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

Stunting is a major unresolved and growing health issue for India. There is a need for a broader interdisciplinary cross sectoral approach in which disciplines such as environment and health have to work together to co-develop integrated socio-culturally tailored interventions. However, there remains scant evidence for the development and application of such integrated, multifactorial child health interventions across Indias most rural communities. In this paper we explore and demonstrate the linkages between environmental factors and stunting thereby highlighting the scope for interdisciplinary research. We examine the associations between household environmental characteristics and stunting in children under five years across rural Rajasthan, India. We used DHS-3 India (2005-06) data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (i) primary source of drinking water, (ii) primary type of sanitation facilities, (iii) primary cooking fuel type, and (iv) agricultural land ownership and stunting adjusting for child age. Results suggest, after adjusting for child age, household access to (i) improved drinking water source was associated with a 23% reduced odds (OR=077, 95% CI 05 to 100), (ii) improved sanitation facility was associated with 41% reduced odds (OR=051, 95% CI 03 to 082), and (iii) agricultural land ownership was associated with a 30% reduced odds of childhood stunting (OR 070, 95% CI 051 to 094). The cooking fuel source was not associated with stunting. Our findings indicate that a shift is needed from nutrition-specific to contextually appropriate interdisciplinary solutions, which incorporate environmental improvements. This will not only improve living conditions in deprived communities but also help to tackle the challenge of childhood malnutrition across Indias most vulnerable communities.