Water, sanitation, and hygiene (WASH) factors associated with growth between birth and 1 year of age in children in Soweto, South Africa: results from the Soweto Baby WASH study

Abstract

Interventions to reduce undernutrition and improve child growth have incorporated improved water, sanitation, and hygiene (WASH) as part of disease transmission prevention strategies. Knowledge gaps still exist, namely, when and which WASH factors are determinants for growth faltering, and when WASH interventions are most effective at improving growth. This study drew cross-sectional data from a longitudinal cohort study and used hierarchical regression analyses to assess associations between WASH factors: water index, sanitation, hygiene index, and growth: height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) at 1, 6, and 12 months postpartum among infants a priori born healthy in Soweto, Johannesburg. Household access to sanitation facilities that were not safely managed was associated with a decrease in HAZ scores at 1 month (β = −2.24) and 6 months (β = −0.96); a decrease in WAZ at 1 month (β = −1.21), 6 months (β = −1.57), and 12 months (β = −1.92); and finally, with WHZ scores at 12 months (β = −1.94). Counterintuitively, poorer scores on the hygiene index were associated with an increase at 1 month for both HAZ (β = 0.53) and WAZ (β = 0.44). Provision of safely managed sanitation at household and community levels may be required before improvements in growth-related outcomes are obtained.

The risk to child nutrition during and after COVID-19 pandemic: what to expect and how to respond

“…Priorities have shifted to COVID-19 emergencies, which have affected household income and the building of safe and healthy communities with clean water, adequate sanitation, and appropriate hygiene. However, now, more than ever, these programs and interventions are essential to avoid child undernutrition and to avert other infection-related diseases (14) .…”

Infection, nutritional status, and body composition: Associations at birth and 6 months postnatally in Soweto, South Africa

“…This study comprises a cross‐sectional analysis of anthropometric and body composition measures at 6 months postnatally. This data originates from a larger study entitled “Interaction between nutrition, infection, household environment and care practices and their impact on growth and development in infants between birth and one year of age,” colloquially also known as the Soweto Baby WASH (SBW) study (Momberg et al, 2020). The aims of the SBW study were to record maternal and infant morbidity and illness, household environment, and infant feeding and care practices as well as assess associations with infant nutritional status and development between birth and 1 year postnatally.…”

“…The Soweto Baby WASH Study received clearance from the University of the Witwatersrand's Human Research Ethics Committee (Medical) (Certificates: M170753, M170872, and M170955) (Momberg et al, 2020). In addition to this, written informed consent was obtained from all participants.…”

“…This questionnaire was adapted to match the study setting. Due to the weekly visits up to 6 months, any illness episodes within a 7‐day period were recalled and recorded for that week (Momberg et al, 2020).…”

“…An interviewer‐administered questionnaire locally adapted from the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Infant and Young Child Feeding Questionnaire was used to assess infant feeding practices (World Health Organization (WHO), 2008). The WHO definition for exclusive breastfeeding (EBF) was used to determine infant feeding practices up to 6 months (Momberg et al, 2020). The WHO definition allows breastmilk, expressed or from a wet nurse, oral rehydration solution, drops, and syrups to be classified as EBF, but nothing else (World Health Organization, 2008).…”