Relationship between household environmental exposures and child stunting in India

Abstract

CARE phased over its 10 yr nutrition program to Gov't of India in 2009; a survey of mothers of children 6–23 mo (n‐3455) was conducted in 4 CARE program states 2 yrs later. This study investigates the relationship between environmental exposures and child stunting in 2011. Relationships between binary predictors (having a pucca [cement, no dirt floor] house, latrine or improved water source in the house) and stunting (HAZ LE ‐2 SD) were assessed through logistic and linear regression adjusted for clustering and for caste, tribal status, supplementary food receipt, feeding practices, distance from Anganwadi (child care) center, child age, state. For 4 states combined, not having a pucca house, latrine or improved water was associated with stunting. The association was significant for pucca house (OR: .81, CI: 0.67 – 0.98). Among states, most associations were negative but inconsistently significant. By linear regression, pucca house, improved water, and latrine significantly increased HAZ (by .22, .18 and .24 SD respectively), but R2 were low (.06). Latrine and improved water increased from 2009 and 2011 but is low (24%; 35%); stunting is high and unchanged (39.9% in 2009; 40% in 2011).Further longitudinal studies could establish these as causal associations, to better guide programs to reduce stunting, so that they also focus on improved water, sanitation and hygiene.Support: USAID FFP with FANTAIII Project, FHI360