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Background Childhood undernutrition has a negative impact on healthy adulthood. Though progress is being made, a considerable number of children are still undernourished in India. The purpose of this study is to evaluate the prevalence of the severity of anthropometric failure (SAF) and its associated factors in India. Methods This study was carried out with a cross-sectional design at the household level. The data we utilized were secondary in nature and collected from all five phases of the National Family Health Surveys from 1992 to 2021. This study comprised 581124 under-five children in India. The severity of anthropometric failure (SAF) was assessed using the composite index of anthropometric failure (CIAF). Children can experience SAF in four ways, categorized as no anthropometric failure (AF), single AF, double AF, or triple AF. Results Over the past three decades, the prevalence of AF among under-five children in India has decreased. The latest NFHS survey indicates that the prevalence of AF was notably higher in rural areas (54.74%) compared to urban areas (47.73%). Single AF was a major issue in both rural (26.12%) and urban (25.37%) areas, while double AF presents a greater concern in rural areas (23.36%). Several socio-demographic and maternal factors have been identified as significant contributors to AF, particularly concerning low birth weight (LBW) and poor wealth index in both urban and rural contexts. In urban settings, AF was more prevalent among Muslim children and those whose mothers had lower levels of education. In rural areas, the condition was more common among children of underweight mothers and those from scheduled castes and scheduled tribes. Conclusions More than two-fifths of under-five children have either S-AF or D-AF, which was significant. The notably higher rates of undernutrition in rural areas highlight the urgent need for targeted interventions. Addressing these issues requires a comprehensive approach that focuses on improving maternal health, increasing educational opportunities, and implementing community-based nutrition programs, especially for vulnerable groups such as those from scheduled castes and tribes.研究背景 儿童期营养不良会对成年期健康产生负面影响。尽管相关工作已取得一定进展，但印度仍有大量儿童存在营养不良问题。本研究旨在评估印度儿童人体测量异常严重程度（Severity of Anthropometric Failure, SAF）的流行现状及其相关影响因素。 研究方法 本研究采用家庭层面的横断面研究设计。所用数据为二手数据，来源于1992年至2021年间开展的全部5轮全国家庭健康调查（National Family Health Surveys, NFHS）。本研究共纳入印度581124名5岁以下儿童。采用复合人体测量失败指数（Composite Index of Anthropometric Failure, CIAF）评估儿童人体测量异常严重程度（SAF）。儿童人体测量异常（Anthropometric Failure, AF）可分为4类：无人体测量异常、单类人体测量异常、双类人体测量异常及三类人体测量异常。 研究结果 近三十年来，印度5岁以下儿童的人体测量异常（AF）流行率呈下降趋势。最新一轮全国家庭健康调查数据显示，农村地区的AF流行率（54.74%）显著高于城市地区（47.73%）。单类人体测量异常是城乡地区共同的主要问题（农村占比26.12%，城市占比25.37%），而双类人体测量异常则在农村地区更为突出（占比23.36%）。多项社会人口学及母亲相关因素被证实为AF发生的重要危险因素，其中低出生体重（Low Birth Weight, LBW）和家庭财富指数低下在城乡地区均为显著影响因素。在城市地区，穆斯林儿童及母亲受教育程度较低的儿童更易出现AF；在农村地区，母亲体重不足的儿童以及来自表列种姓（Scheduled Castes）和表列部落（Scheduled Tribes）的儿童AF流行率更高。 研究结论 超过五分之二的5岁以下儿童存在单类人体测量异常（S-AF）或双类/三类人体测量异常（D-AF），该情况具有显著公共卫生意义。农村地区居高不下的营养不良率凸显了开展针对性干预措施的紧迫性。解决此类问题需采取综合策略，重点包括改善孕产妇健康、提升教育机会以及实施以社区为基础的营养项目，尤其需关注表列种姓、表列部落等弱势群体。