Will malnutrition, morbidities, and household environmental characteristics are risk factors of Coronavirus disease (COVID-19) among children under five in India?

Background: The novel Coronavirus disease (COVID-19) outbreak, caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), is seeing a rapid increase in infected people worldwide and linked with various risk factors. Objective: To find out the risk factors zone associated with Coronavirus disease among children under five age using malnourished status, pre-existing morbidity conditions, household environmental factors, and also with case fatality and active case rate of COVID-19 disease in India.Data sources & Methods: Data was utilized from the 4th round of the National Family Health Survey (NFHS), 2015-16, and CFR and ACR of COVID-19 related data from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to identify the risk factors zone and hot spot analysis (Getis-Ord Gi) has been used. Results: The states and UTs which have a high composite vulnerability score of the COVID-19 among under-5 children are Meghalaya (CVS=1), Uttar Pradesh (CVS=0.93), Jharkhand (CVS=0.86), Bihar, (CVS=0.74), Madhya Pradesh (CVS=0.74), and Odisha (CVS=0.55). The states and UTs which have low composite vulnerability score of the COVID-19 among under-5 children are Sikkim (CVS= -0.90), Daman & Diu (CVS= -0.76) Lakshadweep (CVS= -0.74), Kerala (CVS= -0.72), Chandigarh (CVS= -0.71). The COVID-19 vulnerable/ risk factors zone (hot spot: 99% Confidence interval [CI]) were observed in Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, and Meghalaya states of India, which are spatially high clustered. The low rates of (cold spot: 95% CI) less vulnerable zones were observed in Kerala, Mizoram which is spatially low clustered. Conclusions: Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable areas of COVID-19.