Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

Abstract

Stunting is a complex and enduring challenge with far-reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high-burden settings, such as South Asia and sub-Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.

Keywords: child nutrition; child public health; early growth; sanitation; stunting; water.

Figure 1

The ‘F‐diagram’. Source: Adapted from Wagner & Lanoix 1958 and Kawata 1978.

Figure 2

Typical breakdown of weekly household expenditure in low‐income areas of Khartoum, Sudan (1987). Source: Cairncross & Kinnear 1992.