Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores in Nepal.

Abstract

Background: Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition. Methods: Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to understand the association between height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores and WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined. Results: The mean z-score [standard deviation] for children’s WAZ, HAZ and WHZ scores were -1.33 [1.1], -1.52 [1.3] and -0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12 to 0.48) for WAZ and 0.28 (95%CI: 0.001 to 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07 to 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04 to 0.25) in WAZ and 0.13 (95%CI: 0.01 to 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction=0.002). Conclusions: Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.

Child-sensitive water, sanitation, and hygiene composite score and its association with child nutritional outcomes in St. Martin’s Island, Bangladesh

“…10 Several observational studies clinched that household sanitation coverage, handwashing behavior, and drinking water availability were all significantly associated with HAZ or stunting. 8,11,12 Similarly, improved WASH practices were positively associated with HAZ and WAZ in this study. Evidence from three RCTs suggested a reduction in child stunting after sanitation intervention [37][38][39] and Dangour et al 40 stated a positive effect of water quality and handwashing intervention on child linear growth.…”

“…Unimproved (ref) findings, as was the case in two other studies in Ethiopia and Nepal, 8,12 WHZ was not significantly associated with overall WASH conditions in this study, although that did not hold for a study in Bangladesh. 41 In addition to WASH, the literature suggests that household food insecurity is associated with child nutritional outcomes such as stunting and underweight.…”

“…In the same way, a child's WAZ was found to be increased with sanitation coverage and handwashing practice with soap and water in an observational study in Nepal. 12 According to our…”

“…7 There are a lot of studies on the adverse consequences of poor WASH practices on child nutrition, such as safe drinking water, improved sanitation, and hand hygiene practices. [8][9][10][11][12] Poor water, sanitation, and hygiene (WASH) practices are linked to child survival, growth, and nutritional outcomes in a variety of direct and indirect ways, such as via diarrheal diseases, intestinal parasite infections, and Environmental Enteric Dysfunction (EED). 13 Unsafe water, inadequate sanitation, or insufficient hygiene mediate transmission of fecal pathogens 14,15 that cause diarrhea, and frequent episodes of diarrhea, in turn, induce child growth deficits.…”

Malnutrition among under-five children in St. Martin’s Island, Bangladesh: A cross-sectional study on prevalence and associated factors

“…Literature also supports this association where several studies reported poor sanitation facilities as one of the underlying causes of child malnutrition. [47][48][49] Furthermore, the highest number of siblings or birth order led to an increased risk of being underweight, in agreement with Rahman, 2016. 50…”