Asha Lavanya, Ishan Rohan, Kiran Laksman, Abimayu Devan
Stunting remains the most prevalent chronic undernutrition among Indian children, and Uttar Pradesh, Bihar and Jharkhand carry a disproportionate share of this burden. This study aimed to identify the independent nutritional, maternal and environmental determinants of stunting among children aged six to twenty-three months in these high-burden states and to explain the constraints shaping child feeding. A convergent mixed-methods study was conducted in purposively selected rural and peri-urban districts. The quantitative strand used a community-based case-control design of four hundred twenty matched pairs, comprising eight hundred forty children matched on village cluster and sex, with cases defined by a length-for-age Z score below minus two. Trained interviewers administered a validated structured questionnaire covering socio-demographic, feeding, maternal, antenatal and environmental exposures, complemented by twenty-four in-depth interviews and six focus group discussions conducted until thematic saturation. Data were analysed using univariable and multivariable conditional logistic regression in Stata 17 alongside inductive and deductive thematic coding. Low birth weight and short maternal stature were the strongest determinants, followed by household poverty, inadequate dietary diversity and older infant age. Stunting reflects intergenerational, dietary and structural factors requiring integrated maternal, feeding and sanitation interventions.