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The effect of young children's faeces disposal practices on child growth: evidence from 34 countries
Valerie Bauza1, Jeremy S Guest1
1Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Insights
Proper child feces disposal in improved toilets significantly reduces stunting and improves child growth indicators in low- and middle-income countries. These practices offer greater benefits than just improving toilet access alone.
Area of Science:
- Global Health
- Pediatrics
- Environmental Health
Background:
- Child undernutrition remains a critical global health issue, particularly in low- and middle-income countries.
- Child feces disposal practices are recognized as a key environmental determinant of child health.
- The specific impact of improved child feces disposal on child growth requires further characterization.
Purpose of the Study:
- To investigate the association between child feces disposal methods and child growth outcomes.
- To compare the effects of improved versus unimproved toilet use for child feces disposal.
- To assess the influence of community-level disposal practices on child stunting.
Main Methods:
- Analysis of caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014).
- Inclusion of data for over 200,000 children under five and 80,000 children under two.
- Examination of associations between child feces disposal and stunting, underweight, wasting, and various z-scores (HAZ, WAZ, WHZ).
Main Results:
- Disposal of child feces in improved toilets was linked to reduced stunting and increased height-for-age z-score (HAZ) across all households.
- Even within households with improved sanitation, improved disposal practices correlated with decreased stunting and higher HAZ.
- Improved disposal practices also showed associations with reduced underweight and wasting, and increased weight-for-age z-score (WAZ).
Conclusions:
- Improved child feces disposal practices can yield greater reductions in child undernutrition than solely enhancing toilet access.
- Current classifications of 'safe' disposal may underestimate the benefits of using improved toilets.
- Targeting improved child feces disposal is a crucial strategy for child health interventions.
Objective:
To characterize the relationship between child faeces disposal and child growth in low- and middle-income countries.
Methods:
We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005-2014) for 202 614 children under five and 82 949 children under two to examine the association between child faeces disposal and child growth.
Results:
Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR) = 0.90, 95% confidence interval (CI) 0.89-0.92] and a 0.12 increase in height-for-age z-score (HAZ; 95% CI: 0.10-0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR = 0.94, 95% CI: 0.91-0.96) and a 0.09 increase in HAZ (95% CI: 0.06-0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight-for-age z-score (WAZ), but not an increase in weight-for-height z-score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75-100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting.
Conclusions:
Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as 'safe' regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet.
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