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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

BACKGROUND: This study’s purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from th...

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Autores principales: Dearden, Kirk A., Schott, Whitney, Crookston, Benjamin T., Humphries, Debbie L., Penny, Mary E., Behrman, Jere R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259877/
https://www.ncbi.nlm.nih.gov/pubmed/28114914
http://dx.doi.org/10.1186/s12889-017-4033-1
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author Dearden, Kirk A.
Schott, Whitney
Crookston, Benjamin T.
Humphries, Debbie L.
Penny, Mary E.
Behrman, Jere R.
author_facet Dearden, Kirk A.
Schott, Whitney
Crookston, Benjamin T.
Humphries, Debbie L.
Penny, Mary E.
Behrman, Jere R.
author_sort Dearden, Kirk A.
collection PubMed
description BACKGROUND: This study’s purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. RESULTS: In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. CONCLUSIONS: Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4033-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-52598772017-01-26 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 Dearden, Kirk A. Schott, Whitney Crookston, Benjamin T. Humphries, Debbie L. Penny, Mary E. Behrman, Jere R. BMC Public Health Research Article BACKGROUND: This study’s purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. RESULTS: In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. CONCLUSIONS: Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4033-1) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-23 /pmc/articles/PMC5259877/ /pubmed/28114914 http://dx.doi.org/10.1186/s12889-017-4033-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.
spellingShingle Research Article
Dearden, Kirk A.
Schott, Whitney
Crookston, Benjamin T.
Humphries, Debbie L.
Penny, Mary E.
Behrman, Jere R.
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259877/
https://www.ncbi.nlm.nih.gov/pubmed/28114914
http://dx.doi.org/10.1186/s12889-017-4033-1
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