Published: 22nd March 2020
World Water Day: Researching the links between WASH and stunting
Ensuring universal, affordable and sustainable access to water, sanitation, and hygiene, or WASH, is the essence of Sustainable Development Goal 6. But around 2.2. billion people – one in three – do not have access to safely managed water sources. How does WASH impact on stunting around the world?
Access to water and sanitation is one of the issues the Hub will research in order to better understand its links with stunting. Stunting is a particularly complex issue that involves a ‘cascade’ of interrelated factors. The first 1,000 days of a child’s life are crucial for its development, not least because infants are extremely vulnerable to intestinal disease, which is often caused by poor water and sanitation.
WASH can potential impact stunting through multiple direct and indirect pathways. Diarrhoea is the symptom of an intestinal infection that can be caused by a variety of different bacteria, parasites, or viruses. It is common in low and middle-income countries, where water and sanitation infrastructure is inadequate, and food hygiene behaviours may need to be improved. Access to safe drinking water and sufficient water for hygiene purposes are important for diarrhoea prevention. Diarrhoea causes around half of deaths in children under the age of five around the world today.
Continuous and chronic diarrhoea inhibit nutrient absorption in the gut, and it can lead to nutrition deficiencies. Unfortunately, some children suffer from diarrhoea for most of their childhood, and this can have a real impact on how they grow and develop. Delayed growth is just one of the characteristics of
Moreover, there is growing evidence that there is a link between stunting and environmental enteric dysfunction (EED). EED causes a malfunctioning of the small intestine due to repeated exposed to pathogens, often from faeces. It results in the imbalanced presence of microorganisms in the gut and a deterioration of the intestinal absorptive and immunologic functions. It means that nutrients from food cannot be absorbed properly, and this leaves the child even more likely to get infections. Unsafe drinking water, inadequate sanitation and poor hand washing practices contribute to this problem. WASH can help prevent pathogen transmission through reduction of environmental contamination and supporting hygienic behaviours that reduce exposures in the home.
However, recent large-scale cluster randomised trials of traditional WASH interventions in Bangladesh, Kenya, and Zimbabwe have shown little to no relationship between domestic WASH improvements and child growth alone or in combination with nutritional interventions. These traditional WASH interventions – safe household sanitation, improved drinking water quality, and improved hand-washing – may not be sufficient to prevent pathogen exposures among infants and young children, the population most at risk for stunting.
Action against Stunting will explore the impact of WASH on stunting in our in-country sites as well as explore the contribution of specific routes of WASH exposures among young children not addressed by traditional WASH interventions, such as complementary food hygiene and domestic animal exposures. The Hub will investigate the relationship between WASH and epigenetic, microbiota, parasite, cognitive factors, food preparation behaviours and, ultimately, linear growth outcomes (normal growth pattern) . The aim is to understand how all these factors are interrelated and identify interventions that can change the pattern of stunting.
Clearly WASH is inextricably linked to child stunting but there is a lot that we still don’t know. We hope that the Hub, by exploring the synergies between WASH and other drivers of child stunting, we will be able to better support communities in eradicating stunting.
The journey is still long, but The Hub will keep focused on the ambition to find solutions to end stunting, worldwide.
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