Extra Food Means Nothing to Stunted Kids With Bad Water: Health | Source: by Adi Narayan, Bloomberg, June 2013.
Excerpts – Aameena Mohammed gives her 20-month-old daughter Daslim Banu plenty to eat. The girl’s mother supplements breast milk with eggs, soup and rice to help her grow. The extra food doesn’t help. Daslim still weighs only as much as a healthy infant half her age.
Mohammed’s home, in one of the poorest districts of the south Indian city of Vellore, is among the 65 percent of India’s homes without running water and safe sewage disposal. Feces and urine collect next to the doorway in an open drain — the source of odor permeating the tin-roofed shack and of the microbes likely retarding the toddler’s growth.
Scientists increasingly suspect that constant exposure to bacteria, virus and parasite-laden fecal contaminants may be frustrating attempts to end malnutrition. In effect, the best diet-based measures to fight chronic hunger in the developing world are being negated by a failure to meet basic human needs: clean water and sanitation.
The problem exists not just in India. A quarter of children in developing countries are underweight, and malnutrition is the root cause of the deaths of more than 2 million children annually, according to theUnited Nations Children’s Fund in New York. Worldwide, 870 million people are chronically hungry, almost all of them in developing countries.
“You really can’t address stunting unless you clean up the sanitary environment,” said Clarissa Brocklehurst, Unicef’s former chief of water, sanitation and hygiene, who worked in India from 1999 to 2001. “It doesn’t matter how much extra food you try to stick into kids or how much dietary supplements you give them, it will all just go through them.”
Stunted Children
Daslim, who runs about the home in an oversized red and green dress that hangs limply from her bony shoulders, has suffered at least five bouts of debilitating diarrhea in the past 10 months, and was hospitalized for three days with a high fever in September. In November, she weighed 7 kilograms (15 pounds) — about two-thirds the normal weight of a girl her age.
A decade of economic growth averaging almost 8 percent a year has doubled the size of India’s middle class and produced more billionaires than the U.K. Still, almost half the nation’s children under 5 years remain stunted — and the situation has worsened in the past 10 years. India’s response has been to distribute nutrient-fortified supplements and meals to children. The UN has called for a broader approach that includes providing safe drinking water and toilets.
200,000 Deaths
About 200,000 children under 4 years die in India annually because of diarrheal diseases caused by dirty water and lack of proper sanitation, according to a study published in the Lancet medical journal in April. Waterborne diseases also hamper productivity, depriving India of 73 million working days each year, the nonprofit group WaterAid said in a 2008 report.
As evidence of the economic impact of lingering hunger mounts, scientists are widening their search into understanding the causes of malnutrition.
Mohammed’s daughter is one of more than 200 children in Vellore enrolled in an international study examining how pathogens damage children’s digestive tracts. Previous studies have shown that a gut constantly assaulted by infections is less adept at absorbing nutrients needed for growth and development.
The researchers involved in the latest study, funded by the Bill & Melinda Gates Foundation, are testing urine and stool specimens from the children each month for signs of infection and carbohydrate absorption, and checking the results against their weight and height records. Their hypothesis is that children living in unclean environments are continually ingesting germs, yet don’t show signs of being sick as often because of the defensive response by their intestinal tracts to the daily microbial pummeling. As a tradeoff though, the germs may compromise the uptake of key nutrients through the intestinal wall.
Pathogen Exposure
“The gut is supposed to absorb, secrete and act as a barrier, and all of these functions can be affected in people who are exposed to a lot of pathogens all the time,” said Gagandeep Kang, professor of gastrointestinal sciences at Vellore’s Christian Medical College, who is leading thestudy in India. “You may be getting what is considered an adequate diet, but if you don’t absorb it, it doesn’t help.”
Kang suspects Daslim’s growth is being impeded by environmental enteropathy, a condition in which the nutrient-absorbing finger-like projections lining the small intestine are transformed into broad, leaf-like flaps in response to constant exposure to pathogens. While externally there may be no obvious signs, internally the changes reduce a person’s ability to take in carbohydrates and proteins.
“We think it’s because their gut gets damaged because they are repeatedly infected with organisms that damage the intestinal lining,” said Kang, who has been studying gastrointestinal diseases for the past 25 years. “We are trying to investigate whether that damage is what stops children from being able to use the nutrients they get in the food.”
Cognitive Skills
The condition can be reversed with cleaner drinking water and contaminant-free food, though a toddler with the condition can suffer lasting damage as a result of malnutrition. Children who suffer from malnutrition in the first five years of life are likely to suffer in adulthood with poorer cognition, less stamina, more chronic illness and a shorter life expectancy, according to Unicef.
There are no outward signs of the condition — a child may suffer from environmental enteropathy for months and not have a single bout of diarrhea. More than 100 scientists and epidemiologists worldwide are studying different aspects of the condition, from identifying the underlying biochemical processes to developing a standardized diagnostic test.
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