Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth.

Mahama Saaka,Ferguson N Saapiire,Richard N Dogoli

doi:10.1017/jns.2021.103

Abstract

The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.

Highlights

Childhood undernutrition remains a global public health concern because it is an underlying cause of 3⋅1 million child deaths annually[1]
This is the first paper that has investigated in Ghana how stunted child growth relates to individual and joint composite indicators of poor WASH and inappropriate complementary feeding practices
The results indicate that except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6–23 months

Summary

Introduction

Childhood undernutrition remains a global public health concern because it is an underlying cause of 3⋅1 million child deaths annually[1]. Stunting contributes to the global burden of childhood diseases; 80 % of which is affecting children in developing countries[2]. About 32 % of the world population does not have access to adequate sanitation, about 9 % lacks access to safe drinking water, and this could contribute to infections especially at the household level (United Nations, 2016). In the Jirapa Municipal of Ghana where the present study was carried out, about 81⋅0 % of the households do not Abbreviations: AOR: adjusted odds ratio; CI: confidence interval; HAZ: height-for-age z-score; IYCF: infant and young child feeding; MDD: minimum dietary diversity; MMF: minimum meal frequency; WASH: water, sanitation and hygiene journals.cambridge.org/jns. Minimum meal frequency (children aged 6–23 months). Minimum dietary diversity (children aged 6–23 months). Minimum acceptable diet (children aged 6–23 months).

Methods

Results

Conclusion