Area level indirect exposure to extended conflicts and early childhood anthropometric outcomes in India: a repeat cross-sectional analysis

Abstract

Background Protracted, internal conflicts with geographic variations within countries, are an important understudied community exposure for adverse child health outcomes. Methods Violent events from the Uppsala Conflict Data Program (UCDP) between January 2016–December 2020 and January 2010–December 2015, were included as exposure events for children sampled in National Family Health Surveys (NFHS) 5 (2019–21) and NFHS 4 (2015–16), respectively. Geocoded data from UCDP were merged with residential clusters from NFHS, to identify children living in villages or urban blocks situated at <= 50 km from conflict sites. Within these clusters, which we defined as conflict exposed, we studied risks of stunting, underweight and wasting in children, prenatally, and in 0–3 years. We assessed sensitivity on a subsample of siblings with discordant conflict exposures. Results For NFHS 5, exposure to violence between 0 and 3 years was associated with 1.16 times (95% CI 1.11–1.20) higher risks of stunting, 1.08 (1.04, 1.12) times higher risks of underweight, and no change in wasting. In-utero violence exposure was associated with 1.11 times (95% CI 1.04–1.17) higher risks of stunting, 1.08 (95% CI 1.02–1.14) times higher risks of underweight, and no change in wasting, among children <= 2 years. In 17,760 siblings of 8333 mothers, exposure to violence during 0–3 years, was associated with a 1.19 times higher risk of stunting (95% CI − 0.24 to 0.084). Incremental quartiles of violence exposure had higher risks of stunting and underweight until quartile 3. Conclusion In-utero and early childhood indirect exposure to protracted conflicts were associated with increased stunting and underweight in India. Given the continued exposures of such historically and contextually rooted internal conflicts in many LMICs, chronic violence exposures should be targeted in public health policies as important social and political determinant of child health.