We have overlooked a crucial cause of the world’s nutrition crisis

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Attempts to tackle undernutition in children around the world often overlook an important part of the puzzle, says Priti Parikh



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14 April 2021

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Michelle D’urbano

THE world’s children are in the midst of a nutrition crisis. At least one in three children under 5 globally experiences some form of undernutrition. Not only can this result in them being underweight for their age, it can also lead to stunted growth and affect brain development.

But tackling this problem isn’t simply about food and healthy diets. There is an often overlooked piece of the puzzle that is needed to make a difference: sanitation.

Figures from the World Health Organization show that around 45 per cent of deaths among children under 5 are linked to undernutrition, with most of these occurring in low and middle-income countries.

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The pandemic has worsened nutrition crises. Around 55 million children were considered underweight for their height before covid-19 struck, but since then 7 million more have been added to this category. Current global food stocks are higher than previous years, so a food shortage alone is unlikely to be driving this.

A few years ago, Robert Chambers and Gregor von Medeazza at the UK-based Institute of Development Studies reviewed 250 papers on links between gaps in water and sanitation services and nutrition, chronic diarrhoea and disease to help understand the picture. They found that undernutrition is higher when families lack sanitation facilities in their own homes – an issue that isn’t limited to low-income households – and concluded that sanitation and hygiene are overlooked in nutrition studies.

This also matches a pattern I have seen first hand. My colleagues and I studied nine villages in Rajasthan state in India where half of children under 5 have stunted growth for their age. We observed existing water and sanitation facilities, interviewed families and held group discussions on nutrition and living conditions.

We spoke to a mother of two children whose story was a typical one. Her husband had been forced to migrate to a nearby city for employment, while she spent much of her time working on the family farm, as well as performing domestic chores like cleaning the house and washing clothes and utensils. On top of this, she spent up to 2 hours every day collecting water, resulting in very little time left for cooking.

Only 7 per cent of households in this region have toilets and just 2 per cent have running water inside their homes. This makes sanitation hard, so water-borne diseases are commonplace – often with symptoms like diarrhoea, which reduces the body’s ability to absorb nutrients from food.

This is a double whammy. It is hard for many people to find time to cook sufficient food because of the water and sanitation facilities, and these same facilities make it harder to get nutrients from the food that they do get.

The challenge isn’t unique to Rajasthan. A study using data from the Demographic and Health Surveys Program showed that around 65 per cent of the variation in height for children under 5 can be linked to toilet facilities, when controlling for factors like GDP. Similar links have been established for sub-Saharan Africa.

Covid-19 and the consequent economic downturn risk investment in sanitation infrastructure being reduced. This will further put families at risk of infections and reduce time available to feed children.

Nutrition isn’t just about food distribution – it needs to include improvements to the environment and living conditions. Supporting such ambitious and integrated policies requires experts from nutrition, health, environment and engineering to work together. This is the only way to fix the nutrition crisis faced by children around the world.

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