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.

Content

Author and article information

Journal

Title: UCL Open: Environment Preprint

Publisher: UCL Press

Publication date (Electronic preprint): 28 June 2020

Affiliations

[1 ] University College London

[2 ] Aceso Global Health Consultants Limited

Article

DOI: 10.14324/111.444/000015.v2

SO-VID: 8f8d5a3e-2d98-4c0d-81aa-05ce0cc2f1df

License:

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

Data availability: The data that support the findings of this study are available from India’s National Family Health Survey but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of India’s National Family Health Survey.

ScienceOpen disciplines: Civil engineering,General behavioral science,Environmental engineering

Keywords: environment,water,sanitation,agriculture,fuel,malnutrition,stunting,growth,India,rural,Sanitation, health, and the environment,People and their environment

Comments

UCL Open: Environment Editorial Office wrote:

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:

The scope of the paper has been set out more clearly
The statistical methodology and approach are more clearly explained so that a reader can place the paper amongst the others in this field
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.

2021-01-25 16:39 UTC

One person recommends this

UCL Open: Environment Editorial Office wrote:

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.

2020-09-17 13:26 UTC

UCL Open: Environment Editorial Office wrote:

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.

- 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."

2020-06-29 14:36 UTC

priti parikh wrote:

Thank you for encouraging response and please find below our response to your minor editorial changes:

he following small textual adjustments are required during the production process. Editor’s comments in bold. Author’s words in plain text.

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

RESPONSE: Agree it should be NRHM

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”

RESPONSE: Agree, suggest place '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?

RESPONSE: This is what we were trying to say: ' Use of similar methodologies would allow for better analysis of DHS data sets and facilitate comparisons across various DHS data sets.'

If you feel the above is not adding value, then remove our suggested edit for the sentence.

P17

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.

RESPONSE: Yes it is trend.

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.

RESPONSE: Yes agree with your suggested amendment.

2020-07-21 10:30 UTC

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

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