Effects of improved drinking water quality on early childhood growth in rural Uttar Pradesh, India: A propensity-score analysis

Navigating the nutritional paradox: The impact of sustainable development targets on childhood wasting and overweight prevalence

In 2015, the United Nations member states endorsed the 2030 Agenda for Sustainable Development to chart a path towards a better future for all. Childhood malnutrition, particularly wasting, remains a critical global health challenge, disproportionately affecting children under five in low- and middle-income countries. This study evaluates the impact of achieving selected Sustainable Development Goal (SDG) targets on reducing childhood malnutrition, with a specific focus on wasting and overweight. Utilizing multi-country DHS datasets, this study analyzed data from 138,782 children under five across 27 countries, nested within 13,788 neighborhoods. We simulated the predicted prevalence of wasting and overweight as selected SDG-related health inputs and determinant indicators reached their target values. Our findings reveal a baseline prevalence of 6.3% for wasting and 4.3% for overweight among the children studied. Progress towards the SDGs can potentially decrease wasting prevalence by a quarter (25%), translating to a reduction from 6.3% to 4.7%. This significant reduction in wasting is more pronounced in rural areas (29%) than in urban settings (7%). Conversely, a 14% increase in overweight prevalence was observed, with rural areas experiencing a higher rise (15%) than urban areas (13%). The study also highlighted variations in access to safe sanitation, improved water sources, healthcare services, income, maternal employment, and education levels, underscoring the complex interplay between these factors and malnutrition outcomes. Notably, the reduction in wasting prevalence was mainly attributable to input determinants rather than direct health inputs, suggesting the importance of broader socioeconomic factors in combating malnutrition. Achieving SDG targets presents a significant opportunity to mitigate wasting, particularly in rural communities. However, the uneven distribution of improvements underscores the need for targeted interventions in less affected areas. The concurrent rise in overweight prevalence, points to the emerging challenge of addressing the dual burden of malnutrition. This necessitates integrated, multi-sectoral strategies considering the diverse health determinants and nutritional status.

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review

Importance

Observational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.

Objective

To assess the reporting of observational studies that explicitly aimed to emulate a target trial.

Evidence Review

We searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.

Findings

A total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.

Conclusion and Relevance

In this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.

Stunting among children aged 24-59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24-59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24-59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

Formulation of Water Sustainability Index for India as a performance gauge for realizing the United Nations Sustainable Development Goal 6

Anthropogenic activities targeting economic progress have triggered changes in the Earth system processes causing depletion of resources and degradation of ecosystems. Water is a critical natural resource which has been severely impacted through groundwater depletion, surface water contamination and ocean acidification resulting in repercussions on human health and biodiversity losses. Likewise, India, a mega biodiversity nation has been critically affected by degradation and drawdown of water resources with far-reaching consequences on environmental vitality and socio-economic development. In order to prevent extreme water scarcity in the near future, the country needs to promote sustainable utilisation of water resources by adhering to the targets of Goal 6 of the United Nations Sustainable Development Goals (UN-SDGs). The present work, therefore, has focussed on the development of a Water Sustainability Index (WSI) for India that would help attaining the targets of SDG 6. A total of 12 indicators categorized under biophysical and social development dimensions and synonymous with the targets of SDG 6 have been used for the formulation of WSI and thereby understanding how much water resources are used annually in a sustainable manner. The study also highlights the interrelationship between the diverse social development and health indicators (SDG 3) of Indian community. The research has the potential to provide guidance for efficient use of water resources in India. Acting as a yardstick and guiding star, the sustainability metric will help the nation to monitor whether it is on the right track and navigate its journey towards achieving water sustainability. It also calls for cautious course correction and restructuring of current Indian policy and operational instruments for effective green governance and sustainable water management.

Spatiotemporal Analysis of the Proportion of Unimproved Drinking Water Sources in Rural Ethiopia: Evidence from Ethiopian Socioeconomic Surveys (2011 to 2019)

Currently, around 36% of the rural Ethiopian population is accessing drinking water from unimproved sources and it is unevenly distributed through time and geographic regions. Therefore, this study aimed to analyze the spatiotemporal patterns of unimproved drinking water sources and identify hotspot areas in rural Ethiopia. Ethiopian Socioeconomic Survey (ESS) data obtained from the Central Statistical Agency were used. It was conducted in four waves from 2011 to 2019. A two-stage probability sampling design was applied. The sample of enumeration areas and households were taken as the first and second stages of sampling, respectively. A total of 3912, 3775, 3698, and 3115 sample households with complete information on drinking water sources were taken in each wave of ESS data, respectively. Weighted proportions, autocorrelation (Moran's “I”) statistic, and hotspot analyses were applied to estimate the prevalence, test the presence of clustering, and identify vulnerable areas with unimproved drinking water sources. The STATA version 14, Excel, and ArcGIS 10.6 were used to manage and analyze data. The proportions of households with unimproved drinking water sources were 0.497, 0.385, 0.298, and 0.363 in consecutive waves of ESS data. The results also revealed the existence of geographical and temporal variations of access to drinking water from unimproved sources, and the most recent vulnerable (hotspot) areas in the borders of the West and East Gojjam zones in the western Amhara region, Zone one in southern Afar region, and Liben, Afder, Shebelle, Korahe, and Nobob zones in Somali region were identified. In conclusion, this study reveals significant geographic inequalities in the use of improved drinking water sources. This may be necessary for policies and coverage targeting the most vulnerable regions. The presented map and analytical approaches can provide a mechanism to monitor future reductions in inequality within countries by reflecting resource allocation priorities.

Prevalence and Correlates of Water, Sanitation, and Hygiene (WASH) and Spatial Distribution of Unimproved WASH in Nepal

This study aims to estimate the prevalence and correlation of household levels of water, sanitation, and hygiene (WASH), including the identification of areas where WASH facilities are unimproved in Nepal. The study population was 11,040 household heads, using the data collected in the Nepal Demographic and Health Survey 2016. Logistic regression analysis was performed and crude odds ratios (OR) with 95% confidence intervals (CI) using a 0.05 significance level are presented. Getis–Ord Gi* statistics were used to identify the hot and cold spot areas of unimproved WASH. GPS locations of WASH points were used for spatial analysis. Approximately 95% of households had an improved water source, 84% had improved sanitation facilities, 81% had a fixed place for handwashing, and 47% had soap and water. Education, wealth, and ecology were significantly associated with WASH. The people from the hills were less likely to have an improved water source (OR = 0.32; 95% CI: 0.16–0.64) than those from the plain. Households with a poor wealth index had 78% lower odds of having an improved water source compared to households with a rich wealth index. Respondents from Madhes Province had lower odds (OR = 0.15; 95% CI: 0.08–0.28) and Gandaki Pradesh had the highest odds (OR = 2.92; 95% CI: 1.52–5.61) of having improved sanitation facilities compared to Province 1. Respondents aged 35–44 years had higher odds (OR = 1.16; 95% CI: 1.04–1.29) of having soap and water available compared to those aged 45 years and older. Education and geographical disparities were the factors associated with having reduced access to WASH. These findings suggest the need to focus on advocacy, services, and policy approaches.

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.

Association of basic vaccination with cognitive and learning ability among children: insights from the India Human Development Survey, 2004-05 and 2011-12

Basic vaccination is important to protect children from infectious diseases and illnesses. Adequate levels of vaccination coverage reduce the morbidity and mortality burden among children and promote their physical and mental development. This study aimed to assess the association between basic childhood vaccination and the cognitive and learning ability of school children in India. Nationally representative follow-up data on 6183 children from the Indian Human Development Surveys conducted in 2004-05 and 2011-12 (IHDS I & II) were analysed. Children aged 8-10 years who had received all basic vaccines by the age 12 months performed better in a maths test than partially vaccinated or unvaccinated children (OR: 1.87, 95% CI: 1.48, 2.35). Similarly, fully vaccinated children performed better in writing tasks than partially vaccinated or unvaccinated children (OR: 1.77, 95% CI: 1.44, 2.18). Likewise, fully vaccinated children had better reading skills than fully unvaccinated children (OR: 1.60, 95% CI: 1.23, 2.09). The results suggest that enhancing child vaccination coverage can have significant benefits beyond health and can potentially improve the long-term educational outcomes of children.

Proximal and contextual correlates of childhood stunting in India: A geo-spatial analysis

BACKGROUND

Globally, India is home to every third child affected by stunting. While numerous studies have examined the correlates of childhood stunting (CS) in India, most of these studies have focused on examining the role of proximal factors, and the role of contextual factors is much less studied. This study presents a comprehensive picture of both proximal and contextual determinants of CS in India, expanding the current evidence base. The present study is guided by the WHO conceptual framework, which outlines the context, causes, and consequences of CS.

DATA AND METHODS

The study used exploratory spatial data analysis tools to analyse the spatial pattern and correlates of CS, using data from the fourth round (2015-16) of the National Family Health Survey (NFHS-4) and the 2011 Census of India.

RESULTS

The study findings reiterate that CS continues to be high in India, with several hot spot states and districts, and that children from the central and eastern region of the nation, namely, Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh are particularly vulnerable. Our analysis has identified six risk factors-maternal short stature, large household size, closely spaced births, prevalence of hypertension among women, household poverty, open defecation, and extreme temperature-and four protective factors-female education, access to improved drinking water, dietary diversity among children, and iron and folic acid (IFA) supplementation during pregnancy.

CONCLUSIONS

The study highlights the need for investing in pre-conception care, addressing both demand- and supply-side barriers to increase the coverage of nutrition-specific interventions, implementing programmes to promote the intake of healthy foods from an early age, providing contraceptive counselling and services to unmarried and married adolescents and young women and men, and universalizing quality primary and secondary education that is inclusive and equitable to avert the burden of childhood stunting in India.

Exposure to conflict-related violence and nutritional status of children in Iraq

There is limited empirical evidence of the health effects of war-related violence on child nutritional status. Using unique micro-level data from Iraq, we create measures of cumulative exposure to violence since conception for children ages two to five based on their date of birth and geographic location. We examine the relationship between height-for-age z-scores, a measure of chronic malnutrition, and four indicators of violence in a regression framework, adjusting for potential confounders and trends. We find that a child exposed to the maximum number of violent incidents is likely to experience a 0.5 standard deviation reduction in height-for-age z-score compared to a child who is exposed to no incidents. Each type of attack we evaluate is negatively associated with height-for-age. Further analysis reveals that the associations are the strongest for children in the northern and central regions where the bulk of the violent incidents occurred. Contrary to our expectation, the associations are similar for boys and girls. Our findings suggest that, in addition to efforts aimed at decreasing violent conflict in Iraq in general, the government and its development partners should focus relief, recovery, and reconstruction efforts in the central and northern regions of the country.

Determinants of Households’ Access to Improved Drinking Water Sources: A Secondary Analysis of Eswatini 2010 and 2014 Multiple Indicator Cluster Surveys

Worldwide, millions of people still die from diseases associated with inadequate water supply, sanitation, and hygiene, despite the fact that the United Nations recognized access to clean drinking water and sanitation as a human right nearly a decade ago. The objective of this study was to describe the determinants of access to improved drinking water sources in Eswatini in 2010 and 2014. Using the Eswatini Multiple Indicator Cluster Surveys (EMICSs), data for 4,819 households in 2010 and 4,843 in 2014 were analyzed. Bivariate and multivariate complementary log-log regression analyses were conducted to identify the determinants of households’ access to improved drinking water sources. The study found that households’ access to improved drinking water sources significantly improved from 73.1% in 2010 to 77.7% in 2014 (p<0.0001). In 2010, households whose heads were aged 35–54 and 55 years had lower odds of having access to improved drinking water sources than those with younger ones. In 2014, female-headed households had lower odds, while, in 2010, sex of the household head was not associated with access to improved drinking water sources. In both years, an increase in the number of household members was negatively associated with access to improved drinking water sources compared to those with fewer members. In both years, the odds of access to improved drinking water sources increased with an increase in the wealth index of the household, and households located in urban areas had higher odds of access to improved drinking water sources compared to those in rural settings. In both years, households from the Shiselweni and Lubombo regions had lower odds of access to improved drinking water sources. The government and its partners should continue to upscale efforts aimed at increasing access to improved drinking water, especially in rural areas, to reduce the disparity that exists between urban and rural households.

Hubungan Faktor Water, Sanitation, and Hygiene (WASH) dengan Stunting di Wilayah Kerja Puskesmas Kotakulon, Kabupaten Bondowoso

Background: In 2017 prevalence of stunting in, Indonesia reached 29.6% and Bondowoso District was one of district that contributes the third higher prevalence, amounted 38.3%. One of underlying cause of stunting were water, sanitation and hygiene (WASH).Objectives: This research aims to analyze the correlation between WASH with stunting among children aged 24 - 59 months in working area of Kotakulon Public Health Center, Bondowoso District.Methods: This was an observational analytic study with case-control design. The sample size of this research was 66 children aged 24 to 59 months in working area of Kotakulon Public Health Center, Bondowoso District. This case-control study consisted of 33 children in case group and 33 children sample of contro groupl. The dependent variable was stunting status, while the independent variables were drinking water source, quality of drinking water, the ownership of lathrines, and mother’s handwashing habits. The data were analyzed using chi-square test.Results: Hand washing habit (p<0.001; OR=0.12) was a risk factor of stunting in under-five years old  which has risk 0.12 times higher for mother that has a poor handwashing habit, while drinking water source (p=0.41), quality of drinking source (p=0.58), the ownership of lathrines (p=0.22) were not accunted as a risk of stunting.Conclusions: A poor handwashing habit in mother contribute to stunting in working area of Kotakulon Public Health Center, Bondowoso District.ABSTRAKLatar Belakang: Pada tahun 2017, prevalensi stunting di Indonesia mencapai angka 29,6% dan Kabupaten Bondowoso adalah kabupaten yang menyumbang angka tertinggi ketiga di Jawa Timur yaitu sebesar 38,3% balita stunting. Salah satu penyebab tidak langsung dari stunting adalah faktor water, sanitation, and hygiene (WASH).Tujuan: Penelitian ini bertujuan untuk enganalisis hubungan WASH dengan stunting pada anak usia 24 – 59 bulan di Wilayah Kerja Puskesmas Kotakulon, Kabupaten Bondowoso.Metode: Jenis penelitian adalah observasional analitik dengan desain kasus kontrol. Besar sampel penelitian yaitu 66 balita usia 24 – 59 bulan di wilayah kerja Puskesmas Kotakulon, Kabupaten Bondowoso. Penelitian kasus kontrol ini terdiri dari sampel kasus sebanyak 33 balita yang mengalami stunting dan sampel kontrol sebanyak 33 balita yang tidak mengalami stunting. Variabel dependen adalah kejadian stunting. Variabel independen adalah WASH, meliputi sumber air minum, kualitas fisik air minum, kepemilikan jamban, dan kebiasaan cuci tangan ibu. Data dianalisis menggunakan uji chi-square.Hasil: Kebiasaan cuci tangan (p<0,001; OR=0,12) adalah faktor risiko dari stunting pada balita dengan besar risiko 0,12 kali lebih tinggi bagi ibu yang memiliki kebiasaan cuci tangan kurang baik, sedangkan sumber air minum (p=0,415), kualitas fisik air minum (p=0,58), kepemilikan jamban (p=0,22) bukan merupakan faktor risiko dari stunting.Kesimpulan: Kebiasaan cuci tangan yang buruk pada ibu berkontribusi terhadap kejadian stunting di wilayah kerja Puskesmas Kotakulon Kabupaten Bondowoso.