Child-Sensitive WASH Composite Score and the Nutritional Status in Cambodian Children

Abstract

Progress in health has occurred in the past decades in Cambodia, in terms of health service access and interventions, but several indicators, including the prevalence of malnourished children, remain alarming. The causes of undernutrition are often linked to inadequate access to water, sanitation and hygiene services but limited evidence exists on the direct association between poor WASH practices and children’s’ nutritional statuses. This study investigates the relationship between water, sanitation and hygiene practices, defined as the child-sensitive composite score, and the nutritional status of children under five years old, measured as the weight-for-height z-score, mid-upper arm circumference or height-for-age z-score in six districts of Cambodia. The analysis used data from a longitudinal study, comprising extensive data collection on anthropometry, health, nutrition, WASH, and cognitive development. Chronological trends in wasting and stunting were described cross-sectionally, whereas the effect of WASH practices on the nutritional status of children over up to three consecutive study visits was examined with a linear mixed-effects model. The prevalence of wasting decreased during the study while stunting prevalence increased. A small, but significant, association was found between the WASH child-sensitive composite scores and the wasting child anthropometry indicators: weight-for-height z-score or mid-upper arm circumference. Evidence for an association with height-for-age z-score, detecting stunted children, was found when the independent variable was quantified according to global, but not national, guidelines. This study reinforces discordant existing evidence towards a direct association between WASH practices and children’s nutritional status, suggesting the need to align nutrition and WASH programmes.

The relationship between wasting and stunting in Cambodian children: Secondary analysis of longitudinal data of children below 24 months of age followed up until the age of 59 months

“…Parallelly, the increase in the stunting prevalence over time indicates that postnatal factors also contribute to the maintenance and development of stunting. Analyses conducted using the same data used for this study by other authors have identified several postnatal determinants of stunting in our study population, including inappropriate feeding practices, increased exposure to animal faeces leading to Giardia Duodenalis infection, high incidence of infections and inadequate water and sanitation practices [ 26 – 28 , 53 ]. Also, an interaction between wasting, infection and stunting in Cambodian under-five children has previously been documented [ 27 ].…”

“…However, this is common in many community-based studies. Also, previous publications from the original analysis of these data addressed some of these aspects [ 27 , 28 , 53 , 69 ]. These papers have suggested that infections may be contributing to the occurrence of stunting [ 27 , 53 , 69 ].…”

Maternal mid‐upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life

“…Infant and young child feeding practices were assessed per UNICEF and WHO indicators for appropriate breastfeeding (WHO, ), including early initiation of breastfeeding, breastfeeding status, duration of exclusive breastfeeding, and 24‐hr recall on breastfeeding and bottle frequency. The methodology of MyHealth longitudinal study presented in more details in our previous publications (Hondru et al, ; Manzoni et al, ; Som et al, ; Wieringa et al, ).…”

“…The present study used data collected under the Cambodian longitudinal study, "MyHealth," to quantify the impact of maternal MUAC on linear growth of infants during the first 3. (Hondru et al, 2019;Manzoni et al, 2019;Som et al, 2018;Wieringa et al, 2018).…”

The Association of Household Garbage Management and Socioeconomic with Underweight in Children Under Five in Lebak District and Tangerang City, Banten, Indonesia

“…Improving water, sanitation, and hygiene, as well as housing and access to health services, will promote a healthy environment, will reduce the prevalence of infectious diseases and may affect the decreasing prevalence of malnutrition (UNICEF, 2015). (Manzoni et al, 2019;Kwani et al, 2019).…”