Associations between the household environment and stunted child growth in rural India: a cross-sectional analysis

Date: 25 January 2021

Handling Editor: Prof Dan Osborn

The article has been accepted following peer review and it is suitable for publication in UCL Open: Environment.

Additional comments:

1. The scope of the paper has been set out more clearly
2. The statistical methodology and approach are more clearly explained so that a reader can place the paper amongst the others in this field
3. There is a discussion of interdisciplinarity based on the data in teh paper that should be helpful to resolving the importance of environmental factors in child health in India.

Date: 29/6/2020

Handling Editor: Dan Osborn

The Article has been revised, this article remains a preprint article and peer-review has not been completed.

Date: 29/6/2020

Further comments to the author following revision from the Handling Editor, Prof Dan Osborn:

The paper places important issues linked to child health in a wide context making clear the potential social, economic and environmental factors that may have affected the children in the study. It also sets out the limitations of the current work resulting from the dataset examined which explain the author’s choice of statistical approach. The paper makes important points about how the issues addressed in the paper interact with the operation of policy approaches in the parts of India that have been studied. The paper may contribute to dialogue on how to collect data on stunting etc. The paper recognises that data being collected more recently will be based on some more sophisticated questions than were current in the first decade of the 21st century.

Comments on this article are welcomed under the journal’s open publishing principles. The following small textual adjustments are required during the production process. Editor’s comments in bold. Author’s words in plain text.

P7

- A typographical error on p7: Is it NHRM or NRHM?

P9. Under heading 3.2.3. Other (confounding) Variables

"The confounding variable age was selected on the basis of three conditions (LaMorte, 2016) –

1. Age was associated with both stunting and different explanatory factors, including feeding practices (e.g. Infants and children have predominantly different feeding practices); risk of infection (children who start to grow, crawl, walk, explore and put objects in their mouths risk ingesting bacteria from human and animal sources via open defecation increases)."

- verb in wrong place in this parantheses suggest deleting “increases” or placing “increased” before “risk of infection”

P11. (middle)

"Use of similar estimates would allow better synthesis of evidence and would provide evidence comparability."

- There is something missing from this sentence or it could be deleted?

P17. Under heading 3. DISCUSSION

"In this study we found that drinking water source, sanitation facility, and agricultural land ownership were associated with reduced stunting odds in children across rural Rajasthan, India. Specifically, reported household use of (i) improved drinking water source was associated with a 23% reduced odds, (ii) improved sanitation facility was associated with 41% reduced odds, and (iii) agricultural land ownership was associated with a 30% reduced odds of child stunted growth. Indoor cooking fuel source was not associated with risk of stunting although did approach trend level."

- Do the authors mean the statistical significance here rather than “trend”. If it is trend that is fine.

- Secondly, the source data did not include information regarding any intervention and any intervention, which would have introduced either locally or nationally within 5 years period prior to the onset of study would have disproportional effect on nutritional status of the children.

- I would prefer this short paragraph to read (or something similar): "Secondly, the source data did not include information regarding any intervention introduced either nationally or locally within 5 years of the start of the study that might have had an effect on the nutritional status of the children."