Introduction:
Stunting was a major public health problem throughout the world and in India. Stunting results in increased risk of nutrition-related chronic diseases such as diabetes, hypertension and obesity in future (1). Early life HAP (Household Air Pollution) exposure during pregnancy and through the first year of life increase risk of poorer infant growth among children (2).
In 2017, air pollution was the fifth-highest mortality risk factor globally, and India has a highest rate of >35 of particulate matter emissions (3). Globally around 2.8 billion people cook with traditional polluting biomass fuels (4). In India, over 789 million people – nearly 60 percent of the population – depend on polluting fuel to cook their food. Nearly half a million deaths each year can be attributed to HAP (Household Air Pollution) from cooking and heating. Exposure to smoke from cooking fires causes 3.8 million premature deaths each year, mostly in low- and middle-income countries (5,6). HAP is strongly associated with mortality and morbidity among children under-5 over the decade (7). A systematic review that formed the evidence found particulate matter from biomass cooking fuel increases the risk of Low Birth Weight (LBW), stillbirth and chronic bronchitis (8,9).
Breastfeeding has many benefits for both women and children (10,11). A longitudinal cohort study with bi-weekly data collection from urban region of India found that less than 2% of infants were exclusively breastfed for the first six months of life (13). Children who receive exclusive breastfeeding and any breastfeeding were protective factors for preventing childhood stunting (14).
Therefore, a wide range of socio-demographic factors are associated with stunting among infants ≤ 6 months of age. These factors include infant care practices, hygiene, limited food security among the poorest households, maternal nutrition status and level of education (1).
We aimed to understand the prevalence of stunting and its association between cooking fuel type and breastfeeding among Indian infants (≤ 6 months of age) using National Family Health Survey-4 (NFHS).
Methods
This analysis was based on individual-level data from India National Family Health Survey-4 (NFHS-4), a nationally representative cross-sectional survey conducted between 2015 and 2016. The survey is conducted by the Ministry of Health and Family Welfare, Government of India, and coordinated by the International Institute of Population Sciences, Mumbai. Around 628,900 households in 29 states and seven union territories in India were interviewed for NFHS-4. A sample of 259627 women interviewed with a response rate of 98% was obtained. A detailed description of the sampling design and instruments used in the survey has been provided elsewhere (15).
We used the children recode file, available from the Demography and Health Survey (DHS) program website, for this analysis (16). Based on inclusion and exclusion criteria we ended with a sample size of 15,120 infants with ≤ 6 months of age. A detailed data extraction process was depicted in Figure 1.
 |
Figure 1: Flowchart depicting the data extraction process from the NFHS-4 dataset, India conducted between 2015 and 2016 |
In the present study, stunting was defined as infants whose length/height-for-age z-score is below minus 2 (-2.0) standard deviations (SD) according to WHO Child Growth Standards (17).
The primary exposure variable was the type of cooking fuel used in the household and 12 types of responses were reported by mothers. These fuels were grouped into two categories based on exposure to cooking smoke: “clean fuels” (electricity, liquid petroleum gas (LPG), natural gas, and biogas) and “polluting fuels” (kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crop waste, and dung cakes). However, some previous studies have reported kerosene as a polluting fuel and have found significant associations between morbidity or mortality among children and kerosene fuel use (5). For this reason, kerosene was categorized in the polluting fuels group. Exclusive breastfeeding was defined as the feeding of the infant with only breast milk and no other liquids or solids, not even water except for oral rehydration solution, or drops/syrups of vitamins, minerals or syrups (18). The infant currently breastfed was defined as the infant’s received breastmilk prior to 24 hours of the survey despite the other complementary feeding.
The baseline variables used in the bivariate and multivariable regression analysis included socio-demographic, maternal and infant characteristics. The socio-demographic characteristics included residence (urban/rural). The NFHS-4 was based on the 2011 census, where an urban area constitutes statutory towns, census towns, and outgrowths, while all areas other than urban were rural. The basic unit for rural areas is the revenue village. Specific exposition of what statutory towns, census towns, and outgrowth mean is provided elsewhere (19). Wealth index calculated from a standard set of interviewer-observed assets indicating possession of wealth or assets by the household to which they belonged into five categories (quintiles) namely: poorest, poorer, middle, richer and richest, then we classified as low (poorest, poorer), middle and high (richer, richest) wealth category. Other socio-demographic characteristics included were house type (kaccha, semi-pucca, pucca), type of family (nuclear, non-nuclear) and religion (Hindu, Muslim, Christian and others (Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi/Zoroastrian, no religion, Other (not defined)).
Maternal characteristics included maternal age (< 20, 20-29, 30-39, ≥ 40), antenatal visits (none, 1, 2, 3-4, ≥ 5) during the pregnancy of last birth was considered. Place of delivery was categorized into home delivery (if infant delivered at respondent home, other home, parent home), private hospital and public hospital.
Infant characteristics included gender (male, female), birth order (1, 2, 3 to 4, ≥ 5), birth weight (< 2 kg, 2-2.49 kg, 2.5-3.0 kg and > 3.0 kg) and caesarean delivery (yes, no). Vaccine status was categorized into not immunized (if infant has not received any vaccine dose after recommended age), partially immunized (if received at least one vaccine after recommended age) and completely immunized (if received all the recommended vaccine up to the age).
Statistical analysis
For categorical variables, the relative numbers in each category were calculated. Non-normally distributed data were reported with medians and 25th and 75th interquartile ranges (IQR). Univariate and multivariable logistic regression was performed among infants aged 0-6 months between binary outcome variable stunting and all independent study variables. Crude Odds ratios (cOR) and Adjusted Odds Ratio (aOR) with their 95% CI (Confidence Interval) were estimated to examine the strength of the associations. A P-value of < 0.05 was considered as statistically significant. RStudio Version 1.2.1093 was used for statistical analysis. (RStudio Team (2020). RStudio: Integrated Development for R. RStudio, PBC, Boston, MA URL http://www.rstudio.com/.)
Results
Of the 15120 infants, median (Inter Quartile Range) age was 4 (2-5) months with a female/male ratio of 1:1.06. Most of the study population were males (51.46%), birthweight with 2.5 to 3.0 kg (59.10%), exclusively breastfed (55.23%), currently takes breastfeeding (95.97%), partially vaccine immunized (57.64%), delivered at public institution (69.43%) and firstborn infants (39.33%). The majority of the population were Hindu religion (74.93%), pucca house (47.28%), non-nuclear family (71.18%), rural (75.05%), low socio-economic status (43.88%) and using polluting cooking fuel (68.10%). The majority mothers were in the age group of 20-29 (75.29%), visited ≥ 5 antenatal care (40.01%) and vaginal delivery (81.67%) respectively (Table 1).
| Table 1: Prevalence of stunting according to socio-demographic, maternal and infant characteristics among 0 to 6 months of age infants (N=15,120) |
| Characteristics |
Not stunted (N=12,076) |
Stunted (N=3044) |
Total (N=15,120) |
Socio-demographic characteristics |
Religion, n (%) |
Hindu |
8911 (78.66) |
2418 (21.34) |
74.93 (11,329) |
Muslim |
1687 (82.13) |
367 (17.87) |
13.58 (2054) |
Christian |
911 (86.11) |
147 (13.89) |
07.00 (1058) |
Others[a] |
567 (83.51) |
112 (16.49) |
04.49 (679) |
House type, n (%) |
Kaccha |
715 (78.31) |
198 (21.69) |
06.04 (913) |
Semi-pucca |
5486 (77.73) |
1572 (22.27) |
46.68 (7058) |
Pucca |
5875 (82.18) |
1274 (17.82) |
47.28 (7149) |
Family type, n (%) |
Nuclear |
3465 (79.53) |
892 (20.47) |
28.82 (4357) |
Non-nuclear |
8611 (80.01) |
2152 (19.99) |
71.18 (10,763) |
Place of residence, n (%) |
Urban |
3065 (81.24) |
708 (18.76) |
24.95 (3773) |
Rural |
9011 (79.41) |
2336 (20.59) |
75.05 (11,347) |
Type of cooking fuel, n (%) |
Clean fuel |
4062 (84.22) |
761 (15.78) |
31.90 (4823) |
Polluting fuel |
8014 (77.83) |
2283 (22.17) |
68.10 (10,297) |
Wealth index, n (%) |
Middle |
2586 (81.27) |
596 (18.73) |
21.04 (3182) |
Poor |
5068 (76.38) |
1567 (23.62) |
43.88 (6635) |
Rich |
4422 (83.39) |
881 (16.61) |
35.07 (5303) |
Maternal characteristics |
Maternal age (in years), n (%) |
< 20 |
842 (77.75) |
241 (22.25) |
07.16 (1083) |
20 to 29 |
9078 (79.74) |
2306 (20.26) |
75.29 (11,384) |
30 to 39 |
2065 (81.52) |
468 (18.48) |
16.75 (2533) |
≥ 40 |
91 (75.83) |
29 (24.17) |
00.79 (120) |
Number of antenatal visits, n (%) |
None |
1199 (79.25) |
314 (20.75) |
10.01 (1513) |
1 |
670 (79.20) |
176 (20.80) |
05.6 (846) |
2 |
1581 (78.23) |
440 (21.77) |
13.37 (2021) |
3-4 |
3687 (78.60) |
1004 (21.40) |
31.03 (4691) |
≥ 5 |
4939 (81.65) |
1110 (18.35) |
40.01 (6049) |
Place of delivery, n (%) |
Home |
829 (78.58) |
226 (21.42) |
06.98 (1055) |
Private institution |
2931 (82.17) |
636 (17.83) |
23.59 (3567) |
Public institution |
8316 (79.22) |
2182 (20.78) |
69.43 (10,498) |
Caesarean delivery, n (%) |
No |
9789 (79.28) |
2559 (20.72) |
81.67 (12,348) |
Yes |
2287 (82.50) |
485 (17.50) |
18.33 (2772) |
Infant characteristics |
Gender, n (%) |
Male |
6046 (77.70) |
1735 (22.30) |
51.46 (7781) |
Female |
6030 (82.16) |
1309 (17.84) |
48.54 (7339) |
Birth order, n (%) |
1 |
4700 (79.04) |
1246 (20.96) |
39.33 (5946) |
2 |
4080 (81.16) |
947 (18.84) |
33.25 (5027) |
3 to 4 |
2689 (80.20) |
664 (19.80) |
22.18 (3353) |
≥ 5 |
607 (76.45) |
187 (23.55) |
05.25 (794) |
Birth weight (in kg.), n (%) |
< 2 |
250 (56.43) |
193 (43.57) |
02.93 (443) |
2-2.499 |
1400 (70.04) |
599 (29.96) |
13.22 (1999) |
2.5-3.0 |
7135 (79.85) |
1801 (20.15) |
59.10 (8936) |
> 3.0 |
3291 (87.95) |
451 (12.05) |
24.75 (3742) |
Exclusive breastfeeding, n (%) |
Yes |
6629 (79.38) |
1722 (20.62) |
55.23 (8351) |
No |
5447 (80.47) |
1322 (19.53) |
44.77 (6769) |
Child currently breastfed, n (%) |
No |
463 (75.90) |
147 (24.10) |
04.03 (610) |
Yes |
11613 (80.03) |
2897 (19.97) |
95.97 (14,510) |
Vaccine immunization, n (%) |
Completely immunized |
5144 (80.31) |
1261 (19.69) |
42.36 (6405) |
Partially immunized |
6932 (79.54) |
1783 (20.46) |
57.64 (8715) |
| a Others include Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi/Zoroastrian, no religion and other (not defined) |
The prevalence of stunting was 20.13% (3044/15120; 95% Confidence Interval, 19.50%-20.78%). Stunting among polluting cooking fuel and clean cooking fuel was 22.17% (95% CI, 21.38%-22.98%) and 15.78% (95% CI, 14.78%-16.83%) respectively. Stunting among exclusive breastfed and not exclusive breastfed infants were 20.62% (95% CI, 19.77%-21.50%) and 19.53% (95% CI, 18.60%-20.49%) respectively (Table 1).
In adjusted multivariable logistic regression, households using clean cooking fuel (aOR 0.75; 95% CI, 0.66-0.86) are associated with lower odds of being stunted, compared with polluting cooking fuel. Infants who currently takes breastfeeding (aOR 0.76; 95% CI, 0.62-0.93) had lower odds of being stunted, compared with infants currently not being breastfed. Female Infants (aOR 0.71; 95% CI, 0.66-0.78) had lower odds of being stunted, compared with male. Infants with birthweight of 2.0 to 2.499 kg (aOR 0.55; 95% CI, 0.45-0.68), 2.5 to 3.0 kg (aOR 0.33; 95% CI, 0.27-0.40) and > 3.0 kg (aOR 0.18; 95% CI, 0.15-0.23) had lower odds of being stunted, compared with < 2.0 kg (Table 2).
| Table 2: Socio-demographic, maternal and infant characteristics associated with stunted among 0 to 6 months of age infants |
Characteristics |
Odds Ratio (95% CI) |
p-value |
Adjusted Odds Ratio (95% CI) |
p-value |
Socio-demographic characteristics |
Religion, n (%) |
Hindu |
Ref |
|
Ref |
|
Muslim |
0.80 (0.71, 0.90) |
0.000* |
0.82 (0.73, 0.93) |
0.003* |
Christian |
0.59 (0.49, 0.71) |
0.000* |
0.75 (0.62, 0.90) |
0.003* |
Others[a] |
0.73 (0.59, 0.89) |
0.000* |
0.82 (0.66, 1.01) |
0.067 |
House type, n (%) |
Kaccha |
0.97 (0.82, 1.14) |
0.69 |
0.91 (0.77, 1.08) |
0.29 |
Semi-pucca |
Ref |
|
Ref |
|
Pucca |
0.76 (0.70, 0.82) |
0.000* |
0.93 (0.84, 1.04) |
0.221 |
Family type, n (%) |
Nuclear |
Ref |
|
Ref |
|
Non-nuclear |
0.97 (0.89, 1.06) |
0.51 |
0.99 (0.90, 1.09) |
0.864 |
Place of residence, n (%) |
Urban |
0.89 (0.81, 0.98) |
0.020* |
1.20 (1.08, 1.35) |
0.001* |
Rural |
Ref |
|
Ref |
|
Type of cooking fuel, n (%) |
Clean fuel |
0.66 (0.60, 0.72) |
0.000* |
0.75 (0.66, 0.86) |
0.000* |
Polluting fuel |
Ref |
|
Ref |
|
Wealth index, n (%) |
Low |
Ref |
|
Ref |
|
Middle |
0.75 (0.67, 0.83) |
0.000* |
0.82 (0.72, 0.92) |
0.001* |
High |
0.64 (0.59, 0.71) |
0.000* |
0.82 (0.71, 0.96) |
0.011* |
Maternal characteristics |
Mother age (years), n (%) |
< 20 |
Ref |
|
Ref |
|
20 to 29 |
0.89 (0.76, 1.03) |
0.12 |
1.01 (0.86, 1.19) |
0.862 |
30 to 39 |
0.79 (0.67, 0.94) |
0.010* |
0.98 (0.80, 1.20) |
0.84 |
≥ 40 |
1.11 (0.71, 1.71) |
0.63 |
1.17 (0.72, 1.87) |
0.512 |
No. of antenatal visit, n (%) |
None |
0.94 (0.80, 1.11) |
0.46 |
0.91 (0.77, 1.08) |
0.27 |
1 |
0.94 (0.77, 1.15) |
0.57 |
0.93 (0.76, 1.14) |
0.5 |
2 |
Ref |
|
Ref |
|
3-4 |
0.98 (0.86, 1.11) |
0.74 |
1.04 (0.92, 1.19) |
0.519 |
≥ 5 |
0.81 (0.71, 0.91) |
0.000* |
0.96 (0.84, 1.09) |
0.49 |
Place of delivery, n (%) |
Home |
Ref |
|
Ref |
|
Private institution |
0.8 (0.67, 0.95) |
0.010* |
0.96 (0.80, 1.16) |
0.685 |
Public institution |
0.96 (0.83, 1.13) |
0.63 |
1.02 (0.87, 1.20) |
0.849 |
Caesarean delivery, n (%) |
No |
Ref |
|
Ref |
|
Yes |
0.81 (0.73, 0.90) |
0.000* |
0.94 (0.84, 1.06) |
0.353 |
Infant characteristics |
Gender, n (%) |
Male |
Ref |
|
Ref |
|
Female |
0.76 (0.70, 0.82) |
0.000* |
0.71 (0.66, 0.78) |
0.000* |
Birth order, n (%) |
1 |
0.86 (0.72, 1.03) |
0.09 |
0.93 (0.75, 1.15) |
0.495 |
2 |
0.75 (0.63, 0.9) |
0.000* |
0.83 (0.68, 1.02) |
0.08 |
3 to 4 |
0.8 (0.67, 0.97) |
0.020* |
0.83 (0.68, 1.01) |
0.066 |
≥ 5 |
Ref |
|
Ref |
|
Birth weight (in kg.), n (%) |
< 2 |
Ref |
|
Ref |
|
2.0-2.49 |
0.55 (0.45, 0.68) |
0.000* |
0.55 (0.45, 0.68) |
0.000* |
2.5-3.0 |
0.33 (0.27, 0.4) |
0.000* |
0.33 (0.27, 0.40) |
0.000* |
> 3.0 |
0.18 (0.14, 0.22) |
0.000* |
0.18 (0.15, 0.23) |
0.000* |
Exclusive breastfeeding, n (%) |
Yes |
Ref |
|
Ref |
|
No |
0.93 (0.86, 1.01) |
0.1 |
0.91 (0.84, 1.00) |
0.040* |
Child currently breastfed, n (%) |
Yes |
0.79 (0.65, 0.95) |
0.010* |
0.76 (0.62, 0.93) |
0.008* |
No |
Ref |
|
Ref |
|
Vaccine immunization, n (%) |
Completely immunized |
0.95 (0.88, 1.03) |
0.24 |
1.02 (0.94, 1.11) |
0.672 |
Partially immunized |
Ref |
|
Ref |
|
a Others include Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi/Zoroastrian, no religion and other (not defined)
*P-value less than 0.05 was considered as statistically significant |
The proportion of stunted infants was higher among households using polluting cooking fuel, compared with clean cooking fuel between 0 and 6 months of age. A slightly increase in birthweight proportion was noted among households using clean cooking fuel, compared to polluting cooking fuel (Figure 2).
 |
Figure 2: Prevalence of stunting and birthweight according to type of cooking fuel |
Discussion
The present study was conducted to understand the prevalence of stunting and its association between cooking fuel type and breastfeeding between 0 and 6 months of age infants using NFHS-4 datasets. This study suggests that breastfeeding and cooking fuel type was significantly associated with stunting despite the influences of other socio-demographic, maternal and infant characteristics. In present study, the prevalence of stunting and polluting cooking fuel household was 20.13% and 68.10%. Similar and higher prevalence were noted in other studies conducted across the region of India (20,21).
Exposure to household air pollution (HAP) were significantly associated with health risks among new-born and young infants (22–24). In present study, households with polluting cooking fuel are associated with higher odds of infants being stunted, compared with household using clean cooking fuel. A cohort study conducted in China found exposure of cooking fuel was significantly associated with low birthweight (22). Among household using clean cooking fuel, a mild increase in birth weight were noted. This may be due to a tiny particulate matter of biomass cooking fuel that can interact with the mother's womb while inhaling during the pregnancy period which results in childhood stunting, pneumonia and low birth weight (24,25). In present study, the prevalence of stunting among polluting cooking fuel and clean cooking fuel was 22.17% and 15.78% respectively.
Study conducted in urban region of India with bi-weekly data collection found less than 2 percent were EBF up to six months of life. (13) Exclusive breastfeeding of infants under 6 months was associated with higher mean Length for Age Z-score (LAZ) and Weight for Age Z-score (WAZ). (26) A systematic review that formed the evidence found factors like place of residence, pacifier use, maternal age and education was associated with exclusive breastfeeding up to six months and continuation till two years of life. (27,28) In present study, the prevalence of EBF between 0 and 6 months was 55.23%, whereas NFHS-4 survey being a cross-sectional survey is more prone for recall bias. The proportion of stunting among exclusive breastfed and not exclusive breastfed was 20.62% and 19.53% respectively.
However, a few findings in our analysis are worrying. It is a bad sign to find gender differences in this analysis in terms of stunting. Low birth weight children were more likely to be stunted, compared with children born with normal weight. This may be due to biomass fuel emits high concentrations of airborne particulate matter (PM) and toxic chemicals, including carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and polycyclic aromatic hydrocarbons (PAHs). (29) When these pollutants were absorbed into the maternal bloodstream during pregnancy period, maternal blood's oxygen content were reduced and subsequently, oxygen delivery to the placenta were reduced, resulting in preterm delivery and LBW. Therefore, it is biologically plausible that exposure to biomass smoke increases LBW risk, stillbirth, and other mortality and morbidity. According to NFHS-4 the prevalence of LBW was 18 percent. (30) In present study, baby born with low birth weight were more likely to be stunted, compared to baby born with normal weight. And among polluting cooking fuel, a lower birth weight was noted compared to household using clean cooking fuel.
This being a national representative survey is the biggest strength of the study. The NFHS surveys collect individual, household, and community-level information by conducting face-to-face interviews. And the data were collected by trained staff with a high response rate. An important limitation in the study that could impact breastfeeding information was study design, which is cross-sectional due to which causal relationships between different variables cannot be established. The information on exclusive breastfeeding was based on self-reporting and this may be a reason for recall bias, resulting in overestimation and underestimation of the results.
Conclusion
There is still a high burden of infant undernutrition in India. Interventions targeted towards the high-risk groups will be beneficial for improving the nutritional status. This study indicates that polluting cooking fuel and not being breastfed is associated with an increased risk of infants being stunted. A community-based randomized control trial is needed among pregnant women, followed by clean fuel as intervention to study the infant and maternal health risk. Furthermore, the study highlights the urgent need to raise awareness on the importance of exclusive breastfeeding practices.
Funding statement: No funding was obtained for this study.
Declaration of interests: All authors declare that they have no competing interests.
Acknowledgments: The authors are grateful to the Measure DHS for providing the data for the analysis.
References
- Stop stunting [Internet]. [cited 2022 Jan 25]. Available from: https://www.unicef.org/india/what-we-do/stop-stunting
- Boamah-Kaali E, Jack DW, Ae-Ngibise KA, Quinn A, Kaali S, Dubowski K, et al. Prenatal and Postnatal Household Air Pollution Exposure and Infant Growth Trajectories: Evidence from a Rural Ghanaian Pregnancy Cohort. Environ Health Perspect. 2021 Nov;129(11):117009.
- Health Effects Institute. 2019. State of Global Air 2019. Special Report. Boston, MA:Health Effects Institute. Available at https://www.stateofglobalair.org/sites/default/files/soga_2019_report.pdf
- The State of Access to Modern Energy Cooking Services [Internet]. World Bank; 2020 [cited 2021 Feb 3]. 1. (ESMAP papers). Available from: https://elibrary.worldbank.org/doi/abs/10.1596/34565
- WHO. Household air pollution: Health impacts [Internet]. WHO. World Health Organization; [cited 2021 Feb 3]. Available from: http://www.who.int/airpollution/household/health-impacts/en/
- WHO. Air pollution and child health: prescribing clean air [Internet]. WHO. World Health Organization; [cited 2021 Feb 3]. Available from: http://www.who.int/ceh/publications/air-pollution-child-health/en/
- Naz S, Page A, Agho KE. Household air pollution and under-five mortality in India (1992-2006). Environ Health Glob Access Sci Source. 2016 Apr 26;15:54.
- Li X, Huang S, Jiao A, Yang X, Yun J, Wang Y, et al. Association between ambient fine particulate matter and preterm birth or term low birth weight: An updated systematic review and meta-analysis. Environ Pollut Barking Essex 1987. 2017 Aug;227:596–605.
- Sehgal M, Rizwan SA, Krishnan A. Disease burden due to biomass cooking-fuel-related household air pollution among women in India. Glob Health Action [Internet]. 2014 Nov 4 [cited 2021 Feb 10];7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221659/
- Shamir R. The Benefits of Breast Feeding. Nestle Nutr Inst Workshop Ser. 2016;86:67–76.
- Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr Oslo Nor 1992. 2015 Dec;104(467):96–113.
- WHO. Global Breastfeeding Scorecard, 2018. Available from: https://cdn.who.int/media/docs/default-source/breastfeeding/global-breastfeeding-collective/global-bf-scorecard-2018.pdf
- Reddy NS, Sindhu KN, Ramanujam K, Bose A, Kang G, Mohan VR. Exclusive breastfeeding practices in an urban settlement of Vellore, southern India: findings from the MAL-ED birth cohort. Int Breastfeed J. 2019 Jun 27;14(1):29.
- Keino S, Plasqui G, Ettyang G, van den Borne B. Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food Nutr Bull. 2014 Jun;35(2):167–78.
- International Institute for Population Sciences - IIPS/India, ICF. India National Family Health Survey NFHS-4 2015-16 [Internet]. Mumbai, India: IIPS and ICF; 2017. Available from: http://dhsprogram.com/pubs/pdf/FR339/FR339.pdf
- Guide to DHS Statistics [Internet]. [cited 2021 Jan 13]. Available from: https://dhsprogram.com/data/Guide-to-DHS-Statistics/index.cfm
- WHO. Child growth standards - Length/height-for-age. Available from: https://www.who.int/tools/child-growth-standards/standards/length-height-for-age
- WHO. Exclusive breastfeeding for optimal growth, development and health of infants [Internet]. WHO. World Health Organization; [cited 2022 Jan 25]. Available from: http://www.who.int/elena/titles/exclusive_breastfeeding/en/
- Census of India Website : Office of the Registrar General & Census Commissioner, India [Internet]. [cited 2021 Feb 3]. Available from: https://censusindia.gov.in/
- Das S, Chanani S, Shah More N, Osrin D, Pantvaidya S, Jayaraman A. Determinants of stunting among children under 2 years in urban informal settlements in Mumbai, India: evidence from a household census. J Health Popul Nutr. 2020 Nov 27;39(1):10.
- Murarkar S, Gothankar J, Doke P, Pore P, Lalwani S, Dhumale G, et al. Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study. BMC Public Health. 2020 Oct 16;20(1):1559.
- Jiang M, Qiu J, Zhou M, He X, Cui H, Lerro C, et al. Exposure to cooking fuels and birth weight in Lanzhou, China: a birth cohort study. BMC Public Health. 2015 Jul 28;15:712.
- Liang W, Wang B, Shen G, Cao S, Mcswain B, Qin N, et al. Association of solid fuel use with risk of stunting in children living in China. Indoor Air. 2020 Mar;30(2):264–74.
- Tielsch JM, Katz J, Thulasiraj RD, Coles CL, Sheeladevi S, Yanik EL, et al. Exposure to indoor biomass fuel and tobacco smoke and risk of adverse reproductive outcomes, mortality, respiratory morbidity and growth among newborn infants in south India. Int J Epidemiol. 2009 Oct;38(5):1351–63.
- Mishra V, Retherford RD. Does biofuel smoke contribute to anaemia and stunting in early childhood? Int J Epidemiol. 2007 Feb;36(1):117–29.
- Kuchenbecker J, Jordan I, Reinbott A, Herrmann J, Jeremias T, Kennedy G, et al. Exclusive breastfeeding and its effect on growth of Malawian infants: results from a cross-sectional study. Paediatr Int Child Health. 2015 Feb;35(1):14–23.
- Cohen SS, Alexander DD, Krebs NF, Young BE, Cabana MD, Erdmann P, et al. Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. J Pediatr. 2018 Dec;203:190-196.e21.
- Boccolini CS, Carvalho ML de, Oliveira MIC de. Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review. Rev Saude Publica. 2015;49.
- Zhang JJ, Smith KR. Household air pollution from coal and biomass fuels in China: measurements, health impacts, and interventions. Environ Health Perspect. 2007 Jun;115(6):848–55.
- International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS. Available from: http://rchiips.org/nfhs/nfhs-4Reports/India.pdf
|
