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Water and sanitation associated with improved child growth

European Journal of Clinical Nutrition volume 57, pages 1562–1568 (2003)Cite this article

Abstract

Objective: To examine the relation between household water and sanitation, and the risk of stunting and reversal of stunting in Khartoum and Crezira regions Sudan.

Design: Prospective cohort study.

Setting: A total of 25 483 children aged 6–72 months from rural Sudan enrolled in an 18-month field trial in 1988 to study the effect of vitamin A supplementation on child health and survival.

Results: The mean height-for-age z-scores at baseline and the end of study were −1.66 and −1.55, respectively, for the group with water and sanitation facilities, and −2.03 and −1.94 for the group without water and sanitation, after adjustment for age, region, gender, mother's literacy, intervention group (vitamin A vs placebo), family wealth, breastfeeding and cleanliness. Among children of normal height-for-age at baseline, the risk of stunting (<−2 height-for-age z-score) was lowest in the group that came from homes that had both water and sanitation compared to children from homes without these facilities (multivariate RR=0.79, 95% CI 0.69–0.90). Among children stunted at baseline, those coming from homes with water and sanitation had a 17% greater chance of reversing stunting than those coming from homes without either facility (adjusted RR=1.17, 95% CI 0.99–1.38). We did not detect a synergistic association between access to water and sanitation.

Conclusions: Water and sanitation are independently associated with improved growth of children.

Sponsorship: None.

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Acknowledgements

Funding for this study came from cooperative agreement number DAN-0045-G-6067 of the Office of Nutrition, US Agency for International Development, Washington, DC, and the Harvard Institute of International Development, Cambridge, MA. We thank Penelope Nestel and Alawia el Amin for data collection.

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Author notes

  1. A T Merchant, C Jones, A Kiure, R Kupka, G Fitzmaurice, M G Herrera and W W Fawzi: Contributors: All authors contributed to interpretation of the data and writing of the manuscript. ATM did the data analysis.

Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    A T Merchant, A Kiure, R Kupka, M G Herrera & W W Fawzi

  2. Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA

    A T Merchant

  3. Tufts University School of Medicine, Boston, MA, USA

    C Jones

  4. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    G Fitzmaurice

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    W W Fawzi

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  1. A T Merchant
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  7. W W Fawzi
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Correspondence to A T Merchant.

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Merchant, A., Jones, C., Kiure, A. et al. Water and sanitation associated with improved child growth. Eur J Clin Nutr 57, 1562–1568 (2003). https://doi.org/10.1038/sj.ejcn.1601725

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