Tag Archives: stunting

Crappy water and the science of sanitation

Crappy water and the science of sanitation. The Guardian, November 22, 2016. by  by Mary-Ann Ochota, an anthropologist and author of Hidden Histories: a spotter’s guide to the British landscapehe

Stunting, death and malnutrition: why contaminated water has far more serious effects than the odd bout of diarrhoea 

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Eight year olds in Monze District, Zambia beneath a chalk line indicating the global average height for their age. 40% of children in Zambia suffer from stunted growth, the 10th highest rate in Africa. Photograph: WaterAid/Chileshe Chanda

At the start of this year, the UN recognised sanitation as a universal human right. The Sustainable Development Goals aim to achieve global sanitation by 2030. But despite these grand ambitions, and a hard-working WASH (Water, Sanitation and Hygiene) development sector, 2.4 billion people around the world still don’t have access to a proper toilet.

When we think of poor sanitation, thoughts usually turn to diarrhoea. If you start off healthy, and have the means to prevent dehydration, it’s not usually life threatening. But more than half a million under fives died from diarrhoea in 2013, with around 314,000 deaths directly attributable to poor WASH. And for people continuously exposed to a faecally-contaminated environment, the lack of a toilet can have far-reaching effects.

TOILET = GROW TALLER + THINK BETTER
Recent research has highlighted an indisputable link between toilets, malnutrition and irreversible stunting.

Malnutrition isn’t simply to do with a lack of food – it’s net nutrition that’s key, with access to nutritious food offset against losses to disease, and impairment in the ability to absorb nutrients.

The World Health Organisation estimates that 50% of cases of malnutrition in the world are due to repeated bouts of diarrhoea or intestinal worm infections caused by inadequate water and sanitation provision. Just five cases of severe diarrhoea in the first two years of a child’s life can result in stunting – short height for age – which is a measure for overall health. Stunting is largely irreversible after the age of two, and results in reduced lifelong immune capacity, retarded cognitive and emotional development, and poor physical health.

Read the complete article.

 

Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels

Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Medicine, November 2016.

Background – Stunting affects one-third of children under 5 y old in developing countries, and 14% of childhood deaths are attributable to it. A large number of risk factors for stunting have been identified in epidemiological studies. However, the relative contribution of these risk factors to stunting has not been examined across countries. We estimated the number of stunting cases among children aged 24–35 mo (i.e., at the end of the 1,000 days’ period of vulnerability) that are attributable to 18 risk factors in 137 developing countries.

Methods and Findings – We classified risk factors into five clusters: maternal nutrition and infection, teenage motherhood and short birth intervals, fetal growth restriction (FGR) and preterm birth, child nutrition and infection, and environmental factors. We combined published estimates and individual-level data from population-based surveys to derive risk factor prevalence in each country in 2010 and identified the most recent meta-analysis or conducted de novo reviews to derive effect sizes. We estimated the prevalence of stunting and the number of stunting cases that were attributable to each risk factor and cluster of risk factors by country and region.

The leading risk worldwide was FGR, defined as being term and small for gestational age, and 10.8 million cases (95% CI 9.1 million–12.6 million) of stunting (out of 44.1 million) were attributable to it, followed by unimproved sanitation, with 7.2 million (95% CI 6.3 million–8.2 million), and diarrhea with 5.8 million (95% CI 2.4 million–9.2 million). FGR and preterm birth was the leading risk factor cluster in all regions. Environmental risks had the second largest estimated impact on stunting globally and in the South Asia, sub-Saharan Africa, and East Asia and Pacific regions, whereas child nutrition and infection was the second leading cluster of risk factors in other regions.

Although extensive, our analysis is limited to risk factors for which effect sizes and country-level exposure data were available. The global nature of the study required approximations (e.g., using exposures estimated among women of reproductive age as a proxy for maternal exposures, or estimating the impact of risk factors on stunting through a mediator rather than directly on stunting). Finally, as is standard in global risk factor analyses, we used the effect size of risk factors on stunting from meta-analyses of epidemiological studies and assumed that proportional effects were fairly similar across countries.

Conclusions – FGR and unimproved sanitation are the leading risk factors for stunting in developing countries. Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition.

Childhood stunting can cut future earnings by up to a quarter

Childhood stunting can cut future earnings by up to a quarter | Fox News, Oct 5 2016 |

LONDON (Thomson Reuters Foundation) – Some 250 million children worldwide risk not reaching their full potential due to extreme poverty and stunting, cutting their future earnings by up to 26 percent and seriously impacting national growth, scientists said on Tuesday.

stunting

A boy takes a nap on a street in Port-au-Prince, Haiti, February 24, 2016. (REUTERS/Andres Martinez Casares)

The failure to invest in early child development is costing some low and middle income countries two to three times their current expenditure on health, researchers calculated.

Experts say the first few years of life from conception onwards is critical for brain development.

Writing in The Lancet medical journal, the scientists highlight strong evidence linking stunting and extreme poverty to reduced cognitive and educational development, poorer adult health and lower earnings.

Read the complete article.

Better Nutrition Alone Won’t Stop Stunting, Study Says

Better Nutrition Alone Won’t Stop Stunting, Study Says | Source: The Cambodia Daily, Sept 27 2016 |

Despite steady gains over the past two decades, about a third of Cambodia’s children are still stunted—leaving them smaller, prone to illness and cognitively impaired—according to new research that suggests a more flexible approach is needed to continue progress.

Increased education among parents, better maternal care, improved sanitation and higher incomes were credited as the key drivers in reducing stunting from 51 percent of children in 2000 to 34 percent in 2014, according to a study released last week.

The researchers from the U.K. said that there seemed to be divergent causes for the drop in rural and urban areas.

The study, titled “What Explains Cambodia’s Success in Reducing Child Stunting: 2000-2014?,” also finds that programs focused exclusively on improving child nutrition had not shown sure signs of success.

Read the complete article.

WaterAid – Caught Short: how a lack of access to clean water and decent toilets plays a major role in child stunting

Caught Short: how a lack of access to clean water and decent toilets plays a major role in child stunting, 2016. WaterAid.

WaterAid’s new report reveals the extent of the global stunting crisis and the impact a lack of clean water and decent toilets is having on the futures of millions of children suffering from malnutrition.

caught_short_india_Manjula_Gouramma

Sisters Manjula, 9, and Gouramma, 13, stand in front of a blackboard at their school in Karnataka State, India, showing how their height compares to the average for their age. Gouramma also suffers from hypothyroidism, which doctors say may in part explain her height.

50% of malnutrition cases are linked to chronic diarrhoea caused by lack of clean water, decent sanitation and good hygiene, including handwashing with soap.

For a child, experiencing five or more cases of diarrhoea before the age of two can lead to stunting. Beyond this age, the effects are largely irreversible.

“Stunting not only makes children shorter for their age, but affects their emotional, social and cognitive development, meaning their lives and life chances are forever changed,” says Barbara Frost, WaterAid’s Chief Executive.

The Caught Short report reveals that:

  • India has the highest number of children suffering from stunting in the world – 48 million, or two in every five.
  • Nigeria and Pakistan rank second and third with 10.3 and 9.8 million children suffering from stunting respectively.
  • Timor-Leste has the highest percentage of children who are stunted, at 58%.

 

Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural India

Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural indigenous communities of Jharkhand and Odisha, Eastern India: a cross-sectional study. Maternal & Child Nutrition, June 2016.

Authors: Jennifer Saxton, Shibanand Rath, et. al.

The World Health Organisation has called for global action to reduce child stunting by 40% by 2025. One third of the world’s stunted children live in India, and children belonging to rural indigenous communities are the worst affected. We sought to identify the strongest determinants of stunting among indigenous children in rural Jharkhand and Odisha, India, to highlight key areas for intervention.

We analysed data from 1227 children aged 6–23.99 months and their mothers, collected in 2010 from 18 clusters of villages with a high proportion of people from indigenous groups in three districts. We measured height and weight of mothers and children, and captured data on various basic, underlying and immediate determinants of undernutrition. We used Generalised Estimating Equations to identify individual determinants associated with children’s height-for-age z-score (HAZ; p < 0.10); we included these in a multivariable model to identify the strongest HAZ determinants using backwards stepwise methods.

In the adjusted model, the strongest protective factors for linear growth included cooking outdoors rather than indoors (HAZ +0.66), birth spacing ≥24 months (HAZ +0.40), and handwashing with a cleansing agent (HAZ +0.32). The strongest risk factors were later birth order (HAZ −0.38) and repeated diarrhoeal infection (HAZ −0.23).

Our results suggest multiple risk factors for linear growth faltering in indigenous communities in Jharkhand and Odisha. Interventions that could improve children’s growth include reducing exposure to indoor air pollution, increasing access to family planning, reducing diarrhoeal infections, improving handwashing practices, increasing access to income and strengthening health and sanitation infrastructure.

Scientists put $177 billion price tag on cost of poor child growth

Scientists put $177 billion price tag on cost of poor child growth | Source: Yahoo News, June 29 2016 |

LONDON (Thomson Reuters Foundation) – Children born in developing countries this year will lose more than $177 billion in potential life-time earnings because of stunting and other delays in physical development, scientists said on Wednesday.

Children who have poor growth in their first years of life tend to perform worse at school which usually leads to poorer earning power later on.

The Harvard scientists calculated that every dollar invested in eliminating poor early growth would yield a $3 return.

“$177 billion is a big pay cheque that the world is missing out on – about half a percentage point of GDP of these countries,” said Peter Singer, head of Grand Challenges Canada, which funded the research through its Saving Brains program.

“We have to stop wasting the world’s most precious economic and social asset and ensure children thrive.”

Poor nutrition, premature birth, low breastfeeding rates and early exposure to infection are among several causes of stunting which affects three in 10 children in the developing world.

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