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)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Spatio-temporal trends of child growth failure indicators and their association with household sanitation practices: Observational study from 1998-2021 in India
ABSTRACT
Background:
Undernutrition among under-five children is a subtle indicator of the health and economic status of a country. Despite strong macroeconomic progress in India, it remained a significant burden with a geographical variation, along with poor access to Water, Sanitation, and Hygiene (WaSH) services.
Objective:
We aimed to explore the spatial trends of child growth failure indicators (CGF), and their association with household sanitation practices in India.
Methods:
We used the Indian Demographic and Health Survey (DHS) data from 1998-2021 for this study. District level CGF indicators (stunting, wasting, and underweight), were matched with the sanitation and sociodemographic characteristics. Global Moran’s I and LISA (Local Indicator of Spatial Association) were used to detect the spatial clustering of the indicators. Spatial Regression models was utilized to evaluate the significant determinants of CGF indicators.
Results:
Our study shows a decreasing trend in stunting (44.9% to 38.4%) and underweight (46.7% to 35.7%), however, as an increasing prevalence of wasting (15.7% to 21.0%) over 15-years. The positive value of indicators for Moran’s I between the year 1998 and 2021 indicates the presence of spatial autocorrelation. The geographic clustering was observed in states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat consistently. Improved sanitation facility, wealth index, and mother’s education status showed significant association in reducing stunting. The relative risk maps identified hotspots of child growth failure health outcomes cases, which could be targeted for future interventions.
Conclusions:
Malnutrition has remained a subject of concern despite the existence of several policies and programs. It’s multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. The identification of hotspot locations will aid in the development of control methods for achieving objectives in the target areas.
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