Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 6, 2022
Open Peer Review Period: Jul 31, 2022 - Aug 14, 2022
Date Accepted: Nov 21, 2023
(closed for review but you can still tweet)
Association of Household Sanitation Practices on Child Growth Failure Indicators: A Spatio-Temporal Observational Study in India (1998-2021)
ABSTRACT
Background:
Undernutrition among children under five 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 (WaSH) services.
Objective:
This study aimed to explore the spatial trends of child growth failure indicators (CGF), and their association with household sanitation practices in India.
Methods:
We used data from the Indian Demographic and Health Survey (DHS) spanning 1998–2021. District level CGF indicators (stunting, wasting, and underweight), were cross-referenced with sanitation and sociodemographic characteristics. Global Moran’s I and Local Indicator of Spatial Association (LISA) were employed 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% to 38.4%) and underweight (46.7% to 35.7%), but an increasing prevalence of wasting (15.7% to 21.0%) over 15-years. The positive values Moran’s 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 child growth failure 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.
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