DIET QUALITY, WATER AND TOILETS: WHAT ROLES FOR CHILD UNDERNUTRITION IN INDIA? 20th International Congress of Nutrition , Granada, Spain, September 15–20, 2013.
P. Menon1, S.Cyriac1, S J. Coates2, V M. Aguayo2 | 1 International Food Policy Research Institute, New Delhi, India | 2 UNICEF, New Delhi, India
Background and objectives: Infant and young child feeding (IYCF) practices are critical to child nutrition. Emerging evidence is suggesting important roles for water, sanitation and hygiene (WASH) too. Less is known, however on the intersection of these two inputs. We studied the joint effects of IYCF and WASH on child nutrition in India using national data.
Methods: We used data from ~18, 463 children 0-23.9 month old from the 3rd round of India’s National Family Health Survey. Outcomes: child height-for-age, weight-for-age, weight-for-height z-scores (HAZ, WAZ and WHZ), stunting, underweight and wasting. Main predictor variables: IYCF indicators (breastfeeding and complementary feeding) and WASH indicators (water source, toilet type, disposal of child stools). Linear and logistic regression analyses were used, accounting for clustering. We tested for interactions between IYCF and WASH variables, adjusting for child, maternal and household characteristics and state and urban/rural residence.
Results: Toilet type (TT), child stool disposal (CSD) and diet diversity (DD) were independently associated with nutritional outcomes; drinking water or breastfeeding were not. The effects of DD and TT indicators are not independent, though; better DD and access to improved toilets together led to better nutritional outcomes. Also, improved DD was protective for HAZ and WAZ where TT was unimproved. However, for some combinations of IYCF-WASH, there is a larger main effect of improved sanitation; for others, IYCF is more strongly associated with nutritional outcomes than the sanitation indicators.
Conclusions: In summary, a positive synergistic effect of better complementary feeding and better toilets is seen for all anthropometric indicators, but not for improved drinking water or better ways of disposing child stools. Additionally, IYCF is protective against poor sanitary conditions for most outcomes. Interventions that address IYCF and sanitation constraints to child growth simultaneously can have greater impact than either alone.
