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Observational Study
. 2024 May 24:10:e41567.
doi: 10.2196/41567.

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

Lovely Jain  1 , Sreya Pradhan  2 , Arun Aggarwal  1 , Bijaya Kumar Padhi #  1 , Ramaiah Itumalla  3 , Mahalaqua Nazli Khatib  4 , Shilpa Gaidhane  5 , Quazi Syed Zahiruddin  6 , Celso Augusto Guimarães Santos  7 , Khalid Al-Mugheed  8 , Tahani Alrahbeni  9 , Neelima Kukreti  10 , Prakasini Satapathy  11   12 , Sarvesh Rustagi  13 , Petra Heidler  14 , Roy Rillera Marzo  15
Affiliations
Observational Study

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

Lovely Jain et al. JMIR Public Health Surveill. .

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.

Keywords: DHS; India; LISA; NFHS; WaSH; child; children; epidemiology; intervention; malnutrition; sanitation; spatial epidemiology; stunting; undernutrition; underweight; wasting.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Framework deployed in data extraction and analysis in this study. NFHS, National Family Health Surveys; UT, union territory.
Figure 2
Figure 2
Regions of India.
Figure 3
Figure 3
Trends of stunting by region; data from Indian Demographic and Health Surveys 1998, 2005, 2015, and 2021. NFHS: National Family Health Survey.
Figure 4
Figure 4
Trends of wasting by region; data from Indian Demographic and Health Surveys 1998, 2005, 2015, and 2021. NFHS: National Family Health Survey.
Figure 5
Figure 5
Trends of underweight by region; data from Indian Demographic and Health Surveys 1998, 2005, 2015, and 2021. NFHS: National Family Health Survey.
Figure 6
Figure 6
Univariate LISA (Local Indicator of Spatial Association) maps for the prevalence of (A) stunting, (B) wasting, and (C) underweight. NFHS: National Family Health Survey.
Figure 7
Figure 7
LISA (Local Indicator of Spatial Association) map showing the association between stunting and household sanitation facility between 1998 and 2021.
Figure 8
Figure 8
LISA (Local Indicator of Spatial Association) map showing the association between wasting and household sanitation facility between 1998 and 2021.
Figure 9
Figure 9
LISA (Local Indicator of Spatial Association) map showing the association between underweight and household sanitation facility between 1998 and 2021.
See this image and copyright information in PMC

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