Can sanitation reduce stunting?

Can sanitation reduce stunting?

Context:

• Impact of sanitation on stunting

Introduction:

• The results of two ambitious new trials published this year show that studying the impact of sanitation on stunting is tricky.
• The trials, which implemented water, sanitation and hygiene (WASH) interventions in Bangladesh and Kenyan villages for two years, were an effort to prevent stunting seen in children under two years in developing countries.
• The WASH interventions included replacing poor-quality toilets with improved ones, chlorinating drinking water, and promoting handwashing.

Outcomes of the trials:

• When the trials ended, the researchers found these children were not taller than those who did not receive these interventions.
• The findings are a setback to the hypothesis that improving sanitation can thwart childhood stunting.
• The new trials raise doubts about the link between sanitation and stunting in India too.

The problem of open defecation in India:

• India is the only country today in which over 50% of the rural population still defecates in the open.
• Bangladesh, while close to India in population density, brought down open defecation rates from 42% in 2003 to just 1% in 2016.

Stunting:

• Stunting is a complex problem.
• Children in richer South Asian countries are shorter on average than those in poorer Sub-Saharan African countries, and no intervention so far has closed this gap.

Causes of stunting:

• Prenatal health, breastfeeding and diet, among dozens of factors, have been implicated in stunting.
• Poor sanitation plays a greater role in stunting, because faecal bacteria and parasites deprive the child of nutrition.
• The problem is that most of the data which show that children in households with poor toilets are more likely to be stunted comes from descriptive studies.

Studies in Gambian:

• Studies in Gambian children in the 1990s showed that intestinal inflammation, possibly caused by exposure to faecal germs, is correlated with stunting.
• Among animals, baby mice infected with Escherichia coli, a faecal bacterium, grew slower, and showed signs of such intestinal inflammation when dissected.
• The study also showed that open defecation had a stronger impact on height when population density was higher, as is the case of India and Bangladesh.

Changing people’s sanitation habits:

• India’s Swachh Bharat Abhiyan (SBA) is an example of how difficult it is to change people’s sanitation habits.
• Even though the SBA aims to eliminate open defecation by 2019, data from the 2015-16 National Family Health Survey show the campaign hasn’t changed much since it began.
• Almost halfway through the SBA, open defecation remained quite common in rural India and its distribution across districts looked pretty similar to 2011.

Behavioural change campaigns:

• Behavioral change campaigns need to be initiated to tackle the problem.
• In this background, the Bangladesh study is significant because it did succeed in changing participant behaviour.
• It provides critical information for countries that have already eliminated open defecation.
• They may now want to weigh the merits of sanitation against other interventions like nutrition.