Hi Martina,
yes I did read it. Of course that's interesting and important research, I don't want to dissmiss that. But if the research results are to be confirmed, what do they mean for me, as a sanitation engineer?
- another argument why sanitation and hygiene is so important (or maybe change from the "diarrhea argument" to "Tropical Enteropathy argument").
- nothing new for the solutions we need to provide, we still need to cut the fecal-oral transmission pathes

Hi Florian,

did you read the article in the Lancet? If not you really should do so.
Because, if you follow the reasoning of the author, it becomes clear that this is not just

medical science details

. However, it left us unsure how to wait it.

Thanks for forwarding the citation of Duncan Mara. It gives me a better feeling when he judges the article as worthwhile. However, I didn't find a critical commenting of this article besides that he stated that he liked the article and his message.
Together with some other articles he quoted he came to the interpreation that

...the message [is]: clean up the environment, especially the immediate domestic and peri-domestic environment, by the provision and sustained use of sanitation and handwashing facilities, educate girls, and put public health right up very high on the political agenda. Fingers crossed − it could just work...

.
Or did I miss an important part?

Regards,
Martina.

Hi, Duncun Mara commented on the same article a while ago: duncanmarasanitation.blogspot.com/2009/0...cal-enteropathy.html

To me that feels rather like medical science details, and not like something that changes much for us sanitation people. The fact that envrionmental health and nutrition are closely linked and impacting child health is not so new I think. Another example are helminth infections (see also current discussion on helminths ) that are not really life threatening alone, but most harmfull in combination with other risk factors for child health, especially malnutrition.

As for the "under-five" criterion, this is one of the most commonly used indicators to measure child health by WHO and others, also used in MDG 4. Other common indicators are infant mortality (under 1 year) and neonatal mortality (under 1 month). Why exactly under 5 and not under 6 I do not know, probably both of your assumptions played a role when the indicator was defined.

A pity that nobody answered so far. I would be very interested in the answer!

Reports and papers always refer to the figure of "children under five (years of age)". Why exactly five years?
- Is there such a large change between children with an age of 5 compared to those with an age of 6?
- Or is this just statistics and somewhere one had to draw the line? Hence "children under five" is an artificial border.

Hope somebody is able to answer these questions.
Yours, Martina.

Dear all,

within the SuSanA working group 5 (food security and productive sanitation) we stumbled upon an interesting 'viewpoint' article by Jean Humphrey in the Lancet on a phenomenon known as tropical enteropathy caused by the ingestion of fecal bacteria in larger quantities which is assumed to be one of the key causes of child undernutrition and stunting (see email from Ken Maskall with the respective link below).

Since this is a viewpoint article only, does anyone know if there is any further investigation undertaken on this or does anyone have any more recent information on tropical enteropathy?

Thanks in advance and best regards

rob#

Robert Gensch
German Toilet Organization
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___________________________________________________


I wanted to draw your attention to some recent research evidence which points to a more insidious cause of stunting in children due to chronic ingestion of feacal matter during the critical growth years between 0-2 years of age. Our conventional justification for sanitation programmes has usually be based upon diarrhoeal disease reduction. This new research suggests that rather than diarrhoea episodes being responsible for growth stunting it seems that a phenomenon known as Tropical Enteropathy is a more likely candidate. Essentially this is caused by chronic fecal matter ingestion and associated damage to the small intestines which are responsible for severe nutrient uptake inhibition - leading to stunting.

The attached article published in the Lancet describes the findings more fully. As we seem to be searching for strong correlative links between improved sanitation and increased food security, I feel that these findings need to be highlighted in the paper as they provide a much stronger rationale for toilets and handwashing than hitherto believed.

Here is the link:

www.thelancet.com/journals/lancet/articl...(09)60950-8/fulltext

(note by moderator: you are unfortunately not allowed to place the full article here, only the abstract, because of copyright issues. It can be sent out by e-mail one by one but not placed on a discussion forum. Contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. for clarification - Elisabeth von Muench)

Many thanks again for sharing - we await the final draft with considerable interest.

Best wishes

Ken Maskall


Ken Maskall

Chief of WASH Programme

UNICEF South Sudan
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