Poorly Researched Height and Sanitation Link Study

I was going through an article published in The Hindu, an Indian national daily, based on the study by a researcher from Princeton University’s, titled ‘The long and short of open defecation‘, that correlates height of Indian children with poor sanitation.

I have a few quick reflections on this article of Dean Spears, the researcher of this study.

First of all I see this article about the research on the heights of Indian children with all alien facts  of comparison just by considering ‘malnutrition’ and ‘sanitation’ (toilet use) as major reasons. In general there are certain scientific facts about the level of malnutrition among children in India, and therefore the results about overall growth pattern and the correlation . However, in my view knowing about a child by just measuring the height certainly seems a poorly researched correlation and poor scientific argument.

From this article it appears that because children in developed world take enough food, follow good infant feeding practices and have a toilet, so they are good in height. So, with this logic they fair in height with children of majority of African countries and may be Pathan and Gujjar children’s in India. With same logic what about the children in China, Thailand, Vietnam, Laos, Bhutan, Nepal and NE part of India, and for that matter in developed South Asian countries like Japan, Hong Kong and South Korea? Don’t we have to consider other major factors affecting the height of a child? In my view the researcher needs to think more scientifically and work further on all available facts before coming to any such conclusion.

Again, we certainly can’t learn a lot from measuring the height of a child scientifically, while, as a researchers we can draw ‘some’ inferences about a child’s lifestyle. Therefore, height can’t be treated as an major (only) indicator for absorbed nutrition, child’s early-life health and disease history. If this is the case, then what about genetic diversity within India and various environmental and social factors? Enough food can’t be treated as a major factor for better health, but, nutritive food should be. What about majority of Americans those are poor in taking nutritive food as well?

Also, there are confusing facts given in this research where in place of 74 % Household those didn’t had any toilet facility as per NFHS 2005-06 (Link) has been quoted 55%, similar is the case with Census 2011. Therefore, one should be cautious while referring this study in terms of quoted facts and figures as well.

There are a few more questions on this research;

1. The researcher says that Open Defecation has a stronger link with a child’s height and the germs those are more likely coming from people’s feces. Which specific germ inhibits the height capacity of a child?
2. What are preferred indicators of chronic under nutrition: How it’s a preferred indicator?
3. The reference to 140 DHS surveys are actually repeat surveys counted time again? What is the rationale to count 140 DHS?
4. Where is the sample data and correlation analysis from Indian example ?
5. Why study adopted a generic  control and non-control sampling method, didn’t it has any first hand data?
6. The study sometime refers Indian census data, and time again JMP. Which data one should rely upon, as census is a population survey while NFHS in India purely a Health survey.
7. Out of various nutrients a child takes, how researcher can confirm that a particular nutrient that is responsible for height get lesser absorption in intestine? Do we have such research that specifically tells that it happens in case of height? Which chemicals /elements/minerals and germs interact in this phenomena?
8. The paper correlates stunting directly with Toilet construction! What is the basis to conclude that if there is no toilet it means the children in that area have stunting?

The conclusions by quoting a few generic example of genetic history are among the poor facts in this research to suggest upon the children’s height pattern in India.

Taking stock from Dean’s research, I wonder, how come malnourished Indian children with no-latrines from its poverty ridden states like Bihar and UP succeeded in giving world class managers, engineers, doctors, scientists, politicians, diplomats and researchers?

Just a food for thought for other such researchers as well.

Related articles

• The long and short of open defecation (thehindu.com)