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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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        The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986-2007.

        Despite continued national and international efforts, access to improved water and sanitation remains limited in many developing countries. The health consequences of lacking access to water and sanitation are severe, and particularly important for child development. To investigate the associations between child health and access to water and sanitation, we merged all available Demographic and Health Surveys (DHS) with complete birth histories and water and sanitation information. The merged data set of 171 surveys includes information on 1.1 million children under the age of 5 years in 70 low- and middle-income countries over the period 1986-2007. We used logistic models to estimate the effect of water and sanitation access on infant and child mortality, diarrhoea and stunting. Access to improved sanitation was associated with lower mortality (OR = 0.77, 95% CI 0.68-0.86), a lower risk of child diarorhea (OR = 0.87, 95% CI 0.85-0.90) and a lower risk of mild or severe stunting (OR = 0.73, 95% CI 0.71-0.75). Access to improved water was associated with a lower risk of diarrhoea (OR = 0.91, 95% CI 0.88-0.94) and a lower risk of mild or severe stunting (OR = 0.92, 95% CI 0.89-0.94), but did not show any association with non-infant child mortality (OR = 0.97, 95% CI 0.88-1.04). Although our point estimates indicate somewhat smaller protective effects than some of the estimates reported in the existing literature, the results presented in this article strongly underline the large health consequences of lacking access to water and sanitation for children aged <5 years in low- and middle-income countries.
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          Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam

          Background This study’s purpose was to understand associations between water, sanitation, and child growth. Methods We estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. Results In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. Conclusions Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4033-1) contains supplementary material, which is available to authorized users.
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            Author and article information

            Affiliations
            [1 ] University College London
            Journal
            UCL Open: Environment Preprint
            UCL Press
            06 March 2019
            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
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