The Role of Water Quality in Early Child Nutrition: A Case Study in Uttarakhand

12 Sep 2023
Water Quality

Undernutrition is a global public health problem especially in children below the age of 5 years. It can affect various aspects of children’s development such as physical and mental development. It can be seen in the form of wasting, stunting or underweight. Water is an essential component of healthy growth and development, and ensuring access to clean water, adequate sanitation, and good hygiene is crucial for early childhood nutrition. Proper sanitation & hygiene and safe drinking water can reduce undernutrition and stunting in children by preventing diarrhoeal and parasitic diseases, and damage to intestinal development (environmental enteropathy). Roughly 50 per cent of all malnutrition is associated with repeated diarrhoea or intestinal worm infections as a direct result of inadequate water, sanitation and hygiene (WHO). When children are undernourished, their resistance to infection is lowered and they are more susceptible and more likely to die from diarrhoeal disease and other infections. In fact, diarrhoea is the second-leading cause of death globally in children under five years.[1],[2] The condition of malnutrition is further exacerbated in hills due to the limited availability and accessibility of micro-nutrient-rich staple crops around the year. Thus, as part of the Nutrition Security study, the team examined and collected scientific evidence on water quality in Mukteshwar, Nainital, Uttarakhand. This was investigated through on-site testing of drinking water samples and in-person consultations with medical experts.

The Importance of Water in Child Nutrition

Adequate hydration is crucial for a child’s health and development. It helps regulate body temperature, transport nutrients and oxygen to cells, eliminates waste products, and supports the functioning of vital organs. Dehydration in children can lead to a range of health issues, including fatigue, headaches, constipation, urinary tract infections, and even impaired cognitive function.

In addition to providing hydration, water is also essential for nutrient absorption and digestion. It helps break down food and allows nutrients to be absorbed and transported to cells throughout the body. Without sufficient water intake, children may experience nutrient deficiencies, even if they are consuming a healthy and balanced diet.

It is, therefore, essential to ensure that children have access to clean and safe drinking water at all times. Parents and caregivers should encourage children to drink water throughout the day and offer fluids during meals and snacks. Water should be the primary source of hydration, with sugary drinks and fruit juices limited to occasional treats.

Water Quality and Child Health

Water quality is a critical public health concern. Poor water quality is an ongoing problem in India because the country lacks water treatment facilities that can handle the pollution caused by rapid industrialization and urbanization, and open defecation in many areas without sanitation infrastructure exacerbates the problem. Access to clean and safe drinking water is essential for preventing water-borne diseases and promoting good health. Inadequate or contaminated water can lead to a range of illnesses in children, including diarrhoea (which is the second leading cause of death in children[3]), cholera, typhoid fever, and other bacterial infections.

Water quality is determined by the presence or absence of harmful substances such as bacteria, viruses, and other contaminants, which can cause gastrointestinal diseases. Water can become contaminated due to various reasons such as natural sources, industrial activities, and poor sanitation practices. Children are particularly vulnerable to water-borne diseases as their immune systems are not fully developed, and they are more likely to get dehydrated from diarrhoea and vomiting. Moreover, diarrhoea increases malabsorption, in turn increasing the likelihood of malnutrition. Therefore, it can be hypothesized that water quality in the household has a significant impact on children’s nutritional status in India.[4] Therefore, diarrhoea and malnutrition have a vicious cycle.[5]

According to UNICEF, around 800 children die every day from diarrhoea caused by poor water and sanitation. Lack of access to safe drinking water and sanitation facilities also affects the nutritional status of children due to the loss of nutrients through diarrhoea and other illnesses. According to the latest National Family Health Survey (NFHS-5),35.5 per cent of children between the ages of 0 and 59 months are stunted, 19.3 per cent are wasted, and 32.1 per cent are underweight. The situation is slightly better in Uttarakhand, a state in northern India, with 27 per cent stunting, 13.2 per cent wasting, and 21 per cent underweight. Around 7.3 per cent of children under 5 years reported a prevalence of diarrhoea 2 weeks prior to the survey at the national level compared to 4.4 per cent in Uttarakhand.[6] However, the region is highly vulnerable to the availability and accessibility of micro-nutrient-rich staple foods/crops. Under-five diarrhoeal diseases further exacerbate malnutrition by washing out the critical micronutrients.

Water Quality Assessment in Mukteshwar, Nainital

A study was conducted in Mukteshwar, Nainital district, Uttarakhand, to collect scientific evidence on water quality. The study included on-site testing of drinking water samples and in-person interactions with medical experts deployed in the region.

The water samples were collected and tested from different sources such as springs, naala (open well), water supplied in houses, and storage water. Physico-chemical and microbiological tests were conducted on the samples. The samples reported pH values within the acceptable range of Indian drinking water standards (IS 10500) of 6.5–8.5. Additionally, total dissolved solids (TDS) values were below 500 ppm, which is the acceptable limit for drinking water quality. However, 44 per cent of the water samples had TDS values below 50 ppm, which is too low for drinking water. Generally, water with TDS levels between 50 and 150 is considered most suitable for drinking. Only 13 per cent of water samples tested had TDS values above 100 ppm. Such low TDS water does not need exhaustive water treatment such as reverse osmosis (RO) treatment.

Total coliforms were also tested as an indicator of the cleanliness of the water source. Total coliforms are a large group of different types of bacteria that share several characteristics. They are commonly found in the soil and intestines of animals, including humans, and their presence indicates that water is likely to contain other more harmful pathogens. About 50 per cent of the water samples were contaminated with total coliforms. Although total coliform bacteria themselves do not necessarily cause harmful illnesses, their presence increases the probability of bacteria that can cause water-borne diseases (such as diarrhoea, typhoid, and jaundice) in the exposed population.

The interaction with local medical experts emphasized that both viral and gastrointestinal diarrhoea exist in the area with the increasing prevalence of the latter type of diarrhoea. Water and personal hygiene-related disorders were widespread in 20–25 villages of Mukteshwar, strangely after the monsoon during July–October. The medical expert also suggested that human/animal open defecation is the prime cause of gastrointestinal diarrhoea. The treatment methods such as boiling/disinfecting or filtering before drinking should be adopted by the population. Another way to prevent diarrhoea and other water-borne diseases could be maintenance of personal hygiene.

Water Availability in Hilly Areas

Besides water quality, water availability is another significant issue in most of the hilly areas. As per the Jal Jeevan Mission – Har Ghar Jal Scheme, 64 per cent of households in Uttarakhand have tap water supply as of date. In rural areas, 46 per cent of households have to travel more than 30 minutes to fetch drinking water. Many residents in Mukteshwar rely on storing rainwater from their rooftops during the rainy season for washing and cleaning purposes. However, this water may not be suitable for drinking due to potential contamination. The Uttarakhand Government has announced an ambitious scheme to provide tap water connections to households at a minimal cost of INR 1, which can improve water availability and quality in the future.

Way Forward

The study's findings highlight the need for proper management of water resources, particularly in the Himalayan region, where water scarcity is an issue. Investing in water quality and sanitation is an essential step towards ensuring child health and development. Governments and communities must prioritize safe drinking water and sanitation facilities, especially in areas where access is limited.

A few ways to reduce the prevalence of water-borne diseases include:

The open wells are susceptible to microbial contamination, which may cause water-borne diseases (e.g., diarrhoea, typhoid, etc.). So, point-of-use (POU) water treatment can significantly impact the health and nutrition of vulnerable populations (infants, children, and pregnant women). Hence, disinfection of open well water with bleaching powder or chlorine tablets is recommended for safe drinking water.

The role of the village panchayats is critical for supplying disinfected water to the households.

The Uttarakhand Har Ghar Nal Yojana should ensure adequate water supply and concrete measures to provide good quality water (free from microbes).

Awareness campaigns drives on water quality, quantity, sanitation and hygiene should be conducted to convey the information to villagers.

Regular monitoring of water quality and testing for contaminants is also critical to ensuring that the water is safe for consumption.

Kanhaiya Lal and Vidhu Gupta, Environment and Health, The Energy and Resources Institute (TERI), New Delhi.

[1] Details available at

[2] Details available at 10.1371/journal.pone.0209054

[3] Details available at

[4] Details available at Li, W., Liu, E. & BeLue, R. Household water treatment and the nutritional status of primary-aged children in India: findings from the India human development survey. Global Health 14, 37 (2018).

[5] Details available at

[6] Details available at

Water quality