The WHO and UNICEF Joint Monitoring Programme (JMP) Indicators for Water Supply, Sanitation and Hygiene and Their Association with Linear Growth in Children 6 to 23 Months in East Africa.

Hasina Rakotomanana,Christine N Walters,Barbara J Stoecker,Joel J Komakech

doi:10.3390/ijerph17176262

Abstract

The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children’s Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6–23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (β = 0.13, p < 0.01) and Tanzania (β = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (β = 0.07, p < 0.01) and Tanzania (β = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.

Highlights

Poor growth during the first thousand days leads to negative consequences ranging from decreased immunity to reduced academic performance in adulthood if not corrected early [1]
Even though WASH indicators were noticeably different across East African countries, better
WASH conditions generally were associated with improved child length

Summary

Introduction

Poor growth during the first thousand days leads to negative consequences ranging from decreased immunity to reduced academic performance in adulthood if not corrected early [1]. During the past two decades, child undernutrition rates have declined considerably due to the prioritization of the nutrition agenda worldwide. Global stunting rates for children under five decreased from. The reduction in child stunting in sub-Saharan. Africa remained slow from 46.1% in 1970 to 40% in 2010 compared to the global reduction rate of. The persisting high rates of stunting continue to be a public health concern in sub-Saharan Africa. Stunting rates remain especially high in the East African region where 39% of the children under five were stunted based on data from 2010 to 2016 [4]

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Conclusion