Estimating Spatio-Temporal Trends of Maternal and Child Health Indicators in India using large, nationally representative, publicly available data

Extension to NFHS-6 (2023–24)

Dr. Durgesh Prasad Sahoo, Asst. Professor, Dept of CFM
Dr. Neeraj Agarwal, Professor and Head, Dept of CFM
Dr. Arun Mitra Peddireddy, Asst. Professor, Dept of CFM

Background and objectives

  • MCH indicators in India have improved, but large regional and district-level disparities remain.
  • NFHS-6 (2023–24) was released on 29 May 2026: the first post-COVID round.
  • With NFHS-4 and NFHS-5, it gives three district-level rounds to model trends, not just snapshots.

Objectives

  1. Study spatio-temporal patterns of MCH indicators at state and district level across NFHS-4, 5 and 6.
  2. Investigate spatial clustering across districts, and how clusters persist or emerge between rounds.
  3. Identify and analyse factors influencing the observed spatial and temporal trends.

IEC exemption letter, AIIMS Bibinagar, Ref AIIMS/BBN/IEC/AUG/2024-Exemption, dated 26-08-2024

Data sources

Source Period Level Status (Oct 2026)
NFHS-6 2023–24 State and district fact sheets; unit-level when released Fact sheets out (May 2026); report and unit-level data awaited
NFHS-5 2019–21 State, district; unit-level Available
NFHS-4 2015–16 State, district; unit-level Available
HMIS 2011 onwards Facility, district; monthly Available

Covariates: SEDAC and SHRUG. Boundaries: Survey of India.

Methods

Preprocessing

  • Extract indicators with consistent definitions across NFHS-4, 5 and 6.
  • Harmonise districts to a common frame (crosswalk, population-weighted).

Analysis (per round, then across rounds)

  • Global Moran’s I; local hot spots with Getis-Ord Gi* and LISA maps.
  • Change maps (NFHS-4 → 5 → 6) and persistent / emerging hotspot classification.
  • Bayesian space–time model (BYM2 + time + interaction) fitted with INLA.
  • All analysis in R (sf, spdep, INLA, tidyverse).

Expected outputs and considerations

Expected outputs

  • District maps and trajectories for caesarean sections, stunting and wasting across three rounds.
  • Persistent and newly emerging hotspots to guide targeted interventions.

Considerations

  • District boundary changes; indicator definitions not always comparable.
  • NFHS-6 unit-level data pending; early work uses fact sheets only.