Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia

Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review

OBJECTIVE

To identify predictors of stunting among children 0-24 months in Southeast Asia.

METHODS

This scoping review focused on articles with observational study design in English published from 2012 to 2023 from five international databases. The primary keyword used were: "stunting" OR "growth disorder" AND "newborn" AND "predict" AND "Southeast Asia".

RESULTS

Of the 27 articles selected for the final analysis there are thirteen predictors of stunting in seven Southeast Asia countries. The thirteen predictors include the child, mother, home, inadequate complementary feeding, inadequate breastfeeding, inadequate care, poor quality foods, food and water safety, infection, political economy, health and healthcare, water, sanitation, and environment, and social culture factor.

CONCLUSION

All these predictors can lead to stunting in Southeast Asia. To prevent it, health service providers and other related sectors need to carry out health promotion and health prevention according to the predictors found.

Hand Washing Practice and Food Insecurity are Associated With Undernutrition of Breastfeeding Mothers in Rural Ethiopia: A Cross-sectional Study

Background

Breastfeeding mothers are prone to undernutrition. However, factors contributing to maternal undernutrition are not exhaustively understood. Hence, this study aimed to determine prevalence of undernutrition among breastfeeding mothers and identify associated factors.

Methods

A cross-sectional study was conducted among 606 breastfeeding mothers from selected rural districts in Oromia and Sidama regional states of Ethiopia. Data were collected through an interviewer-administered questionnaire. Nutritional status was assessed using body mass index (BMI) and mid-upper-arm-circumference (MUAC). Logistic regression analysis was used to identify factors associated with maternal undernutrition.

Results

One out of ten breastfeeding mothers was found undernourished as determined by BMI (12.6%) and MUAC (10.7%). Mothers who did not practice hand washing after cleaning children's bottom were 2 and 3 times more likely to be undernourished compared to their counters, as measured by BMI (AOR = 2.29, P = .002) and MUAC (AOR = 3.03, P < .001), respectively. Mothers living in mildly or moderately food insecure households (AOR = 2.37, P = .019) were more than two times more likely to be undernourished as determined by MUAC. Mothers who breastfed children in the age range of 9 to 11 (AOR = 2.79, P = .025) or 12 to 23 (AOR = 2.57, P = .018) months were more than two and half times more likely to be undernourished as determined by BMI.

Conclusions

Maternal undernutrition is a medium-level public health problem in rural districts of Oromia and Sidama regional states in Ethiopia. The lack of hand washing practice after cleaning a child's bottom, household food insecurity and higher child age increased the odds of maternal undernutrition. Mothers should prioritize and improve their nutritional care as the age of their breastfed child increases. Nutrition programs in rural districts of Ethiopia should also aim to improve personal hygiene practices and food insecurity integrated with implementation researches to evaluate program's impact on nutritional status of breastfeeding mothers.

Assessment of water, hygiene, and sanitation practice and associated factors among Bihari refugee camp in Bangladesh: A cross-sectional study

Background and Aims

The global significance of water, sanitation, and hygiene (WASH) cannot be overstated, extending far beyond the confines of developing nations and encompassing even the most developed ones. This study, rooted in the Bihari refugee camp in Bangladesh, seeks to underscore the universality of WASH concerns.

Methods

Using a cross-sectional design and a structured questionnaire, we conducted a meticulous evaluation of WASH practices with 313 participants selected through random sampling.

Results

Findings shows the water practice, among all of them, only 4.8% of the respondents were very happy with the water supply system and 16.0% of the respondents were happy with this. A total of 29.7% of the respondents were satisfied with safe drinking water and only 4.8% of the respondents were very satisfied with safe drinking water. Regarding the hygiene practice, among all respondents, 10.2% of them were satisfied with using the same bathroom by multiple people. Only 5.4% respondents were happy in their living environment. Regarding sanitation practice, only 31.3% had private toilet facilities. Among all of the respondents, 13.7% of the respondents were satisfied with using the same toilet by multiple people. Respondents who were illiterate (p < 0.01) and self-employed (p < 0.04) were satisfied with the water supply. Similarly, respondents who were illiterate (p < 0.03) and self-employed (p < 0.00) were satisfied with safe drinking water. Respondents who were illiterate (p < 0.02) and whose monthly income was below 8000 BDT (p < 0.00) were satisfied using same bathroom by multiple people. Respondents who were self-employed (p < 0.01), whose monthly income 8000-12,000 BDT (p < 0.01) and having single room (p < 0.00) were satisfied using the same toilet by multiple people.

Conclusion

Enhanced access to safe WASH facilities, coupled with a comprehensive understanding of the study's findings, have the potential to serve as vital signposts for the development and implementation of policies and interventions.

Assessment of water, sanitation, and hygiene among women living in precarious households in a Turkish urban area

BACKGROUND

This study aimed to identify the determinants of water, sanitation, and hygiene (WASH) behaviors and conditions among women in poor neighborhoods in Izmir, Turkey, and to develop a scale for assessing WASH behaviors and conditions that is specifically designed for use in precarious urban areas.

METHODS

The study used a cross-sectional design, as well as a methodological feature for developing the scale. The sample size was calculated as 243 households out of 2667 households in the Basmane neighborhood, with a 95% confidence interval and a 6% margin of error, and a woman who was responsible for cleaning was invited to participate from each household. The scales for WASH behaviors and conditions, which served as dependent variables, were developed in a four-stage process, yielding two distinct scales. The WASH-Behaviors Scale had 14 items about hand, body, and home hygiene, whereas the WASH-Conditions in Households Scale included 16 items about variables like area per capita, physical structure, and cleaning tool availability. Age, ethnicity, number of children, education, work status, and income were among the independent variables. Data was collected through household visits. The scales' validity was evaluated using exploratory factor analysis. Linear logistic regression analysis was employed to assess the determinants of WASH behaviors.

RESULTS

The women, with an average age of 40.65 ± 14.35 years, faced economic challenges, as a substantial portion earned an income below the minimum wage. More than half of them were uninsured, and 72.6% were identified as migrants or refugees. Factor analysis confirmed the compatibility of both scales (KMO = 0.78-0.80, p < 0.05), elucidating 52-54% of the total variance. Factors such as ethnicity, number of children, husband's education level, income perception, and WASH conditions explained 48% of WASH behaviors.

CONCLUSIONS

WASH-Behaviors and WASH-Conditions in Households scales met the validity criterion, and their scores were related to basic sociodemographic and economic characteristics like education, income, household size, and ethnicity. The scale development process emphasized the importance of considering both behaviors and household conditions, albeit using different techniques. The findings indicated that WASH conditions are more problematic than behaviors, and that behavioral interventions will not work unless the conditions are corrected.

Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan

BACKGROUND

Reasons for undernutrition are food insufficiency, impaired child care, limited access to healthcare, and maternal lack of health literacy. In addition, there are several environmental factors, such as drinking water quality, poor sanitation, and hygienic practices that can lead to poor nutritional status in children. The present study aimed to compare household-associated risk factors, including water, sanitation, and hygiene (WASH) practices of mothers, with children's stunting under the age of five.

METHODS

A face-to-face cross-sectional survey was conducted with mothers of children under the age of five in the Dera Ghazi Khan district in southern Punjab, Pakistan. World Health Organization criteria for stunting were used to identify the participants. A sociodemographic questionnaire was used to collect information from consented parents/guardians on children's age, feeding, and WASH practices. Pearson's chi-square, simple regression, and hierarchical regression models were applied for data analysis.

RESULTS

A total of 204 mothers of children of both genders participated in this study. The children's mean (SD) age was 15.67 (± 10.2) months, their weight was 5.44 (± 1.45) kg, their height was 67.69 (± 10.05), and their mid-upper arm circumference was 9.75 (± 1.30) cm. Children's stunting was mild (z-score > -2) at 17.6%, moderate (z-score - 2 to -3) at 16.7%, and severe (z-score < -3) at 65.7% of participants. A simple regression model showed a strong association, r2 = 0.062, p = 0.013, with age as the most significant sociodemographic factor. The hierarchical regression model showed a combined value of r2 = 0.0128, p = 0.027, with hand pump and tank water as the significant source of drinking water that was related to stunting among children.

CONCLUSION

Stunting can be associated with several risk factors, including WASH parameters. This study concluded that children aged under five years are susceptible to stunting in southern Punjab, Pakistan. The contamination of hand pumps and tank water resources was found to be the major contributing factor to stunting.

Association of both Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF) practices with childhood malnutrition in Lao PDR: a cross-sectional study of the 2017 Lao Social Indicator Survey II

OBJECTIVE

We assessed whether Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF), either alone or combined, were associated with malnutrition among Lao People's Democratic Republic (Lao PDR) children aged 6 to <24 months.

DESIGN

This is a secondary analysis of the 2017 Lao Social Indicator Survey II (LSIS II), which used multistage probability proportional to size sampling. Logistic regression analyses were conducted with OR and its corresponding 95% CI.

SETTING

The LSIS II was conducted a nationwide household-based survey covering all 18 provinces in Lao PDR.

PARTICIPANTS

We had a total of 3375 children (weighted sample 3345) and 357 households with data on drinking water.

OUTCOME MEASURES

The outcomes of this study were stunting and wasting.

RESULTS

The prevalence of stunting and wasting was 28.9% and 10.1%, respectively. Even though households with access to a basic or improved water source were high (82.5%), over 83% of drinking water was contaminated with Escherichia coli. Access to improved sanitation, basic hygiene and adequate IYCF gave a significant lower risk of becoming stunted. The combined effect of these practices on stunting was (adjusted OR (AOR)=0.54; 95% CI=0.41 to 0.73) greater than each practice alone (improved sanitation: AOR=0.75; 95% CI=0.61 to 0.93; basic hygiene: AOR=0.69; 95% CI=0.57 to 0.83; adequate IYCF: AOR=0.79; 95% CI=0.64 to 0.98). Access to improved sanitation and adequate IYCF was associated with a significant lower risk for being wasted, and again the combined effect of these practices was (AOR=0.64; 95% CI=0.44 to 0.92) greater than each practice alone (improved sanitation: AOR=0.68; 95% CI=0.49 to 0.93 and adequate IYCF: AOR=0.66; 95% CI=0.47 to 0.92).

CONCLUSION

Given the strong associations with both stunting and wasting, and the added benefits when combining WASH and IYCF, there is a need of multisectoral interventions to reduce early childhood malnutrition in Lao PDR.

Exploring Factors Associated with Stunting in 6-Month-Old Children: A Population-Based Cohort Study in Sulawesi, Indonesia

Stunting in children under the age of two is a significant global concern, particularly in low- and middle-income countries like Indonesia. Intervention efforts often come too late as many of the underlying causal factors have already occurred earlier. While antenatal multiple micronutrient supplements (MMS) have demonstrated positive effects on pregnancy outcomes, their impact on infant growth in the first six months remains inadequately explored in epidemiological studies. This study aims to identify factors associated with stunting at six months in infants whose mothers received MMS. A population-based cohort study was conducted in four subdistricts of Banggai, Indonesia. Pregnant women were recruited in their third trimester and followed up until their children were six months of age. Validated questionnaires were employed to gather data on social determinants of health and diet, and standardised methods were utilised for anthropometric measurements. Stunting was determined based on the WHO child growth standards. The analysis comprised data from 152 mother-child pairs. The prevalence of stunting during early infancy (first two months) was 18.4%, which decreased to 15.8% in later infancy (at six months). Factors such as small-for-gestational-age (AOR = 11.29; 2.73-46.66), preterm birth (AOR = 6.33; 1.25-31.97), short birth length (AOR = 4.31; 1.11-16.78), maternal mid-upper arm circumference (MUAC) below 23.5 cm, and female infants (AOR = 3.27; 95%CI: 1.04-10.27) were associated with stunting at six months. This study highlights that stunting in the first six months is present at birth, with small-for-gestational-age (SGA) as a strong predictor. In addition, there was a trend to improved growth (-0.30 [-0.79 to 0.18]) in infants born to mothers who received MMS supplementation pre-pregnancy rather than during pregnancy, although it was not statistically significant.

Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation

Poor child nutrition is a major public health challenge in Tanzania. Large between and within regional nutritional inequalities exist in rural and urban areas. We looked at how locational circumstances hinder children from having an equal opportunity for good nutrition. We used the 2008/09 Living Standards Measurement Study data for Tanzania to identify the part played by water and sanitation in rural and urban inequality of opportunity in child nutrition. We used the dissimilarity index and the Shapley decomposition technique to quantify and decompose inequality of opportunity in nutrition. We find that 16% of the circumstance-driven inequality of opportunity needs to be redistributed for equality of opportunity to prevail. We find that in rural areas, about 42% of the inequality of opportunity in nutrition is due to water and sanitation problems and 22% to child age. In urban areas, we find that the inequality of opportunity is related mainly to the child's sex, price fluctuations and intergenerational factors. The findings suggest that policies to improve water and sanitation coverage could help equalize opportunities for children in rural areas. In urban areas, policies that could help equalize opportunities require incentives to change social norms and behavior around feeding practices and vaccination.

Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach

Background

Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia.

Methods

A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review.

Results

The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child’s stool, or improved household flooring and child wasting.

Conclusion

The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14309-z.

Determinants of Feeding Patterns with Stunting in Children in the Coastal Area of Bengkulu City

BACKGROUND: The age of 0–2 years is a golden period for human growth and development known as the “golden age,” characterized by rapid growth. This period is the First 1000 Days of Life (HPK). The proper diet greatly affects the nutritional status of children. AIM: The purpose of the study was to determine child feeding patterns with the incidence of stunting in children in the Coastal area of Bengkulu City. METHODS: This study was an analytical observational study with a cross-sectional design. The research sample was children under five aged 6–24 months in the coastal area of Bengkulu City as many as 75 children were selected using the accidental sampling technique. Children’s nutritional intake using the Semi Food Frequency questionnaire for energy, protein, fat, carbohydrates, calcium, iron, zinc, and phosphorus. Nutritional intake data were processed by nutrisurvey. Data analysis with Chi-square test and the level of significant 0.05. RESULTS: The frequency of food consumed by children 6–24 months in the form of mashed food 2 times a day was 54.2%, soft food 3 times a day was 54.5%, and family food 3 times a day was 82.5%. The percentage of children with energy, protein, fat, and carbohydrate intake below the recommendation was much higher in normal children (in sequence 84.6%, 81.8%, 84.9%, and 86.3%) compare to stunted children (in sequence 15.4%, 18.2%, 15.1%, and 13.7%). Likewise, calcium, fe, zinc, and phosphor intake below the recommendation was much higher in normal children (in sequence 82%, 85.5%, 80.6%, and 82.1%) compare to stunted children (in sequence 18%, 14.5%, 19.4%, and 17.9%). CONCLUSIONS: There was no relationship between the type of food, macronutrient and micronutrient intake with stunting. Education and counseling at Integrated Healthcare Center need to be carried out, regarding the importance of consuming the proper food and the proper frequency of eating, surveys of nutritional consumption and routine health checks for pregnant women and children under five.

The association of socio-demographic and environmental factors with stunting among under-five children in Hawassa City, Sidama National Regional State, Ethiopia

Undernutrition in children is a challenging problem in developing countries, including Ethiopia. Stunting is the most prevalent form of undernutrition. The majority of studies on childhood stunting and its associated factors focused on children, maternal and socioeconomic components. However, a few studies reported poor WaSH status and antibiotic exposure as environmental risk factors for child stunting, and the case of socio-demographic factors also lacks consistency. Concerning this, there is a lack of information in Ethiopia. Therefore, the present study assessed the association of socio-demographic, WaSH, and antibiotic exposure with stunting among under-five children. A cross-sectional study was conducted involving 340 mother-child pairs. Anthropometric data were collected using standard and calibrated height and weight scales. For factorial data, an interviewer-guided standard questionnaire was used. Logistic regression analyses were used to identify factors determining childhood stunting. In the present study, the prevalence of stunting, underweight and wasting was 14⋅7 % (95 % CI 10⋅9, 18⋅5), 4⋅4 % (95 % CI 2⋅4, 6⋅8) and 2⋅1 % (95 % CI 0⋅6, 3⋅5), respectively. Low dietary diversity, being born from a mother with an education level of secondary school, and belonging to a female-headed household were positively associated (P < 0⋅05) with stunting. The prevalence of overall undernutrition was lower (21⋅2 %) in the study area. Stunting was significantly associated with dietary diversity, maternal educational level and sex of households head. The government policy should focus on enhancing the dietary diversity of households, and encouraging women's education.

Effect of maternal employment on child nutritional status in Bale Robe Town, Ethiopia: a comparative cross-sectional analysis

Adequate nutrition is essential for early childhood to ensure healthy growth, proper organ formation, and function, a strong immune system, neurological and cognitive development. The main aim of the present study was to assess the effect of maternal employment on nutritional status among children aged 6-23 months in the town of Bale Robe, Ethiopia. A community-based comparative cross-sectional study was conducted on about 597 (293 unemployed and 304 employed) having children aged 6-23-month-old children sampled were employed with a multistage sampling technique. A face-to-face interview was conducted using a structured pretested questionnaire. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The magnitude of stunting (39.9 %), underweight (39⋅9 %) and wasting (22⋅2 %) was greater in 6-23-month-old children born to employed mothers than their counterparts in unemployed ones [stunted (31⋅3 %), underweight (24⋅0 %) and wasted (11⋅8 %)]. Being a girl [AOR 0⋅31; 95 % CI (0⋅17, 0⋅54)] in employed mothers and [AOR 0⋅29; 95 % CI (0⋅16, 0⋅51)] in unemployed people significantly protected stunting. This study demonstrated that the nutritional status of 6-23-month-old children is better among unemployed mothers than among employed mothers. Therefore, concerted efforts may decrease child undernutrition in a study area.

Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program

Background

The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children.

Objective

We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors.

Methods

Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys.

Results

Mothers’ exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5% and 10%, respectively, mediated by household water, sanitation, and hygiene facilities and practices.

Conclusions

These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television.

Factors Influencing the Incidence of Stunting in Jaya Bakti Village, Pagimana District, Banggai Regency

Stunting is a chronic malnutrition problem caused by a lack of nutrition for a long time which leads to abnormal growth in children, such as lower or shorter height than the standard age. Therefore, this study aims to determine the factors associated with the incidence of stunting at the age of 12 to 60 months in Banggai Regency, Indonesia in 2020. Observation analysis and cross-sectional approach were used in this study and the sample size was 161 toddlers at the age of 12 to 60 months. The data were obtained through observations and direct interviews using questionnaires and were processed and analyzed using the Chi-Square test. The results showed that 51.6% of children below 60 months were with stunting and 48.4% had normal nutritional status, while there were 65.8% of proper birth lengths. Chi-Square test results showed a significant relationship between birth length (p = 0.000), birth weight (p = 0.253), exclusive breastfeeding (p = 0.000), various types of food (p = 0.003), frequency of feeding (p = 0.000), hygiene practices (p = 0.000), growth monitoring (p = 0.000) with the incidence of stunting, and there was no relationship, such as birth weight (p = 0.253) with the incidence of stunting in children below 60 months in Jaya Village Bakti, Pagimana District, Banggai Regency. The sample is limited to the group of toddlers from 12 to 60 months, therefore, further study on 0 to 11 months is recommended in Jaya Bakti Village, Pagimana District, Banggai Regency

Determinants of Incident Stunting in Elementary School Children in Endemic Area Iodine Deficiency Disorders Enrekang Regency

BACKGROUND: Stunting is a global health emergency, including in Indonesia. The prevalence of childhood stunting in 2019 in Enrekang amounted to 44.8%. Enrekang Regency is the area with the highest stunting and is an endemic area. Iodine Deficiency Disorder (IDD) is thought to be correlated with the incidence of stunting. AIM: This study aims to identify the determinants of stunting in elementary school children in IDDs endemic areas in the Enrekang Regency. METHODS: An observational analytic study with a cross-sectional approach. The subjects of this study were mothers and their children aged 6–12 years. 100 total samples were collected based on the purposive sampling method. Collecting data using a questionnaire, FFQ, iodine test kit, microtia, and palpation. Data analysis using chi-square and logistic regression. RESULTS: The results showed that there was a relationship between maternal height (p = 0.020), diet (p = 0.049), PHBS practice (p = 0.012) on the incidence of stunting. While the use of iodized salt (p = 0.510) and palpation of the thyroid gland (p = 1000) were not associated with stunting. Lack of PHBS practices for children has a 6333-fold chance of experiencing stunting, while stunted mothers have a 5.583-fold chance of giving birth to stunting children. CONCLUSIONS: There is a relationship between mother’s height, child’s diet, and PHBS practice with stunting. Analysis of determinants related to the incidence of stunting is very important so that it becomes input and empirical evidence to the regional governments in formulating policies to overcome the problem of stunting, which is the highest in South Sulawesi.

Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review

OBJECTIVE

This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years.

DESIGN

This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

SETTING AND PARTICIPANTS

PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles.

MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS

Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight.

CONCLUSIONS AND IMPLICATIONS

The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.

Water, sanitation and hygiene interventions and the prevention and treatment of childhood acute malnutrition: A systematic review

Undernutrition is more prevalent among children living in unsanitary environments with inadequate water, sanitation and hygiene (WASH). Despite good evidence for the effect of WASH on multiple infectious diseases, evidence for the effect of WASH interventions on childhood undernutrition is less well established, particularly for acute malnutrition. To assess the effectiveness of WASH interventions in preventing and treating acute childhood malnutrition, we performed electronic searches to identify relevant studies published between 1 January 2000 and 13 May 2019. We included studies assessing the effect of WASH on prevention and treatment of acute malnutrition in children under 5 years of age. Data were extracted by two independent reviewers. We included 26 articles of 599 identified references with a total of 43,083 participants. Twenty-five studies reported on the effect of WASH on prevention, and two studies reported its effect on treatment of acute malnutrition. Current evidence does not show consistent associations of WASH conditions and interventions with prevention of acute malnutrition or with the improvement of its treatment outcomes. Only two high-quality randomized controlled trials (RCTs) demonstrated that improved water quality during severe acute malnutrition treatment improved recovery outcomes but did not prevent relapse. Many of the interventions consisted of a package of WASH services, making impossible to attribute the effect to one specific component. This highlights the need for high-quality, rigorous intervention studies assessing the effects of WASH interventions specifically designed to prevent acute malnutrition or improve its treatment.

Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth

The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

Handwashing Practice and Its Predictors Among Mothers of Children Aged 0 to 23 Months in South Ethiopia: Community Based Cross-Sectional Study

BACKGROUND

Maternal handwashing practice is an important measure to prevent the spreading of childhood disease. Handwashing is still being practiced to a very low extent especially at critical times since the global prevalence of handwashing with soap was estimated at 19% by a systematic review after compiling 42 studies all over the world.

OBJECTIVE

To assess the handwashing practice and its predictors among mothers of children aged 0 to 23 months in Mareka District, south Ethiopia, 2020.

METHOD

A community-based cross-sectional study was conducted with a multistage sampling technique on 520 women having children aged 0 to 23 months in Mareka District. Data were collected by using interviewer-administered pre-tested structured questionnaires. Data were checked for completeness and entered into Epi data entry 4.6.2. The data were exported into SPSS version 22 for analysis with multivariate logistic regression analysis at P < .05.

RESULT

Mothers wash their hands with soap and water after visiting the latrine (27.1%), after cleaning the child's bottom (28.5%), before cooking (6.2%), before eating (6.9%), and before feeding the child (21.2%). The most important predictors were water availability near the handwashing location with an adjusted odds ratio (AOR) 5.26 (95% CI 1.99-13.69) and soap availability near the handwashing location with AOR 0.40 (95% CI 0.18-0.89) for good handwashing practice.

CONCLUSION

The handwashing practice at critical times was low. The presences of water and soap near the handwashing location were the most important predictors. It is necessary to increase the provision of both water and soap near the handwashing location for improving handwashing with soap and water at key times.

A Systematic Literature Review of Blockchain Technology for Smart Villages

According to the United Nations, Sustainable Development Goals are framed for improving rural health, hunger, poverty issues, environmental conditions, and illiteracy globally. With the upcoming technology, there have been many advances in the lifestyle of people all around the world. Comparatively, more emphasis has been given to the development of urban areas than rural. The sustainable development of a country depends on the growth of its rural areas. Countless technological and theoretical models, projects, and frameworks have been proposed and implemented to help overcome sundry issues and challenges faced by rural people in quotidian life. New technological methods are deemed to be the future of livability, therefore; a technologically advanced solution for sustainable rural development is called for. Blockchain Technology is the next step for innovation and development and it has far many applications in sustainable rural development that are yet to be discovered. The objective of this paper is to explicitly review research conducted in rural development to fill the undone work in the future with better research ideas, to make rural areas a livable and advanced place while also maintaining their integrity leading to sustainable development. To conduct such a review, a systematic research methodology is applied following regulations in the conduction of standardized but explorative analysis. Within the timeline of 2010-2021, 112 papers are carefully selected to perform the systematic review. This review will provide a comprehensible as well as concise research compendium for all applications proposed, implemented, and possible in the future to realize the concept of smart villages for the development of rural areas using blockchain technology.

Identification and Analysis of Stunting Risk Factors in Children under Three Years of Age in the Area of Kampar Watershed

Growth and development that is not optimal is a form of chronic malnutrition, one of which is marked by height for age which is below the standard deviation (<-2 SD) and is called stunting. Stunting has a negative impact on children's motor development, reduces children's performance in school, increases the risk of excess nutrition, infectious diseases, and even death as well as reduces productivity in adulthood. The purpose of this study was to identify risk factors for stunting in people living in the Kampar watershed. This research is a mixed-method with an explanatory sequential design which is a modification of (1–3). The research was carried out on people living in the Kampar river basin. The priority areas for specific stunting reduction interventions in this study are the Work Areas of the Kampar Kiri Hulu II Health Center, the Koto Kampar XIII Health Center, and the Kampar Kiri Health Center. This study found that the dominant factors of the five variables were home sanitation and parenting, as both affected the incidence of stunting. The findings obtained are different from the results of data analysis obtained from interviews, observations, and descriptive statistics. Based on the results of data analysis from interviews, observations, and descriptive statistics, it was found that all variables of the three factors became the main factors that had a close relationship with the incidence of stunting in the community in the Kampar watershed.

The anthropometric assessment of body composition and nutritional status in children aged 2-15 years: A cross-sectional study from three districts in Bangladesh

Background

Early life nutrition plays a critical role in the development of better health and nutrition in adulthood. However, assessing the nutritional status of Bangladeshi children and adolescents through measurement of body composition using skinfold thickness is barely studied. The current study aims to determine children’s body composition and nutritional status, and contributing factors among children aged 2 to 15 years in the northern part of Bangladesh.

Methods

This is a descriptive cross-sectional study done in Bangladesh. Anthropometric methods, including multiple skinfold thickness and basic anthropometric and socio-demographic characteristics, were used. Body composition was calculated from multiple skinfold thicknesses using the standard regression equation. Nutritional status was measured using Z score according to WHO 2007 reference standard. A total of 330 children from Naogaon, Bogra and Kurigram districts in Bangladesh were examined from April 2019 to September 2019.

Results

The Nutritional status of 2–15 years old child is exceedingly poor in the northern part of Bangladesh. Fat mass and fat-free mass were higher among children from Kurigram district than from Bogra and Naogaon district. Body fat percentages and arm fat area were greater among female children than males. The overall prevalence of stunting, underweight and wasting was around 25%, 32% and 29%, respectively, and the rate was higher among girls and children aged 2–5 years. The average SD score for weight-for-age, height-for-age, and BMI-for-age was -1.295, -0.937 and -1.009. The median weight-for-age and height-for-age Z scores of boys and girls were below the WHO reference percentile rank. Girls were twice (OR:1.951, CI:1.150–3.331) as likely to suffer from being underweight than boys. Children who don’t practice handwashing are three times (OR:3.531, CI:1.657–7.525) more likely to be underweight. Children become underweight and stunted when their family income is not sufficient to maintain their nutritional requirements.

Conclusions

The children of the three northern districts had a poor nutritional status, and family income was the potential contributing factor. Therefore, interventions like the promotion of income-generating activities and integrated approaches to ensuring food diversification could be an option to address the nutritional problem of children of the three northern districts of Bangladesh.

Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study

Background

Stunting was a significant public health problem for under-five in developing countries including Ethiopia. Globally, it was estimated 21.9% or 149 million (81.7 million in Asia and 58.8 million in Africa) under-five children stunted in 2018. In East Africa, 24 million are stunted which is the highest-burden from African regions. Hence, this study aimed to assess the prevalence of stunting and its association with Water Sanitation and Hygiene (WASH) in northwestern Ethiopia.

Method

A community-based cross-sectional study design was conducted among 630 participants from December to mid-January 2019. From five kebeles, two were selected by a simple random sampling technique for the study. To reach study participants a systematic sampling technique was used. Data were collected by using an observational checklist, pretested questionnaire, and anthropometric measurement. Anthropometric indicator, height-for-age was determined using the current World Health Organization (WHO) growth standards. Multivariable logistic regression analysis was computed to analyze the data. From the multivariable analysis the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) and P-value < 0.05 were used to declare statistical significance.

Result

The prevalence of stunting among under-five children was 35.6% (95%CI; 31.9–39.5%). The result from this study showed that having illiterate father and mother, give birth before marriage (single), large family size, short maternal height, unimproved drinking water source, unimproved sanitation, poor hygienic practice, having diarrhea in the previous 2 weeks before the data collection, method of child feeding, age at which complementary feeding started, frequency of feeding, not deworming and mothers who had antenatal care visit of fewer than three times were statistically associated with stunting.

Conclusion

In this study, stunting was an important public health problem among under-five children. It remains the same as the national average prevalence of Ethiopia. To alleviate this problem proper family planning utilization, good dietary intake, maternal and paternal education, and WASH interventions are critical.

Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India

BACKGROUND

Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India.

METHODS

This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors).

RESULTS

Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants' exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers' motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors.

CONCLUSIONS

Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant's enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels.

Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study

BACKGROUND

Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user.

OBJECTIVE

To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia.

METHODS

A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.

RESULTS

The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever.

CONCLUSION

The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.

Operationalising a One Health approach to reduce the infection and antimicrobial resistance (AMR) burden in under-5 year old urban slum dwellers: The Childhood Infections and Pollution (CHIP) Consortium

The WHO advocates the use of a One Health approach to address antimicrobial resistance (AMR), focusing on integrating human, animal and environmental health factors. Nevertheless, there is a dearth of AMR research investigating the complexity of down and upstream factors across the One Health spectrum, especially in resource-deprived settings. The Childhood Infections and Pollution Consortium (CHIP) was designed to reduce the burden of childhood infections and AMR in urban slums, particularly in low-and middle-income countries, using One Health and technology-enabled Citizen Science approaches. Currently operationalized in three countries; India, Indonesia and Chile; CHIP is composed of interdisciplinary academics, healthcare professionals, veterinarians, international and local non-governmental organisations, current and former policymakers, local artists and community champions, amongst others. The CHIP Consortium invites collaborations for evidence-driven research, targeted investment and co-development of interventions in slums. We will host our third annual consortium workshop in Hong Kong in 2021 to build on our current work and explore new avenues to tackle childhood infections and AMR.