Expanding the WASH Perspective: How do Water, Animals, Sanitation, and Hygiene Relate to Child Height?
Fierstein, Jamie.
2017
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Abstract: The lack of safe water, sanitation, and hygiene (specifically hand
washing) (WASH) is responsible for millions of cases of infectious diarrhea in children
under five. Childhood enteric infections lead to malnutrition, inflammation, and
ultimately, stunted growth. Low height-for-age (HAZ) (i.e., stunting) is associated with
diminished cognition, suppressed immunity, and reduced econom... read moreic productivity in adulthood.
Although the underlying framework between WASH and child height is well established, the
empirical evidence is limited. The question of whether the individual components of
household WASH are synergistic in relation to child height remains unanswered, as does the
problem of whether household and neighborhood WASH act together to influence child height.
One reason for the inconsistency is that observational WASH studies often do not adjust for
child dietary intake. Another reason is that WASH research has focused on human fecal
contamination, but in impoverished areas where households depend on domestic animals for
food and income, domestic animal feces may also play a role in child height. This
dissertation is comprised of three papers on the relationship between child HAZ and water,
animals, sanitation, and hygiene. We used the 2011 Uganda Demographic and Health Survey to
perform multiple linear regressions adjusted for dietary intake of children under two.
Paper 1 evaluated the relationship between child HAZ and household ownership of native
cattle, nonnative cattle, goats, sheep, chickens, and pigs. We found that nonnative cattle
ownership was positively associated with HAZ in rural children 0 to < 2 years old (+1.32
HAZ; 95% confidence interval [CI]: 0.2 to 2.5) and 2 to < 5 years old (+0.58 HAZ; 95%
CI: 0.003 to 1.2), and urban children 2 to < 5 years old (+1.08 HAZ; 95% CI: 0.38 to
1.8). Sheep ownership was positively associated with HAZ in rural children 2 to < 5
years old (+0.29 HAZ; 95% CI: 0.002 to 0.58) and goat ownership was positively associated
with HAZ in rural children 0 to < 2 years old (+0.27 HAZ; 95% CI: 0.003 to 0.55).
Children that lived in households that owned nonnative cattle consumed dairy more
frequently; yet the relationship between child HAZ and nonnative cattle ownership was not
mediated by child dairy consumption. Paper 2 evaluated the relationship between HAZ of
children under five and the individual and combined elements of household water,
sanitation, and hygiene. We found that water treatment was positively associated with HAZ
in rural households (+0.25 HAZ; 95% CI: 0.02 to 0.41), and that hand washing with water and
soap was positively associated with HAZ in urban households (+0.43 HAZ; 95% CI: 0.02 to
0.6). In addition, we used a Guttman scale to determine that most households adopted WASH
improvements in the following order: 1) Drinking water, 2) water treatment, 3) sanitation,
and 4) hand washing with water and soap. Paper 3 evaluated the relationship of child HAZ
with the combined effect of neighborhood and household sanitation, as well as with the
effect of neighborhood ownership of goats, chickens, and pigs. We observed that improved
sanitation of the surrounding households had a significant benefit for the height of
children who lived in households with unimproved sanitation infrastructure, but we did not
observe this relationship for children who lived in households with existing improved
sanitation. We also found a positive relationship between child HAZ and neighborhood goat
ownership (+0.006; 95% CI: 0.002 to 0.01) in rural areas, but no evidence for a mediating
effect of meat or dairy consumption. This research indicates that the WASH sector continue
to prioritize the prevention of child exposure to human fecal contamination in the
household and neighborhood. Sanitation may be a primary building block for child height,
since children from unsanitary households can benefit from the sanitation investments of
their neighbors. We found that domestic animals may not be detrimental to child height, and
that ownership of nonnative cattle, sheep, and goats is beneficial for child height. The
dual provision of household and neighborhood sanitation, optimal child feeding, and
promotion of modifiable WASH behaviors such as water treatment and hand washing, may be
effective approaches to prevent stunting.
Thesis (Ph.D.)--Tufts University, 2017.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Beatrice Rogers.
Committee: Janet Forrester, and Misha Eliasziw.
Keywords: Nutrition, and Public health.read less - ID:
- cj82kk68p
- Component ID:
- tufts:22747
- To Cite:
- DCA Citation Guide EndNote
