Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

Open Defecation, Livestock Ownership, and Child Nutritional Status in India

South Asian children are among the most severely malnourished worldwide. One prominent hypothesis is that open defecation in the local area exposes children to human fecal pathogens that can cause diarrhea and malnutrition. Much of the existing research uses district-level measures of open defecation, which could mask important local-area variation. A second hypothesis is that animal fecal matter is a major source of exposure. This analysis tested these dual hypotheses using census data collected from 949 villages in Tamil Nadu, India, and a survey conducted in a random sample of 5,000 households in the same area. The final analytic sample consisted of 2,561 children aged 0-10 years. We estimated the association between the measures of village- and household-level open defecation, household livestock ownership, and child height-for-age Z-scores in a regression framework, controlling for potential confounders. Results revealed that village- and household-level open defecations are negatively associated with child height. There was an estimated difference of approximately 0.5 height-for-age Z-score between children living in villages with no open defecation and children in villages where all households practiced open defecation (P = 0.001) and a 0.2 Z-score difference between children living in households that practiced open defecation and those living in households that did not (P = 0.001). Livestock ownership was not associated with child height. Overall, the findings provide evidence on the centrality of open defecation in explaining persistent child malnutrition in India and the higher risk of exposure to human fecal pathogens compared with animal feces in the south Indian context.

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

BACKGROUND

Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children's linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia.

METHODS

We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.

RESULTS

Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.

CONCLUSION

Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Examining toilet use and menstrual hygiene practices among beneficiary households of Swachh Bharat Abhiyaan (Clean India Mission) in rural areas of Mayurbhanj district of Odisha, India

Background

Basic sanitation and waste management have always remained a central issue in India. The country launched its flagship sanitation program - Swachh Bharat Abhiyan (SBA) (Clean India Mission) in 2014 to abolish open defecation and achieve universal sanitation coverage.

Objective

This study aimed to examine barriers to toilet use and women's menstrual hygiene practices in relation to the availability of toilets among rural residents.

Materials and Methods

Using a cross-sectional design and multi-stage sampling method, 120 households were selected from rural villages of the Mayurbhanj district of Odisha. Structured questionnaires and direct observation methods were used for data collection.

Results

All the houses had SBA latrines, yet 25% population defecated outside. About 40% households reportedly never cleaned their toilets. Most menstruating women (86.2%) preferred to change their menstrual pads/cloths in their bedroom instead of bathrooms. Incomplete construction was reported as the major reason for not using toilets. Large family size and low caste were found to be other predictors of non-use of toilets. Rural women did not use toilets for menstrual purposes as they do not consider these places as clean and safe.

Conclusion

This study clearly suggests that constructing toilets without adequate behaviour change interventions would not solve the problem of hygiene and sanitation in India, particularly in rural areas. There must be adequate monitoring of SBA scheme and utilization of funds for toilet usage. Development and implementation of suitable behaviour change strategies for toilet use in rural areas are essential to achieve the goal of open defaecation-free India.

Hand Washing Practice and Food Insecurity are Associated With Undernutrition of Breastfeeding Mothers in Rural Ethiopia: A Cross-sectional Study

Background

Breastfeeding mothers are prone to undernutrition. However, factors contributing to maternal undernutrition are not exhaustively understood. Hence, this study aimed to determine prevalence of undernutrition among breastfeeding mothers and identify associated factors.

Methods

A cross-sectional study was conducted among 606 breastfeeding mothers from selected rural districts in Oromia and Sidama regional states of Ethiopia. Data were collected through an interviewer-administered questionnaire. Nutritional status was assessed using body mass index (BMI) and mid-upper-arm-circumference (MUAC). Logistic regression analysis was used to identify factors associated with maternal undernutrition.

Results

One out of ten breastfeeding mothers was found undernourished as determined by BMI (12.6%) and MUAC (10.7%). Mothers who did not practice hand washing after cleaning children's bottom were 2 and 3 times more likely to be undernourished compared to their counters, as measured by BMI (AOR = 2.29, P = .002) and MUAC (AOR = 3.03, P < .001), respectively. Mothers living in mildly or moderately food insecure households (AOR = 2.37, P = .019) were more than two times more likely to be undernourished as determined by MUAC. Mothers who breastfed children in the age range of 9 to 11 (AOR = 2.79, P = .025) or 12 to 23 (AOR = 2.57, P = .018) months were more than two and half times more likely to be undernourished as determined by BMI.

Conclusions

Maternal undernutrition is a medium-level public health problem in rural districts of Oromia and Sidama regional states in Ethiopia. The lack of hand washing practice after cleaning a child's bottom, household food insecurity and higher child age increased the odds of maternal undernutrition. Mothers should prioritize and improve their nutritional care as the age of their breastfed child increases. Nutrition programs in rural districts of Ethiopia should also aim to improve personal hygiene practices and food insecurity integrated with implementation researches to evaluate program's impact on nutritional status of breastfeeding mothers.

Association of both Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF) practices with childhood malnutrition in Lao PDR: a cross-sectional study of the 2017 Lao Social Indicator Survey II

OBJECTIVE

We assessed whether Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF), either alone or combined, were associated with malnutrition among Lao People's Democratic Republic (Lao PDR) children aged 6 to <24 months.

DESIGN

This is a secondary analysis of the 2017 Lao Social Indicator Survey II (LSIS II), which used multistage probability proportional to size sampling. Logistic regression analyses were conducted with OR and its corresponding 95% CI.

SETTING

The LSIS II was conducted a nationwide household-based survey covering all 18 provinces in Lao PDR.

PARTICIPANTS

We had a total of 3375 children (weighted sample 3345) and 357 households with data on drinking water.

OUTCOME MEASURES

The outcomes of this study were stunting and wasting.

RESULTS

The prevalence of stunting and wasting was 28.9% and 10.1%, respectively. Even though households with access to a basic or improved water source were high (82.5%), over 83% of drinking water was contaminated with Escherichia coli. Access to improved sanitation, basic hygiene and adequate IYCF gave a significant lower risk of becoming stunted. The combined effect of these practices on stunting was (adjusted OR (AOR)=0.54; 95% CI=0.41 to 0.73) greater than each practice alone (improved sanitation: AOR=0.75; 95% CI=0.61 to 0.93; basic hygiene: AOR=0.69; 95% CI=0.57 to 0.83; adequate IYCF: AOR=0.79; 95% CI=0.64 to 0.98). Access to improved sanitation and adequate IYCF was associated with a significant lower risk for being wasted, and again the combined effect of these practices was (AOR=0.64; 95% CI=0.44 to 0.92) greater than each practice alone (improved sanitation: AOR=0.68; 95% CI=0.49 to 0.93 and adequate IYCF: AOR=0.66; 95% CI=0.47 to 0.92).

CONCLUSION

Given the strong associations with both stunting and wasting, and the added benefits when combining WASH and IYCF, there is a need of multisectoral interventions to reduce early childhood malnutrition in Lao PDR.

Soil micronutrients linked to human health in India

Trace soil minerals are a critical determinant of both crop productivity and the mineral concentration of crops, therefore potentially impacting the nutritional status of human populations relying on those crops. We link health data from nearly 0.3 million children and one million adult women across India with over 27 million soil tests drawn from a nationwide soil health program. We find that soil zinc availability is positively associated with children's linear height growth, and soil iron availability is positively associated with hemoglobin levels. The link between soil zinc and childhood stunting is particularly robust-a one standard deviation increase in satisfactory soil zinc tests is associated with approximately 11 fewer children stunted per 1000. We also find that this zinc-stunting relationship is strongest in wealthier households. Our results suggest that soil mineral availability impacts human nutritional status and health in at least some areas of India, and that agronomic fortification may be a beneficial intervention.

Effects of the level of household access to water, sanitation and hygiene on the nutritional status of children under five, Benin

BACKGROUND

Whether or not the Water, Sanitation and Hygiene (WASH) conditions in which children under five live determine their nutritional status is still under discussion. The work aimed to study the effects of household WASH conditions to which children under five are exposed on their nutritional status in Benin.

METHODS

The study utilized a cross-sectional design and consisted of secondary analyses using datasets from the fifth Demographic and Health Survey (DHS-V) conducted in Benin. Stunting, wasting and underweight were the dependent variables. The WASH conditions in which children live were evaluated in the immediate environment, i.e., at the level of their households. After describing the study variables, the relationships between the dependent variables and the exposures were checked using multivariate logistic regression. Data analysis was performed with Stata 15 and took into account the survey's sampling design.

RESULTS

The prevalence of stunting, wasting and underweight was 31.15% (95% CI = 29.90-32.42), 4.79% (95% CI = 4.33-5.31) and 15.82% (95% CI = 14.92-16.76), respectively. The stunting odds were 1.35 (95% CI = 1.15-1.59) and 1.27 (95% CI = 1.01-1.59) times higher for children from households with no water and sanitation services, respectively, compared to children living in households with basic water and sanitation services. Children under five from households with no hygiene facilities and using limited hygiene services had 1.31 (95% CI = 1.05-1.63) and 1.35 (95% CI = 1.10-1.67) times the odds of being stunted, respectively, compared to children covered by basic hygiene facilities. There is no evidence of a significant relationship between household access to WASH and wasting in children under five. The odds of being underweight were 1.33 (95% CI = 1.02-1.72) times higher among children under five from households with limited hygiene facilities than among children from households with basic hygiene facilities.

CONCLUSION

Interventions to fight malnutrition in children under five should include a WASH dimension.

Determinants of stunting among children under age five in Burundi: Evidence from the 2016-2017 Burundi Demographic and Health Survey (BDHS 2016-17)

Burundi has one of the highest prevalence of stunting in the world. This study aimed to identify determinants of stunting among children under age five in Burundi. A total of 4993 children with anthropometric measurements from the 2016-2017 Burundi Demographic and Health Survey were included in the study. Stunting was assessed from the height-for-age Z-scores (HAZ). Logistic regression models were analyzed to identify demographic, maternal, child-related, and structural variables that influence stunting. In total, 56.9% of children under age five were stunted, of those 31.0% moderately and 25.9% severely. Multivariable logistic regression indicated that older children, male children (adjusted OR (aOR) = 1.41, 95% CI 1.24-1.61), and children who were perceived as small (aOR = 2.00, 95% CI 1.55-2.59) or very small at birth (aOR = 2.37, 95% CI 1.57-3.59) were significantly more likely to be stunted. Moreover, children of single mothers, with lower levels of education, who were underweight at the time of the survey (aOR = 1.95, 95% CI 1.42-2.68), who had short stature (aOR = 3.76, 95% CI 2.50-5.66) or who conceived more than four children (aOR = 1.22, 95% CI 1.05-1.42) were more commonly stunted. Stunting was more prevalent in rural areas (aOR = 2.53, 95% CI 1.72-3.73) and in households with no access to improved types of toilet facilities (aOR = 1.27, 95% CI 1.10-1.45). The results of this study show that the prevalence of stunting in children under age five in Burundi is alarmingly high and underscores the urgent need for decisive and determined action.

Analyzing determinants from both compositional and contextual level impeding desired linear growth of children in Indian context

Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India's Demography and Health Survey (DHS) conducted in 2019-2021. A total of 1, 46,521 children aged 0-59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons.

Undernutrition and anaemia among Indian adolescents: role of dietary diversity and hygiene practices

In 2021, the Lancet Commission on adolescent nutrition highlighted the need to prioritise the elimination of adolescent malnutrition to tap the human capital potential and break the intergenerational malnutrition trap. The nutritional requirement during adolescence reaches its peak. The present study aims to appraise the prevalence of undernutrition (stunting and thinness) and anaemia among adolescents (10–19 years) in India and the role of socioeconomic, individual-level hygiene behaviour and dietary diversity in nutritional outcomes. We have used the nationally representative Comprehensive National Nutrition Survey (CNNS-2016–18) that covers children and adolescents (0–19 years) in India. The prevalence of stunting, anaemia and thinness among adolescents was 27⋅2, 28⋅5 and 24⋅1 %, respectively. Bivariate and multivariable logistic regression models were applied to estimate the likelihood of undernutrition. The likelihood of stunting was higher for late adolescence (OR 1⋅21, 95 % CI 1⋅15, 1⋅27), low dietary diversity (OR 1⋅37, 95 % CI 1⋅26, 1⋅49) and low hygiene behaviour compliance (OR 1⋅53, 95 % CI 1⋅42, 1⋅64). Adolescents from the poorest quintile were more likely to be stunted (OR 3⋅20, 95 % CI 2⋅94, 3⋅48), anaemic (OR 1⋅66, 95 % CI 1⋅47, 1⋅87) and thin (OR 1⋅68, 95 % CI 1⋅54, 1⋅82). We found that lower hygienic compliance was significantly associated with undernutrition and anaemia. Therefore, promoting hygienic practices should be emphasised to tackle undernutrition and anaemia. Furthermore, dietary diversity and poverty were strong predictors of stunting and thinness, therefore targeting the poor and focusing on improving dietary diversity should be the priority.

Hygienic practice during complementary food preparation and associated factors among mothers of children aged 6-24 months in Debark town, northwest Ethiopia, 2021: An overlooked opportunity in the nutrition and health sectors

BACKGROUND

Hygienic practices during complementary food preparation are suboptimal in developing countries, in Ethiopia in particular. Hygienic complementary food preparation is crucial to prevent childhood communicable diseases like diarrhea and associated malnutrition among children aged 6-24 months. However, in Ethiopia, there is a paucity of evidence on the practice of hygiene during complementary food preparation. Thus, this study is aimed to assess the hygienic practice of complementary food preparation and associated factors among women having children aged 6-24 months in Debark town, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 423 mothers with 6-24 months of age children from December 1 to January 30, 2021. A simple random sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. Epi-data version 4.6 and SPSS version 23 software were used for data entry and analysis, respectively. Binary logistic regressions (Bivariable and multivariable) were performed to identify statistically significant variables. Adjusted odds ratio with 95% CI was used to declare statistically significant variables on the basis of p-value < 0.05 in the multivariable logistic regression model.

RESULTS

The study revealed that 44.9% (95% CI (40.2, 49.4%)) of the mothers having children aged 6-24 months had good practice of complementary food preparation. Maternal age of 25-29 years[AOR:3.23, 95% CI: (1.555-9.031)], husband's attained secondary school and above (AOR:2.65, 95% CI (1.211-5.783)], using modern stove for cooking [AOR:3.33,95% CI (1.404-7.874)], having a separate kitchen[AOR: 8.59, 95%Cl: (2.084-35.376], and having a three bowl dishwashing system(AOR: 8.45, 95% CL: (4.444-16.053)) were significantly associated with good hygiene practice of complementary food preparation.

CONCLUSIONS

The findings have indicated that the majority of the mothers had poor hygienic practices of complementary food preparation. Mother's age, husband's educational status, type of stove used for cooking, having a separate kitchen, having a three bowl dishwashing system were factors that significantly influenced the hygiene practice of mothers during complementary food preparation. Therefore, training and counseling mothers and caregivers on complementary food processing and preparation is important and such endeavors which inform the development and implementation of complementary food hygiene interventions in urban communities are recommended.

Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation

Poor child nutrition is a major public health challenge in Tanzania. Large between and within regional nutritional inequalities exist in rural and urban areas. We looked at how locational circumstances hinder children from having an equal opportunity for good nutrition. We used the 2008/09 Living Standards Measurement Study data for Tanzania to identify the part played by water and sanitation in rural and urban inequality of opportunity in child nutrition. We used the dissimilarity index and the Shapley decomposition technique to quantify and decompose inequality of opportunity in nutrition. We find that 16% of the circumstance-driven inequality of opportunity needs to be redistributed for equality of opportunity to prevail. We find that in rural areas, about 42% of the inequality of opportunity in nutrition is due to water and sanitation problems and 22% to child age. In urban areas, we find that the inequality of opportunity is related mainly to the child's sex, price fluctuations and intergenerational factors. The findings suggest that policies to improve water and sanitation coverage could help equalize opportunities for children in rural areas. In urban areas, policies that could help equalize opportunities require incentives to change social norms and behavior around feeding practices and vaccination.

Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach

BACKGROUND

Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia.

METHODS

A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review.

RESULTS

The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child's stool, or improved household flooring and child wasting.

CONCLUSION

The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting.

Correlates of access to sanitation facilities and benefits received from the Swachh Bharat Mission in India: analysis of cross-sectional data from the 2018 National Sample Survey

OBJECTIVE

Equitable and affordable access to improved sanitation facilities is linked to health and is among the priority areas of development programmes in a country like India. This study assesses the level of different sanitation facilities accessed by households and attempts to understand the socioeconomic characteristics of the households that received financial benefits from the Swachh Bharat Mission (Swachh Bharat Abhiyan), a Government of India flagship programme.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The study extracted data from the 76th round (2018) of the National Sample Survey, consisting of 106 837 households in India.

OUTCOME MEASURES

Sanitation services and benefits received from the Swachh Bharat Mission in the last 3 years preceding the survey were the two outcome variables of this study. Bivariate and multinomial logistic regression analysis were performed to identify factors associated with the outcome variables.

RESULTS

Findings show the existence of state and regional disparities, along with rural-urban gaps, in the accessibility of sanitation facilities. Half of the households (52%, n=55 555) had access to safely managed sanitation facilities, followed by basic services (14.8%, n=15 812), limited services (11.4%, n=12 179) and unimproved services/open defecation (21.8%, n=23 290). Limited and unimproved facilities decreased significantly (p<0.001) with increase in economic status, although poor and less educated households received the maximum benefit from the Swachh Bharat Mission.

CONCLUSION

The mission has been successful in increasing access overall; however, many people continue to lack access to improved sanitation and there remains a need to follow up poor and rural households to determine their usage of and the current state of their sanitation facilities.

Region matters: Mapping the contours of undernourishment among children in Odisha, India

Background

Levels of child undernutrition and its correlates exhibit considerable spatial variation at different levels of granularity. In India, such variations and their interrelation have not been studied at the sub-district level primarily due to the non-availability of good quality granular data. Given the sheer regional diversity in India, it is essential to develop a region-specific evidence base at the micro-level.

Data and objectives

The current study utilised, for the first time, a sub-district level survey data (Concurrent Child Monitoring Survey-II, 2014–15) to investigate the statistically significant clusters and spatial patterns of burden of undernutrition among children. The emergence of distinct patterns at the level of natural geographical regions of the state–coastal, southern and northern regions, lead to a region-specific analysis to measure the impact of various demographic, socio-economic and maternal factors on the prevalence of undernutrition specific to the three regions, using the National Family Health Survey-IV unit-level data.

Methods

The spatial dependence and clustering of child undernourishment across sub-districts in Odisha were studied using various spatial statistical techniques, including spatial econometric models. Binary logistic regression was applied in the region-specific analysis.

Results

Findings indicated statistically significant spatial clustering of undernutrition among children in specific geographic pockets with poor sanitation, low institutional and skilled deliveries, poor maternal health reinforcing the need for inter-sectoral coordination. Disparities across the three natural-regions, suggest that the parameters requiring priority for intervention may differ across levels of overall development.

Conclusion

The spatial clustering of different socio-demographic indicators in specific geographic pockets highlights the differential impact of these determinants on child undernutrition thereby reinforcing a strong need for targeted intervention in these areas. Present analysis and the evidence-based micro-level analysis can be utilised as a model for other Indian states and low-resource countries, making interventions more effective through multiple, synergistic and a multi-sectoral approach.

Sense and Manner of WASH and Their Coalition With Disease and Nutritional Status of Under-five Children in Rural Bangladesh: A Cross-Sectional Study

This study aimed to assess the knowledge and practice of caregivers and their relationship to the disease and nutritional status of children under 5 years of age in rural areas of Sylhet, Bangladesh. A total of 110 households with at least a child aged 6 to 59 months were selected by simple random method from 10 rural communities of three Upazila of Sylhet from September 2019 to February 2020. Descriptive statistics were used to assess the "Water Access, Sanitation, and Hygiene" (WASH) knowledge and practice, and multivariate chi-square analyses were performed to assess associations among diseases and nutritional status with WASH following a structured questionnaire. The study found a significant association between WASH with childhood disease and nutritional status, and 65% of children were found to be in a diseased state and 35% of children were found in a no exposure of disease state within the last 6 months. The findings sketched that mother with poor WASH knowledge and practice was at greater risk for disease outbreaks, disease frequency, and duration. The highest incidence of diarrhea was 17% in children aged 12 to 23 months. A significant effect of WASH was also found in children's nutritional status, which was reflected in the ratio of stunted, underweight, and wasted children. Integrated convergent work focusing on providing clean water within the household, stopping open defecation, promoting handwashing, behavior change, and poverty alleviation is needed to improve the situation. Health, nutrition, and livelihood programs should be uninterrupted, and mothers or caregivers should be encouraged to participate in these programs.

Spatial analysis of stunting determinants in 514 Indonesian districts/cities: Implications for intervention and setting of priority

While the national prevalence of stunting in Indonesia has decreased, the level remains high in many districts/cities and there is significant variation. This ecological study employed aggregated data from the Basic Health Research Report and the District/City Poverty Data from 2018. We investigated the determinants of stunting prevalence at the district/city level, including autocorrelation applying the spatial autoregressive (SAR) model. The analyses revealed stunting prevalence above the national average in 282 districts/cities (54.9%), i.e. ≥30% in 297 districts/cities (57.8%) and ≥40% in 91 districts/cities (17.7%). Autocorrelation was found between Sumatra, Java, Sulawesi as well as Bali, East Nusa Tenggara and West Nusa Tenggara (Bali NTT NTB). The SAR modelling revealed the following variables with significant impact on the stunting prevalence in various parts of the country: closet defecation, hand washing, at least four antenatal care visits during pregnancy, poverty, immunisation and supplementary food for children under 5 years.

Predictive algorithm to stratify newborns at-risk for child undernutrition in India: Secondary analysis of the National Family Health Survey-4

Background

India is at the epicentre of global child undernutrition. Strategies to identify at-risk populations are needed in the context of limited resources

Methods

Data from children under the age of five surveyed in the 2015-2016 National Family Health Survey were used. Child undernutrition was assessed using anthropometric measurements. Predictor variables were identified from the extant literature and included if they could be measured at the time of delivery. Survey-weighted logistic regression was applied to model the outcome. Internal validation of the model was performed using 200 bootstrapped samples representing half of the total data sets.

Results

In 2016, 54.4% (95% CI = 54.0%-54.8%) of Indian children were undernourished, according to a composite index of anthropometric failure. The predictive model for overall undernutrition included maternal (height, education, reproductive history, number of antenatal visits), child (sex, birthweight), and household characteristics (district of residence, caste, rural residence, toilet availability, presence of a separate kitchen). The model demonstrated reasonable discrimination ability (optimism-adjusted c = 0.67). The group of children classified in the lowest decile for risk of undernutrition had a prevalence of 25.9%, while the group classified in the highest decile had a prevalence of 77.4%.

Conclusions

It is possible to stratify newborns at the time of delivery based on their risk for undernutrition in the first five years of life. The model developed by this study represents a first step in adopting a risk-score based approach for the most vulnerable population to receive services in a timely manner.

Child-sensitive water, sanitation, and hygiene composite score and its association with child nutritional outcomes in St. Martin's Island, Bangladesh

Objectives

This study aimed to outline water, sanitation, and hygiene (WASH) practices for children under 5 years of age among the households of St. Martin's Island as well as examine the role of water, sanitation, and hygiene on child nutritional outcomes.

Methods

A total of 256 children under 5 years of age were anthropometrically measured, and multiple linear regression was performed to understand the relationship between combined water, sanitation, and hygiene score and child nutritional outcomes: height-for-age, weight-for-age, weight-for-height z-scores.

Results

The majority of the sampled households had improved drinking water facilities. Over one-third of the participants (36.5%) did not have access to better sanitation, and 12.4% reported defecating in open places. Just over one-third of those surveyed reported washing their hands with soap or detergents after defecation, with more than 22% of people not having access to a handwashing station on their premises. Stunting, wasting, and underweight were found to be prevalent in 34.4%, 17.6%, and 18.9% of the sampled children, respectively. Height-for-age (0.08 SDs) and weight-for-age (0.014 SDs) were greater on average in children from households with improved water, sanitation, and hygiene conditions, but weight-for-height did not significantly differ from those from WASH-unimproved households.

Conclusion

Certain aspects of WASH, particularly, sanitation facilities and hygiene practices were not up to the mark in St. Martin's Island, and consistent with findings from other studies, our study findings underlined the potential benefits of improved water, sanitation, and hygiene practices in addressing child undernutrition.

Regional Water Availability and WASH Indicators as Predictors of Malnutrition in Under-5 Children: Analysis of the National Family Health Survey, India (2015-16)

BACKGROUND

Water, sanitation and hygiene (WASH) practices determine child nutrition in resource-constrained countries and are influenced by regional water availability. We assessed any relationship between malnutrition and WASH practices among under-5 children in India's areas as per water availability.

METHODS

We did a secondary data analysis of the National Family Health Survey-IV. Stunting, wasting and being underweight were the significant outcomes. Regional water availability, households' source of water, sanitation and disposal of the child stool were the major independent variables. We report the prevalence estimates, bivariate associations and adjusted odds ratio to predict the child's malnutrition per regional water availability after using appropriate sampling weight.

RESULTS

Of the 186 875 children, 41%, 20% and 36% were stunted, wasted and underweight. Only 26% of children had access to improved drinking water sources, whereas 50.0% were defecating in open. Around 65% of children's stools were disposed of in unhygienic ways. Undernutrition depicted a significant association with independent variables. There were higher chances of stunting with a decrease in regional water availability, unimproved sanitation and unhygienic ways of stool disposal. Wasting was intensified by all these factors, except the safe disposal of stools.

CONCLUSIONS

WASH indicators exert a protective effect on undernutrition.

Reusable sanitary napkins in rural India: a remote quality improvement project for adolescent girls promoting menstrual hygiene health during the COVID-19 pandemic

Medical and public health research supports an ongoing need for health promotion in meeting menstrual hygiene needs, including menstrual hygiene management (MHM) education and the adoption of reusable sanitary napkins. This quality improvement project focuses on menstruation education for adolescent girls in rural Tamil Nadu, India and the promotion of reusable sanitary napkins. Results indicate a significant improvement in MHM knowledge, confidence in managing menstruation, adoption of reusable sanitary napkins, and a decrease in missed school days. These findings support global recommendations for health promotion in India.

Factors Influencing the Incidence of Stunting in Jaya Bakti Village, Pagimana District, Banggai Regency

Stunting is a chronic malnutrition problem caused by a lack of nutrition for a long time which leads to abnormal growth in children, such as lower or shorter height than the standard age. Therefore, this study aims to determine the factors associated with the incidence of stunting at the age of 12 to 60 months in Banggai Regency, Indonesia in 2020. Observation analysis and cross-sectional approach were used in this study and the sample size was 161 toddlers at the age of 12 to 60 months. The data were obtained through observations and direct interviews using questionnaires and were processed and analyzed using the Chi-Square test. The results showed that 51.6% of children below 60 months were with stunting and 48.4% had normal nutritional status, while there were 65.8% of proper birth lengths. Chi-Square test results showed a significant relationship between birth length (p = 0.000), birth weight (p = 0.253), exclusive breastfeeding (p = 0.000), various types of food (p = 0.003), frequency of feeding (p = 0.000), hygiene practices (p = 0.000), growth monitoring (p = 0.000) with the incidence of stunting, and there was no relationship, such as birth weight (p = 0.253) with the incidence of stunting in children below 60 months in Jaya Village Bakti, Pagimana District, Banggai Regency. The sample is limited to the group of toddlers from 12 to 60 months, therefore, further study on 0 to 11 months is recommended in Jaya Bakti Village, Pagimana District, Banggai Regency

An assessment of the health risks associated with shared sanitation: a case study of the community ablution blocks in Durban, South Africa

Shared sanitation facilities have been hailed as an innovative approach to solve the challenge with sanitation access. However, these facilities may act as hotspots for disease transmission due to unhygienic conditions. In this study we used quantitative (based on Escherichia coli contamination) techniques to assess the health risks associated with the use of community ablution blocks (CABs). The most contaminated surfaces were the cistern handle (5.7 Log₁₀ cfu/cm²) and internal pull latch (5.8 Log₁₀ cfu/cm²). Based on the E. coli contamination, at least two people out of 100 CAB users might be potentially infected when they touch "hot" surfaces. These risks were modelled assuming transfer of potentially pathogenic E. coli from these surfaces to the mouth. The incorporation of risk-reduction measures, such as wiping of these surfaces or washing of hands, could potentially result in significant reduction of infection risks. The most significant risk-reduction intervention was determined to be wiping of the contact surfaces, especially twice prior to contact. A combination of risk-reduction interventions could further reduce the risks. This study shows that contamination of contact surfaces within shared CABs could lead to increased risks of infections, requiring measures aimed at reducing the associated risks. The risk assessment framework used in this study could therefore be applied in similar settings to estimate associated health risks with the use of such facilities.

Exploring the challenges in the management of childhood pneumonia-qualitative findings from health care providers from two high prevalence states in India

India ranks among the top five countries in the world in child deaths due to pneumonia. Apart from poor public awareness, inadequate health infrastructure and treatment services have compromised effective management. This qualitative study guided by components of the Andersen-Newman's health care utilization framework explored contextual and community challenges faced by health care providers (HCPs) in the delivery of care services for children with pneumonia in select districts of Uttar Pradesh (UP) and Madhya Pradesh (MP). Semi structured interviews (SSIs) and focus groups discussions (FGDs) were carried out with a purposive sample of HCPs selected from three districts in each state. The HCPs included doctors and community health workers (CHWs). All SSIs and FGDs were audio- recorded, with consent, transcribed verbatim, entered into NVivo and analysed using thematic analysis. A total of 15 SSIs were conducted with doctors and eight FGDs were carried out with CHWs. Two themes that best explained the data were:, 1. Health systems: barriers faced in delivery of care services and 2. Evaluated Need: perceptions on community awareness and practices. According to the HCPs inadequacies in government health infrastructure both manpower and equipment, and skill deficits of paramedical staff and CHWs contributed to poor quality of care services for management of childhood pneumonia. This combined with inadequate understanding of pneumonia in the community, dependence on unqualified care providers and distrust of government hospitals acted as barriers to seeking appropriate medical care. Additionally, poor compliance with exclusive breast feeding practices, nutrition and hygiene had contributed to the high prevalence of the disease in these states. Strengthening public health facilities, instilling trust and confidence in people about the availability and the quality of these services and enhancing health literacy around childhood pneumonia would be critical towards protecting children from this disease.

Associations of Nutritional Status with Full Immunization Coverage and Safe Hygiene Practices among Thai Children Aged 12–59 Months

Prevailing prevention measures against morbidity, such as vaccination and safe hygiene practices, vary among local cultural contexts, and little is known about the extent to which these behaviors mitigate poor nutritional status in young children in Southeast Asia. We examined the associations between nutrition status with full immunization coverage, and water, sanitation and hygiene status among children aged 12–59 months in the 2015–2016 Thailand Multiple Indicator Cluster Survey (n = 9060). When adjusted for confounding factors, children with incomplete immunization status were more likely to be stunted (adjusted odds ratio (aOR) 1.47; 95% confidence interval (CI): 1.24–1.75, p < 0.001), wasted (aOR 1.67, 95% CI: 1.31–2.12, p < 0.001), and overweight (aOR 1.24, 95% CI: 1.01–1.51, p < 0.05), whereas children who used unimproved water sources were more likely to be overweight (aOR 2.43, 95% CI: 1.27–4.64, p < 0.01). The further implementation of simple and cost-effective health promotion activities and practices at the household level may be important interventions for healthy child growth and development, particularly under restricted living conditions due to COVID-19.

Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth

The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

The Role of Land Ownership and Non-Farm Livelihoods on Household Food and Nutrition Security in Rural India

South Asia remains the region with the highest prevalence of undernourishment with India accounting for 255 million food insecure people. A worsening of child nutritional outcomes has been observed in many Indian states recently and children in rural areas have poorer nutrition compared to those in urban areas. This paper investigates the relationship between land ownership, non-farm livelihoods, food security, and child nutrition in rural India, using the Young Lives Survey. The survey covers the same rural households and children over the period 2002–2013 in the states of Andhra Pradesh and Telangana. Our empirical analysis uses a sample of 1209 children (and their households) who were aged around 1 year in 2002. Our results show that large agricultural land ownership is significantly associated with better child nutrition (measured using height-for-age and stunting) and household food security. A transition from farm to non-farm work improves child nutrition, but only among landless households. While access to land is still critical for improving household food and nutrition security among rural households, there is a trend towards greater non-farm livelihoods, and a decline in reliance on farming, particularly among landless and marginal farmers.

Factors Associated with the Stunting in Toddlers in the Work Area of Tikson Raya Public Health Center

Background: Stunting often called stunted or short, is a condition of failure to thrive due to chronic malnutrition and psychosocial stimulation and exposure to repeated infections in the First 1000 Days of Life (from fetus to child aged 2 years). Objective: The purpose of this study was to determine the factors associated with the incidence of stunting in the working area of the Tikson Raya Public Health Center, Banggai Laut District. The quantitative study with a case-control research design was applied. The number of samples used was 90 people with the Stratified Random Sampling technique. The data was collected by a questionnaire and analyzed by using univariate, bivariate, and multivariate analysis. Results: An association between breastfeeding (p=0.009), the timing of complementary feeding (p=0.009), history of infectious disease (p=0.001), basic health practices (p=0.000), environmental sanitation hygiene (p=0.000), knowledge of maternal nutrition (p = 0.000) with the incidence of stunting in the working area of the Tikson Raya Public Health Center, Banggai Laut District. The environmental sanitation hygiene variable was identified as the most related to the value of OR = 17.367. Conclusion: Exclusive breastfeeding, complementary breastfeeding, infectious diseases, basic health practices, environmental sanitation, and knowledge of maternal nutrition are associated with the incidence of stunting in toddlers in the working area of Tikson Raya Public Health Center, Banggai Laut District.

Magnitude of Stunting and Associated Factors among Adolescent Students in Legehida District, Northeast Ethiopia

BACKGROUND

Undernutrition including stunting particularly at an adolescent stage was not emphasized by various intervention strategies in the Ethiopian context. Assessing the magnitude and potential risk factors of undernutrition is thus helpful for policymakers to design appropriate intervention strategies. Hence, this study was aimed at assessing the magnitude of stunting and associated factors among adolescent students in Legehida district, Northeast Ethiopia.

METHODS

A school-based cross-sectional study was conducted among 424 adolescent students from February 15th to March 15th, 2018. A stratified sampling followed by a simple random sampling technique was used to select the study participants. A pretested, structured, and self-administered questionnaire was used to collect the required data. Height was measured by using a portable stadiometer and the height-for-age (HFA) z-score was calculated as an indicator of stunting. SPSS version 25 and WHO AnthroPlus software were applied to analyze the data. A multivariable logistic regression analysis was performed to identify factors associated with adolescent stunting. Statistical significance was determined at a p value of <0.05 and association was described by using an odds ratio at a 95% confidence interval.

RESULTS

A total of 406 adolescent students (with a response rate of 95.7%) participated in the study. The magnitude of stunting among adolescent students in this study was 24.9% (95% CI: 24.6%-35.3%).

CONCLUSIONS

Stunting among adolescent students was significantly associated with being male [AOR = 2.1; 95% CI: 1.73-5.90], meal frequency (<3/day) [AOR = 4.6; 95% CI: 2.61-8.24], infrequent handwashing practice [AOR = 3.6; 95% CI: 1.30-9.40], absence of latrine facility (AOR = 5.51; 95% CI: 3.03-9.9), and consumption of unsafe water [AOR = 2.8; 95% CI: 1.35-6.19]. Hence, conducting routine nutrition screenings and assessments, promotion of proper food intake, and emphasis on nutrition education and counseling are needed to be strengthened.

Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study

Background

Stunting was a significant public health problem for under-five in developing countries including Ethiopia. Globally, it was estimated 21.9% or 149 million (81.7 million in Asia and 58.8 million in Africa) under-five children stunted in 2018. In East Africa, 24 million are stunted which is the highest-burden from African regions. Hence, this study aimed to assess the prevalence of stunting and its association with Water Sanitation and Hygiene (WASH) in northwestern Ethiopia.

Method

A community-based cross-sectional study design was conducted among 630 participants from December to mid-January 2019. From five kebeles, two were selected by a simple random sampling technique for the study. To reach study participants a systematic sampling technique was used. Data were collected by using an observational checklist, pretested questionnaire, and anthropometric measurement. Anthropometric indicator, height-for-age was determined using the current World Health Organization (WHO) growth standards. Multivariable logistic regression analysis was computed to analyze the data. From the multivariable analysis the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) and P-value < 0.05 were used to declare statistical significance.

Result

The prevalence of stunting among under-five children was 35.6% (95%CI; 31.9–39.5%). The result from this study showed that having illiterate father and mother, give birth before marriage (single), large family size, short maternal height, unimproved drinking water source, unimproved sanitation, poor hygienic practice, having diarrhea in the previous 2 weeks before the data collection, method of child feeding, age at which complementary feeding started, frequency of feeding, not deworming and mothers who had antenatal care visit of fewer than three times were statistically associated with stunting.

Conclusion

In this study, stunting was an important public health problem among under-five children. It remains the same as the national average prevalence of Ethiopia. To alleviate this problem proper family planning utilization, good dietary intake, maternal and paternal education, and WASH interventions are critical.

Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India

BACKGROUND

Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition.

OBJECTIVES

We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India.

METHODS

In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates.

RESULTS

Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM.

CONCLUSIONS

An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.

Household Water Insecurity Affects Child Nutrition Through Alternative Pathways to WASH: Evidence From India

BACKGROUND

Household water security matters greatly for child nutrition outcomes in the global South. Water's role in sanitation/hygiene, via diarrheal disease, is cited as a primary mechanism here. Yet, the relationship between Water along with Sanitation and Hygiene (WASH) and child stunting remains inconclusive. Water-related mechanisms outside of the traditional scope of WASH might assist with explaining this.

OBJECTIVE

We aim to test the mediating role of reduced dietary diversity as an additional potential mechanism in linking worse household water access to increased risk of early childhood stunting, separating its effects from sanitation and diarrhea among children (as a proxy for hygiene) and taking into account regional water availability.

METHOD

We use nationally representative India Demographic and Health Survey (2015-16) data for 58 038 children aged 6 to 23 months, applying generalized structural equation modelling to estimate water's direct and indirect effects (as mediated through dietary diversity and access to sanitation) on a child's likelihood of being stunted.

RESULTS

Suboptimal water access is significantly associated with elevated likelihood of child stunting. More than 30% of the effect is indirect. In the context of low water access and availability, children's dietary diversity alone mediates more than 20% of its total effect on child stunting.

CONCLUSION

Beyond the WASH mechanisms, household water access affects child stunting indirectly, mediated through its impacts on children's dietary diversity. These mediating effects are also moderated by regional water availability. Water interventions in low-water regions should help reduce children's risk of nutrition-related stunting in households with lowest water access.

Living environment and health of under-five children in urban slums of a coastal region in South India

Objective

The primary objective of the study was to determine the association between the living environment and morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums in southern India.

Methods

This study included 224 mothers of under-five children living in urban slums of Udupi Taluk, Karnataka. A total of 17 urban slums were selected randomly using random cluster sampling.

Results

Undernutrition was high among children of illiterate mothers (63.8%), and the children of working mothers were affected by more morbidity (96.6%) as compared with housewives. Morbidity was also found to be high among children belonging to families with low incomes (66.1%) and low socio-economic backgrounds (93.1%). Safe drinking water, water supply, sanitation, hygiene, age of the child, mother's and father's education, mother's occupation and age, number of children in the family, use of mosquito nets, type of household, and family income were significantly associated with child morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums.

Conclusion

Overall, in our study, family characteristics including parental education, occupation and income were significantly associated with outcomes among under-five children. The availability of safe drinking water and sanitation, and the use of mosquito nets to prevent vector-borne diseases are basic needs that need to be urgently met to improve child health.

Funding

Self-funded.

Association between Infectious Disease and Hygiene Practice on Stunting Toddler Aged 24-59 Months

Background : Child nutrition problem is still a major health problem in Indonesia. Toddlers are a period where children experience rapid growth and development, so they need a high nutrient. The problem of malnutrition can be identified from the children’s slow growth, one of which is in terms of body length or height. A condition where a children’s length or height is not optimal is called stunting. The incidence of stunting affected by several factors, such as infectious disease and bad hygiene practices.Method : The method of this study is observational research with case control research design. The sample of this study was grouped into two, case group and control group, with the number of each group is 28 respondents. The case group was a group of toodlers with stunting ages 24 – 59 months, while the control group was a group of toodlers ages 24 – 59 months with no stunting case. The study was conducted in Bulak Banteng Public Health work area from January -  May 2019. Data collection was carried out by collecting questionnaire about infectious disease and hygiene practices which were carried out by interview and observation method. Results : The result showed that there was an influence between the incidence of infectious disease (p=0,000) (OR= -3.402), and hygiene practices (p=0,000) (OR= -2.442) on stunting.Conclusion : The conclusion in this study is that there is a significant relationship between infectious diseases and hygiene practices with the incidence of stunting in toddler aged 24-59 months  (in Bulak Banteng Health Center, Surabaya).

Are fathers a good substitute for mothers? Paternal care and growth rates in Shodagor children

Biparental care is a hallmark of human social organization, though paternal investment varies between and within societies. The facultative nature of paternal care in humans suggests males should invest when their care improves child survival and/or quality, though testing this prediction can be challenging because of the difficulties of empirically isolating paternal effects from those of other caregivers. Additionally, the broader context in which care is provided, vis-à-vis care from mothers and others, may lead to different child outcomes. Here, we examine the effects of paternal care on child growth among Shodagor fisher-traders, where fathers provide high levels of both additive and substitutive care, relative to mothers. We modeled seasonal z-scores and velocities for height, weight, and body mass index (BMI) outcomes using linear mixed models. Our evidence indicates that, as predicted, the context of paternal care is an important predictor of child outcomes. Results show that environmental seasonality and alloparental help contribute to a nuanced understanding of the impact of Shodagor paternal care on child physiology.

Environmental, Metabolic, and Inflammatory Factors Converge in the Pathogenesis of Moderate Acute Malnutrition in Children: An Observational Cohort Study

Acute malnutrition affects more than 50 million children worldwide. These children are at an increased risk of morbidity and mortality from infectious disease. However, the pathogenesis of acute malnutrition and mechanisms underlying the increased risk and poor outcomes from infection are not well understood. Our objective was to identify differences in inflammation and inflammatory responses between children with moderate acute malnutrition (MAM) and healthy controls (HCs), and search for environmental, pathophysiological, and metabolic factors that may influence this response. Sixteen children with MAM and 16 HCs aged 18-36 months were studied in Nairobi, Kenya. None of the children had symptoms of an infectious disease (fever, diarrhea, or cough) in the 2 weeks before enrollment and sample collection. Demographic and health data were provided by their primary caregivers. Blood samples were collected to measure various biomarkers and the response to an inflammatory stimulus. Children with MAM were more frequently from households with contaminated water, crowding, and unstable income sources. They also had increases in basal inflammation, circulating bacterial lipopolysaccharide (LPS), markers of intestinal damage, and an exaggerated whole blood inflammatory response to LPS. Metabolic changes in children with MAM led to increased plasma levels of long-chain fatty acids, which were found to contribute to the pro-inflammatory state. These exploratory findings suggest convergence of multiple factors to promote dysregulated inflammatory responses and prompt several mechanistic hypotheses that can be pursued to better understand the pathogenesis of MAM.

Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study

BACKGROUND

Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user.

OBJECTIVE

To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia.

METHODS

A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.

RESULTS

The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever.

CONCLUSION

The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.

Associations Between Improved Water Supply and Sanitation Usage and Childhood Diarrhea in Ethiopia: An Analysis of the 2016 Demographic and Health Survey

BACKGROUND

Diarrheal disease is one of the leading causes of death in children under the age of 5. Access to and use of improved water and sanitation services is associated with this, but there is little country-level evidence for this relationship in Ethiopia. Therefore, associations between improved water supply and sanitation usage and childhood diarrhea in Ethiopia have been identified as the objective of this study.

METHODS

This study was a cross-sectional study using data from Ethiopia's 2016 Demographic and Health Survey. Through interviews with mothers/caregivers who had children under the age of 5 years, data was collected. The outcome of this study was the response of the mothers/caregivers interviewed to the 2-week occurrence of diarrhea. Logistic regression analysis was used to examine the relationship between dependent and independent variables.

RESULTS

The survey results found that the use of improved drinking water and latrine facilities was 59.3% (95% CI: 58.36-60.31) and 17.3% (95% CI: 16.59-18.09), respectively. With respect to the handling practices of child feces, 24.8% (95% CI: 23.8-25.70) of the child feces of the interviewed mothers/caregivers were disposed of safely. The prevalence of childhood diarrhea in the preceding 2 weeks was 11% (95% CI: 10.36-11.61). Residence of Somali Region (AOR = 1.81, 95% CI: 1.25-2.61), having more than 2 under-5 children (AOR = 1.21, 95% CI: 1.01-1.46), having more than 5 family members (AOR = 1.18, 95% CI: 1.03-1.36), sex of the indexed child (AOR = 0.88, 95% CI: 0.77-0.99) and unsafe child feces disposal practices (AOR: 1.32; 95% CI: 1.14-1.54) were significantly associated with childhood diarrhea.

CONCLUSION

Residing in the Somali region, having more than 2 children under the age of 5 and having more than 5 household members, indexed child sex, and safe disposal of child feces were significantly associated with diarrhea. Therefore, in Ethiopia, the prevention of childhood diarrhea should concentrate on eliminating household crowding and encouraging the safe disposal of child feces.

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia

BACKGROUND

Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices.

METHODS

A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used.

RESULTS

A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition.

CONCLUSIONS

Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Complementary feeding practices and associated factors among children aged 6-23 months in Pakistan

Premature mortality and undernutrition rates in Pakistan are among the highest in the world. Inadequate infant and young child feeding are the major causes of premature mortality and undernutrition. Yet, very little is known about the determinants of complementary feeding practices in Pakistan. Therefore, this study aims to identify the determinants of inadequate complementary feeding practices among children aged 6 to 23 months in Pakistan by using the latest nationally representative data from the Pakistan Demographic and Health Survey (2017–18). The results show that only 12% of children consume a minimum acceptable diet, 21% achieve minimum dietary diversity, and 38% reach minimum meal frequency. Multivariate regression analysis shows that child age, child weight at birth, mother’s access to newspapers/magazines at the individual level, wealth at the household level, and prenatal visits at the community level are significant predictors of complementary feeding practices among children aged 6–23 months in Pakistan. These findings show that, in addition to poverty alleviation, raising awareness through health practitioners, increasing access to media, and expanding access to child and maternal healthcare can improve complementary feeding practices in Pakistan. This consequently reduces premature mortality and undernutrition.

Associations between the household environment and stunted child growth in rural India: a cross-sectional analysis

Stunting is a major unresolved and growing health issue for India. There is a need for a broader interdisciplinary cross-sectoral approach in which disciplines such as the environment and health have to work together to co-develop integrated socio-culturally tailored interventions. However, there remains scant evidence for the development and application of such integrated, multifactorial child health interventions across India's most rural communities. In this paper we explore and demonstrate the linkages between environmental factors and stunting thereby highlighting the scope for interdisciplinary research. We examine the associations between household environmental characteristics and stunting in children under 5 years of age across rural Rajasthan, India. We used Demographic and Health Survey (DHS)-3 India (2005-2006) data from 1194 children living across 109,041 interviewed households. Multiple logistic regression analyses independently examined the association between (i) the primary source of drinking water, (ii) primary type of sanitation facilities, (iii) primary cooking fuel type, and (iv) agricultural land ownership and stunting adjusting for child age. The results suggest, after adjusting for child age, household access to (i) improved drinking water source was associated with 23% decreased odds [odds ratio (OR) = 0.77, 95% confidence interval (CI) 0.5-1.00], (ii) improved sanitation facility was associated with 41% decreased odds (OR = 0.51, 95% CI 0.3-0.82), and (iii) agricultural land ownership was associated with 30% decreased odds of childhood stunting (OR 0.70, 95% CI 0.51-0.94]. The cooking fuel source was not associated with stunting. Our findings indicate that a shift is needed from nutrition-specific to contextually appropriate interdisciplinary solutions, which incorporate environmental improvements. This will not only improve living conditions in deprived communities but also help to tackle the challenge of childhood malnutrition across India's most vulnerable communities.

Predictors of stunting among children age 6-59 months in Ethiopia using Bayesian multi-level analysis

In developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6-59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6-59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child's age (AOR = 1.022; 95% CrI 1.018-1.026), being a male child (AOR = 1.16; 95%CrI 1.05-1.29), a twin (AOR = 2.55; 95% CrI 1.78-3.56), having fever (AOR = 1.23; 95%CrI 1.02-1.46), having no formal education (AOR = 1.99; 95%CrI 1.28-2.96) and primary education (AOR = 83; 95%CrI 1.19-2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20-1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93-0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35-2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

Possible transmission of viruses from contaminated human feces and sewage: Implications for SARS-CoV-2

Humanity has experienced outbreaks by viruses such as severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) in 2003, Eastern respiratory syndrome coronavirus (MERS-CoV) in 2012, Ebola virus in 2014 and nowadays SARS-CoV-2. While clinicians seek for a vaccine to reduce the epidemic outbreak, environmental engineers need to understand consequence of virus entity in sewage given the reported persistency of viruses in human feces and sewage environments for more than days. Herein, we discuss about concerns associated with virus occurrence in human feces and sewage, with attention to the possible SARS-CoV-2 transmission routes, based on the review of recent studies on SARS-CoV-2 as well as the previous pandemic events. Given the reported environmental stability of coronavirus, the feces- and sewage-derived transmission routes may be of importance to prevent unprecedented spread of coronavirus disease 2019 (COVID-19) particularly in developing countries. However, so far, limited number of studies detected infectious SARS-CoV-2 even in human feces, whereas a number of virus RNA copies were identified in both feces and sewage specimens. Therefore, uncertainty remains in the possibility of this transmission pathway, and further investigation is warranted in future studies, for example, by increasing the number of specimens, examining the effectiveness of methods for viral viability test, considering the patient medical history, and so forth.

Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study

BACKGROUND

Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2.

OBJECTIVE

The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices.

METHODS

Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not.

RESULTS

One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information.

CONCLUSIONS

Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.

Multiple anthropometric and nutritional deficiencies in young children in Ethiopia: a multi-level analysis based on a nationally representative data

BACKGROUND

In Ethiopia, child undernutrition and anemia are major public health concerns, resulting in increased childhood morbidity and mortality. Despite progress made to reduce the prevalence of malnutrition (especially stunting) from 50% in 2000 to 38% in 2016, little is known about the magnitude and risk factors for concurrent nutritional deficiencies in Ethiopia.

METHODS

Analysis for this study was based on a total sample of 9218 children aged 6-59 months drawn from the Ethiopian Demographic and Health Survey (EDHS) conducted in the year 2016. The study used two outcome variables: Multiple nutrition deficit index formed by combining stunting, underweight, wasting and anemia status; and a concurrent stunting and anemia (CAS) index. Two mixed effect regression models, Poisson and Logistic, were used to identify the key risk factors of the two outcome variables, respectively.

RESULTS

The proportion of children with stunting (length-for-age), underweight (weight-for-age) and wasting children (weight-for-length) was 38%, 25.2% and 9.4%, respectively. About 58% of the children had anemia. The prevalence of children with concurrent stunting and anemia children was 24.8%. Our results showed that the risks of multiple nutritional problems were determined by a range of individual, household and behavioral factors including: sex of the child, age of the child, birth order, parity, parental education, religion, household wealth index and type of family structure. The proximate variables (hygiene and sanitation score, feeding practice, and child health service utilization score) were also found to exert a strong influence on the risk of multiple nutritional deficiencies. The likelihood of co-occurrence of stunting and anemia was determined by certain individual and household factors, including sex of the child, age of the child, maternal education, household asset based wealth, religion and household hygiene and sanitation.

CONCLUSIONS

This study underscores the importance of improving parental education, household wealth, hygiene and sanitation conditions, promoting feeding practice and child health service utilization. Also, any nutrition sensitive and specific intervention should consider a child's characteristics such as his/her age, gender and birth order.