Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links

Abstract

There is scarce research and programmatic evidence on the effect of poor water, sanitation, and hygiene (WASH) conditions of the physical environment on early child cognitive, sensorimotor, and socioemotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first 3 years of life, when gut health and linear growth are established. We review evidence linking WASH, anemia, and child growth, and highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. We propose the concept of baby WASH as an additional component of early childhood development programs.

Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh

“…28 One potential intervention that has been piloted in rural Zimbabwe is the use of playpens that provide a hygienic play space, which reduces child contact with microbiological contamination in their environment. 44 Future studies should evaluate the efficacy of this intervention in reducing exposure to enteric pathogens, EE, and stunting in susceptible pediatric populations.…”

The International Scale of the Groundwater Issue

“…Baldursson and Karanis (2011) give a comprehensive review of worldwide waterborne disease outbreaks that occurred and were documented between 2004 and 2010. Similarly, a recent study based on a systematic review by Ngure et al (2014) provides a global assessment of drinkingwater microbial contamination. All incidence of waterborne diseases cannot be attributed to groundwater, because microbial contamination of water can occur in surface water bodies and in distribution pipes.…”

Application of Luminex Gastrointestinal Pathogen Panel to human stool samples from Côte d’Ivoire

“…EE is characterized by small-intestinal inflammation, reduced absorptive capacity, and increased intestinal permeability. Consequently, asymptomatic enteric infections could represent not only a crucial source of new infections, but they also contribute to worsening the state of malnutrition and making people more susceptible to infectious diseases [2,7].…”

“…They are caused by a wide range of viruses, bacteria, and parasites, which are linked by the common fecal-oral transmission route and diarrheal disease. The highest burden of infections is concentrated in areas characterized by poor water, sanitation, and hygiene (WASH), and affects mostly children and young adults [2][3][4]. In sub-Saharan Africa, the mortality rate due to acute diarrhea varies from 1.9% in Gambia and 9% in Côte d'Ivoire, up to 37% in Nigeria [5][6].…”