Examining the relationship between WASH characteristics and malnutrition outcomes in Bihar, India in order to inform CARE-India study Público
Govindu, Madhumita (Spring 2018)
Abstract
Intro: Undernutrition contributes to almost 45% of the mortality rate in children under five years of age. Stunting, wasting, and severe wasting, also classified as severe acute malnutrition (SAM), are three of the major nutritional outcomes, putting children at risk for poor development, morbidity, and mortality. In this study, the role of an unsafe environment is explored, specifically the role of water, sanitation, and hygiene (WASH), in relation to malnutrition outcomes in Bihar, India.
Methods: Secondary data analysis was conducted using the Fourth National Family and Health Survey data for Bihar (n=25110). Binary logistic regressions were conducted to examine the associations between WASH and child nutrition. For adjusted models, a WASH composite index was created that summed the key WASH variables. Qualitative cognitive interviews (n=23) were conducted to contextualize the WASH questionnaire for the Bihar context and inform the on-going CARE-India SAM study.
Results: The prevalence of malnutrition is significantly higher in Bihar than compared to the global average. 47.6% of children 0-59 months are stunted, 20.3% are wasted, and 6.7% are severely wasted (SAM). Age of the child, household wealth index, and the maternal education and literacy were significant predictors of SAM and wasting. For stunting, the scheduled caste/tribe status of the household was also significant. WASH was a significant predictor for all three nutritional outcomes during crude analyses, and adjusted models continued to show this association for stunting and wasting outcomes. Qualitative data analysis of cognitive interviews indicated that use and functionality of the water source, water quality and understanding of water security issues, and distrust were major themes.
Conclusion: The significant association of WASH with malnutrition, along with the high rates of malnutrition outcomes in the region, makes WASH a key target area for CARE-India to reduce malnutrition outcomes among children 0-59 months. Integration of the revised WASH tool into SAM study will likely better inform CARE-India on the state of water security in Bihar to improve programs targeted at malnutrition. Programs integrating education of proper nutrition and safer WASH practices will likely be the best approach to reducing the rates of malnutrition in Bihar.
Table of Contents
INTRODUCTION …………………………………………………………………………….. 1
LITERATURE REVIEW …………………………………………………………………….... 3
The State of Bihar
What is Malnutrition?
The Role of WASH
Why do we care?
METHODS ……………………………………………………………………………............... 9
National Family and Health Survey – IV (2014-2015)
The CARE-India Study
Qualitative Interviews
RESULTS .…………………………………………………………………………….................. 19
NFHS-IV
Qualitative Interviews with CARE-India
DISCUSSION ……………………………………………………………………………......... 36
Stunting
Wasting and SAM
Qualitative Interviews
Recommendations
Significance
Limitations
CONCLUSION …..………………………………………………………………………......... 46
REFERENCES ……………………………………………………………………………........ 47
APPENDICES ……………………………………………………………………………......... 53
Appendix A: Demographic profiles of 10 CARE-India districts in Bihar, India
Appendix B: Nutrition profiles of 10 CARE-India districts in Bihar, India
Appendix C: WASH and Illness profiles of 10 CARE-India districts in Bihar, India
Appendix D: WASH tool used for cognitive interviewing in Bihar, India
Appendix E: Revised water security module
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