Effects of the level of household access to water, sanitation and hygiene on the nutritional status of children under five, Benin

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Abstract

Background

Whether or not the Water, Sanitation and Hygiene (WASH) conditions in which children under five live determine their nutritional status is still under discussion. The work aimed to study the effects of household WASH conditions to which children under five are exposed on their nutritional status in Benin.

Methods

The study utilized a cross-sectional design and consisted of secondary analyses using datasets from the fifth Demographic and Health Survey (DHS-V) conducted in Benin. Stunting, wasting and underweight were the dependent variables. The WASH conditions in which children live were evaluated in the immediate environment, i.e., at the level of their households. After describing the study variables, the relationships between the dependent variables and the exposures were checked using multivariate logistic regression. Data analysis was performed with Stata 15 and took into account the survey’s sampling design.

Results

The prevalence of stunting, wasting and underweight was 31.15% (95% CI = 29.90-32.42), 4.79% (95% CI = 4.33–5.31) and 15.82% (95% CI = 14.92–16.76), respectively. The stunting odds were 1.35 (95% CI = 1.15–1.59) and 1.27 (95% CI = 1.01–1.59) times higher for children from households with no water and sanitation services, respectively, compared to children living in households with basic water and sanitation services. Children under five from households with no hygiene facilities and using limited hygiene services had 1.31 (95% CI = 1.05–1.63) and 1.35 (95% CI = 1.10–1.67) times the odds of being stunted, respectively, compared to children covered by basic hygiene facilities. There is no evidence of a significant relationship between household access to WASH and wasting in children under five. The odds of being underweight were 1.33 (95% CI = 1.02–1.72) times higher among children under five from households with limited hygiene facilities than among children from households with basic hygiene facilities.

Conclusion

Interventions to fight malnutrition in children under five should include a WASH dimension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-023-00751-8.

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Most cited references 36

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Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016)

Blessing J. Akombi, Kingsley E Agho, Dafna Merom … (2017)

Background Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. Methods Cross-sectional data from the most recent Demographic and Health Surveys (2006–2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. Results Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. Conclusion The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.

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Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

Jee Rah, Aidan Cronin, Bhupendra Badgaiyan … (2015)

Objectives Increasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0–23 months in rural India. Setting India. Participants A total of 10 364, 34 639 and 1282 under-2s who participated in the 2005–2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis. Primary outcome measures The association between WASH indicators and child stunting was assessed using logistic regression models. Results The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, p<0.05). Conclusions Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.

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Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries

Zhihui Li, Rockli Kim, Sebastian Vollmer … (2020)

Key Points Question What are the most important factors associated with child undernutrition, and how do they vary across countries? Findings In this cross-sectional study of 299 353 children aged 12 to 59 months in 35 low- and middle-income countries, household socioeconomic status and parental nutritional status were the leading factors associated with child undernutrition in pooled analyses and in most country-specific analyses. Environmental conditions, health behaviors, disease prevalence, and maternal reproductive care were less frequently associated with child undernutrition, with substantial heterogeneity among countries. Meaning The findings of this study suggest that interventions to improve socioeconomic status and parental nutritional status (eg, education for women and poverty reduction) should accompany food and nutrition programs, but the potential benefits of investing in specific conditions are highly dependent on the context.

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Author and article information

Contributors

Nicolas Gaffan: gafnicolas@gmail.com

Journal

Journal ID (nlm-ta): BMC Nutr

Journal ID (iso-abbrev): BMC Nutr

Title: BMC Nutrition

Publisher: BioMed Central (London )

ISSN (Electronic): 2055-0928

Publication date (Electronic): 1 August 2023

Publication date PMC-release: 1 August 2023

Publication date Collection: 2023

Volume: 9

Electronic Location Identifier: 95

Affiliations

[1 ]GRID grid.412037.3, ISNI 0000 0001 0382 0205, Department of Epidemiology and Biostatistics, Regional Institute of Public Health, , University of Abomey-Calavi, ; Ouidah, Benin

[2 ]GRID grid.412037.3, ISNI 0000 0001 0382 0205, Department of Environmental Health, Regional Institute of Public Health, , University of Abomey-Calavi, ; Ouidah, Benin

[3 ]University Hospital Hygiene Clinic, National Hospital and University Centre Hubert Koutoukou Maga, Cotonou, Benin

[4 ]GRID grid.412037.3, ISNI 0000 0001 0382 0205, Department of Health Promotion, Regional Institute of Public Health, , University of Abomey-Calavi, ; Ouidah, Benin

Article

Publisher ID: 751

DOI: 10.1186/s40795-023-00751-8

PMC ID: 10391820

PubMed ID: 37528455

SO-VID: 37472a77-fe53-4d88-8229-93405f5d562e

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 December 2022

Date accepted : 17 July 2023

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Keywords: child,dhs,water,sanitation,hygiene,wash,stunting,wasting,underweight,benin

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Keywords: child, dhs, water, sanitation, hygiene, wash, stunting, wasting, underweight, benin

Effects of the level of household access to water, sanitation and hygiene on the nutritional status of children under five, Benin

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Abstract

Background

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Supplementary Information

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UCL: UN SDG 06 Clean Water and Sanitation

Most cited references 36

Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016)

Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys

Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries

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