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 the 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 India's 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 5 years of age across rural Rajasthan, India. We used Demographic and Health Survey (DHS)-3 India (2005-2006) data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (i) the 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. The results suggest, after adjusting for child age, household access to (i) improved drinking water source was associated with 23% decreased odds [odds ratio (OR) = 0.77, 95% confidence interval (CI) 0.5-1.00], (ii) improved sanitation facility was associated with 41% decreased odds (OR = 0.51, 95% CI 0.3-0.82), and (iii) agricultural land ownership was associated with 30% decreased odds of childhood stunting (OR 0.70, 95% CI 0.51-0.94]. 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 India's most vulnerable communities.
Highlights
Childhood undernutrition is a global health priority for sustainable development
There was a significant relationship between drinking water source and stunting when controlling for age category, with 23% decreased odds of stunting for children consuming water from improved sources in comparison to those who use unimproved sources (Table 3)
Unadjusted models reported a significant association between sanitation facility and stunting
Summary
Childhood undernutrition is a global health priority for sustainable development. Despite persistent efforts the global nutritional targets for children under 5 years of age (U5) remains to be met. Contributing to almost onethird of the world’s childhood chronic undernutrition burden with 46.6 million U5 stunting [2], India is the priority target to set the pace of progress towards a better-nourished world. The lasting impact of malnutrition during this critical period of development transcends generations. These include long‐term effects on cognitive development, school achievement [4], adult economic productivity, maternal reproductive outcomes [5] and risk for obesity and non-communicable diseases [6]
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