Water, sanitation and hygiene (WASH) and its association with stunting in developing countries in Asia: A systematic review
DOI:
https://doi.org/10.70347/svsthya.v2i2.81Keywords:
Stunting, water, sanitation, hygiene, toddler, public health, enviromental healthAbstract
Stunting is a vital health issue in developing Asian countries, where millions of individuals suffer from chronic malnutrition. Stunting not only is caused by chronic malnutrition but is also influenced by inadequate water supply, sanitation problems, and poor hygiene practices in the community. However, research on water, sanitation, and hygiene (WASH) and its association with stunting is limited, particularly in developing countries. This study aimed to analyze the associations between water, sanitation, and hygiene practices and the occurrence of stunting in Asia. This article is a systematic literature review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A total of 1,002 articles were reviewed, of which 560 were published. Additionally, articles could be selected and dropped because they had no original research. After duplicate articles were removed, 168 articles were removed. The screening and extraction results revealed 14 articles eligible for review. After the article was reviewed and read, only five articles were eligible, and only 5 articles could be reviewed because the article discussed WASH and stunting in developing countries in Asia. Inadequate WASH practices were strongly associated with stunting among children under five years of age. An insufficient water supply and access to safe drinking water contribute to this condition, as inadequate water availability can increase the risk of stunting. Additionally, groundwater unfit for consumption increases the likelihood of undernutrition, including stunting, underweight, and wasting in children. Access to improved drinking water sources is essential for reducing stunting, as households with such access report lower stunting rates. Solutions to address stunting in children under five years of age include enhancing drinking water sources, improving sanitation facilities, and promoting better hygiene practices. Local governments should provide adequate water provision and accessible drinking water.
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References
De Onis M, Blössner M, Borghi E. Prevalence and trends of stunting among preschool children, 1990-2020. Public Health Nutr 2012;15:142–8. https://doi.org/10.1017/S1368980011001315.
Vilcins D, Sly PD, Jagals P. Environmental risk factors associated with child stunting. Ann Glob Health 2018;84:551–62. https://doi.org/10.9204/aogh.2361
WHO. Joint child malnutrition estimates. World Health Organization 2022. https://www.who.int/data/gho/data/themes/topics/joint-child-malnutrition-estimates-unicef-who-wb (accessed August 29, 2024).
Food and Agriculture Organization (FAO). Regional overview of food security and nutrition 2023: statistics and trends., Bangkok: Food and Agriculture Organization of The United Nations; 2023. https://doi.org/https://doi.org/10.4060/cc8228en.
Farera G, Karo MB, Manullang RS. Multifactorial determinants of adolescent stunting in West Java, Indonesia: A cross-sectional analysis among students aged 13–15 years. Svāsthya: Trends in General Medicine and Public Health 2024;1:e17. https://doi.org/10.70347/svsthya.v1i3.17.
Mudadu Silva JR, Vieira LL, Murta Abreu AR, de Souza Fernandes E, Moreira TR, Dias da Costa G, et al. Water, sanitation, and hygiene vulnerability in child stunting in developing countries: a systematic review with meta-analysis. Public Health 2023;219:117–23. https://doi.org/10.1016/j.puhe.2023.03.024.
Wolf J, Johnston RB, Ambelu A, Arnold BF, Bain R, Brauer M, et al. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes. The Lancet 2023;401:2060–71. https://doi.org/https://doi.org/10.1016/S0140-6736(23)00458-0.
Kwami CS, Godfrey S, Gavilan H, Lakhanpaul M, Parikh P. Water, sanitation, and hygiene: Linkages with stunting in rural Ethiopia. Int J Environ Res Public Health 2019;16. https://doi.org/10.3390/ijerph16203793.
Ademas A, Adane M, Keleb A, Berihun G, Tesfaw G. Water, sanitation, and hygiene as a priority intervention for stunting in underfive children in northwest Ethiopia: a community-based cross-sectional study. Ital J Pediatr 2021;47:1–11. https://doi.org/10.1186/s13052-021-01128-y.
Adrizain R, Faridah L, Fauziah N, Berbudi A, Afifah DN, Setiabudi D, et al. Factors influencing stunted growth in children: A study in Bandung regency focusing on a deworming program. Parasite Epidemiol Control 2024;26:e00361. https://doi.org/10.1016/j.parepi.2024.e00361.
Mbuya MNN, Humphrey JH. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: An opportunity for stunting reduction in developing countries. Matern Child Nutr 2016;12:106–20. https://doi.org/10.1111/mcn.12220.
Hasanah I, Susanti H. Does water and sanitation effects on children’s physical development? Evidence from Indonesia Family life Survey (IFLS) 2014. E3S Web Conf 2018;74. https://doi.org/10.1051/e3sconf/20187409007.
United Nations. Transforming our world: The 2030 agenda for sustainable development. New York: United Nations, Department of Economic and Social Affairs 2015;1:41. https://sdgs.un.org/2030agenda (accessed September 28, 2024).
Batool M, Saleem J, Zakar R, Butt MS, Iqbal S, Haider S, et al. Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan. BMC Public Health 2023;23:1–7. https://doi.org/10.1186/s12889-023-17135-z.
Adnyana IMDM. Meta Analisis. In: Akbar H, editor. Biostatistika Epidemiologi. 1st ed., Bandung: CV. Media Sains Indonesia; 2023, p. 185–205.
Conway K, Akseer N, Subedi RK, Brar S, Bhattarai B, Dhungana RR, et al. Drivers of stunting reduction in Nepal: a country case study. Am J Clin Nutr 2020;112:844S-859S. https://doi.org/10.1093/ajcn/nqaa218.
Rahut DB, Mishra R, Bera S. Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia. Nutrition 2024;120:112346. https://doi.org/10.1016/j.nut.2023.112346.
Dimitrova A, Muttarak R. After the floods: Differential impacts of rainfall anomalies on child stunting in India. Glob Environ Change 2020;64:102130. https://doi.org/10.1016/j.gloenvcha.2020.102130.
Shofifah A, Lilis Sulistyorini, Sarva Mangala Praveena. Environmental sanitation at home and history of infection diseases as risk factors for stunting in toddlers in Drokilo Village, Kedungadem District, Bojonegoro Regency. J Environ Health 2022;14:289–95. https://doi.org/10.20473/jkl.v14i4.2022.289-295.
Cameron L, Chase C, Haque S, Joseph G, Pinto R, Wang Q. Childhood stunting and cognitive effects of water and sanitation in Indonesia. Econ Hum Biol 2021;40:100944. https://doi.org/10.1016/j.ehb.2020.100944.
WHO. Stunting in a nutshell 2015. https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell (accessed September 28, 2024).
Ritchie H. What is childhood stunting? 2022. https://ourworldindata.org/stunting-definition (accessed September 28, 2024).
Suratri MAL, Putro G, Rachmat B, Nurhayati, Ristrini, Pracoyo NE, et al. Risk factors for stunting among children under five years in the province of East Nusa Tenggara (NTT), Indonesia. Int J Environ Res Public Health 2023;20. https://doi.org/10.3390/ijerph20021640.
Nur T, Lukman E, Anwar F, Riyadi H, Harjomidjojo H, Martianto D. Birth Weight and length associated with stunting among children under-five in Indonesia. J Gizi Pangan 2021;16:99–108.
Imam A, Hassan-Hanga F, Sallahdeen A, Farouk ZL. A cross-sectional study of prevalence and risk factors for stunting among underfives attending acute malnutrition treatment programmes in northwestern Nigeria: Should these programmes be adapted to also manage stunting? Int Health 2021;13:262–71. https://doi.org/10.1093/inthealth/ihaa043.
Cameron L, Chase C, Haque S, Joseph G, Pinto R, Wang Q. Childhood stunting and cognitive effects of water and sanitation in Indonesia. Econ Hum Biol 2021;40:100944. https://doi.org/10.1016/j.ehb.2020.100944.
Berendes D, Capone D, Knee J, Holcomb D, Sultana S, Pickering AJ, et al. Associations between enteric pathogen carriage and height-for-age, weight-for-age and weight-for-height in children under 5 years old in urban Dhaka, Bangladesh. Epidemiol Infect 2020. https://doi.org/10.1017/S0950268820000369.
Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Open 2015;5:e005180. https://doi.org/10.1136/bmjopen-2014-005180.
Audiena NP, Siagian ML. Association between infectious disease and hygiene practice on stunting toddler aged 24-59 months. Amerta Nutrition 2021;5:149. https://doi.org/10.20473/amnt.v5i2.2021.149-157.
Ravsanjanie MM, Pawitra AS, Diyanah KC, Zakaria ZA, Marmaya NHBTE. Utilization of clean water, personal hygiene of toddler caregivers, and smoking behavior of family members as risk factors for cases of stunting toddlers. J Environ Health 2021;13:48–56. https://doi.org/10.20473/jkl.v13i1.2021.48-56.
Rohmah M, Arini. Parental knowledge and personal hygiene practices associated with stunting incidence in children 24-60 months old in Mlarak Village Ponorogo. J Res Public Health 2023;5:42–9. https://jrph.org/index.php/JRPH/article/view/61
Purba IG, Sunarsih E, Trisnaini I, Sitorus RJ. Environmental sanitation and incidence of stunting in children aged 12-59 months in Ogan Ilir regency. J Environ Health 2020;12:189–99. https://doi.org/10.20473/jkl.v12i3.2020.189-199.
Ernawati R, Nurjanah M, Wahyuni T. The Correlation of environmental sanitation with stunting incidents in school-age children. Indonesian J Glob Health Res 2024;6:553–64. https://jurnal.globalhealthsciencegroup.com/index.php/IJGHR/article/view/2994
Pradana VN, Suparmi S, Ratnawati R. Personal hygiene, water availability, and environmental sanitation with the incidence of stunting in toddlers aged 6–59 months in the working area of the Singorojo I Public Health Center, Kendal Regency. Amerta Nutrition 2023;7:421–6. https://doi.org/10.20473/amnt.v7i3.2023.421-426.
Manalu SMH, Syaputri D, Bambang S ThT, Tanjung N, Tanjung R, Damanik AP. The effect of clean water facilities and household food sanitation hygiene on stunting in toddlers. Contagion Sci Period J Public Health Coastal Health 2023;5:969. https://doi.org/10.30829/contagion.v5i3.17239.
Sahiledengle B, Petrucka P, Desta F, Sintayehu Y, Mesfin T, Mwanri L. Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study. BMC Public Health 2024;24:1–14. https://doi.org/10.1186/s12889-024-18931-x.
Larsen DA, Grisham T, Slawsky E, Narine L. An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea: Evidence from DHS and MICS surveys. PLoS Negl Trop Dis 2017;11:1–13. https://doi.org/10.1371/journal.pntd.0005591.
Vyas S, Kov P, Smets S, Spears D. Disease externalities and net nutrition: Evidence from changes in sanitation and child height in Cambodia, 2005–2010. Econ Hum Biol 2016;23:235–45. https://doi.org/10.1016/j.ehb.2016.10.002.
Dearden KA, Schott W, Crookston BT, Humphries DL, Penny ME, Behrman JR. Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam. BMC Public Health 2017;17:1–19. https://doi.org/10.1186/s12889-017-4033-1.
Chakrabarti S, Singh P, Bruckner T. Association of Poor Sanitation With Growth Measurements Among Children in India. JAMA Network Open 2020;3:e202791. https://doi.org/10.1001/jamanetworkopen.2020.2791.
UNICEF. The Impact of Poor Sanitation on Nutrition. Sanitation and Hygiene Applied Research for Equity 2014:1–12. https://thousanddays.org/wp-content/uploads/The-Impact-of-Poor-Sanitation-on-Nutrition-1.pdf
Bekele T, Rawstorne P, Rahman B. Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: A systematic review and meta-analysis. BMJ Open 2020;10:1–12. https://doi.org/10.1136/bmjopen-2019-034812.
Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia. Sci Rep 2022;12:1–11. https://doi.org/10.1038/s41598-022-23981-5.
Jokhu LA, Syauqy A. Determinants of concurrent wasting and stunting among children 6 to 23 mo in Indonesia. Nutrition 2024;122. https://doi.org/10.1016/j.nut.2024.112390.
De Vita A, Licciardo GD, Femia A, Di Benedetto L, Pau D. μw Preprocessing Unit for Virtual Sensors Based on Tri-axial Smart Accelerometers. 17th IEEE International New Circuits and Systems Conference, NEWCAS 2019 2019:12–5. https://doi.org/10.1109/NEWCAS44328.2019.8961264.
Mzumara B, Bwembya P, Halwiindi H, Mugode R, Banda J. Factors associated with stunting among children below five years of age in Zambia: Evidence from the 2014 Zambia demographic and health survey. BMC Nutrition 2018;4:1–8. https://doi.org/10.1186/s40795-018-0260-9.
Biswas S, Chattopadhyay A, Shaw S, Hoffmann R. Assessing groundwater quality and its association with child undernutrition in India. Sci Total Environ 2024;943:173732. https://doi.org/10.1016/j.scitotenv.2024.173732.
Wicaksono RA, Arto KS, Mutiara E, Deliana M, Lubis M, Batubara JRL. Risk factors for stunting in indonesian children aged 1 to 60 months. Pediatr Indones 2021;61:12–9. https://doi.org/10.14238/pi61.1.2021.12-9.
Dangour AD, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, et al. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Cochrane Database Syst Rev 2013;2013. https://doi.org/10.1002/14651858.CD009382.pub2.
Agyen VA, Annim SK, Asmah EE. Neighborhood mothers’ education and its differential impact on stunting: Evidence from 30 Sub-Saharan African countries. Soc Sci Med 2024;340:116462. https://doi.org/10.1016/j.socscimed.2023.116462.
Olakunle AA. Analyzing the drivers of stunting reduction in twelve subsaharan African countries using the RIF decomposition approach. BMC Public Health 2024;24. https://doi.org/10.1186/s12889-024-19327-7.
Cumming O, Cairncross S. Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Matern Child Nutr 2016;12:91–105. https://doi.org/10.1111/mcn.12258.
Sari DP, Yusuf S, Andid R, Darussalam D, Dimiati H, Amna EY. Water, sanitation, and hygiene (WASH) factors associated with stunting among underfives: A hospital-based cross-sectional study in Banda Aceh, Indonesia. AcTion Aceh Nutrition J 2024;9:614. https://doi.org/10.30867/action.v9i3.2022.
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