Abstract / Summary
Abstract Background Minimum acceptable diet (MAD), a composite indicator of minimum dietary diversity and minimum meal frequency, is essential for optimal growth and development during the first two years of life. Despite ongoing improvements in maternal and child health programmes in India, complementary feeding practices remain inadequate and exhibit substantial geographic variation. Although previous studies have identified several determinants of MAD, evidence on district-level spatial heterogeneity remains limited. This study examined the spatial distribution and determinants of MAD among children aged 6–23 months across India. Methods This study used data from the fifth round of National Family Health Survey (NFHS-5, 2019–21), including 67,507 children aged 6–23 months. District-level estimates of MAD and selected child, household, and environmental characteristics were generated for spatial analysis. Global Moran's I and Local Indicators of Spatial Association (LISA) were used to assess spatial clustering. Associations between district-level determinants and MAD were examined using ordinary least squares and spatial regression models. Multiscale geographically weighted regression (MGWR) and generalized additive models with geographically varying smooth effects were subsequently applied to investigate spatial heterogeneity and nonlinear geographic variation. Results Overall, 10.2% of children aged 6–23 months met the criteria for a minimum acceptable diet. Significant positive spatial clustering of MAD was observed across Indian districts (Moran's I = 0.459, p < 0.001). Higher district-level prevalence of breastfeeding, urban residence, greater vegetation cover (NDVI), and higher precipitation were positively associated with MAD, whereas a higher proportion of male children showed a negative association. Spatial regression models provided a better fit than conventional regression, indicating the presence of significant spatial dependence. Among all competing models, MGWR demonstrated the best model performance (AIC = − 1088.45; R² = 0.613), highlighting that the influence of key determinants varies across geographic regions. The generalized additive model further confirmed significant spatially varying effects for breastfeeding, urban residence, and NDVI. Conclusions Minimum acceptable diet among young children in India demonstrates marked geographic disparities that are influenced by behavioural, environmental, and contextual factors. The spatial variation in these relationships suggests that uniform national strategies may not adequately address regional nutritional inequalities. District-specific interventions that strengthen breastfeeding promotion, improve access to diverse foods, and account for local environmental and socioeconomic conditions may enhance complementary feeding practices and contribute to improved child nutrition outcomes.