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Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 175-179

WASH practices in childhood stunting – A narrative review article

School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Submission06-Dec-2021
Date of Decision16-Feb-2022
Date of Acceptance28-Mar-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Neha Gurbani
School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_451_21

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Childhood stunting, malnutrition, and WASH practices censure millions of people around the globe to a life of drawbacks and physical impairment. Diarrhea and weak development which have interminable effects on well-being of a child are mostly due to malnourishment, dietary deficiency, and exposure to contamination. Stunting is a composite challenge with reactions of those who got affected because of it and the community as a whole. To fasten the process in removing stunting, the efforts required should be broad to reach the level of the sector in nutrition to gear the underlying reasons of malnutrition. To make faster progress in eradicating stunting, more initiatives are required that go beyond dietetics to label the fundamental sources of malnourishment. According to the research reviewed, inadequate WASH situations have a significant detrimental influence on child development and growth, owing to long-term exposure to intestinal pathogens as well as larger social and economic causes. To fully realize the promise of WASH to reduce stunting, attempts to attain a universal approach to these facilities, as envisioned by the Sustainable Development Goals, must be redoubled. It can also necessitate new or converted WASH techniques that can go past typical treatments to target exposure routes in the first 24 months of life when the stunting process is mostly absorbed. The interest is increasing in whether water, sanitary practice, and hygiene (WASH) interference can help plans in reducing stunting and it may also need new and upgraded WASH techniques and plans that should work above the traditional plans in reducing the divulgence of child's early 24 months of life when the procedure of stunting is evaporated.

Keywords: Childhood stunting, early child development, sanitation, stunting, WASH, wasting

How to cite this article:
Gurbani N, Dhyani A, Ammarah S, Baghel P. WASH practices in childhood stunting – A narrative review article. J Datta Meghe Inst Med Sci Univ 2022;17:175-9

How to cite this URL:
Gurbani N, Dhyani A, Ammarah S, Baghel P. WASH practices in childhood stunting – A narrative review article. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 16];17:175-9. Available from: http://www.journaldmims.com/text.asp?2022/17/1/175/352243

  Introduction Top

India is among the largest countries in the world which comprises one-sixth of the world's population. Although India has made progress across the time between 2006 and 2016 in the reduction of stunting among children.[1] The dissimilarity which was autoroute seen in reducing the stunting was in the factors of common national policy structure for plans that include health and nutrition, food security, and nutrition.[2]

There are many studies globally of how the countries have achieved in reducing stunting so far. There are many success stories of national-level stunting depletion from Bolivia, Nepal, Brazil, and Bangladesh where the policy action was taken by the requirement to eliminate hunger. The research should be enlarged on subnational stunting reduction if it can help provide the interplay between national policies and plan frameworks and customized measures at a subnational level.[3]

The key indicator of chronic undernutrition is immature for age or sociodemographic weak development in youngsters. Despite significant and sustained economic progress, India is a silhouette with a high prevalence of stunted growth. Studies reveal that the ongoing trends in India are because of the practices to defecate in open and unhealthy sanitation.[4] Despite good personal sanitation habits, individual people lead to fecal pathogens because of the behavior of open defecation that brings high negative externality. The water and environment surround contamination of water with dirty microorganisms which leads to diseases and decreases the absorption of nutrients, which leads to stunting and long-term malnourishment.

Almost half of the household population in India has been following open defecation for so long, and there is a lack of approach to pure water to drink. India reports for around one-third of the world's load of children with a low height for age.[5]

Cluster stunting has declined by 10% points in India over the last NFHS decade, from 47% in 2006 to 07–37% in 2014–2015. Although the reduction has been decided with considerable state-level stratification. In 2014–2015, Bihar, a northern Indian state, had the greatest percentage of stunted children, with 47% of children under the age of 5 stunted, while Kerala, a demographically contemporary southern Indian state, had the lowest, with 25%. Upper outliers with the highest fertility and percentage of stunting in childhood are Uttar Pradesh, Bihar, and Madhya Pradesh, whereas lower outliers with the lowest fertility and percentage of stunting in childhood are Odisha, Punjab, and Tamil Nadu. There are two key explanations for such variation in child nutrition between states, according to studies: “covariate effects” and “coefficient effects.”[6] Differences in qualities such as affluence, cleanliness, education, food, and childcare practices can exist between two states. The term “covariate effects” is used to describe this.

The study which is going on presently lies in assessing the role of sanitation practices and ingesting habits which explain the differences between states. It is now widely acknowledged that child feeding practices and dietary range are examples of nutrition behavior that has played a critical role in determining the status of childhood stunting.[7] However, in most regions of India, major factors in the environment that have influenced the high rate of stunting in children and bad child well-being results are a preference to open defecation and unimproved sanitation facilities according to recent studies. The sanitary practices which are unhealthy and inadequate hygiene in the community and at home wreak havoc on the environment in the neighborhood by introducing disease-carrying organisms that might cause intestinal or enteric disorders, which impact children with shorter statures more than mortality.[8]

The youth of today will be the citizens of the future. It is critical to think about a child's well-being not just as an investment in a country's future providence but also as a vital measure of the country's standard of living. Usually, the development of a child's physical and mental health takes place in the early school-going stage of his life.[9] However, above all, a lack of adequate nourishment in primary school-going children can give rise to various health conditions such as easy vulnerability to common diseases in childhood such as diarrhea and respiratory diseases which can lead to poor classroom performance, high absent students, low school admissions, and higher dropout rates.[10] Currently, school health services are primarily concerned with children's dietary support and clinical evaluation. These inputs are critical, but it is also necessary to educate youngsters about personal cleanliness, which is linked to the aforementioned aspects directly or indirectly. In light of the foregoing, the research was carried out with the following goals in mind:

  1. To evaluate the dietetics level of primary school children (6–12 years) in that study region
  2. To evaluate the individual cleanliness exercises of primary school children.

Both anemia and stunting are primarily caused by three immediate sources: (a) poor quality, quantity, and divergence of children's foodstuffs combined with substandard feeding and safekeeping practices; (b) insufficient dietetics and care for women; and (c) high figures of communicable infections due, first and foremost, to a deleterious atmosphere, a lack of approach to necessary health services, and/or unhealthy practices. The association between anemia and household cleaning methods is less well known.[11] Inflammation, after iron deficiency, is the second most usual cause of anemia, and it leads to illnesses such as diarrhea and severe respiratory infections, which are linked to poor WASH services and practices.

  Methodology Top

A literature search was done systematically on various journal indexes such as PubMed, Embase, Google Scholar, and others to identify various studies done about WASH practices and childhood stunting. The major keywords used were childhood stunting, sanitation, WASH practices, and WASH. Articles from the last year were included, and the other data were collected through various relevant publications. To select samples for the investigation, a multistage stratified two-stage cluster sampling approach was used. The data set for children was built on woman and family surveys, and it covered children under the age of 5.

Can clean drinking water, sanitation, and hygiene help to reduce stunting?

The links between inadequate WASH and stunting in childhood are complicated, involving various straight botanical pathways as well as other wider, less direct ones. To comprehend this, it is crucial to position the normally finer studied straight botanical links within a larger socioeconomic structure that takes into account components such as water supply and sanitation facility accessibility and affordability. Regardless of the origin, the prevalence of diarrheal sickness as a syndrome is closely linked to growth failure.

It is difficult to establish a relationship between diarrhea and malnutrition since malnutrition may increase the frequency and severity of diarrhea. Infections during pregnancy can cause nutritional assimilation and maternal anemia, both of which are linked to birth stunting. These changes in gut function and composition might have serious effects for children, such as growth, early development of the child, and immune function problems. Although additional study on WASH and stunting is required, it has been suggested that EED, rather than diarrhea, can be the key causative apparatus between WASH and child growth.

The energy price of transporting water over vast intervals from the origin to the dwelling is another crucial link. When water is carried by professional dealers, as is more typically the case in metropolitan regions, the cost to the consuming family is much higher. The poor suffer by far the greatest price for water, leaving them with inadequate finances to eat a healthy diet. Given the role of food in determining mortality, many of the poor pay with their lives for water. WASH may appear to be the Holy Grail of community-based nutrition activities, enabling savings for more food, particularly for the poorest.

Because water is seen as a “women's industry,” the savings flow straight to the housewife and mother, the household member most likely to guarantee that children welfare. The scarcity of research in the writings demonstrating this demonstrates the challenge of cross-sectoral sight and teamwork. Hopefully, now the time is more knowledgeable, when nutritional advantages may be obtained through more nuanced interventions than just passing out food.

Priorities for a nutrition-conscious WASH sector

While investigation research is needed to improve future nutrition-conscious WASH treatments, clear themes appear from the current knowledge center that might aid in the development of nutrition-conscious WASH initiatives. In spirit, the problem is to make sure that the appropriate treatments are delivered to the appropriate individuals at the appropriate time. This implies ensuring that communities with a high prevalence of stunting are selected with suitable WASH measures besides more traditional nutrition-particular interventions before or when growth falters. To guarantee that young children are secured from enteric infections, interventions that go beyond the usual collection of WASH initiatives, such as “better” water and sanitation as explained under the MDG objective, may be required to reach and protect individuals at risk.

The first step in determining which WASH treatments are likely to be most effective is to identify prominent fecal–oral disclosure routes for children who are young when they are most exposed to the adverse results of polluted surroundings. WASH initiatives that objective crucial disclosure points for children who are young, such as enhancing baby and early child feeding, should be addressed alongside nutrition-specific targets. Targeting WASH interventions at stunted citizens has two public health benefits: first, stunting reductions may be hastened if WASH interventions intentionally target children at risk, and second, the influence of WASH on diarrhea and other infections may be intensified by targeting malnourished children who are more exposed to infection and associated mortality.

  Results Top

Overall in the study above, 65% of mothers had >5 years of education. Almost 82% of the families had a plan for better water and 55% had a plan for better sanitation. Despite this, just 32% of families utilized water to make it clean to drink. More than 55% of caretakers said that they always cleansed their hands after assisting the child with defecation as well as after using the restroom. However, only 38% of people cleansed their hands before cooking.

  Discussion Top

The studies discovered that not only WASH practice but also stunting schedule, household earnings, and height of maternal side have an authentically noteworthy relationship with stunting retrieval. Most certainly, the examination disclosed that the children who were scrubbed at mature age had excessive possibilities of retroceding to normal in age up to 24 months.[11] However, there is a scarcity of information about such a growth path. Several studies have found that as people get older, the rate at which their immune systems become more effective. This can be a feasible description of the findings with regard to the role of the schedule of stunting on the turnaround situation of stunting in this division of children.[12]

Dietary diversity has also been recognized in several studies as a useful indicator of micronutrient consumption in newborns and early children. Micronutrients, such as zinc, selenium, iron, copper, Vitamins A, C, E, and B6, as well as folic acid, help the immune system by building up epithelial barriers and cellular and humoral immune responses. If a child is not getting sufficient consumption of these vitamins and microelements, then that can cause immune repression and it could direct that child to infection and in time malnourishment.[13] According to the discussion above, children from financially stable households consume a variety of foods that help them strengthen their immune systems and retrieve from stunting. However, the above declaration demands further inspection.[14]

The primary goal of this study was to determine the impact of WASH methods on stunting retrieval. Even after regulating for the confounders, the study did not discover any noteworthy outcome of cleansing exercises on retrieval from stunting.[15] Although they were not able to discover any descriptive studies narrating that relationship, water, sanitation, and handwashing had little influence on children's linear development, according to a recent cluster-randomized experiment.[16] It did show that the links between poor washing habits and stunting are complicated. As a result, more research is needed to regulate the precise benefit of WASH methods on the development of disability. According to the discovery of the ongoing study, at finest, they can suppose that only providing of sufficient WASH convenience and hygienic exercises would alone not put an end to stunting in assets-poor situations.[17]

Despite having rapid macroeconomic growth, India has long been chastised for making sluggish progress in the fight against childhood stunting. There have been many studies done on those who attempted to recognize the correlates of childhood stunting, in which there are very few who have traversed the relation of covariates through the whole dispersal of stunting and labeled the broad space in development between the Indian states.[18] Unhealthy sanitary practices, rather than a need of effort to upgrade the nutrition quality, have been blamed for India's dismal growth in childhood stunting, according to a growing body of literature.[19] The current study adds to the existing literature by examining the comparable significance of community-level disease atmosphere and nutrition practices in determining juvenile stunting.[20]

The main aim of public plans and schemes is to supply products and assistance at a minimal amount to the deprived segments of the community.[21] If public schemes work well, the impact of a family's socioeconomic position and other maternal and child well-being metrics on stunting of a child should not be demographically noteworthy. That is due to the lFEow-cost products and assistance were given to the poorer segments of the community will have a significant impact on growing their situations than their acquiring ability.[22]

In conclusion, the findings come up with a rigorous confirmation of the character of WASH practices that are associated with a childhood development disability.[23] There is no consequence of WASH practices on retrieval from stunting in this group of children.[24] Although the schedule of stunting had a rigidly noteworthy partnership with regaining from stunted growth at age up to 24 months. This study detection specifies that plans to avert the development of disability should be administered at the advanced feasible interval in the untimely path of life.[25]

  Conclusion Top

Macroeconomic growth may be important but not an adequate state in enhancing the nutrition of a child. For example, in spite of steady economic growth, the use of radical social plans prompted market-balanced refinements such as synergetic organization, which included the poor and needy citizens in the apparatus of growth and development of national, dietetic, and social plans, resulting in a remarkable depletion in poverty and undernutrition.

Children who are suffering from weak development those who do not have good immunity and those who are at higher risk of being infected cannot be neglected from schemes and health facilities observing the failure of growth. Thus, efforts are needed to protect the children who are stunted from getting diseases and the long-term consequences of childhood growth negligence. Coproduction is defined as producing public goods and services that are of importance to them by which the citizens of the country can actively take part in setting up the policies and schemes. The main aim is to make the community realize their responsibilities toward the reduction of stunting in children by focusing on the circumstances.

There are no policies or plans that define stunting accurately. The studies and findings define that the difference and identification between the stunting cases that are severe and moderate should be more influential in managing and reduction of the misfortune. This study supports that there should be a feeling of possession of the difficulty of stunting in children among the planning customers in the community that integrates nutrition and sanitation interventions to build up the impact of plans on the result.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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