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Beyond malnutrition: the role of sanitation in stunted growth.

Schmidt CW - Environ. Health Perspect. (2014)

View Article: PubMed Central - PubMed

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At best, she says, they improve growth by about a third of the typical height deficit in stunted Asian and African children. “This tells us that dietary improvements are important but not sufficient,” she says. “If we really want to eliminate stunting, we need to do more. ” Meanwhile, mounting evidence has shown that poor hygiene and sanitation also constrain linear growth in children... One study found that Bangladeshi children who had access to clean drinking water, improved toilets, and facilities for handwashing with soap, for instance, had a roughly 50% improvement in HAZ scores compared with control children who didn’t... But in other studies, the evidence was less compelling... Researchers in Karachi, Pakistan, for example, found that handwashing by children and their parents was highly protective against diarrhea but had no effect on stunting... EE isn’t easy to diagnose; biopsies are definitive but impractical for research, says Stephen Luby, a professor at Stanford University’s Freeman Spogli Institute for International Studies... High lactulose levels in urine therefore predict EE, “but the test is hard to standardize and interpret,” Luby says. “Stunting is easy to measure; EE, not so much. ” Despite its limitations, the L:M ratio has provided much of the evidence in support of a role for EE in stunting... The most highly cited of these studies was published in 1991 by researchers who concluded that abnormal L:M ratios could explain nearly half the impaired growth observed in a group of Gambian children... Humphrey says the Gambian study was critical because it was the first to show that interventions to reduce clinical diarrhea could be highly successful without changing the incidence of stunting at all... She says this reaction drains off energy and nutrients that children would otherwise need to grow to their full potential. “The immune response in EE is lifesaving, but it’s also metabolically expensive,” she says... Humphrey now believes that diarrhea is a minor contributor to stunting when compared with EE, which she calls a “chronic immune-activating disorder that chips away at growth and affects kids on a population level. ” Luby points out that in extreme cases, chronic diarrhea and EE might go hand in hand, making it difficult to tease out their individual effects... Specific causative bacterial agents in EE remain unknown, Luby says, but preliminary investigations in Bangladesh found that children with access to better hygiene had fewer intestinal pathogens, lower L:M ratios, less immune stimulation, and better linear growth... Sue Coates, chief of the WASH Section with the United Nations Children’s Fund India, adds that when it comes to stopping open defecation in India, toilet construction isn’t the main problem. “The real problem is promoting a social demand for initial and sustained toilet use,” she says.

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Trends in child stunting by UN region (1990–2025)Source: de Onis et al. (2013)7
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d35e189: Trends in child stunting by UN region (1990–2025)Source: de Onis et al. (2013)7


Beyond malnutrition: the role of sanitation in stunted growth.

Schmidt CW - Environ. Health Perspect. (2014)

Trends in child stunting by UN region (1990–2025)Source: de Onis et al. (2013)7
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216152&req=5

d35e189: Trends in child stunting by UN region (1990–2025)Source: de Onis et al. (2013)7

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

At best, she says, they improve growth by about a third of the typical height deficit in stunted Asian and African children. “This tells us that dietary improvements are important but not sufficient,” she says. “If we really want to eliminate stunting, we need to do more. ” Meanwhile, mounting evidence has shown that poor hygiene and sanitation also constrain linear growth in children... One study found that Bangladeshi children who had access to clean drinking water, improved toilets, and facilities for handwashing with soap, for instance, had a roughly 50% improvement in HAZ scores compared with control children who didn’t... But in other studies, the evidence was less compelling... Researchers in Karachi, Pakistan, for example, found that handwashing by children and their parents was highly protective against diarrhea but had no effect on stunting... EE isn’t easy to diagnose; biopsies are definitive but impractical for research, says Stephen Luby, a professor at Stanford University’s Freeman Spogli Institute for International Studies... High lactulose levels in urine therefore predict EE, “but the test is hard to standardize and interpret,” Luby says. “Stunting is easy to measure; EE, not so much. ” Despite its limitations, the L:M ratio has provided much of the evidence in support of a role for EE in stunting... The most highly cited of these studies was published in 1991 by researchers who concluded that abnormal L:M ratios could explain nearly half the impaired growth observed in a group of Gambian children... Humphrey says the Gambian study was critical because it was the first to show that interventions to reduce clinical diarrhea could be highly successful without changing the incidence of stunting at all... She says this reaction drains off energy and nutrients that children would otherwise need to grow to their full potential. “The immune response in EE is lifesaving, but it’s also metabolically expensive,” she says... Humphrey now believes that diarrhea is a minor contributor to stunting when compared with EE, which she calls a “chronic immune-activating disorder that chips away at growth and affects kids on a population level. ” Luby points out that in extreme cases, chronic diarrhea and EE might go hand in hand, making it difficult to tease out their individual effects... Specific causative bacterial agents in EE remain unknown, Luby says, but preliminary investigations in Bangladesh found that children with access to better hygiene had fewer intestinal pathogens, lower L:M ratios, less immune stimulation, and better linear growth... Sue Coates, chief of the WASH Section with the United Nations Children’s Fund India, adds that when it comes to stopping open defecation in India, toilet construction isn’t the main problem. “The real problem is promoting a social demand for initial and sustained toilet use,” she says.

Show MeSH