Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam

BMC Public Health

Research Article

Debbie L. Humphries¹  Benjamin T. Crookston²  Kirk A. Dearden³  Mary E. Penny⁴  Jere R. Behrman⁵  Whitney Schott⁵ 

[1] Department of Epidemiology, Yale University, New Haven, CT, USA;Department of Health Science, Brigham Young University, Provo, UT, USA;IMA World Health, Dar es Salaam, Tanzania;Instituto de Investigación Nutricional, Lima 12, Peru;Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA;

关键词: Water;    Sanitation;    Stunting;    Thinness;   

DOI  :  10.1186/s12889-017-4033-1

 received in 2016-07-12, accepted in 2017-01-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThis study’s purpose was to understand associations between water, sanitation, and child growth.MethodsWe estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. ResultsIn unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness.ConclusionsResults from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness.

【 授权许可】

CC BY   
© The Author(s). 2017