BackgroundJharkhand, a state with substantial tribal population in Eastern India has very high rate of undernutrition. The study tries to understand the social determinants of inequities in under-nutrition (weight-for-age) among children aged less than 5 years, in Gumla District of the State.MethodsCross sectional study of 1070 children from 32 villages of 4 Blocks of Gumla District.Results54.3 % (95 % CI 51.3–57.3) children were found to be underweight (less than -2SD), with insignificant difference between girls and boys. Multivariate analysis showed that poverty was the single most important predictor of undernutrition, where a child from the poorest quintile was 70 % more likely to be underweight (aOR 1.70, CI 1.13–2.57), compared to one from the least poor group (Quintile 5). While the difference in weight-for-age status between Scheduled Tribes and “OBC and other communities” was non-significant (95 % OR 1.12, CI 0.88–1.42) in the study context; community disaggregated data revealed that there were large variations within the tribal community, and numerically smaller communities also ranked lower in wealth, and their children showed poorer nutritional status. Other factors like maternal education beyond matriculation level also had some bearing. Bivariate analysis showed that chances of a child being underweight (<−2SD) was 43 % more and being severely underweight (<−3SD) was 26 % more for mothers with less than 10 years of schooling compared to those who had attended school for more than 10 years. Educational attainment of mothers did not show any significant difference between tribal and non-tribal communities.ConclusionOverall nutritional status of children in Gumla is very grim and calls for immediate interventions, with universal coverage. Risk was almost equal for both genders, and for tribal and non-tribal population, though within tribal communities, it was slightly higher for smaller tribal communities, calling for soft targeting. Comprehensive programme addressing poverty and higher education for girls would be important to overcome the structural barriers, and should be integral part of any intervention. The study highlights the importance of soft targeting vulnerable communities within the universal coverage of government programmes for better nutritional outcomes.

About four in 10 individuals in pre-ART care were lost to follow-up within 1 year of registration. This needs urgent attention. Routine cohort analysis in the national programme should include those in pre-ART care to enable improved review, monitoring and supervision. Further qualitative research to ascertain reasons for loss to follow-up is required to design future interventions.