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Abstract

There is scarce research and programmatic evidence on the effect of poor water, sanitation, and hygiene (WASH) conditions of the physical environment on early child cognitive, sensorimotor, and socioemotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first 3 years of life, when gut health and linear growth are established. We review evidence linking WASH, anemia, and child growth, and highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. We propose the concept of baby WASH as an additional component of early childhood development programs.

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... Both academic researchers and practitioners have observed how water-sanitation-hygiene (WASH) and nutritional insecurities co-occur, overlap, and mutually reinforce each other (e.g. Fanzo, 2014;Ngure et al., 2014). Nutrition-sensitive WASH, for example, outlines the interrelated pathways through which inadequate sanitation, animal separation, and water resources contribute to inadequate and unsafe food and caregiving behaviours resulting in underweight and stunting in children (Chase & Ngure, 2016). ...
... Moreover, as children develop, play and exploration is critical yet may introduce pathogens. WASH security, then, requires an understanding of the role of caregivers, including mothers and others who are responsible for child-minding, feeding, and child toileting practices (Arriola et al., 2020;Menon & Frongillo, 2018;Ngure et al., 2014) within the home and communally. Scholars have speculated that the WASH Benefits and SHINE trials may have missed community-level effects as they assessed only household-level interventions Null et al., 2018). ...
... Animals (Prendergast et al., 2019), air (Clasen & Smith, 2019), and/or chemical contamination and exposure (Kearns, 2020;Kearns et al., 2019) are under-examined and important precursors to WASH-related health outcomes. Researchers must consider sequalae of food insecurity beyond malnutrition including, for example, micronutrient deficiencies or anaemia (Ngure et al., 2014). While not within the scope of this paper, solid waste also poses risks and WASH should address the management of solid waste in addition to faecal sludge management. ...
Article
Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security—one that addresses myriad transmission pathways and co-occurring diseases—that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.
... However, the dynamics of relationships between pathogens and commensals, both prokaryotes and eukaryotes, are often underestimated [17,18] or focused on single microorganisms [19][20][21]. Poor water, sanitation, and hygiene conditions in low and middle-income countries sustain the susceptibility to multiple and asymptomatic infections [22]. ...
... The high number of asymptomatic individuals suggests an adaptation to constant and cumulative exposure to enteropathogens due to the common risk factors associated with low-income countries [22,23,[56][57][58]. ...
Article
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Background: The human gut microbiota is a microbial ecosystem contributing to the maintenance of host health with functions related to immune and metabolic aspects. Relations between microbiota and enteric pathogens in sub-Saharan Africa are scarcely investigated. The present study explored gut microbiota composition associated to the presence of common enteric pathogens and commensal microorganisms, e.g., Blastocystis and Entamoeba species, in children and adults from semi-urban and non-urban localities in Côte d'Ivoire. Methods: Seventy-six stool samples were analyzed for microbiota composition by 16S rRDNA sequencing. The presence of adeno-, entero-, parechoviruses, bacterial and protozoal pathogens, Blastocystis, and commensal Entamoeba species, was analyzed by different molecular assays. Results: Twelve individuals resulted negative for any tested microorganisms, 64 subjects were positive for one or more microorganisms. Adenovirus, enterovirus, enterotoxigenic Escherichia coli (ETEC), and Blastocystis were frequently detected. Conclusions: The bacterial composition driven by Prevotellaceae and Ruminococcaceae confirmed the biotype related to the traditional dietary and cooking practices in low-income countries. Clear separation in UniFrac distance in subjects co-harboring Entamoeba hartmanni and Blastocystis was evidenced. Alpha diversity variation in negative control group versus only Blastocystis positive suggested its possible regulatory contribution on intestinal microbiota. Pathogenic bacteria and virus did not affect the positive outcome of co-harbored Blastocystis.
... Some studies on child malnutrition found that water, sanitation, and hygiene (WASH) is a prominent determinant in South Asia [10][11][12], including Pakistan [13,14]. Children and infants are more prone to malnourishment and stunting because of frequent exposure to diarrhea and other gastrointestinal infections, which are associated with open defecation and bad WASH conditions [15,16]. ...
... In India, poor access to water and sanitation is associated with lower birth weight in infants and preterm birth [47]. Evidence shows that WASH might impact child development, principally via stunting [12]. ...
Article
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Objectives: This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan. Methods: Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017–2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition. Results: The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers’ education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children. Conclusion: Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan
... While household poultry ownership and some forms of ICDS participation in the study were robustly associated with beneficial feeding habits, their odds of improving children's nutrition outcomes were largely insignificant. In the case of household poultry ownership, the absence of a more robust connection with good nutrition outcomes despite the children's better feeding habits could be partially explained through the frequently greater occurrence of enteric diseases in poultry-keeping households due to the higher likelihood of children ingesting poultry faeces (Kaur et al., 2017;Ngure et al., 2014). Children in such households may thus be more likely to receive more nutritious diets but be unable to fully utilise all the nutrients due to greater morbidity from diarrhoea, environmental enteropathy, and other diseases. ...
... Such research could also look further into how livestock ownership in different areas relates to prevalent norms about appropriate child feeding. 22 Government policy could aim to raise awareness in this regard as well, for example about the benefits of keeping livestock separate from the families' living areas (Ngure et al., 2014). the length of time of ICDS participation and the quantities of different food types consumed is impossible. ...
Article
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Relative to its economic growth and poverty levels, Indian children suffer from higher levels of malnutrition than children in many other low- and middle-income countries. Research presented in this article examined the links between infant and young child feeding practices among Indian children and their rates of stunting, underweight, wasting, and anaemia, with a particular focus on the types of semisolid complementary food consumed. It did so through a comprehensive analysis of data on more than 57,000 6-to-23-month-old children obtained from the nationally representative National Family Health Survey IV (2015-2016). One of the key findings was that especially feeding children animal-sourced and vitamin-A-rich food was associated with lower malnutrition rates. The study further interrogated whether livestock ownership and participation in the Integrated Child Development Services programme could be supportive of better complementary child feeding and concluded that daily food receipts from the programme and poultry ownership were indeed linked with significantly higher rates of children following the recommended feeding practices as well as with somewhat lower children's malnutrition rates. Supplementary information: The online version contains supplementary material available at 10.1007/s12571-021-01202-7.
... While household poultry ownership and some forms of ICDS participation in the study were robustly associated with beneficial feeding habits, their odds of improving children's nutrition outcomes were largely insignificant. In the case of household poultry ownership, the absence of a more robust connection with good nutrition outcomes despite the children's better feeding habits could be partially explained through the frequently greater occurrence of enteric diseases in poultry-keeping households due to the higher likelihood of children ingesting poultry faeces (Kaur et al., 2017;Ngure et al., 2014). Children in such households may thus be more likely to receive more nutritious diets but be unable to fully utilise all the nutrients due to greater morbidity from diarrhoea, environmental enteropathy, and other diseases. ...
... Such research could also look further into how livestock ownership in different areas relates to prevalent norms about appropriate child feeding. 22 Government policy could aim to raise awareness in this regard as well, for example about the benefits of keeping livestock separate from the families' living areas (Ngure et al., 2014). the length of time of ICDS participation and the quantities of different food types consumed is impossible. ...
Article
Full-text available
Relative to its economic growth and poverty levels, Indian children suffer from higher levels of malnutrition than children in many other low-and middle-income countries. Research presented in this article examined the links between infant and young child feeding practices among Indian children and their rates of stunting, underweight, wasting, and anaemia, with a particular focus on the types of semisolid complementary food consumed. It did so through a comprehensive analysis of data on more than 57,000 6-to-23-month-old children obtained from the nationally representative National Family Health Survey IV (2015-2016). One of the key findings was that especially feeding children animal-sourced and vitamin-A-rich food was associated with lower malnutrition rates. The study further interrogated whether livestock ownership and participation in the Integrated Child Development Services programme could be supportive of better complementary child feeding and concluded that daily food receipts from the programme and poultry ownership were indeed linked with significantly higher rates of children following the recommended feeding practices as well as with somewhat lower children's malnutrition rates.
... Gizaw and Worku (2019) point out that the current evidence of the effects of WASH on children nutritional status seems to be conflicting. Nevertheless, the results of the present review linking water treatment with prevention of SAM and improved recovery rates during SAM treatment seem to be consistent with the results of other systematic reviews (Dangour et al., 2013;Gera et al., 2018;Ngure et al., 2014), which observed slight but consistent associations of improved water supply and quality with better growth outcomes. ...
... Worku, 2019). Available evidence suggest that combined WASH interventions have a greater effect on growth outcomes when compared with single interventions(Bekele et al., 2020;Gera et al., 2018;Gizaw & Worku, 2019;Ngure et al., 2014); it also has shown that effects of WASH are greater among children under 2(Gizaw & Worku, 2019).Despite the need of more intervention studies evaluating the individual and combined effects of each WASH component, these findings highlight the need for early and comprehensive targeted WASH interventions in order to improve child growth outcomes.Overall, it is unclear whether the lack of evidence to support the theoretical causal pathways between WASH exposure and nutrition outcomes translates to an incorrect hypothesized causal chain between poor WASH and child acute malnutrition due to confounding factors and the multicausality of acute malnutrition. What is certain is that there is a lack of high-quality intervention studies from which we can more confidently draw conclusions regarding the effects of individual or combined WASH interventions on childhood acute malnutrition and better clarify which WASH interventions are most effective in improving acute malnutrition outcomes. ...
Article
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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.
... It means that individuals with adequate environmental cleanliness behavior are also affected by appropriate knowledge of disaster. This finding is also supported by the research, which stated that environmental knowledge affects behavior through different pathways and tends to possess implications or interventions that seek to enhance environmentally friendly behavior [57]. Another research stated a significant relationship between sanitation knowledge and a person's educational level. ...
... Individuals that possess environmental knowledge tend to have a better awareness of environmental management. Meanwhile, knowledge (objective and subjective) affects proenvironmental behavior [57][58][59]. ...
... Another important contribution of our study is that we were able been proposed as one approach to address environmental risks (Ngure et al., 2014), no evidence to date exists on the feasibility, acceptability and effectiveness of integrating RS and baby WASH inputs. Evidence on successful integration of EN and household-level WASH inputs is emerging, but effects on child growth and development are mixed (Pickering et al., 2019;Stewart et al., 2018;Tofail et al., 2018). ...
... These residual negative intervention effects could be due to environmental risks not accounted for in our model.For example, if the RS intervention increased free exploration and play activities on the ground, this may have increased children's exposure to pathogens and environmental risks. Increased or persistent immune stimulation may contribute to poor child growth and socioemotional development(Ngure et al., 2014). Alternatively, the RS and EN inputs may have been insufficient to address existing environmental risks for poor child growth and development in this vulnerable context. ...
Article
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This study examined whether child diet and mother–child interactions mediated the effects of a responsive stimulation and nutrition intervention delivered from 2009 to 2012 to 1324 children aged 0–24 months living in rural Pakistan. Results showed that the intervention improved children's cognitive, language and motor development through child diet and mother–child interactions. Although the intervention did not improve child growth or socio-emotional development, we observed positive indirect effects on child growth via child diet and on socio-emotional development via both child diet and mother–child interactions. In addition, child diet emerged as a shared mechanism to improve both child growth and development, whereas mother–child interactions emerged as a distinct mechanism to improve child development. Nevertheless, our results suggest the two mechanisms were mutually reinforcing and that interventions leveraging both mechanisms are likely to be more effective at improving child outcomes than interventions leveraging only one of these mechanisms. Key messages • A responsive stimulation and nutrition intervention delivered to young children from birth to 24 months of age in rural Pakistan improved child cognitive, language, and motor development at 24 months, but not child growth or socio-emotional development. • Child diet and mother–child interactions mediated intervention effects on child cognitive, language and motor development. • Although we found no total intervention effects on child growth and socio-emotional development, we observed positive indirect effects on socio-emotional development through both child diet and mother–child interactions, and positive indirect effects on child growth through child diet. • Leveraging both child diet and mother–child interactions as mechanisms may help enhance intervention effects on child outcomes.
... There is increasing interest in the hypothesis that WASH interventions may improve, not only growth but also neurodevelopmental outcomes. The potential impact of WASH on neurocognitive development is suggested to operate through multiple interlinked pathways, including effects on malnutrition, enteropathy, and infection (Ngure et al., 2014;Piper et al., 2017). Poor cognitive, sensorimotor, and socioemotional development are hypothesised to be mediated, in part, through anaemia of chronic disease and stunting, resulting from poor gut health and chronic immune stimulation, in addition to other well-established causes of developmental deficits (Ngure et al., 2014). ...
... The potential impact of WASH on neurocognitive development is suggested to operate through multiple interlinked pathways, including effects on malnutrition, enteropathy, and infection (Ngure et al., 2014;Piper et al., 2017). Poor cognitive, sensorimotor, and socioemotional development are hypothesised to be mediated, in part, through anaemia of chronic disease and stunting, resulting from poor gut health and chronic immune stimulation, in addition to other well-established causes of developmental deficits (Ngure et al., 2014). Systemic inflammation may directly impair neurodevelopment, and indirectly drive anaemia which directly compromises brain development through its role in myelination, neurotransmission, and protein expression Gladstone et al., 2019;Prendergast et al., 2014). ...
Article
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Life history theory emphasises plasticity in developmental and biological programming where conditions in early life, lead to long-term consequences for health and wellbeing. Studies linking water, sanitation, and hygiene, nutrition, and child growth and development have emphasised the optimisation of linear growth as a key metric for the evaluation of intervention efficacy. Life history characteristics pertaining to human growth and phenotypic plasticity, suggest that different developmental outcomes in early childhood may be responsive to different stimuli at different ages. Energy utilisation by the human brain, from birth through childhood, accounts for a disproportionate percentage of the resting metabolic rate. Undernutrition in early life, and its relative resultant energy deficiency, may trigger adaptive physiological mechanisms prioritising brain growth at the expense of body growth. Emphasis placed on linear growth may have impeded the significance of WASH due to excluding aspects of child development beyond height/weight. We propose that incorporating evolutionary public health and life history theory perspectives, allows for the identification of age-appropriate biological outcomes and WASH indicators, while anticipating the timing and life-course suitability of the interventions being operationalised. Finally, integrating reflections regarding context allows for the development of transformative WASH interventions.
... Some studies on child malnutrition found that water, sanitation, and hygiene (WASH) is a prominent determinant in South Asia [10][11][12], including Pakistan [13,14]. Children and infants are more prone to malnourishment and stunting because of frequent exposure to diarrhea and other gastrointestinal infections, which are associated with open defecation and bad WASH conditions [15,16]. ...
... In India, poor access to water and sanitation is associated with lower birth weight in infants and preterm birth [47]. Evidence shows that WASH might impact child development, principally via stunting [12]. ...
Article
Full-text available
Objectives: This research investigates the association of malnutrition with social and economic factors in general and environmental factors in specific such as sanitation facilities and drinking water sources for Pakistan. Methods: Authors used the latest data of 1010 Under-Three children from Pakistan Demographic and Health Survey (PDHS) 2017-2018. Cumulative Index of Anthropometric Failure (CIAF) was developed to measure the malnutrition status among children based on z-scores of WHZ, WAZ, and HAZ, respectively. The study has applied the discrete-choice logistic methodology to find the relationship of malnutrition with socio-economic characteristics. The interaction terms of drinking water source and sanitation facility have been measured to see the impact of environmental factors on child malnutrition. Results: The study results depict that the likelihood of malnutrition increases when the child had diarrhea recently and the child belongs to the deprived region such as KPK, Sind, and Baluchistan. However, the chances of child malnutrition drop with (1) an escalation of mothers' education, (2) a rise in wealth status of the household, and (3) the improved water source and sanitation facility in the household. The only water-improved sanitation category of the interaction term is significant in the model which depicts that households having both improved water and improved sanitation facilities had very fewer chances of malnutrition among their children. Conclusion: Authors conclude that malnutrition in younger children is associated with improved water as well as sanitation facilities, maternal education, and household wealth in Pakistan.
... It is essential to draw worldwide attention to improve and enhance access to safe drinking water, sanitation and hygiene conditions among vulnerable communities like Sylhet to reduce diarrheal morbidity and mortality. The habit of washing hands with soap can ensure significant improvement in a child's nutrition and health (Pickering et al., 2015) Access to water, sanitation and hygiene (WASH) is a prerequisite for human well-being, health and even economic development (Ngure et al., 2014). Therefore, only a few studies have scouted evidence of interaction among various washing ingredients on children's nutrition outcomes. ...
... Children who lived in houses with less dirty sewage had a lower risk of diarrhea. Similarly, environmental enteropathy which is mainly a result of regular ingestion of fecal bacteria due to poor sanitation and hygiene conditions has been reported in under-five children (Humphrey, 2009, Ngure et al., 2014. Proper hand washing with soap (HWWS) which focuses on hygiene promotion is more effective in reduction of diarrhoeal episodes among children and reduces the risk of disease transmission to 47% (Curtis V, 2003). ...
Preprint
This study aimed to assess knowledge and practice of caregivers and its relationship to the disease and nutritional status of children under five years of age in rural areas of Sylhet, Bangladesh. A total of 110 households having 6 to 59 months aged children was selected by simple random method from ten rural communities of three Upazila of Sylhet during September 2019 to February 2020. Descriptive statistics were used to assess the WASH knowledge & practice and multivariate chi-square analyses were performed to assess associations among diseases & nutritional status with WASH following a structured questionnaire. The study found a significant association of WASH with childhood disease and nutritional status, and 65% of children were found to be in a diseased state and 35% of children were found to be in a disease-free state within the last six months. The findings sketched that mother with poor wash knowledge and practice was at greater risk for disease outbreaks, disease frequency and duration. The highest incidence of diarrhea was 17% in children aged 12 to 23 months. Significant effect of WASH was also found in children nutrition status, that was reflected in the ratio of stunted, underweight and wasted children. Integrated convergent work focusing on the provision of clean water within the household, stop open defecation, promotion of hand washing, behavior change and poverty alleviation is needed to improve the situation. Health, nutrition and livelihood programs should be uninterrupted, and mothers or caregivers should be encouraged to participate in these programs.
... Additionally, chronic undernutrition can have several long term consequences including increased cost of medical care, unsatisfactory educational/schooling performance and heavy school dropout, marginal economic productivity and poverty, and each of which can inhibit national development (Victora et al., 2008). Undernutrition among children is undoubtedly caused by insufficient calorie and nutrition intake or reduced nutrition absorption capacity due to frequent and persistent illness, which are themselves caused by intra-household high food competition, contaminated living environment, poor medical and immunization practices, and poor maternal and household socio-economic conditions (Black et al., 2008;Caulfield et al., 2004;McDonald et al., 2015;Ngure et al., 2014;Petrou & Kupek, 2010). ...
... The association between household wealth status and undernutrition was more pronounced and consistent across all three forms of undernutrition measures. Findings from the earlier studies suggest that, children from the richer households are more likely to receive appropriate quality and quantity of complementary foods (Patel et al., 2012), better and preventive health care for infectious diseases (Victora et al., 2003), hygienic environment (Ngure et al., 2014;Pongou et al., 2006) among others and these factors altogether may lead to the pathways to better nutrition outcomes in young children. In contrast, poorer households often suffer from serious household food insecurity, inadequate health care which could have substantial negative impacts on nutritional outcomes of the children (Boyle et al., 2006). ...
Article
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This study comprehensively analyses and maps the spatial variability and spatial spread (inequality) in nutritional outcomes among young children residing in the 277 high-focus districts in the EAG region. We used data from the fourth update of National Family Health Survey (NFHS-4), from 2015 to 2016, and adopted a Bayesian distributional structured additive regression (STAR) approach to quantify the variations in the mean level and dispersion in the undernutrition indicators across space and based on other demographic and socioeconomic indicators available to the child, mother, and household. Markov random field and Bayesian P-splines were used as prior distributions for the spatial and nonlinear effects, respectively. Substantial intra-district heterogeneity in childhood nutritional deficiency found in EAG region; the districts where dispersions are huge, are predominantly located in three states: Uttar Pradesh, Madhya Pradesh, and Bihar. Our findings provide evidence of strong spatial structure that suggests neighbouring districts from different states have similar pattern of distribution in terms of undernourished children. The effects of child's age, mother’s age and her BMI were found to be non-linear. Furthermore, we find significant linear effects of several categorical covariates, such as, gender, birth order, birth size, maternal schooling, household wealth and sanitary condition, on indicators of undernutrition in young children. Findings strongly recommend that nutrition improvement programmes in the EAG states need to account for internal spatial heterogeneity evident across the districts of this region. Efforts are needed in assessing the district-specific causes of nutritional deficiency among the young children.
... Although some cohort studies have reported that diarrhea episodes contribute to stunting, others have attributed the significant catch-up growth occurring after these episodes restrict long-run impacts on linear growth [28]. Repeated and persistent infection may contribute to environmental enteric dysfunction, a subclinical condition leading to growth restrictions [29]. Research lately has speculated that animal feces may contribute to ecological enteric dysfunction and stunting [30] and exposure is unlikely to be influenced by conventional WASH hardware. ...
Article
Background: Water, sanitation and hygiene (WASH) practices determine child nutrition in resource-constrained countries and are influenced by regional water availability. We assessed any relationship between malnutrition and WASH practices among under-5 children in India’s areas as per water availability. Methods: We did a secondary data analysis of the National Family Health Survey-IV. Stunting, wasting, and being underweight were the significant outcomes. Regional water availability, households’ source of water, sanitation, and disposal of the child's stool were the major independent variables. We report the prevalence estimates, bivariate associations, and adjusted odds ratio to predict the child’s malnutrition per regional water availability after using appropriate sampling weight. Results: Of the 186 875 children, 41%, 20% and 36% were stunted, wasted and underweight. Only 26% of children had access to improved drinking water sources, whereas 50.0% were defecating in open. Around 65% of children’s stools were disposed of in unhygienic ways. Undernutrition depicted a significant association with independent variables. There were higher chances of stunting with a decrease in regional water availability, unimproved sanitation and unhygienic ways of stool disposal. Wasting was intensified by all these factors, except the safe disposal of stools. Conclusions: WASH indicators exert a protective effect on undernutrition.
... Toutefois, le risque existe que les aliments d'appoint ne soient pas donnés à l'âge approprié ou selon la fréquence requise ou qu'ils ne soient pas de bonne qualité [18]. Selon Ngure et al, la reconnaissance du rôle fondamental que jouent les mauvaises pratiques dans le secteur de l'eau, l'assainissement et l'hygiène dans l'installation et la perpétuation de la malnutrition est allée croissante ces dix dernières années [11,19]. Concernant la mortalité des enfants, nos résultats ont révélé que, si les cibles des plans étaient atteintes, 214 192 vies d'enfants de moins de 5 ans seraient sauvées pour la période 2014-2023. ...
Article
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Au Mali, le niveau de la sous nutrition des enfants de moins de 5 ans restent préoccupants. L'objectif de cette étude était d'évaluer l'impact de l'atteinte des cibles de couverture des indicateurs de plans SMNI&N en vigueur au Mali sur la sous nutrition et la mortalité des enfants de moins de 5 ans. Matériel et méthodes : Nous avons modélisé l'impact de deux paquets d'intervention dans LiST entre 2014 et 2023. Une projection incluait les interventions et les cibles des plans en vigueur en 2014. Une autre projection portait à une couverture de 100% les interventions nutritionnelles et de WASH. Résultats : Nos résultats montrent que, si le Mali atteint les cibles des plans, plus de 115 800 cas de malnutrition chronique seraient évités en 2018 et jusqu'à plus de 711 000 cas en 2023. Les pratiques appropriées d'alimentation de complément éviteraient plus de 364000 cas. La malnutrition chronique serait réduite de 38% à 33,9% contre 31,9% pour le scenario. La malnutrition aigüe serait réduite de 12,9% à 9,9% contre 8,8% pour le scénario. Le nombre de vies sauvées chez les enfants serait de plus de 71 500 en 2018 et plus de 214 000 en 2023. La réduction la plus importante s'observerait pour la mortalité infanto-juvénile qui passerait à 126,6 à 80‰ naissances vivantes en 2023. Conclusion : L'étude a révélé que, même avec la mise à échelle des interventions à une couverture de 100% du secteur de la Santé et du WASH, les objectifs de sous- nutrition des plans ne seront pas atteints. D'où la nécessité de mener des actions multisectorielles coordonnées.
... Inadequate sanitation and poor fecal sludge management contribute to the spread of fecal contamination and associated pathogens in the environment , and exposure to fecal contamination poses the risk of developing gastroenteritis, environmental enteric dysfunction, and stunting (Ngure et al., 2014). Each year there are an estimated 1.7 billion cases of pediatric diarrhea and 525,000 deaths attributed to diarrheal disease among children under five across the globe (World Health Organization, 2015). ...
Article
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Background During 2014 to 2019, the SaniPath Exposure Assessment Tool, a standardized set of methods to evaluate risk of exposure to fecal contamination in the urban environment through multiple exposure pathways, was deployed in 45 neighborhoods in ten cities, including Accra and Kumasi, Ghana; Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Atlanta, United States; Dhaka, Bangladesh; Lusaka, Zambia; Kampala, Uganda; Dakar, Senegal. Objective Assess and compare risk of exposure to fecal contamination via multiple pathways in ten cities. Methods In total, 4053 environmental samples, 4586 household surveys, 128 community surveys, and 124 school surveys were collected. E. coli concentrations were measured in environmental samples as an indicator of fecal contamination magnitude. Bayesian methods were used to estimate the distributions of fecal contamination concentration and contact frequency. Exposure to fecal contamination was estimated by the Monte Carlo method. The contamination levels of ten environmental compartments, frequency of contact with those compartments for adults and children, and estimated exposure to fecal contamination through any of the surveyed environmental pathways were compared across cities and neighborhoods. Results Distribution of fecal contamination in the environment and human contact behavior varied by city. Universally, food pathways were the most common dominant route of exposure to fecal contamination across cities in low-income and lower-middle-income countries. Risks of fecal exposure via water pathways, such as open drains, flood water, and municipal drinking water, were site-specific and often limited to smaller geographic areas (i.e., neighborhoods) instead of larger areas (i.e., cities). Conclusions Knowledge of the relative contribution to fecal exposure from multiple pathways, and the environmental contamination level and frequency of contact for those “dominant pathways” could provide guidance for Water, Sanitation, and Hygiene (WASH) programming and investments and enable local governments and municipalities to improve intervention strategies to reduce the risk of exposure to fecal contamination.
... During program implementation, WFP advocated for improving the quality of complementary health activities to maximize the intended overall impact on stunting prevention. 19,55 This advocacy effort resulted in a renewal of district-level activities focused not only on nutrition but also on health, including hygiene (eg, handwashing promotions), parasite control (eg, deworming services), and reproductive health services (eg, provision of iron folic acid tablets). The multisectoral nature The Right Foods at the Right Time may help explain why program exposure resulted in significant reductions in malaria and fever prevalence. ...
Article
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Background The rural district of Ntchisi is in the central region of Malawi. Among children aged 6 to 23 months, the stunting prevalence is 40% to 50%. To address this high prevalence, the World Food Programme, with cooperating partners, supported the Government of Malawi to implement an integrated stunting prevention program entitled The Right Foods at the Right Time from 2013 to 2018. Objective To provide implementation lessons learned from systematic documentation of how the Scaling Up Nutrition (SUN) movement, combined with other international and national initiatives and policies, was translated into tailored programming. Methods During program conception, early design, and implementation, this descriptive study systematically documented the process of translating SUN principles and government policies into an operational stunting prevention program in rural Malawi. Results We identified 8 factors that contributed to successful translation of policy into program activities: (1) well-structured National SUN framework, (2) reliable coordination platforms and district ownership, (3) systematic and evidence-informed program design, (4) multiple forms of data used to inform program planning, (5) multisectoral implementation approaches to stunting prevention, (6) innovation in technology to improve overall program efficiency, (7) systematic collaboration among diverse stakeholders, and (8) strong public health nutrition capacity of program team members. Conclusions Lessons from this nutrition program in Ntchisi, Malawi, provide one case illustrating how the SUN movement, government policies, and global evidence base can be operationalized into tailored programming for improving nutrition.
... To address undernutrition among children, attention has been drawn to preventive approaches that recognize the importance of a clean, safe environment to prevent cross-contamination and diarrheal infection. In a review examining the link between water, sanitation, and early child development, Ngure et al. (2014) proposed the importance of a clean environment to prevent the ingestion of microbes and pathogens by infants and young children. With the evidence on the importance of preventing cross-contamination, access to improved water, sanitation, and hygiene (WASH) has been endorsed as a key means of combating diarrhea and child morbidity and mortality in developing countries (WHO & UNICEF 2017). ...
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Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p = 0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing. HIGHLIGHTS Access to improved water is limited in rural areas, with surface water being a common source of drinking water.; Diarrhea among a very young age group of infants and toddlers is also prevalent and is associated with water and sanitation services.; The use of surface water for drinking at the household level is associated with diarrhea and also poor diversity in feeding a variety of foods to infants and children.;
... The constant exposure to faecal bacteria could also cause environmental enteropathy which hampers the absorption of nutrients and worsens malnutrition. [47][48][49] Furthermore, it is important to note that the human brain development is largely driven by experience. 50 A lack of adequate learning opportunities and stimulation in the early years can have long-lasting consequences for the functioning of the brain. ...
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Objective To assess how pregnancy anaemia affects the offspring’s early childhood development, child haemoglobin (Hb) levels child growth and diseases incidence 2 years after birth in a low-income setting. Furthermore, we investigate the mediating role of childhood Hb levels with disease incidences and skills. Design Prospective cohort study. Setting and participants The study participants are 941-999 mother–child dyads from rural Madhepura in Bihar, India. In 2015, the women were recruited during pregnancy from registers in mother–child centres of 140 villages for the first wave of data collection. At the time of the second wave in 2017, the children were 22–32 months old. Primary and secondary outcome measures The recruited women were visited at home for a household survey and the measurement of the women’s and child’s Hb level, child weight and height. Data on the incidence of diarrhoea and respiratory diseases or fever were collected from interviews with the mothers. To test motor, cognitive, language and socioemotional skills of the children, we used an adapted version of the child development assessment FREDI. Results The average Hb during pregnancy was 10.2 g/dL and 69% of the women had pregnancy anaemia. At the age of 22–32 months, a 1 g/dL increase in Hb during pregnancy was associated with a 0.17 g/dL (95% CI: 0.11 to 0.23) increase in Hb levels of the child. Children of moderately or severely anaemic women during pregnancy showed 0.57 g/dL (95% CI: −0.78 to −0.36) lower Hb than children of non-anaemic women. We find no association between the maternal Hb during pregnancy and early skills, stunting, wasting, underweight or disease incidence. While childhood anaemia does not correlate with childhood diseases, we find an association of a 1 g/dl increase in the child's Hb with 0.04 SDs higher test scores. Conclusions While pregnancy anaemia is a risk factor for anaemia during childhood, we do not find evidence for an increased risk of infectious diseases or early childhood development delays.
... A possible explanation for the slower weight gain and growth seen in some children may be because care and hygiene knowledge vary tremendously among impoverished populations, particularly among those with minimal education. There is evidence suggesting that poor childcare and hygiene may affect growth and development of infants[65][66] An explanation for the accelerated weight gain and normal growth exhibited by EBFI, particularly during the first half of the study, can probably be found in thefeedback offered by mothers. During the monthly anthropometric measurements and physical evaluations, LMs were regularly asked if they could notice any significant impact from the consumption of the daily RBEE ration. ...
Article
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Background: The nutritional composition of the bran layer of rice (RB), a globally available product of the rice milling process, has attracted attention as a nutraceutical food source. However, to capitalize on RB’s nutritional properties for humans, it is necessary to achieve a level of bioavailability that increases the efficacy needed to impact the nutritional well-being of lactating mothers and their breastfed infants. To accomplish this, a hydrolyzed enzymatic extract (RBEE) with increased protein, vitamin, carbohydrate, and antioxidant bioactivity has been developed.Objective: To determine the impact of RBEE on the nutritional status of lactating mothers (LM) and the growth of their exclusively breastfed (EBF) infants, living in food-insecure environments in rural Guatemala. Methods: A RBEE daily ration was consumed by post-puerperium LM for 4.5 months of the EBF period. The nutritional impact on LMs was determined by body mass index (BMI). Anemia prevalence and packed cell volume (PCV) were obtained via hematocrit (HCT). Infant growth was determined monthly following World Health Organization (WHO) guidelines, including weight-for-length (WHZ), weight-for-age (WAZ), length-for-age (LAZ), BMI-for-age (BAZ) and head circumference-for-age (HCZ). Initial, midterm and final growth indicators were analyzed by Student t-test for independent samples. Results: While no significant differences were found between the initial and final BMI in LMs, anemia prevalence was significantly reduced from 12.1% to 4%. HCT results in LMs showed a significant increase (p<0.05) in PCV by the study’s end, from 40.55% to 41.42%. Following a student t-test analysis, infant growth indicators WHZ, WAZ and BAZ showed a highly significant (p<0.01) increase. A significant (p<0.05) improvement was detected in WAZ, while LAZ scores improved from -1.9 to -1.76.Conclusions: The dietary supplementation of lactating mothers with an RBEE during the EBF period significantly impacted the mother-infant dyad, with improved growth of the exclusively breastfed infants and a reduction in anemia prevalence in mothers. Further research will include the quantity and quality of the putative increased maternal milk synthesis. Keywords: rice bran, bioactive, bioavailability, enzyme-treated extract, functional food, infants, exclusive breastfeeding, lactating mothers, anemia, chronic, acute, malnutrition, Guatemala, growth, nutrition, children.
... There have been several cross-sectional studies that demonstrated the beneficiary role of WASH on child growth indicators. 13,19,20 On the other hand, a clusterrandomized controlled trial (RCT) in rural Bangladesh demonstrated that integration of water, sanitation, and handwashing with nutrition did not result in superior linear growth of children. 21 Similar findings were reported in two other investigations conducted in Kenya and India. ...
... [15][16][17][18][19][20] Young children may be particularly at risk of enteropathogen infection from environmental contamination given their frequent hand-to-mouth and exploratory behaviors. 21 Indeed, direct observational studies have shown that infants engage in geophagy and even consumption of chicken feces in normal day-to-day behavior. [22][23][24][25][26] Zoonotic enteropathogens have distinct livestock reservoirs and transmission pathways. ...
Article
Livestock can provide benefits to low-income households, yet may expose children to zoonotic enteropathogens that cause illness and negative long-term health outcomes. The aim of this cross-sectional study was to determine whether livestock-related risk factors, including animal ownership, exposure to animal feces, and consumption of animal-source foods, were associated with bacterial zoonotic enteropathogen infections in children 6–59 months old in Greater Accra, Ghana. Stool samples from 259 children and 156 household chickens were analyzed for atypical enteropathogenic Escherichia coli (aEPEC), Campylobacter jejuni/coli ( C. jejuni/coli ), Salmonella , and Shiga toxin–producing Escherichia coli (STEC) using quantitative polymerase chain reaction (qPCR). aEPEC, C. jejuni/coli, STEC, and Salmonella were detected in 45.6%, 11.6%, 4.3%, and 0.8% of children’s stool samples, respectively. In adjusted logistic regression models, household ownership of goats or sheep was associated with STEC detection in children (odds ratio [95% confidence interval {CI}]: 4.30 [1.32, 14.08]), as were positive detection of STEC in chicken feces (7.85 [2.54, 24.30]) and frequent consumption of fresh cow’s milk (3.03 [1.75, 5.24]). No livestock-related risk factors were associated with aEPEC or C. jejuni/coli infection in children. Our findings suggest that ruminant ownership in southern Ghana may expose children to STEC through household fecal contamination and foodborne routes. The lack of association between livestock risk factors and the more commonly detected pathogens, aEPEC and C. jejuni/coli , warrants further research, particularly to help explain how animal-keeping and sanitation practices affect transmission of fecal pathogens that were highly prevalent in chicken feces.
... There have been several cross-sectional studies that demonstrated the beneficiary role of WASH on child growth indicators. 13,19,20 On the other hand, a clusterrandomized controlled trial (RCT) in rural Bangladesh demonstrated that integration of water, sanitation, and handwashing with nutrition did not result in superior linear growth of children. 21 Similar findings were reported in two other investigations conducted in Kenya and India. ...
Article
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Objectives This study aimed to outline water, sanitation, and hygiene (WASH) practices for children under 5 years of age among the households of St. Martin’s Island as well as examine the role of water, sanitation, and hygiene on child nutritional outcomes. Methods A total of 256 children under 5 years of age were anthropometrically measured, and multiple linear regression was performed to understand the relationship between combined water, sanitation, and hygiene score and child nutritional outcomes: height-for-age, weight-for-age, weight-for-height z-scores. Results The majority of the sampled households had improved drinking water facilities. Over one-third of the participants (36.5%) did not have access to better sanitation, and 12.4% reported defecating in open places. Just over one-third of those surveyed reported washing their hands with soap or detergents after defecation, with more than 22% of people not having access to a handwashing station on their premises. Stunting, wasting, and underweight were found to be prevalent in 34.4%, 17.6%, and 18.9% of the sampled children, respectively. Height-for-age (0.08 SDs) and weight-for-age (0.014 SDs) were greater on average in children from households with improved water, sanitation, and hygiene conditions, but weight-for-height did not significantly differ from those from WASH-unimproved households. Conclusion Certain aspects of WASH, particularly, sanitation facilities and hygiene practices were not up to the mark in St. Martin’s Island, and consistent with findings from other studies, our study findings underlined the potential benefits of improved water, sanitation, and hygiene practices in addressing child undernutrition.
... Lastly, improved sanitation likely reduces exposure to pathogens and environmental risks contributing to poor child development through persistent immune stimulation and poor gut health. 40 Although promising, these findings on potential modifiers should be interpreted with caution, given the wide CIs for many of the subgroups we examined. ...
Article
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Objective To assess the associations between diet, stimulation and development among children 36–59 months of age in low-income and middle-income countries (LMICs). Design We pooled Demographic and Health Survey data on 12 126 children aged 36–59 months from 15 LMICs. Child diet indicators included dietary diversity score (DDS, range 0–7), minimum dietary diversity (MDD, defined as DDS ≥4) and animal source foods (ASFs) consumption. Child development was assessed using the Early Childhood Development Index and stimulation by the number of stimulation activities (range 0–6). Associations were assessed using generalised linear models. Results In our sample, 18% of children met MDD and 50% received ≥4 stimulation activities. The prevalence of suboptimal cognitive, socioemotional, literacy-numeracy and physical development was 24%, 32%, 87% and 11%, respectively. Higher DDS, meeting MDD and consuming ASFs were associated with 8%–13% more stimulation activities. Children who met MDD were slightly less likely to have suboptimal literacy-numeracy development compared with children who did not meet MDD: relative risk 0.97 (95% CI 0.95 to 1.00). DDS, meeting MDD and ASFs consumption were not associated with cognitive, socioemotional or physical development. However, there was evidence of positive associations between MDD and cognitive and literacy-numeracy development among subgroups of children, including those who received ≥4 stimulation activities or attended an early childhood care and education programme. Conclusions Child diet was associated with more stimulation activities. However, independent of stimulation, socioeconomic status and other factors, child diet appeared to be a prominent determinant only of literacy-numeracy development among children 36–59 months of age.
... Young monkeys are curious by nature and engage in hand-to-mouth exploration and although the housing floor substrates are flushed daily, fecal waste may accumulate between cleanings and lead to early-age exposure to a number of enteric pathogens. This explorative behavior, coupled with these exposure conditions, appears to model some of the challenges associated with implementing water, sanitation, and hygiene (WASH) interventions among young children in developing countries 20 . Interestingly, prior studies indicate that the gut microbiome of rhesus macaques is clearly distinct from that of human cohorts from the United States and instead more closely resembles the microbiomes observed in developing countries and resource-poor settings such as Malawi, Burkina Faso, Bangladeshi slums, and Amerindians from Venezuela [21][22][23] . ...
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Environmental enteric dysfunction is associated with malnutrition as well as infant growth stunting and has been classically defined by villous blunting, decreased crypt-to-villus ratio, and inflammation in the small intestine. Here, we characterized environmental enteric dysfunction among infant rhesus macaques that are naturally exposed to enteric pathogens commonly linked to human growth stunting. Remarkably, despite villous atrophy and histological abnormalities observed in the small intestine, poor growth trajectories and low serum tryptophan levels were correlated with increased histopathology in the large intestine. This work provides insight into the mechanisms underlying this disease and indicates that the large intestine may be an important target for therapeutic intervention.
... Biomarkers of intestinal barrier disruption by epithelial inflammation have helped to understand more about the pathophysiology of EED and its growth and developmental consequences in children [19,20]. The effects of intestinal and systemic inflammation that are integral to the pathophysiology of EED contribute to low nutrient absorption and anemia, leading to altered brain development in young children and subsequent poor neurocognitive development [21]. Although the mechanisms through which EED is associated with poor responses to oral vaccine are not well understood, it is again likely that intestinal and systemic inflammation are the major causes [20,22,23]. ...
... Inflammation may have been further exacerbated by poor hand washing practices as majority (75·5 %) of the girls washed their hands only with water before consuming food. Chronic intestinal inflammation can lead to atrophy of the intestinal villi and impaired absorption of haematopoietic nutrients from the diet, without obvious diarrhoea (50,51) . Evidence suggests that children exposed to long-term poor quality of water, sanitation and hygiene conditions and open defecation have lower haemoglobin levels due to increased risk of intestinal infection and chronic gut inflammation (52,53) . ...
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Objective High burden of anemia exists amongst rural adolescent girls in India. The objective of this study was to characterize anemia in school going adolescent girls in rural Haryana, India. Design Linear and multiple logistic regression analysis of data collected prior to an intervention trial was conducted. Participants were classified into anemic (hemoglobin <12g/dl) and non-anemic group and were further classified into deficiencies of iron, folate or vitamin B 12 , mixed, anemia of other causes and inflammation. Setting Three schools in Ballabgarh block of Faridabad District, Haryana, India. Participants 198 non-anemic and 202 anemic adolescent girls (12-19 years). Results Anemic girls had 29.6% iron deficiency, 28.1% folate or vitamin B 12 deficiency, 15.8% mixed deficiency and 9.7% acute inflammation. Anemia of other causes was found in 16.8% of the anemic participants. Girls with iron and isolated folate deficiency had 2.5 times and 4 times higher odds of developing anemia; respectively, as compared to non-anemic girls. Iron deficiency with no anemia was found amongst 11% non-anemic girls. Non-anemic girls had a high prevalence of combined deficiency of folate or vitamin B 12 (29.5%) and acute inflammation (14.4%). Conclusions The current strategy of iron and folic acid supplementation alone will not suffice for achieving the desired reduction in the prevalence of anemia as unknown causes and anemia of inflammation contribute to a substantial proportion of anemia. Integrating other nutrition-specific components like improving water, sanitation and hygiene practices with the ongoing micronutrient supplementation program will comprehensively tackle anemia. Unknown causes of anemia warrants further research.
... However, not only the food people are consuming is lacking in nutrients but often also the soils where the crops are grown This can be due to geology and soil formation, but also to intense cropping in response to high population pressures, resulting in various nutrient element deficiencies essential for plant growth [28]. Furthermore, every soil naturally has a different composition and potential to grow crops. ...
Article
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Micronutrient malnutrition is a global health challenge affecting almost half of the global population, causing poor physical and mental development of children and a wide range of illnesses. It is most prevalent in young girls, women, and pre-school children who are suffering particularly from the low consumption of vitamins and micronutrients. Given this global challenge, biofortification has proven to be a promising and economical approach to increase the concentration of essential micronutrients in edible portions of staple crops. Produce quality and micronutrient content can be further enhanced with the use of micronutrient fertilizers. Especially developing countries with a high percentage of malnourished populations are attracted to this integrated biofortification, combining modern agronomic interventions and genetic improvement of food crops. Consequently, maize, rice, wheat, beans, pearl millet, sweet potato, and cassava have all been biofortified with increased concentrations of Fe, Zn, or provitamin A in various developing countries. Today, there are several large-scale success stories in Africa and Asia that support the research and development of biofortified crops. In this review, we summarized what has been achieved to date and how edible crops can be further improved by integrating agronomic and genetic strategies to upgrade the nutritional status of children and adults around the world.
... The habit of washing hands with soap can ensure significant improvement in a child's nutrition and health (24). Access to WASH is a prerequisite for human well-being, health, and even economic development (25). Therefore, only a few studies have scouted interaction among various washing ingredients on children's nutrition outcomes. ...
Article
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This study aimed to assess the knowledge and practice of caregivers and their relationship to the disease and nutritional status of children under 5 years of age in rural areas of Sylhet, Bangladesh. A total of 110 households with at least a child aged 6 to 59 months were selected by simple random method from 10 rural communities of three Upazila of Sylhet from September 2019 to February 2020. Descriptive statistics were used to assess the “Water Access, Sanitation, and Hygiene” (WASH) knowledge and practice, and multivariate chi-square analyses were performed to assess associations among diseases and nutritional status with WASH following a structured questionnaire. The study found a significant association between WASH with childhood disease and nutritional status, and 65% of children were found to be in a diseased state and 35% of children were found in a no exposure of disease state within the last 6 months. The findings sketched that mother with poor WASH knowledge and practice was at greater risk for disease outbreaks, disease frequency, and duration. The highest incidence of diarrhea was 17% in children aged 12 to 23 months. A significant effect of WASH was also found in children’s nutritional status, which was reflected in the ratio of stunted, underweight, and wasted children. Integrated convergent work focusing on providing clean water within the household, stopping open defecation, promoting handwashing, behavior change, and poverty alleviation is needed to improve the situation. Health, nutrition, and livelihood programs should be uninterrupted, and mothers or caregivers should be encouraged to participate in these programs.
... 37 Caregivers plays a primary role in the levels of hygiene that ensure children's good health, and also the feeding practices crucial for their nutritional status. 38 The time burdens imposed on caregivers by inadequate WASH provision and poor environmental conditions can also compromise their capacity for supervision, a vital function given the hazards in many poor urban environments. 39 The challenges associated with the caregiver's role will be discussed more fully in the gender section. ...
... However, studies, e.g. WSSCC (2006), Gutierrez (2007), Kilsby (2012) and Ngure et al. (2014), showed that WaSH programme has been considered helpful to improve women lives, rights and strengthen community relationship in the short term as well as spur positive economic growth and technological renewal in the longer term-depending on the domestic capacity of nations to rebuild ...
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The present study deals with the gender aspects of water, sanitation and hygiene (WaSH) situation in post-cyclone Aila period in Bangladesh. Data were collected using participa- tory approaches like individual interview, key informant interview, focus group discussion and field level observation. Study reveals that after Aila, women had to travel 500 m–2 km per day to fetch water from safe water sources spending 30–90 min. People used pit and hanging latrines, uncovered water framed latrines as well as had open defecation. Consid- ering the impromptu needs, government and other aid-giving agencies focused on immedi- ate WaSH programme. The paper is an outcome of a critical assessment of those arduous efforts made to overcome the WaSH challenges after Aila, particularly women’s role in and challenges faced by them to improving the situation. Also attempt has been made to examine the opportunities and challenges of sustainability of WaSH programme pursued in the post-disaster period. For recovery of the WaSH system, a two-part strategy was fol- lowed where one was to make technology (tubewell, pond and filter, saline purification and rainwater harvesting plants) that supporting social arrangement and another was social arrangement (group formation, capacity building on construction, operation and mainte- nance) that supporting technology. A techno-social contingent model has been followed for addressing the post-disaster WaSH situation following a WasH approach. Women’s these roles in meeting the households’ WaSH requirements might be called WaSH-feminism. The main finding is that although there was a technical challenge to overcome the water and sanitation crises, after the disaster a set of appropriate technologies could remove it considerably, but a corresponding social arrangement was required there to operate it. Many kinds of technical and social limiting factors were there for women that could be removed partly but not totally.
... Postrainy season, children in households who boiled and strained their drinking water demonstrated better z-weight than children in households who drank untreated water. Water sources and systems in Timor-Leste are commonly contaminated with bacteria (World Bank, 2018), increasing the risk of water-borne disease transmission among children (Ngure et al., 2014). Water treatment is particularly important in the rainy season because runoff due to heavy rains and floods can contaminate water sources such as open wells. ...
Article
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Both child growth and dietary diversity are poor in rural Timor-Leste. The rainy season is associated with food scarcity, yet the association between seasonal scarcity, food diversity, and child growth is underdocumented. This study assesses the relationship between household dietary diversity and children's standardized growth across the 2018 food-scarce (April-May; post-rainy period) and post-harvest (October) seasons in the agricultural community of Natarbora, on the south-coastal plains of Timor-Leste. We conducted household interviews and collected anthropometric data across 98 and 93 households in the post-rainy and post-harvest periods, respectively. Consumed household foods were obtained via 24-h diet recalls and were subsequently categorized into a nine-food-group dietary diversity score (DDS; number of different food groups consumed). The DDS was related to children's standardized short-term growth (z-weight, z-body mass index [BMI] and percent change in weight over the harvest season) via linear mixed models. Across seasons, DDS increased from 3.9 (standard deviation [SD] = 1.0) to 4.3 (SD = 1.4; p < 0.05). In the post-rainy season, children in high DDS households had higher z-weight than those in low DDS households and higher z-BMI than children in medium and low DDS households. In the post-harvest period, household DDS did not predict children's z-weight but predicted z-BMI. Consumption of protein-rich foods, particularly animal-source foods and legumes, in low- and medium-DDS households may be associated with improved child growth. While consuming more animal-source foods in the post-rainy season would be ideal, promoting the consumption of locally grown legumes, such as beans and pulses, may facilitate better nutritional outcomes for more children in rural Timor-Leste.
... Handwashing practice: mean score for all constructs was computed and dichotomized into positive and negative. If the mother scored below the mean, she would be labeled as having poor handwashing practice [23]. ...
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Background Wasting continued to threaten the lives of 52 million (7.7%) under-five children globally. Sub-Saharan Africa accounts for one-third of all wasted children globally, and Ethiopia is among the countries with the highest magnitude of Wasting in the region. Despite, the little decrement in the prevalence of other forms of malnutrition (stunting and underweight), the burden of wasting remains the same in the country. Gedeo zone is among those with a high prevalence of under-five wasting.Objective To identify determinants of wasting among children aged 6-59 months in Wonago Woreda, 2018.MethodsA facility-based unmatched case-control study was conducted from May 11 to July 21/2018. A total of 356 (119 cases and 237 controls) mothers/caregivers of under-five children who visited the Wonago woreda public health facilities were included in the study using systematic random sampling. Data were collected using a structured questionnaire and anthropometric measurement. Descriptive analysis was used to describe data. Binary logistic regression was used to identify determinants of wasting among children aged 6-59 months. Variables with p-value < 0.25 in bi-variate analysis entered to multivariate analysis. Those variables with a p-value less than 0.05 during the multivariate regression were considered significant.ResultsDeterminants which found to have an association with wasting in this study were; maternal illiteracy [AOR = 2.48, 95% CI (1.11, 5.53)] family size
... Comparable studies in Indonesia, Zambia and Haiti (Agustina et al. 2013;Medgyesi et al. 2018a;Reid et al. 2018;Satter 2019) have linked this practice to increased non-dietary hand-to-mouth contacts in the exploratory stage of childhood (i.e. between 3-6 years). As reported by Ngure et al. (2014) and George et al. (2020), non-dietary hand-to-mouth contacts promote the ingestion of faecal pathogens, helminths and roundworms through contact with soil and other contaminated objects leading to environmental enteropathy and diarrhoea in children. However, due to the high caregiver: child ratio in ECDCs (1:77 children), proper supervision of children's mouthing during both meal and playtimes remains a challenge. ...
Article
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Diarrhoeal disease remains a leading cause of death in children in sub-Saharan Africa, attributed to environmental health factors such as inadequate water, sanitation and hygiene (WASH) and food hygiene. This formative study in low-income areas of Blantyre focussed on the practices in Early Childhood Development Centre (ECDCs) environments where children spend a significant amount of time. A mixed-methods approach was applied to identify key hygiene behaviours in ECDCs through; checklist and structured observations (n = 849 children; n = 33 caregivers), focus group discussions (n = 25) and microbiological sampling (n = 261) of drinking water, food handler’s hands, and eating utensils. ECDCs had inadequate WASH infrastructure; coupled with poor hygiene practices and unhygienic environments increased the risk of faecal-oral disease transmission. Presence of E. coli in drinking water confirmed observed poor water handling habits by staff and children. Addressing undesired hygiene practices in ECDCs has the potential to improve the health outcomes of children in low-income settings.
... Furthermore, in addition to psychosocial stimulation interventions, nutritional counseling was recommended as part of the guideline (8). There are also potential links between water, sanitation, and hygiene (WASH) and outcomes including child development in this population, particularly because enteric dysfunction is common in children with SAM and especially in those who have an acute illness (9)(10)(11)(12). ...
Article
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Background: Children with severe acute malnutrition (SAM) who require nutritional rehabilitation unit (NRU) treatment often have poor developmental and nutritional outcomes following discharge. The Kusamala Program is a 4-d hospital-based counseling program for caregivers of children with SAM that integrates nutrition, water, sanitation, and hygiene and psychosocial stimulation, aimed at improving these outcomes. Objectives: The aim was to evaluate the effects of the Kusamala Program on child development and nutritional status in children with SAM 6 mo after NRU discharge. The other aim was to qualitatively understand perceptions and experiences of caregivers who participated in the intervention. Methods: A cluster-randomized controlled trial was conducted with caregivers and their children 6-59 mo of age with SAM admitted to the Moyo NRU in Blantyre, Malawi. The primary outcome of the trial was child development according to Malawi Developmental Assessment Tool (MDAT) composite z-scores of gross motor, fine motor, language, and social domains. A qualitative component with focus group discussions and in-depth interviews was also completed with a subset of caregivers who participated in the trial. Results: Sixty-eight caregivers and children were enrolled to clusters by week and randomly assigned to the comparison arm and 104 to the intervention arm. There were no differences in child development, with mean MDAT composite z-scores in the comparison arm of -1.2 (95% CI: -2.1, -0.22) and in the intervention arm of -1.1 (95% CI: -1.9, -0.40) (P = 0.93). The qualitative evaluation with 20 caregivers indicated that the 3 modules of the Kusamala Program were appropriate and that they applied many of the lessons learned at home as much as possible. Conclusions: The Kusamala Program did not result in improved developmental or nutritional outcomes, yet it was viewed positively by caregivers according to qualitative results. Future research should evaluate more intensive interventions for caregivers and children with SAM. This trial was registered at www.clinicaltrials.gov as NCT03072433.
... This study documented that potential fecal contamination of drinking water and ready-to-eat foods measured by E. coli were significantly associated with elevated concentration of fecal biomarkers of EED and high EED composite score in children. This finding is in line with findings of other studies [56][57][58][59]. When food and water are fecally contaminated, children continuously exposed to enteropathogens through the ingestion of contaminated foods and water [3,12,60,61]. ...
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Background: Environmental enteric dysfunction is a subclinical intestinal disorder characterized by gut inflammation accompanied by morphological changes, such as blunted villi and crypt hyperplasia. This is a common illness in low and middle-income countries. However, environmental enteric dysfunction evidence is limited in Ethiopia. Accordingly, this study was conducted to measure fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24-59 months in rural northwest Ethiopia. Methods: A community-based cross-sectional study was employed among 235 randomly selected children in a rural setting of the east Dembiya district. Stool samples were collected without fixative and analyzed for fecal biomarkers of environmental enteric dysfunction (Alpha-1-antitrypsin, neopterin, and myeloperoxidase) using commercial enzyme-linked immunosorbent assay kits and analyzed for intestinal parasites using wet mount and Kato-Katz techniques. Child behaviors related with exposure to enteropathogens, condition of the living environment and socio-demographic information were collected using interviewer-administered questionnaire and structure observation. We fitted multivariable linear regression model to assess the association between environmental factors and concentration of fecal biomarkers of environmental enteric dysfunction in the stool. Statistically significant associations were declared based on adjusted betas with the corresponding 95% confidence interval and p-value < 0.05. Results: The median concentration of fecal markers of environmental enteric dysfunction was 350 μg/ml for Alpha-1-antitrypsin, 3320.2 ng/ml for myeloperoxidase, and 1562 nmol/l for neopterin. The median concentration of Alpha-1-antitrypsin among 161 (68.5%), myeloperoxidase among 168 (71.5%), and neopterin among 188 (80%) of the stool samples were above the normal values in non-tropical settings. Moreover, 100 (42.6%) of the children had high EED disease activity score (above the median score). The elevated concentrations of fecal biomarkers of gut inflammation and the high EED disease activity score were significantly associated with open defecation practice, mouthing of soil contaminated materials, Escherichia coli (E. coli) contamination of drinking water, E. coli contamination of foods, E. coli contamination of soil, and intestinal parasites. Conclusion: Overall, Alpha-1-antitrypsin, myeloperoxidase, and neopterin levels among the children in the studied region were highly elevated in comparison to populations in high-income countries. Moreover, the EED disease activity score in significant proportion of children was high, suggesting widespread intestinal inflammation and increased intestinal permeability. Extensive E. coli contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil), hygiene and sanitation behaviors (such as open defecation and mouthing of soil contaminated materials), and a high burden of intestinal parasites were identified as factors associated with the elevated concentration of fecal biomarkers of environmental enteric dysfunction. Parental care to children to avoid mouthing of soil contaminated materials and other risky behaviors that increase exposure enteric infections, and protecting the living environment (water, food and soil) from fecal contamination are important.
... 8 Over 200 million children born in low-income countries are at risk of not reaching their development potential and poor sanitation and hygiene practices were reported as one of the potential causes of that developmental deficit. [9][10][11][12] . Every year about 2.4 million deaths (4.2% of all deaths) could be prevented globally if appropriate hygiene was practiced and everyone had reliable sanitation and drinking water. ...
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Background: Over 200 million under-five-children born in low-income countries are at risk of not reaching their development potential and infectious diseases are the leading cause of development deficits in these regions. Methods: A cross-sectional study was conducted to investigate personal and household hygiene practices among 154 mothers and their association with the incidence of infectious diseases among 167 children aged 6 months to 59 months in Patuakhali district, Bangladesh. Results: Only 13.6% of the mothers had proper hand washing knowledge. Besides, 14% and 53.9% of the mothers washed their hands with soap and only with water respectively before feeding their child. About 68.2% of mothers prepared food on the ground and half (49.5%) of the toilet did not have a hand washing location beside it. The risk of childhood infectious disease was significantly associated with hand washing of mothers before feeding a child (OR: 2.3, 95% CI: 1.5-4.1, p<0.05) and hand washing of child before eating (OR: 3.4, 95% CI: 1.8-5.7, p<0.05). Conclusions: Hand washing agents were inadequate and compliance to hand washing was poor. Therefore, the continuous focus is needed on the mother's awareness construction to increase the compliance to hand washing practice among mothers as well as their child with soap, especially during child feeding
... In accord with birth weight, a recent study added fetal growth restriction and preterm birth as risk factors and suggested they account for as much as 32% of stunted children [6]. Additional risks in some studies include environmental factors [7][8][9], maternal health status [10][11][12], and child health status [13,14]. However, these risk factors combined are still insufficient to explain the current levels of stunting. ...
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Background: Stunting, an indicator of restricted linear growth, has become a primary measure of childhood undernutrition due to its persistent high prevalence globally, and importance for health and development. Although the etiology is recognized as complex, most analyses have focused on social and biomedical determinants, with limited attention on psychological factors affecting care and nurturing in the home. We assessed whether the psychological distress of parents is related to child linear growth and stunting, and documented the associated risk factors, and examined the relationship between parental distress and behavioral and other risk factors for stunting. Methods: We used data from the Indonesia National Health Survey 2013, including 46,315 children 6-59 months of age. Multivariate linear, logistic, and multilevel multinomial logistic regression, using survey weights, were used to assess the relationship between parental distress, as assessed by the WHO Self Reporting Questionnaire (SRQ20), with height-for-age z score (HAZ), stunting, and behavioral and other risk factors for stunting. Results: Maternal, paternal and parental distress (i.e. both maternal and paternal distress) were associated with reduced linear growth of the children by 0.086 (95% CI -0.17, -0.00), 0.11 (95% CI -0.24, -0.02) and 0.19 (95% CI -0.37, -0.00) HAZ-scores, respectively. Maternal and paternal distress increased the risk of mild stunting (HAZ <-1) by 33% (95% CI 1.17,1.50) and 37% (95% CI 1.18,1.60), and the risk of moderate stunting (HAZ <-2) by 25% (95% CI 1.10,1.43) and 28% (95% CI 1.08,1.51]), respectively. Parental stress increased the risk of moderate stunting by 40% (95% CI 1.06,1.85). Amongst specific groups of risk factors, the proportion of HAZ-score lost was associated with socioeconomic factors (30.3%) including, low wealth, low maternal occupational status, low maternal education, rural residence, and low paternal occupational status; physiological factors (15.5%) including low maternal height, low maternal mid-upper arm circumference, being male, low paternal height; behavioral factors (8.9%) including open garbage disposal, paternal smoking, not using iodized salt; and experiencing at least one infectious diseases episode (1.1%). Conclusions: Maternal, paternal and parental stress were associated with reduced linear growth of children. These findings highlight the complex etiology of stunting and suggest nutritional and other biomedical interventions are insufficient, and that promotion of mental and behavioral health programs for parents must be pursued as part of a comprehensive strategy to enhance child growth and development, i.e. improved caretaker capacity, integrated community development, improved parenting skills, as well as reduced gender discrimination, and domestic violence.
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This chapter focuses on the state of child behavioral healthcare systems, policy, and research efforts across African countries, specifically Ghana. The investments in child behavioral health have been too minimal and there is scarce evidence of impact. The following recommendations are made: (1) There is a need for appropriate measurement and screening tools/scales that will take into account context-specific issues. This will require that some qualitative studies that explore context-specific social expectations and standards for behaviour in childhood are undertaken. (2) There is a need to incorporate behavioral health services in all regional and district hospitals by establishing behavioral health units. This will ensure that there is an equitable distribution of accessible behavioral healthcare services across all the regions. (3) There is a need for extensive and continuous research into behavioral health problems, promotion, and prevention. This will require collaboration between academics, various health institutions, and nongovernmental organizations (NGOs). Findings can be used as proven basis to inform policy and practice.
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ABSTRACT Background: Stunting prevalence is quite high in West Sumatra Province, including Padang City. Parenting factors and nutritional status play a role in children's development.Objective: This study aims to determine the association between parenting and stunting status with the development of children aged 12-36 months.Method: Design study was cross sectional with the population being children aged 12-36 months who lived in the Pauh Public Health Center working area in Padang City with a total sample of 86 children. The sample was taken by using simple random sampling. Data on development of children were collected using KPSP, parenting data by a structured questionnaire, and stunting data through measuring child height. The data is processed by the SPSS program and displayed univariate, bivariate and multivariate data.Results: The results showed that parenting, especially eating patterns and stunting status were related to the development of children aged 12-36 months. The factor most related to the development of children aged 12-36 months is the stunting status of the child (POR = 4.368; 95% CI = 1.781-10.711; p value = 0.001)Conclusion: It should be noted that a balanced diet in accordance with the needs of children in addition to improving health, hygiene and psychosocial parenting mainly for stunting children so that the child's physical growth and development are normal.
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Diarrheal disease remains a leading cause of child mortality, globally. In the Democratic Republic of the Congo (DRC), each year there are an estimated 45 million episodes of diarrhea in children under five years of age. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to develop theory-driven, evidence-based approaches to reduce diarrheal diseases among young children. The REDUCE prospective cohort study in Walungu Territory in Eastern DRC took guidance from the risks, attitudes, norms, abilities, and self-regulation model, the integrated behavioral model for water, sanitation, and hygiene (WASH), and other behavior change theories to identify psychosocial factors associated with WASH behaviors. Psychosocial factors were measured among 417 caregivers at baseline and caregiver responses to child mouthing of dirty fomites and handwashing with soap was assessed by 5-hour structured observation at the 6-month follow-up. Caregivers who agreed that their child could become sick if they put dirt in their mouth (perceived susceptibility) and caregivers that agreed they could prevent their child from playing with dirty things outside (self-efficacy) were significantly more likely to stop their child from mouthing a dirty fomite. Higher perceived susceptibility, self-efficacy, and disgust, and lower dirty reactivity, were associated with higher handwashing with soap behaviors. This study took a theory-driven and evidence-based approach to identify psychosocial factors to target for intervention development. The findings from this study informed the development of the REDUCE Baby WASH Modules that have been delivered to over 1 million people in eastern DRC.
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This chapter explores the transmission of trauma, models of transmission, intersection of PTSD in parents and parent-infant attachment, determinants of the PTSD transmission within the Rwandan context, possible pathways of child traumatization in post-genocide Rwanda, conclusions, and further perspectives.
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In this chapter, an overview of the related problems and determinants of food insecurity and malnutrition, both globally and in the context of Ghana, is presented. Then, the consequences of food insecurity and malnutrition on child health, development, and behavioral outcomes in the country are explored. Finally, the chapter concludes with a discussion of policy, programming, and research solutions implemented to date to confront issues of malnutrition and food insecurity in Ghana. In sum, this chapter focuses on three learning objectives: (1) define food insecurity and malnutrition and describe the situation and trends globally and in Ghana; (2) identify key consequences of food insecurity and malnutrition on child health, development, and behavioral outcomes globally and in Ghana; and (3) characterize policy, program, and research solutions that have been applied in Ghana for achieving food security and reducing malnutrition.
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Using pooled data from the 1991–2011 waves of the China Health and Nutrition Survey (CHNS), this paper proposes an empirical study on inequality of opportunity in child nutritional outcomes. Children's nutritional outcomes were measured using anthropometric indicators including underweight, stunting, wasting, overweight and obesity. We examine the role played by circumstances beyond the control of individuals—for instance, children's age, gender, hukou status, household size, birth order, family background, region and sanitation—in generating nutritional outcomes inequality among Chinese children aged 0–15. We find that the largest relative share of inequality of opportunity (IOP) in child nutritional outcomes in China is 11.49% (stunting) for the entire sample. Shapley-value decompositions reveal that region and family background are the dominant contributors to inequality of opportunity for most of the nutritional outcomes. IOP turns out to be largest for the 6–10 age cohort. Heterogeneity analysis further shows that disadvantaged groups, for instance, children living in the rural area of western China, face higher unequal opportunities for undernutrition. Conversely, children from urban area of the east show a higher inequality of opportunity in overnutrition. In addition, our counterfactual analysis indicates that if those rural children had migrated to cities, the IOP for the full sample would increase by more than 19%, implying greater attention should be paid to equalizing opportunity amid massive migration and urbanization in China in the years to come.
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Background: Levels of child undernutrition and its correlates exhibit considerable spatial variation at different levels of granularity. In India, such variations and their interrelation have not been studied at the sub-district level primarily due to the non-availability of good quality granular data. Given the sheer regional diversity in India, it is essential to develop a region-specific evidence base at the micro-level. Data and objectives: The current study utilised, for the first time, a sub-district level survey data (Concurrent Child Monitoring Survey-II, 2014-15) to investigate the statistically significant clusters and spatial patterns of burden of undernutrition among children. The emergence of distinct patterns at the level of natural geographical regions of the state-coastal, southern and northern regions, lead to a region-specific analysis to measure the impact of various demographic, socio-economic and maternal factors on the prevalence of undernutrition specific to the three regions, using the National Family Health Survey-IV unit-level data. Methods: The spatial dependence and clustering of child undernourishment across sub-districts in Odisha were studied using various spatial statistical techniques, including spatial econometric models. Binary logistic regression was applied in the region-specific analysis. Results: Findings indicated statistically significant spatial clustering of undernutrition among children in specific geographic pockets with poor sanitation, low institutional and skilled deliveries, poor maternal health reinforcing the need for inter-sectoral coordination. Disparities across the three natural-regions, suggest that the parameters requiring priority for intervention may differ across levels of overall development. Conclusion: The spatial clustering of different socio-demographic indicators in specific geographic pockets highlights the differential impact of these determinants on child undernutrition thereby reinforcing a strong need for targeted intervention in these areas. Present analysis and the evidence-based micro-level analysis can be utilised as a model for other Indian states and low-resource countries, making interventions more effective through multiple, synergistic and a multi-sectoral approach.
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The burden of infant malnutrition is greatest in low- and middle-income countries (LMICs). Infant malnutrition is defined based on distinct subcategories, among them stunting (low-height-for-age) and wasting (low-weight-for-height). Some experts are shifting more toward understanding the interplay between these overlapping phenotypes and other confounding factors such as maternal nutrition and environmental hygiene. Current guidelines emphasize appropriate breastfeeding and nutrition within the 1000 days from conception to a child's second birthday to optimize early development. Future research directed toward better biomarkers of malnutrition before acute clinical symptoms develop will help direct targeted efforts toward at-risk populations.
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Objective This study aimed to determine risk factors of growth faltering by assessing childhood nutrition and household water, sanitation, and hygiene (WASH) variables and their association with nutritional status of children under 24 months in rural Cambodia. Design We conducted surveys in 491 villages (clusters) randomised across 55 rural communes in Cambodia in September 2016 to measure associations between child, household and community-level risk factors for stunting and length-for-age z-score (LAZ). We measured 4036 children under 24 months of age from 3877 households (491 clusters). We analysed associations between nutrition/WASH practices and child growth (LAZ, stunting) using generalised estimating equations (GEEs) to fit linear regression models with robust SEs in a pooled analysis and in age-stratified analyses; child-level and household-level variables were modelled separately from community-level variables. Results After adjustment for potential confounding, we found household-level and community-level water, sanitation and hygiene factors to be associated with child growth among children under 24 months: presence of water and soap at a household’s handwashing station was positively associated with child growth (adjusted mean difference in LAZ +0.10, 95% CI 0.03 to 0.16); household-level use of an improved drinking water source and adequate child stool disposal practices were protective against stunting (adjusted prevalence ratio (aPR) 0.80, 95% CI 0.67 to 0.97; aPR 0.82, 95% CI 0.64 to 1.03). In our age-stratified analysis, we found associations between child growth and community-level factors among children 1–6 months of age: shared sanitation was negatively associated with growth (−0.47 LAZ, 95% CI −0.90 to –0.05 compared with children in communities with no shared facilities); improved sanitation facilities were protective against stunting (aPR 0.43, 95% CI 0.21 to 0.88 compared with children in communities with no improved sanitation facilities); and open defecation was associated with more stunting (aPR 2.13, 95% CI 1.10 to 4.11 compared with children in communities with no open defecation). These sanitation risk factors were only measured in the youngest age strata (1–6 months). Presence of water and soap at the household level were associated with taller children in the 1–6 month and 6–12 month age strata (+0.10 LAZ, 95% CI −0.02 to 0.22 among children 1–6 months of age; +0.11 LAZ, 95% CI −0.02 to 0.25 among children 6–12 months of age compared with children in households with no water and soap). Household use of improved drinking water source was positively associated with growth among older children (+0.13 LAZ, 95% CI −0.01 to 0.28 among children 12–24 months of age). Conclusion In rural Cambodia, water, sanitation and hygiene behaviours were associated with growth faltering among children under 24 months of age. Community-level sanitation factors were positively associated with growth, particularly for infants under 6 months of age. We should continue to make effort to: investigate the relationships between water, sanitation, hygiene and human health and expand WASH access for young children.
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Animal ownership has reported financial and nutritional benefits but has also been associated with enteric and respiratory infections, and inadequate sanitation and hygiene can lead to children touching and ingesting animal fecal matter. We identified key indicators for poultry feces management and investigated their social determinants using data from a baseline survey of a randomized-controlled trial of a poultry management training program in rural Western Uganda. The baseline survey was conducted in the Masindi and Kiryandongo districts of Uganda in September 2019, and data collected from 609 households were used. We evaluated indicators for poultry feces management behaviors using scale development methods, including descriptive statistics, bivariate correlation analyses, and Factor Analysis of Mixed Data. We also investigated social determinants of key poultry feces management behaviors using logistic and multinomial logistic regression models. A significant increase in odds of having free-roaming poultry was found for each additional poultry owned (OR = 1.18, P < 0.001). The odds of a household having an observed enclosure for poultry increased by 5% with each incremental poultry owned (OR = 1.05, P < 0.001), and by 4% with increasing wealth with each additional point on the poverty probability index score (OR = 1.04, P < 0.001). Our results also suggest enclosures are intermittently used and constructing them without further intervention likely will not be sufficient for effectively managing animal fecal contamination. We recommend that future studies on animal feces management measure indicators for corralling and feces disposal practices and evaluate their relationship to enteric pathogen exposure and health outcomes. Insights from this work can inform the development of robust indicators of poultry feces management behaviors that can be used for monitoring and evaluation purposes.
Background: Food safety incorporates the handling, preparation, and storage of food materials in ways that prevent foodborne illness. We aimed to investigate the typical food safety practices in a Bangladeshi slum context and to explore if stunting among school-age children was associated with various components of food safety. Method: We analysed the MAL-ED birth cohort data from the Bangladesh site. A total of 265 healthy children were enrolled in the study; we could follow up and collect food safety-related data from 187 participants. Results: The average age of the children was 6.5 years (standard deviation or SD 0.04) and 49% of them were female. About 26% of the children were stunted. In our bivariate analysis, caregivers’ handwashing practice after using the toilet, treatment of drinking water, presence of insects/pests in the cooking area, and child’s eating ready-made/street food more than three times per day were significantly associated with stunting. After adjusting for pertinent factors, treatment of drinking water (adjusted odds ratio or AOR = 2.50, 95% confidence interval or CI: 1.03, 6.05), and child’s eating ready-made/street food more than three times/day (AOR = 2.34, 95%CI: 1.06, 5.15) remained significantly associated with stunting. Conclusions: Diverse aspects of food safety practices have a substantial association with stunting among school-age children living in an unhygienic slum environment in Dhaka, Bangladesh.
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From an evolutionary perspective, the normal social play of children involves kids of various ages. Our human and great-ape ancestors most likely lived in small groups with low birth rates, which made play with others of nearly the same age rare. Con-sequently, the evolutionary functions of children's social play are best understood by examining play in groups that include children of different ages. The author calls this kind of play "age mixed." He reviews the research on such play, including his own research conducted at the Sudbury Valley School in Massachusetts where students from ages four to about eighteen mix freely. He concludes that age-mixed play offers opportunities for learning and development not present in play among those close in age, permitting younger children to learn more from older playmates than they could from playing with only their peers. In age-mixed play, the more sophisticated behavior of older children offers role models for younger children, who also typi-cally receive more emotional support from older kids than from those near their own age. Age-mixed play also permits older children to learn by teaching and to practice nurturance and leadership; and they are often inspired by the imagination and creativity of their younger playmates. The picture of a group of children all nearly the same age playing in a school yard may seem familiar to modern eyes, but it is an odd image from the long perspective of human cultural and evolutionary history. As anthropologist Melvin Konner pointed out more than thirty-five years ago, play among children close in age (same-age play) is largely an artifact of modern times. 1 Same-age play became common only with the rise of age-graded schooling and, still more recently, with the proliferation of age-graded, adult-organized activities for chil-dren outside schools. Over the history of our species, as natural selection shaped the brain mechanisms of play, children's social play usually occurred among individuals of different ages, often widely different ages. Therefore, if we want to understand the evolutionary value of children's social play—the adaptive func-tions that led natural selection to shape social play into its human forms—we should observe such play among children in age-mixed groups.
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We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.23 SDs (95% CI = -0.63, 0.17) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.36 SDs decrease in HAZ (95% CI = -0.64, -0.07). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.
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Background/objectives: To examine the bacteriological quality of complementary foods (CF) and to correlate the results with diarrhoeal morbidity and nutritional status of Bangladeshi children aged 6-24 months. Subjects/methods: A total of 212 CF samples were tested, of which 72 were collected immediately before the first time of feeding (≤ 1 h of food preparation) and 140 were collected at second/third time of feeding from 140 households located in urban and rural areas of Bangladesh. Anthropometry, food frequency data and demographic information of the children were collected. Results: Of the first time feeding samples, 3% from each of urban and rural areas were found to be contaminated with faecal coliforms (FC) at ≥ 100 CFU/g. E. coli was isolated from 11% and 6% of samples, and B. cereus from 8% and 6% of samples from urban and rural areas, respectively. In contrast, 33% of the second/third time feeding samples from urban areas and 19% from rural areas were contaminated with FC at ≥ 100 CFU/g (P<0.05). E. coli was isolated from 40% and 39% of samples, and B. cereus from 33% and 26% of samples from urban and rural areas, respectively. Significantly high numbers of wasted rural children had CF with a high aerobic plate count, which was also significantly associated with diarrhoeal morbidity in children. Conclusions: Around 40% of CF samples were contaminated with E. coli, which was mainly attributable to food preparation practices. Consumption of contaminated CF appeared to be associated with a higher frequency of diarrhoea and malnutrition in children.
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Objective: To determine which interventions can reduce linear growth retardation (stunting) in children aged 6-36 months over a 5-year period in a food-insecure population in Ethiopia. Design: We used data collected through an operations research project run by Save the Children UK: the Child Caring Practices (CCP) project. Eleven neighbouring villages were purposefully selected to receive one of four interventions: (i) health; (iii) nutrition education; (iii) water, sanitation and hygiene (WASH); or (iv) integrated comprising all interventions. A comparison group of three villages did not receive any interventions. Cross-sectional surveys were conducted at baseline (2004) and for impact evaluation (2009) using the same quantitative and qualitative tools. The primary outcome was stunted growth in children aged 6-36 months measured as height (or length)-for-age Z-scores (mean and prevalence). Secondary outcomes were knowledge of health seeking, infant and young child feeding and preventive practices. Setting: Amhara, Ethiopia. Subjects: Children aged 6-36 months. Results: The WASH intervention group was the only group to show a significant increase in mean height-for-age Z-score (+0·33, P = 0·02), with a 12·1 % decrease in the prevalence of stunting, compared with the baseline group. This group also showed significant improvements in mothers' knowledge of causes of diarrhoea and hygiene practices. The other intervention groups saw non-significant impacts for childhood stunting but improvements in knowledge relating to specific intervention education messages given. Conclusions: The study suggests that an improvement in hygiene practices had a significant impact on stunting levels. However, there may be alternative explanations for this and further evidence is required.
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This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children's educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.
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Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.
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We documented inequitable, cumulative environmental risk exposure and health between predominantly White low-income and middle-income children residing in rural areas in upstate New York. Cross-sectional data for 216 third- through fifth-grade children included overnight urinary neuroendocrine levels, noise levels, residential crowding (people/room), and housing quality. After control for income, maternal education, family structure, age, and gender, cumulative environmental risk exposure (0-3) (risk >1 SD above the mean for each singular risk factor [0, 1]) was substantially greater for low-income children. Cumulative environmental risk was positively correlated with elevated overnight epinephrine, norepinephrine, and cortisol in the low-income sample but not in the middle-income sample. Cumulative environmental risk exposure among low-income families may contribute to bad health, beginning in early childhood.
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A classic in the field, this third edition will continue to be the book of choice for advanced undergraduate and graduate-level courses in theories of human development in departments of psychology and human development. This volume has been substantially revised with an eye toward supporting applied developmental science and the developmental systems perspectives. Since the publication of the second edition, developmental systems theories have taken center stage in contemporary developmental science and have provided compelling alternatives to reductionist theoretical accounts having either a nature or nurture emphasis. As a consequence, a developmental systems orientation frames the presentation in this edition. This new edition has been expanded substantially in comparison to the second edition. Special features include: A separate chapter focuses on the historical roots of concepts and theories of human development, on philosophical models of development, and on developmental contextualism. Two new chapters surrounding the discussion of developmental contextualism--one on developmental systems theories wherein several exemplars of such models are discussed and a corresponding chapter wherein key instances of such theories--life span, life course, bioecological, and action theoretical ones--are presented. A new chapter on cognition and development is included, contrasting systems' approaches to cognitive development with neo-nativist perspectives. A more differentiated treatment of nature-oriented theories of development is provided. There are separate chapters on behavior genetics, the controversy surrounding the study of the heritability of intelligence, work on the instinctual theory of Konrad Lorenz, and a new chapter on sociobiology. A new chapter concentrates on applied developmental science.
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Objective: This study was conducted to measure the impact of a hygiene intervention on the contamination of weaning food in Bangladesh. Methods: Sixty households were selected: 30 study and 30 control households. Samples of weaning food were collected from all the 60 households at baseline and examined for faecal coliforms (FC), faecal streptococci (FS) and Clostridium perfringens (CP) following standard procedures. After cooking, food samples were collected on three occasions before feeding. Following Hazard Analysis Critical Control Point (HACCP) procedures, critical control points were determined. The mothers in the 30 study households were then trained for 4 weeks in how to attain the control point conditions. Then, again the food samples were collected and analysed. Results: At baseline, weaning foods from study and control households were heavily contaminated with FC and FS. The FC and FS counts were 1.84 log(10) and 1.92 log(10) colony-forming unit (cfu)/g, respectively, in the study households, and 0.86 log(10) and 1.33 log(10) cfu/g, respectively, in the control households in the first feeding. After the intervention, the FC and FS counts in study households had dropped to 0.10 log(10) and 0.09 log(10) cfu/g, respectively, a statistically significant reduction (P < 0.001). Monitoring the sustainability of the behaviour change after 3 months showed that the mothers were maintaining food hygiene. Conclusions: A hygiene intervention following the HACCP approach reduced the weaning food contamination significantly. Awareness building among mothers about weaning food hygiene could be an important intervention for preventing weaning food-related diarrhoea in Bangladesh.