Water, Sanitation and Hygiene (WASH) and Breastfeeding Contribute to Child Stunting in Rural Malawi. The FASEB Journal, April 2015, vol. 29 no. 1 Supplement 579.6.
Authors: J Ruel-Bergeron, P Christian, et al.
Evidence linking water, sanitation and hygiene (WASH) to stunting has been mixed but constitutes a possibly important contributor to chronic undernutrition in low and middle income countries. Using cross-sectional baseline data of an impact evaluation of a nutrition program targeted at reducing maternal and child undernutrition, we assessed the extent to which optimal WASH practices contribute to reduced odds of stunting (length-for-age z-score <-2 SD) among children 6 to 24 months of age living in two rural districts of Malawi.
We used multivariable logistic regression with robust standard error estimation to measure the relationship between stunting and a composite of six WASH indicators (measured as an unweighted score ranging from 0-11, with scores of 0, 1 or 2 assigned for levels of optimal water source and treatment, sanitation facility and cleanliness, handwashing with soap, and safe disposal of child feces), controlling for potential health, dietary, and socioeconomic confounders. 53% of children were stunted in this population.
The median (IQR) of the WASH score was 5.5 (4-6). A high WASH score (蠅8) (OR=0.71, 95% CI 0.51-1.00) and breastfeeding 蠅10 times per day in the last 7 days (OR=0.50, 95% CI 0.27-0.92) were associated with a reduced odds of stunting in an adjusted analysis; diarrhea, child age, sex, and maternal education, were all significantly associated with stunting in this population. Integration of WASH and infant and young child feeding interventions in nutrition programs may contribute to reductions in stunting in Malawi.
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