Please have a look at this paper:

What causes childhood stunting among children of San Vicente, Guatemala:
Employing complimentary, system-analysis approaches

www.sciencedirect.com/science/article/pii/S1438463917306272

Thank you,
F H Mughal

This is interesting, thank you.
I am not focusing however on toilet provision as such - more the environment where the infant plays and eats and contamination.
But then I would agree that it is likely that having a flush toilet might mean proper disposal of child faeces and perhaps improved sanitation behaviour as a whole.

I came across this paper, a rather long one (34pp): Child Malnutrition and the Provision of Water and Sanitation in the Philippines, available at: www.tandfonline.com/doi/abs/10.1080/13547860701252298

Though it is nearly 11 years old, it has a powerful message. The abstract reads (in part):

“The prospects for achieving the Millennium Development Goal on nutrition are predicted to be bleak in the Philippines. These predictions, however, take no account of the interactions between nutritional and sanitary interventions.”

“The results confirm that water and sanitation provision have a positive effect on nutritional status, but these effects are not substantial. Community-based piped water provision and flush toilets have the greatest potential to reduce malnutrition. Household access to point source water and latrines are more likely to reduce the probability of birth malnutrition among poor households than other public infrastructure.”

The paper concludes (in part):

“ . . . this study confirms the negative effect of access to safe water and sanitary facilities on malnutrition in the Philippines, which has been found in previous studies using different data sources.”

“The negative effect that community-based provision of safe water (in the form of
piped water sources) has on the probability of birthweight stunting is larger than the
effect caused by access to less safe water sources (that is, point sources). In terms
of sanitation facilities, the probability of birthweight stunting is reduced most when
households have access to flush toilets. In the absence of such facilities, access to
latrines reduces the household probability of birthweight stunting more than drop or
overhang disposure.”

Does your experience confirms use of flush toilets in poor rural settings? My answer will be negative, based on my rural exposure here.

I reckon, you will find the paper’s observations useful in your research.

F H Mughal

Thank you - yes that report is great, I have used it a lot!

I will certainly send papers your way,

Sophie

Attached is a short (8pp) paper by WHO-UNICEF-World Bank on Levels and Trends in Child Malnutrition - Key Findings, which you may find helpful in your research.

Regards,
F H Mughal

As a matter of fact, I do need your help. During this brief interaction with you, I was thinking on what could be the reasons of not washing hands, across various countries.

In case of Sindh, two aspects clearly stand out: one, the mothers are all uneducated. Second, they don’t wash hands because they consider babies’ feces to be harmless.

In case of Ghana, the paper says:

The current study, a national survey of Ghanaian mothers, found that as few as 4% of mothers engaged in HWWS after defecation, and only 2% after cleaning a child's bottom.

And, then goes on to say (in conclusions):

The failure of this and other quantitative studies to explain much of the variance in handwashing behaviour observed leads us to suggest that theory development is required, alongside the development of new measures and tools that delve deeper into understanding the influence of psychological and psycho-social factors in determining and motivating hygiene behaviours.

While, I admit, I haven’t read the whole paper, it transpires from the Ghana paper that it is the problem of behavioural change, and involvement of psychological and psycho-social factors.

I’m interested in knowing the factors that play, in other countries. If you happen to get papers and reports of other countries on this topic, kindly share them with me.

Kind regards,
F H Mughal

Yes she is a brilliant researcher - I went to LSHTM where she is a lecturer.

Many thanks - if I can help in turn do let me know!

The Ghana paper is interesting. One of the authors is Dr. Val Curtis of UK. She has done lot of work in developing countries.

As regards your research, I will see, if I can come up with some publications.

Regards,
F H Mughal

Hi again,

That's interesting, thanks for your insight.
I have found a paper with similar findings in Ghana which was interesting:
t.co/JS6nVx8cm2

I am looking at the gap between WASH and nutrition and stunting in infants in Ethiopia - particularly the contribution of environmental enteric dysfunction from chronic pathogen exposure.

Dear Ms. Sophie,

This is based on my large rural experience. Years back, I used to watch ladies in my extended family, in a rural town called Shikarpur, doing this.

Quite sometime back, I received an email, in which I was told that this practice exists in other countries as well. I'm afraid, I'm unable to trace that email. But since, you are doing research, you can search this out . By the way, what is the topic of your doctoral research?

Thanks for the Super Amma paper link.

Regards,
F H Mughal

Really interesting about not washing babies - closely ties into my own research about faecal exposure in malnutrition.
If you have any sources on this I'd be grateful.

SuperAmma was a great design. I'm sure you have read the paper, but if not it is here:
www.sciencedirect.com/science/article/pi...X13701608?via%3Dihub

Regards,
Sophie

Sanitation Taboos

One major taboo, prevalent in the rural areas of Sindh, Pakistan, pertains to the cleaning of babies. Mothers do not wash hands with soap after cleaning babies’ feces and babies themselves. The reason is that the mothers in rural areas (almost all of them are uneducated), believe that babies’ feces are harmless.

Recent news in the local newspaper shows efforts of soap operas to break taboos in Pakistan
(www.dawn.com/news/1382645/soap-operas-se...k-taboos-in-pakistan)

In India, there is Super Amma campaign for changing behaviors concerning handwashing. Super Amma, according to my understanding, is a cartoon program.

Could I kindly request the forum users for information on Super Amma; and whether soap operas are effective in breaking sanitation taboos.

F H Mughal