Environmental determinants and child morbidity across three informal settlements in Mumbai: a comparative cross-sectional study

Children living in urban informal settlements experience multiple environmental risks, yet conditions and health outcomes are not uniform within cities. We compared environmental exposures and child morbidity across three informal settlements in Mumbai with distinct urban contexts: Gautam Nagar, Dharavi, and Govandi. A comparative cross-sectional survey was conducted between January and December 2024 among 500 households with an index child aged 0–8 years. Caregivers reported morbidity in the preceding six months, and trained fieldworkers collected anthropometric measurements to assess nutritional status. Multivariable regression models adjusted for child age, sex, household size, and caregiver education, with outcome-specific exposures included where appropriate. Severe sanitation deficits and widespread perception of poor water quality were observed across all settlements, while key hazards differed by location, including near-universal asbestos roofing in Gautam Nagar and landfill proximity in Govandi. Compared with Gautam Nagar, children in Govandi had higher adjusted prevalence of pneumonia and stunting and lower prevalence of reported waterborne disease. Nutritional indicators were also poorest in Govandi. These findings demonstrate marked intra-urban heterogeneity in environmental risk and child morbidity within a single metropolitan system. Urban health strategies that treat informal settlements as homogeneous units may overlook important spatially differentiated vulnerabilities.