Abstract
Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.
Highlights
Received: 13 November 2021Poor childhood nutritional status remains a global concern
Compared with children who lived in households with improved water access, those whose households had unimproved water access were poorer, more likely to have older siblings and be left-behind and had primary caregivers who were less educated, more likely to smoke, and less likely to wash their hands with soap
We found that in children aged 6 to 59 months, unimproved water access was associated with low height-for-age z-score (HAZ) and hemoglobin concentration, as well as a 50% and 34% increase in the odds of stunting and anemia, respectively
Summary
Poor childhood nutritional status remains a global concern. A total of 22.0%, 6.7%, and 39.8% of children under 5 years of age were estimated to have stunting, wasting, and anemia globally in 2019, respectively [1,2]. The nutritional status of children under 5 years of age in China has improved substantially, with reductions in the prevalence of stunting (from 9.4% in 2010 to 4.8% in 2017), wasting (from 2.3% in 2010 to 1.9% in 2017), and anemia (from 19.0% in 2010 to 18.8% in 2019) [3,4]. Identifying the modifiable risk factors for poor childhood nutritional outcomes in rural areas of central and western China is imperative for developing appropriate interventions and improving nutrition-related long-term outcomes, including educational achievements, productivity, and overall well-being
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