District-Level Disparities in Maternal and Child Health Performance in Manipur: A CRITIC-TOPSIS Assessment.

Objectives

This study assesses district-level disparities in maternal and child health performance across nine districts of Manipur using the CRITIC-TOPSIS approach. It aims to provide a multidimensional assessment of relative district performance and identify patterns of inter-district disparities to support differentiated maternal and child health planning.

Methods

Eleven indicators relating to antenatal care, institutional delivery, postnatal care, immunization, breastfeeding, and nutritional outcomes of children were analyzed using data from the National Family Health Survey-5 (NFHS-5), 2019-2021. The CRITIC method was used to obtain objective weights by considering indicator variability and intercriteria correlations, and TOPSIS was used to construct the composite index and rank the districts according to their relative proximity to an ideal health performance profile. K-means clustering of the standardized composite index was used to explore relative district groupings, with alternative cluster solutions, Ward.D2 hierarchical clustering, and random-initialization stability used to assess the clustering results.

Results

The results revealed substantial inter-district variation, with Imphal West having the highest composite index (0.8674), followed by Bishnupur (0.5851) and Imphal East (0.5564), while the lowest value was observed for Ukhrul (0.3499). Strong positive associations were observed among several components of the maternal and newborn continuum of care, particularly institutional delivery and maternal and newborn postnatal care. K-means clustering produced a three-cluster grouping comprising Imphal West in the Higher-Performance cluster; Bishnupur, Imphal East, Churachandpur, Thoubal, and Tamenglong in the Intermediate-Performance cluster; and Senapati, Chandel, and Ukhrul in the Lower-Performance cluster. Although K = 2 yielded the highest silhouette width, it primarily separated Imphal West from all remaining districts. Therefore, K = 3 was retained as an exploratory grouping because it provided greater differentiation among the remaining districts while maintaining positive silhouette values and showing complete agreement with Ward.D2 hierarchical clustering and stability across random initializations.

Conclusions

The findings reveal a more nuanced pattern of maternal and child health performance than a simple geographical dichotomy and highlight the value of district-specific assessment. The CRITIC-TOPSIS framework, complemented by cluster analysis, provides a reproducible approach for identifying relative disparities and supporting differentiated maternal and child health planning.