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[CAPE TOWN] Improved housing with piped water and keeping animals out of the home may be the key to improving childhood nutrition, a study suggests.
According to the 2017 WHO Africa Nutrition Report, 58.5 million children suffered stunting— being too short for one’s age — in 2016. The WHO global targets include a 40 per cent reduction by 2025 in low weight-for height children under five years old.
“This study highlights the critical importance of combining nutrition-specific interventions such as nutritional supplementation, with sanitary interventions,” says study co-author Andrew Prentice, professor of international nutrition at the Medical Research Centre unit of the London School of Hygiene and Tropical Medicine in the Gambia.
Published in the journal BMC Medicine last week (1 November), the study analysed 230 children of Gambian staff living at the Medical Research Unit in rural Keneba between 1993 and 2009. The staff included scientists, physicians, laboratory technicians and fieldworkers and support staff such as cleaners. The population was chosen because of its diversity of wealth, education housing conditions and access to free health services.

“This study highlights the critical importance of combining nutrition-specific interventions, such as nutritional supplementation, with sanitary interventions.”

Andrew Prentice, London School of Hygiene and Tropical Medicine

Researchers assigned five socio-economic scores to the children and compared growth data which was routinely taken at the unit’s clinic, and found that height-for-age outcomes were strongly predicted by the scores.
“Not surprising, those with the lowest socio-economic scores had the shortest, most stunted children, and the gradient wasn’t as big as we’d expected,” says Prentice. “The group at the top, however, had the widest variation.”
Half of children in this upper grouping lived in Western-style housing with running water, flush toilets and kept animals out of the home. The other half lived within the village without similar amenities.
Comparisons of these children showed that those living in Western-style houses grew well with no incidents of stunting or underweight. Children in the village fared less well, with below average height and weight.
Based on this, researchers suggest a very high socio-economic and hygienic threshold before rates of stunting and underweight can be eliminated. “We speculate the key issue is piped water and keeping animals out of the home,” says Prentice.
Keeping animals such as poultry, which can be disease carriers, free range in the home can contribute to childhood diseases that exacerbate malnutrition, Prentice explains.
“We need investment in infrastructure, including water supply, and investment in populations’ economic development to improve stunting and childhood growth,” he adds.
Doug Momberg, doctoral fellow at the Development Pathways for Health Research Unit at the University of the Witwaterstrand in South Africa, says that context and cultures vary significantly on the African continent. But he explains that policymakers would benefit from integrating the study’s findings into their policies and implementation plans to “better articulate and address the intricacies of water, sanitation and hygiene in various contexts”.
“Targeted research on the governance of WASH [water, sanitation and hygiene] in relation to health-related outcomes is imperative to address the burden of child undernutrition,” Momberg says.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Mayya Husseini and others Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia (BMC Medicine, 1 November 2018)