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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. 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.

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          Author and article information

          Journal
          UCL Open: Environment Preprint
          UCL Press
          28 June 2020
          Affiliations
          [1 ] University College London
          [2 ] Aceso Global Health Consultants Limited
          Article
          10.14324/111.444/000015.v2

          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

          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.

          Civil engineering, General behavioral science, Environmental engineering

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

          Comments

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

          This paper can now ready to move to full publication for the following reasons:

          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

          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

           

          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
          +1
          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.

          P7

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

          RESPONSE: Agree it should be NRHM

           

          P9

          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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