A total of 165 million children worldwide are considered stunted, which is associated with increased risk of death prior to age 5 years and cognitive disability. Stunting has, in part, been attributed to the presence of environmental enteropathy. Environmental enteropathy is a poorly understood condition leading to chronic intestinal inflammation. It has been postulated that small intestine bacterial overgrowth contributes to the pathogenesis of environmental enteropathy as overgrowth has been associated with intestinal inflammation and micronutrient malabsorption when it develops in other clinical contexts.

This study confirms the finding that overgrowth occurs at high rates in the developing world. This is the first study to show that overgrowth is associated with intestinal inflammation and linear growth delay in this setting and is the first to examine why children with no known gastrointestinal dysfunction develop overgrowth from the developing world environment.

This abstract of this article (http://mbio.asm.org/content/7/1/e02102-15.full) is as follows:

Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy.

We performed a cross-sectional analysis of 90 Bangladeshi 2-year-olds monitored since birth from an impoverished neighborhood. SIBO was diagnosed via glucose hydrogen breath testing, with a cutoff of a 12-ppm increase over baseline used for SIBO positivity. Multivariable logistic regression was performed to investigate SIBO predictors. Differences in concomitant inflammation and permeability between SIBO-positive and -negative children were compared with multiple comparison adjustment. A total of 16.7% (15/90) of the children had SIBO.

The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.03 to 0.60) and an open sewer outside the home (OR, 4.78; 95% CI, 1.06 to 21.62). Recent or frequent diarrheal disease did not predict SIBO. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml; P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g; P = 0.004) were elevated in SIBO-positive children. Measures of intestinal permeability and systemic inflammation did not differ between the groups.

These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation.

A growing body of evidence indicates that access to safe drinking-water, sanitation, and hygiene (WASH) services has an important positive impact on nutrition. Achieving the six Global Nutrition Targets 2025, as well as global goals for WASH and health, will require greater investments in nutrition and WASH. It will also require maximizing impact through smart and sustainable integrated actions.

This document (http://apps.who.int/iris/bitstream/10665/193991/1/9789241565103_eng.pdf?ua=1), jointly prepared by WHO, UNICEF and USAID, summarizes the current evidence on the benefits of WASH for improving nutrition outcomes. It describes how WASH interventions can be integrated into national nutrition policies and programmes to add value.

It will also serve as a valuable tool to help countries implement the policy options on WASH recommended in the Framework for Action adopted by the 2nd International Conference on Nutrition (ICN2), Rome, November 2014.

World Bank study on WASH and Nutrition in Bangladesh: Can Building Toilets Affect Children’s Growth?

January 12, 2016

Issued early in 2016, the World Bank study provides a systematic review of the evidence on the relationship between water and sanitation and nutrition in Bangladesh. The report is intended to accomplish two things: first, to synthesize the results/evidence evolving on the pathway of WASH and undernutrition for use by practitioners working in the nutrition […]

Read the full article →

WASHplus Learning Brief on WASH and Nutrition

January 12, 2016

This first in the series of learning briefs, “WASH and Nutrition,” documents WASHplus’ WASH and nutrition integration programming efforts to stimulate the discussion and improve the evidence base as well as share experiences and approaches to integrating the two sectors at the global and country level.  WASHplus has been stimulating the discussion and improving the […]

Read the full article →

Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction

November 9, 2015

Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Maternal and Child Nutrition, Nov 2015. Authors: Mduduzi N.N. Mbuya and Jean H. Humphrey.  Full text: http://goo.gl/4WOXOK In 2011, one in every four (26%) children under 5 years of age worldwide was stunted. The realization that most stunting cannot be explained by poor […]

Read the full article →

Water, Sanitation, Hygiene, and Nutrition in Bangladesh” Can Building Toilets Affect Children’s Growth?

November 9, 2015

Water, Sanitation, Hygiene, and Nutrition in Bangladesh” Can Building Toilets Affect Children’s Growth? 2015. Full text Authors: Iffat Mahmud and Nkosinathi Mbuya. World Bank. This report provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition.  We also examine the potential impact […]

Read the full article →

Notes from the SuSanA WASH & Nutrition Working Group

September 8, 2015

Notes from the SuSanA WASH & Nutrition Working Group (The notes below are from Claire Gaillardou/ACF of the SuSana Working Group on WASH & Nutrition meeting at World Water Week in August 2015) Dear members/followers of WG 12, I would like firstly to thank you for your participation during the side event ACF-GWN on WWW. The […]

Read the full article →

The Impact of Poor Sanitation on Nutrition – SHARE; UNICEF

September 1, 2015

The Impact of Poor Sanitation on Nutrition, 2015. SHARE; UNICEF. Link  With 165 million children suffering from chronic undernutrition (being stunted) and 52 million suffering from acute malnutrition (being wasted) (UNICEF et al., 2012), more concerted and cross-sectoral action is needed. Improving water, sanitation and hygiene (WASH) in the context of nutrition programming offers one […]

Read the full article →

Epidemiology of Cholera in the Philippines

September 1, 2015

Epidemiology of Cholera in the Philippines. PLoS NTDS, Jan 2015. Link Authors: Anna Lena Lopez , Lino Y. Macasaet, Michelle Ylade, Enrique A. Tayag, Mohammad Ali Cholera has been increasingly reported in the past decade. It is most feared because of its tendency to spread rapidly resulting in deaths in a short time, if appropriate […]

Read the full article →

Cholera prevention and control in Kenya

September 1, 2015

Cholera prevention and control in Kenya, 2015.  A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Public Health in the Department of Health Policy and Management in the Gillings School of Global Public Health. Link  Author: Gretchen […]

Read the full article →