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Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study

Jain L 1 , Pradhan S 2 , Aggarwal A 1 , Padhi BK 1 , Itumalla R 3 , Khatib MN 4 Show all authors , Gaidhane S 5 , Zahiruddin QS 6 , Santos CAG 7 , Al-Mugheed K 8 , Alrahbeni T 9 , Kukreti N 10 , Satapathy P 11 , Rustagi S 12 , Heidler P 13 , Marzo RR 14

Affiliations 

  • 1 Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 2 IPE Global House, Delhi, India
  • 3 School of Management, The Apollo University, Chittoor, India
  • 4 Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
  • 5 One Health Centre, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
  • 6 Global Health Academy, Division of Evidence Synthesis, School of Epidemiology and Public Health and Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
  • 7 Department of Civil and Environmental Engineering, Federal University of Paraíba, João Pessoa, Brazil
  • 8 Adult Health Nursing and Critical Care, Riyadh Elm University, Riyadh, Saudi Arabia
  • 9 Molecular Toxicology and Genetics, Riyadh Elm University, Riyadh, Saudi Arabia
  • 10 School of Pharmacy, Graphic Era Hill University, Dehradun, India
  • 11 Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
  • 12 School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
  • 13 Institute International Trade and Sustainable Economy, IMC Krems University of Applied Sciences, Krems, Austria
  • 14 Faculty of Humanities and Health Sciences, Curtin University, Miri Sarawak, Malaysia
JMIR Public Health Surveill, 2024 May 24;10:e41567.
PMID: 38787607 DOI: 10.2196/41567

Abstract

BACKGROUND: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services.

OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India.

METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators.

RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions.

CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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