Abstract
.Environmental enteric dysfunction (EED), a subclinical disorder of the small intestine, and poor growth are associated with living in poor water, sanitation, and hygiene (WASH) conditions, but specific risk factors remain unclear. Nested within a birth cohort study, this study investigates relationships among water quality, EED, and growth in 385 children living in southwestern Uganda. Water quality was assessed using a portable water quality test when children were 6 months, and safe water was defined as lacking Escherichia coli contamination. Environmental enteric dysfunction was assessed using the lactulose:mannitol (L:M) test at 12–16 months. Anthropometry and covariate data were extracted from the cohort study, and associations were assessed using linear and logistic regression models. Less than half of the households (43.8%) had safe water, and safe versus unsafe water did not correlate with improved versus unimproved water source. In adjusted linear regression models, children from households with safe water had significantly lower log-transformed (ln) L:M ratios (β: −0.22, 95% confidence interval (CI): −0.44, −0.00) and significantly higher length-for-age (β: 0.29, 95% CI: 0.00, 0.58) and weight-for-age (β: 0.20, 95% CI: 0.05, 0.34) Z-scores at 12–16 months. Furthermore, in adjusted linear regression models, ln L:M ratios at 12–16 months significantly decreased with increasing length-for-age Z-scores at birth, 6 months, and 9 months (β: −0.05, 95% CI: −0.10, −0.004; β: −0.06, 95% CI: −0.11, −0.006; and β: −0.05, 95% CI: −0.09, −0.005, respectively). Overall, our data suggest that programs seeking to improve nutrition should address poor WASH conditions simultaneously, particularly related to household drinking water quality.
Highlights
An estimated 155 million children less than 5 years of age are stunted, that is, have a length/height-for-age Z-score (LAZ/HAZ) of less than −2.1 Stunting is associated with an array of health and economic consequences, including a greater risk of infections in childhood, diminished cognitive development, poorer educational outcomes, and lower economic productivity and earnings in adulthood.[2]
In this study of 385 children living in rural southwestern Uganda, we found that those from households with safe drinking water, assessed using a compartment bag test (CBT) at the 6-month timepoint, had significantly lower ln L:M ratios and %LE at 12– 16 months
We found that lower LAZ at birth, 6 months, and 9 months were significantly associated with higher mean ln L:M ratios at 12–16 months
Summary
An estimated 155 million children less than 5 years of age are stunted, that is, have a length/height-for-age Z-score (LAZ/HAZ) of less than −2.1 Stunting is associated with an array of health and economic consequences, including a greater risk of infections in childhood, diminished cognitive development, poorer educational outcomes, and lower economic productivity and earnings in adulthood.[2]. Known interventions to resolve stunting implemented at 90% coverage would only avert 20% of the global burden, leaving most of the problem unaddressed.[3] One of the domains of potential concern for stunting is poor environmental conditions (water, sanitation, and hygiene [WASH]) and associated intestinal health. Some studies have demonstrated an association between poor WASH and poor growth outcomes,[4,5,6,7] but the assumption that repeated symptomatic diarrheal infections are the main mechanism at work has not been supported. According to the 2008 Lancet Maternal and Child Nutrition Series, WASH interventions implemented at 99% coverage would reduce diarrhea incidence by 30%, which would reduce the prevalence of stunting by only 2.4% at 36 months of age.[8] in a pooled analysis of nine studies, only 25% of stunting at 24 months was attributable to a high burden of diarrhea (3 5 episodes before 24 months).[9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
