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a researcher with two women and a child in Bangladesh

Stronger approaches needed to help malnourished children grow

Improvements in water, sanitation and handwashing infrastructure improved health of malnourished children, but not growth after two years, study finds.

How well a child grows in early childhood can be marker for survival, cognitive development and economic success later in life. Malnutrition and diarrhea cause poor health and stunted growth for millions of children living in poverty worldwide, but intervention strategies to combat the problem have not been rigorously tested.

A new study led by Stanford epidemiologist Stephen Luby, MD, is one of the first to examine what are known as water, sanitation and hygiene (WASH) interventions as a way of improving children’s growth in low-income communities. Contrary to expectations, the results – published today in The Lancet Global Health – showed improvements in water, sanitation and handwashing infrastructure improved children’s health, but not growth after two years.

A Stanford press release explains:

The study… examined the health and growth of children from over 5,000 pregnant women in rural Bangladesh after two years. The mothers were grouped according to geographic clusters and randomly assigned to one of six interventions or a control group….

Children in the Bangladesh trial who received nutritional supplements in addition to WASH interventions did grow taller and were less likely to die during the study, but WASH interventions alone did not improve growth.

Luby discussed the significance of the research in a corresponding video, shown above:

What this tells us is that these interventions, even with high uptake, likely didn’t clean the environment enough to impact child growth. This is a disappointment but also helps to provide direction as a way forward.

Part of what this teaches us is that this problem of stunting – children who don’t grow normally – is not going to be fixed easily by a little bit of attention to water, sanitation and hygiene. And it suggests that what has been a hard problem continues to be a hard problem and we need to think anew about strategies that help these children grow.

Photo by GMB Akash; video by the Stanford Woods Institute for the Environment

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