Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys

Abstract

Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty‐seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% of countries, children with off‐premises water access had significantly increased odds of anemia. In over a quarter of countries, children exposed to surface water had higher odds of anemia. In Burundi, children were 1.65 times more likely to be anemic when reported to be living in households using surface water. However, in India, a protective effect was noted (adjusted OR: 0.70, P < 0.001) for surface water. In 60% and 65% of countries, women and children exposed to an open sanitation facility had higher odds of being anemic, respectively. There is evidence of an association between selected water and sanitation indicators and anemia. Promoting policies, practices and research that strengthen access to improved WASH should be considered for reducing anemia prevalence alongside standard nutrition interventions.

Association between anemia and household water source or sanitation in preschool children: the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

“…The 3 countries they selected were India, Burundi, and Senegal, where they adjusted for age, sex, residence, education, wealth, iron supplementation, and deworming. In alignment with our findings, they found all 3 countries showed an association between unimproved and shared sanitation facilities and higher odds of anemia, although 1 of the associations was nonsignificant ( 31 ). Additionally, they also found a mix of associations between water source and anemia ( 31 ).…”

“…The authors found PSC exposed to unimproved sanitation facilities had higher odds of anemia compared to those who had improved sanitation facilities in 18 of 45 countries, adjusting for sex and age ( 31 ). Notably, the authors only conducted multivariable logistic regressions in 3 countries that showed strong unadjusted ORs and represented different parts of the world ( 31 ). The 3 countries they selected were India, Burundi, and Senegal, where they adjusted for age, sex, residence, education, wealth, iron supplementation, and deworming.…”

“…A recent analysis of DHS data utilized cross-sectional health survey data and meta-analysis techniques similar to those used here to explore the associations between water, sanitation, and anemia ( 31 ). The authors found PSC exposed to unimproved sanitation facilities had higher odds of anemia compared to those who had improved sanitation facilities in 18 of 45 countries, adjusting for sex and age ( 31 ). Notably, the authors only conducted multivariable logistic regressions in 3 countries that showed strong unadjusted ORs and represented different parts of the world ( 31 ).…”

Socio-Cultural Risk Factors of Anemia among Children under Five Years of Age in District Muzaffarabad, Azad Jammu & Kashmir, Pakistan

“…Regarding house and environmental factors, the current study reported that children living in mud house and open sewerage system areas are likely to be anemic. These results are supported by studies [32][33] that household type and living environment are the major contributing factors of anemia. Considering the association of the maternal knowledge of balanced diet, anemia causes and preventive measures, prevalence of anemia was found to be high among children, whose mothers had poor knowledge about these parameters.…”

Time to Detection of Anemia and Its Predictors Among Children Receiving Antiretroviral Therapy at Debre Tabor Referral Hospital and University of Gonder Compressive Specialized Hospital, 2020: A Multicenter Retrospective Follow-Up Study

“…Anemia is a leading cause of hospital admission, reduced cognitive development, growth, and poor immune function in children 7 , since the etiology and pathogenesis of anemia are complex 14 , caused by a multifactorial of factors. such as cancer; micronutrient de ciencies; infections, such as malaria and tuberculosis(TB) 15 . In HIV-infected children, the virus can infect parts of the bone marrow responsible for manufacturing red blood cells and erythropoietin, which is required to stimulate red blood cell production 16 .…”