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

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          Abstract

          Stunting is a major unresolved and growing health issue for India. Yet there remains scant evidence for the development and application of integrated, multifactorial child health interventions across Indias most rural communities. We examine the associations between household environmental characteristics and stunting in children under 5 years across rural Rajasthan, India. We used DHS-3 India data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (1) main source of drinking water, (2) main type of sanitation facilities, (3) main cooking fuel type, and (4) agricultural land ownership and stunting adjusting for child age. After adjusting for child age, household access to (1) improved drinking water source was associated with a 23% reduced odds (OR=077, 95% CI 05 to 100), (2) improved sanitation facility was associated with 41% reduced odds (OR=051, 95% CI 03 to 082), and (3) agricultural land ownership was associated with a 30% reduced odds of childhood stunting (OR 070, 95% CI 051 to 094). Cooking fuel source was not associated with stunting. Although further research is needed, intervention programmes should consider shifting from nutrition-specific to nutrition-sensitive solutions to address Indias childhood malnutrition crisis. Results and implications are discussed.

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          Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults.

          Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity. We obtained economic data from 1424 Guatemalan individuals (aged 25-42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0-7 years) who had been enrolled in a nutrition intervention study during 1969-77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years. Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US$0.67 per hour (95% CI 0.16-1.17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years. Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.
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            Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

            A long literature in demography has debated the importance of place for health, especially children’s health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together. Electronic supplementary material The online version of this article (doi:10.1007/s13524-016-0538-y) contains supplementary material, which is available to authorized users.
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              Author and article information

              Journal
              UCL Open: Environment Preprint
              UCL Press
              06 March 2019
              Affiliations
              [1 ] University College London
              Article
              10.14324/111.444/000015.v1

              This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

              Funding
              N/A N/A

              Comments

              Date: 11/6/2020

              Handling Editor: Dan Osborn

              The Handling Editor requested revisions; the article has been returned to the authors to make this revision.

              2020-09-17 13:25 UTC
              +1

              Date: 8/3/2020

              Handling Editor: Dan Osborn

              This article is a preprint article and has not been peer-reviewed. It is under consideration following submission to UCL Open: Environment Preprint for open peer review.

              2020-09-17 13:25 UTC
              +1

              Decision of the handling editor after review:

              This manuscript requires revisions before it can be published. Once the author has revised the manuscript it shall need to undergo further peer-review. We encourage the authors to revise this version 1 and resubmit for open peer review.

              1. Provide fuller context for the study in relation to other studies on child growth stunting in India, pointing out the links between the three main pillars of sustainability and this study.
              2. Match the statistical analysis more closely to the nature of the complex dataset involved.
              3. Provide some more characterisation of the social, economic and environmental circumstances of the non-stunted and stunted samples based on the datasets.
              4. Provide fuller explanatory legends for the Tables in the draft paper.
              5. Clarify the text in certain sections.
              2020-02-14 13:12 UTC
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