There is certainly no doubt about this in expert circles, but I think especially the environmental enterophathy research makes a strong case for improving environmental hygiene.

The reasons why I especially stress that concept, is that for many non-experts and decision makers, WASH boils down to building hand-pumps, laying water pipes, promoting the construction of toilets and maybe adding some hand-washing campaigns.
While all of these make sense and ultimately contribute to the real goal of a healthy environment, it is easy to loose sight of this real goal when one focuses solely of these few interventions (and the result are for example toilets that are a health hazard and so forth).

Our role (amongst others) as sanitation expert therefore needs to be finding strong advocacy tools, that can convince people to aim for a real improvement in sanitation and hygiene.

According to a paper presented at SACOSAN-V by Guy Hutton and Payal Hathi (attached), poor sanitation can have an adverse effect on health and overall wellbeing of children.

Diarrhea: Diarrhea causes 1.4 million preventable child deaths per year. This is attributed to unsafe drinking water quality, poor sanitation and hygiene. Positive association has been established between childhood diarrhea and stunting, due to the cyclical effect of diarrhea causing under-nutrition, which predisposes children to subsequent, longer episodes of diarrhea (Moore et al, 2010).

Stunting: In developing countries, 32% of school children are stunted (stunting means that a child is too short for his/her age). According to a Sindh government report (Karachi, Pakistan), the stunting percentage among school children is 49.8. This percentage is dangerously high and, shows extremely poor sanitation facilities in school.

Stunting is the result of poor sanitation. Threats to children’s health can result in long-term cognitive deficits, poorer school performance, fewer years of completed schooling, and lower adult productivity, as well as increased risk of infections and higher mortality rates. Evidence confirms that these early life deficits are not easily made up for later in life, suggesting potential loss of equity in life outcomes over time (Hutton and Hathi, 2013).

Open defecation, common in Sindh, produces airborne germs. When a child’s environment is infested with germs, the child inhales airborne germs and, overtime, this is reflected in child’s stunting.

Environmental enteropathy: It is a subclinical condition in children, caused by exposure to poor sanitation and hygiene (Korpe and Petri, 2012). Frequent ingestion of fecal bacteria causes inflammation and structural changes in intestine, which reduced the ability of intestine to absorb nutrients, resulting in the reduced growth of the child.

Malnutrition: Children are underweight because of poor sanitation. In Sindh, 40.5% of the children are underweight. Poor sanitation causes infectious diseases and, frequent attacks of infectious diseases cause imbalance in child’s intestinal bacteria, which contributes to malnutrition.

In addition to the interesting and useful paper by Hutton and Hathi, I’m also attaching a informative paper by Korpe and Petri on environmental enteropathy.

Sectt: Please check – Thanks

F H Mughal