Beyond Malnutrition: The Role of Sanitation in Stunted Growth. Env Health Perspect, Nov 2014

Author: Charles W. Schmidt

An excerpt from the article: Beyond Nutrition – Nutritionists have tried dozens of approaches to prevent stunting, such as micronutrient supplements for pregnant women and children (especially growth promoters including iron, zinc, calcium, and folate); increased availability of fat-fortified commercial products such Nutributter and Plumpy’nut; a concerted push to encourage breastfeeding during the first six months of life; and efforts to improve the nutritional quality of the complementary foods babies eat while weaning.6

But Jean Humphrey, a professor of human nutrition at the Johns Hopkins Bloomberg School of Public Health, says none of these interventions has been able to eliminate stunting completely. At best, she says, they improve growth by about a third of the typical height deficit in stunted Asian and African children. “This tells us that dietary improvements are important but not sufficient,” she says. “If we really want to eliminate stunting, we need to do more.”

Meanwhile, mounting evidence has shown that poor hygiene and sanitation also constrain linear growth in children. One study found that Bangladeshi children who had access to clean drinking water, improved toilets, and facilities for handwashing with soap, for instance, had a roughly 50% improvement in HAZ scores compared with control children who didn’t.18 Similar results emerged from studies in Sudan19 and Mexico,20 yet it was unclear exactly why poor WASH would contribute to stunting and WASH improvements would help to ameliorate it.

Understanding the Rapid Reduction of Undernutrition in Nepal, 2001–2011: IFPRI Discussion Paper 01384, 
October 2014.

AUTHORS: Derek D. Headey (d.headey@cgiar.org) is a senior research fellow in the Poverty, Health, and Nutrition
Division of the International Food Policy Research Institute (IFPRI), Washington, DC.

John Hoddinott is a senior research fellow in the Poverty, Health, and Nutrition Division of IFPRI,  Washington, DC.

Abstract: South Asia has long been synonymous with unusually high rates of undernutrition. In the past decade, however, Nepal has arguably achieved the fastest recorded decline in child stunting in the world and has done so in the midst of civil war and postconflict political instability. Given recent interest in reducing undernutrition–particularly the role of nutrition-sensitive policies–this paper aims to quantitatively understand this surprising success story by analyzing the 2001, 2006, and 2011 rounds of Nepal’s Demographic Health Surveys.

To do so, the authors first construct and test basic models of the intermediate determinants of child and maternal nutritional change and then decompose predicted changes in nutrition outcomes over time. They identify four broad drivers of change: asset accumulation, health and nutrition interventions, maternal educational gains, and improvements in sanitation.

Many of these changes were clearly influenced by policy decisions, including increased public investments in health and education and community-led health and sanitation campaigns. Other factors, such as rapid growth in migration-based remittances, are more a reflection of household responses to changing political and economic circumstances.

Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As

October 31, 2014

Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As, October 2014. Full text Robert Chambers and Gregor von Medeazza, Institute of Development Studies. The dominant nutrition discourse concerns access to adequate food and its quality. It now includes food security, food rights and justice, governance and agriculture. Despite many initiatives to assure food access, and growing […]

Read the full article →

Open Defecation Evidence from a New Survey in Rural North India

September 25, 2014

Open Defecation: Evidence from a New Survey in Rural North India. Ecom & Polit Weekly, Sept 2014. Full text Authors: Diane Coffey, Aashish Gupta, Payal Hathi, Nidhi Khurana, Nikhil Srivastav, Sangita Vyas, Dean Spears Despite economic growth, government latrine construction, and increasing recognition among policymakers that open defecation constitutes a health and human capital crisis, it […]

Read the full article →

The intestinal microbiome in early life: health and disease

September 25, 2014

The intestinal microbiome in early life: health and disease. Front. Immunol., 05 September 2014 | doi: 10.3389/fimmu.2014.00427 Full text Marie-Claire Arrieta, Leah T. Stiemsma, et al. Human microbial colonization begins at birth and continues to develop and modulate in species abundance for about 3 years, until the microbiota becomes adult-like. During the same time period, […]

Read the full article →

Are you still pouring your Post-2015 water investments down the drain

September 25, 2014

Are you still pouring your Post-2015 water investments down the drain? Stockholm World Water Week, September 2, 2014. Full text Presentations by; Hanna Woodburn, Global Public-Private Partnership for Handwashing; Orlando Hernandez, USAID WASHplus Project; Jane Wilbur, WaterAid; and Corrie Kramer, Plan USA Individual Presentations WASH Pre- and Post-2015 Making an Economic Case for Investing in […]

Read the full article →

Turning Rapid Growth into Meaningful Growth: Sustaining the Commitment to Nutrition in Zambia

September 25, 2014

Turning Rapid Growth into Meaningful Growth: Sustaining the Commitment to Nutrition in Zambia, 2014. Institute of Development Studies. Full text Edited by Jody Harris, Lawrence Haddad and Silke Seco Grütz Zambia suffers high levels of child stunting and is struggling to achieve the nutrition-related MDGs, with significant constraints in the provision of services to address every […]

Read the full article →

UNICEF – Levels & Trends in Child Mortality: Report 2014

September 17, 2014

Levels & Trends in Child Mortality: Report 2014. UNICEF. Full text, pdf Substantial global progress has been made inreducing child deaths since 1990. The number ofunder-five deaths worldwide has declined from 12.7 (12.5, 12.9)1 million in 1990 to 6.3 (6.1, 6.7)million in 2013. While that translates into around 17,000 fewer children dying every day in […]

Read the full article →

Focus on WASH & Nutrition: WASHplus Weekly, Sept 5, 2014

September 5, 2014

Issue 160 | Sept 5, 2014 | Focus on WASH & Nutrition This issue contains some of the most recent studies on stunting, open defecation, nutritional interventions, and other WASH and nutrition issues. Recent reports from the World Bank Water and Sanitation Program discuss the impacts of improved sanitation on child growth in Vietnam and Lao PDR. Training […]

Read the full article →

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration

August 21, 2014

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration. Int J Public Health, June 2014. Full text Authors: Jordan Teague, E. Anna Johnston, Jay P. Graham. Objectives – This study explores the integration of water, sanitation, and hygiene (WASH) and nutrition programming for improved child health outcomes and aims to identify barriers to […]

Read the full article →