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Beyond malnutrition: the role of sanitation in stunted growth.

Schmidt CW - Environ. Health Perspect. (2014)

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That’s both a health and an economic problem for affected countries, given how stunting impacts human capital and productivity... And although its prevalence is in steady decline—from 40% of children under age 5 in low-and middle-income countries in 1990 to 26% in 2011, mainly as a result of rising incomes and improved living standards—stunting remains pervasive... Then known as tropical enteropathy, the disorder was seen initially on biopsy—intestinal linings tended to thin out and fill with inflammatory secretions... Experts describe people with EE as having “leaky guts,” and the disorder was eventually found to be pervasive in the developing world... 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 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... But he adds that a number of different organisms can infect the intestinal tract and cause gut dysfunction without inducing diarrhea... 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... The study is comparing growth outcomes in relation to measures of gut function among villagers at two locations... One of the villages has access to latrines, treated drinking water, and programs to limit exposure to fecal microbes, while the other does not... 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.

That’s both a health and an economic problem for affected countries, given how stunting impacts human capital and productivity... And although its prevalence is in steady decline—from 40% of children under age 5 in low-and middle-income countries in 1990 to 26% in 2011, mainly as a result of rising incomes and improved living standards—stunting remains pervasive... Then known as tropical enteropathy, the disorder was seen initially on biopsy—intestinal linings tended to thin out and fill with inflammatory secretions... Experts describe people with EE as having “leaky guts,” and the disorder was eventually found to be pervasive in the developing world... 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 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... But he adds that a number of different organisms can infect the intestinal tract and cause gut dysfunction without inducing diarrhea... 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... The study is comparing growth outcomes in relation to measures of gut function among villagers at two locations... One of the villages has access to latrines, treated drinking water, and programs to limit exposure to fecal microbes, while the other does not... 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
Related in: MedlinePlus