Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=−0.09; 95% −0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=−0.11; 95% −0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory. | PR | 2 Promoting Healthy Diets and Nutrition for all; IFPRI3; CRP4; DCA | PHND; A4NH | CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=−0.09; 95% −0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=−0.11; 95% −0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.

Abstract Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle‐income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross‐sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI‐HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log‐binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI‐HWI with child outcomes. Moderate‐severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI‐HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI‐HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.