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The East African : February 10th 2014
The EastAfrican OUTLOOK FEBRUARY 8-14,2014 H E ALT H Poor sanitation linked to stunting in children The condition is influenced by open defecation and not economic g≥owth as p≥eviously thought By SARAH OOKO The EastAfrican T he world has people of different sizes and heights. By just looking at physical attributes of human beings, it is possible to tell whether a person is short or tall — and this is as far as it goes for most people. But for health experts, the sto- ry does not end here. Ruth Nduati, professor of pae- diatrics and child health at the University of Nairobi, notes that height also indicates whether a child is properly fed. Severely malnourished children, she says, are too short for their age — a condition known as stunting. “This also shows that their brains are poorly developed,” states Prof Nduati. She warns that if stunting is not corrected by the age of two years, then children affected will have a permanent lower brain performance compared to those well fed. “This translates to poor school performance, high dropouts and reduced ability to earn income when they are older,” she says. For a long time, economic experts and other policy makers linked stunting to poverty, based on the assumption that rich families could afford to give their children the right kind of food in sufficient quantities. But these arguments did not hold water for long. Studies in the mid-1990s showed that increased economic growth in South Asia – especially India – did not translate into improved nutritional status in children. Moreover, statistics showed that average heights of children in the region were lower than that of those in sub-Saharan African households that were poorer. Economic experts referred to this as the “Asian Enigma.” However, a study released re- cently by the World Bank unravelled the mystery by providing evidence showing that contrary to popular belief, stunting in children across countries is influenced by open defecation and not economic growth. The study entitled “How Much Variation in Child Height Can Sanitation Explain?” found that the average height of children in India was lower than that of sub-Saharan Africa as the former has higher open defecation rates. Research Institute for Compassionate Economics executive velopment in children. Yet, 44 per cent of children in Rwanda, 42 per cent in Tanzania, 35 per cent in Kenya and 33 per cent in Uganda are stunted — based on the 2014 Unicef State of the World Children report. Prof Nduati notes that “this means that all their brains are also not functioning at optimal levels.” “And at the root of this prob- lem, are poor hygiene and sanitation practises such as open defecation, which must be addressed urgently,” says Dr Abdulahi Tinorgah, head of child survival and development at Unicef Kenya. Indeed, World Bank statistics show that the annual cost of open defecation to the national economy is $46 million in Tanzania, $41 million in Uganda and $88 million in Kenya. Dr Spear’s study established that open defecation negatively affects children’s height irrespective of their social status. When faeces are washed into rivers or eaten by flies that can When faeces are washed into rivers like the one in which the children are playing, above, or eaten by flies that can land on anyone’s food, then eventually everyone is affected. Picture: File director and lead author of the study Dr Dean Spears notes that there are no average differences on height potential among children worldwide. “No one is predestined to be short or tall based on genetics or geographical factors,” he says. It is for this reason that the World Health Organisation (WHO) has set uniform heightfor-age measurements worldwide for determining whether a child is stunted or not. For instance, a healthy five-year-old boy should be about 110.2 centimetres tall. However, variations in height often emerge as a result of malnutrition affecting a child before birth and within the first two years of life. “And here, open defecation plays a key role as it will determine whether nutrients are lost or retained in the body,” he says. Dr Spears explains: “Even if a child eats right, the food has to be absorbed and used up by the body for it to have the intended effect on development.” He says that germs ingested by children from faeces left in the open interfere with this take-up mechanism. “So the child may get all required nutri- Frequent exposure to faecal germs can affect children’s development without them ever showing any symptoms of disease such as diarrhoea ents but she will still be stunted,” he notes. Dr Spears states that faecal germs cause ailments like diarrhoea which make children loose nutrients. In addition, when children are sick, most of what they eat is also spent fighting diseases than propelling their growth. “And if they step on faeces with bare foot, they can get worms which will then use up nutrients they get from food and leave them malnourished,” says Dr Spears, who is also an expert on sanitation and health economics. Worse, emerging research is pointing to a condition known as environmental enteropathy where frequent exposure to faecal germs can silently affect children’s development without them ever showing any symptoms of disease such as diarrhoea. “This happens because the germs cause a chemical reaction in a child’s intestines that inhibits his or her ability to absorb nutrients from the food they consume,” notes Dr Spears. The WHO warns that malnu- trition is responsible for about 30 per cent of child deaths globally. It also makes children prone to catastrophic effects of diseases like pneumonia and malaria that are leading causes of child mortality in East Africa. Health experts warn that if ignored, stunting will deny East Africa qualified human resource to propel its economic growth as it impedes proper brain de- An informal settlement in Nairobi. Picture: File GLOBAL EMERGENCY Health officials in countries like Kenya are registering higher rates of stunting in densely populated informal settlements. Since urban centres are often more densely populated than rural areas, the impact of open defecation on children’s height will be more pronounced in the former than latter locations. According to Dr Spears’s study, the likelihood of a child becoming stunted as a result of open defecation rises with age. Based on findings of his study, which focused on all low and middle income countries, Dr Spears notes that open defecation is a global emergency. “Policy makers can no longer ignore open defecation since it compromises ability of future generations to effectively participate in nation building and development initiatives,” Dr Spears said. 1.2m 33 Pit larines Kenya requires to eliminate open defecation, compared with 1 million for Uganda and 650,000 for Tanzania land on anyone’s food, Dr Tinorgah notes, then eventually everyone is affected. To curb this challenge, he says that Unicef is working with governments to implement a strategy known as Community-Led Total Sanitation (CLTS). “Each one of us needs to desist from open defecation. Because if you construct a toilet and your neighbour doesn’t do so, then you can’t be safe,” he notes. According to the World Bank, Kenya, Tanzania and Uganda need 1.2 million, one million and 650,000 pit latrines, respectively, to eliminate open defecation. Dr Tinorgah states that sim- ple interventions such as boiling or treating drinking water and frequent washing of hands with soap can reduce the spread of disease causing faecal germs. “But all this requires behaviour change in societies.” In his study, Dr Spears further states that as much as open defecation is an issue for everyone, it is especially critical for those living in densely populated areas. “Children here are more likely to get into contact with faeces than those from sparsely populated places.” India’s population of 1.2 bil- lion obviously outpaces subSaharan Africa’s population of about 800 million. Thus, notes Dr Spears, children from India have an increased threat of stunting than those in any African country.
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