Water, Sanitation, and Hygiene (WASH) Indicators and Their Association with Child Linear Growth: A Multi-Country DHS Analysis in East Africa (P10-013-19)

Abstract

ObjectivesThe reduction of child stunting in the East African region remains slow, emphasizing the need to examine the contributions of less commonly studied determinants of linear growth faltering. The purpose of this study was to determine the association between the newly issued WHO and UNICEF Joint Monitoring Programme WASH indicators and child length in East Africa. MethodsThe most recent Demographic and Health Survey (DHS) nationally representative data from Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Data from young children aged 6–23 months were included in the analyses. The association between individual water, sanitation and hygiene indicators and length-for-age (LAZ) was analyzed using linear regression models while controlling for the known child, maternal, and household characteristics for each country. ResultsStunting rates were very high in all countries (more than 25%) reaching 44.6% in Burundi. In most of the countries, more than half of the population did not have improved WASH indicators. Better drinking water was significantly associated with higher LAZ in Burundi (b = 0.05, P < 0.05, R2 = 0.24), Kenya (b = 0.04, P < 0.01, R2 = 0.14), Tanzania (b = 0.06, P < 0.01, R2 = 0.21), and Zambia (b = 0.05, P < 0.05, R2 = 0.19) in the adjusted models. Improved sanitation facilities were associated with LAZ in Ethiopia (b = 0.20, P < 0.001, R2 = 0.24) and Uganda (b = 0.12, P < 0.05, R2 = 0.20). Lastly, the positive association between LAZ and hygiene practices remained significant after adjustments only in Ethiopia (b = 0.04, P < 0.01, R2 = 0.23). ConclusionsImproved water quality was associated with better LAZ in most countries. Integrating nutrition interventions with WASH components for young children might be effective in reducing high child stunting rates in East Africa. Funding SourcesNone.