Examining the relationship between socio-economic status, WASH practices and wasting.

Mohammad Jyoti Raihan,Fahmida Dil Farzana,Nuzhat Choudhury,Md Ahshanul Haque,Sabiha Sultana,Ahmed Shafiqur Rahman,Tahmeed Ahmed,Ben Mccormick,Jillian L Waid,Mahfuzar Rahman

doi:10.1371/journal.pone.0172134

Abstract

Childhood wasting is a global problem and is significantly more pronounced in low and middle income countries like Bangladesh. Socio Economic Status (SES) and Water, Sanitation and Hygiene (WASH) practices may be significantly associated with wasting. Most previous research is consistent about the role of SES, but the significance of WASH in the context of wasting remains ambiguous. The effect of SES and WASH on weight for length (WHZ) is examined using a Structural Equation Model (SEM) to explicitly describe the direct and indirect role of WASH in the context of SES.A nationally representative survey of 10,478 Bangladeshi children under 5 were examined. An expert defined SEM was used to construct latent variables for SES and WASH. The SEM included a direct pathway from SES to WHZ and an indirect pathway from SES to WHZ via WASH along with regression of relevant covariates on the outcome WHZ and the latent variables. Both SES (p<0.01) and WASH (p<0.05) significantly affect WHZ. SES (p<0.01) also significantly affects WASH. Other structural components showed that child’s age (p<0.01) affects WHZ and types of residence (p<0.01) affects SES. WASH practices at least partially mediate the association between SES and wasting status. WASH and SES are both significantly associated with WHZ.

Highlights

Wasting, as an indicator of acute malnutrition, is defined by a weight-for-height/length zscore (WHZ) of more than -2 standard deviations below the World Health Organization (WHO) growth standard [1]
The Structural Equation Model (SEM) model showed that socio-economic status (SES) had statistically significant direct effect on WHZ, but crucially that there is a substantial indirect relationship that is mediated through WASH practices
Our finding suggests that approximately 60% of the association between SES and the WHZ is mediated though WASH

Summary

Introduction

As an indicator of acute malnutrition, is defined by a weight-for-height/length zscore (WHZ) of more than -2 standard deviations below the World Health Organization (WHO) growth standard [1]. Adverse effect on long term physical and cognitive development have been suggested [8].

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Discussion

Conclusion