Stunting in early childhood is a form of childhood undernutrition that is associated with long-term poor health and cognition. 151 million children under 5 are stunted, and the burden of the problem is in Asia and Africa, where progress towards meeting the WHO target of reducing stunting has been very slow. Intensive nutrition interventions have failed to improve the growth of children in these low- and middle-income settings. Improved water, sanitation and hygiene interventions for communities in these settings, to address the contribution of unhygienic environments to growth failure in children, have also been unsuccessful.
Dr Helen Nabwera, Senior Clinical Research Associate at the Centre for Maternal and Newborn Health, was one of the researchers involved in a study which sought to explore potential reasons behind this persistent problem of stunting in early childhood in rural Gambia. The study has been published in the journal BMC Medicine: Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia.
The team examined the thresholds of socio-economic status and living standards associated with childhood malnutrition by assessing 230 children who lived either in the UK Medical Research Council field station in Keneba or in the surrounding village. Some of these children had parents working at the field station and lived in Western style housing; others lived in traditional housing within the village.
The key findings were that children in this rural environment brought up in Western style housing including access to indoor running water, flushing toilets and tiled floors with fewer domestic animals in the compounds were less likely to be stunted that those living in traditional housing (mud walls) with access to clean water from a communal tap but non-flushing toilets in their compounds. This suggests that a very high threshold for hygiene and access to water and sanitation needs to be achieved for children to achieve their growth potential.
Dr Helen Nabwera: “This study shows that the thresholds of quality of housing, access to water and sanitation and levels of hygiene that need to be achieved to prevent stunting in early childhood are probably significantly higher than what many intervention studies have been able to achieve. It would therefore be very difficult to achieve the targets of reduction in childhood undernutrition without tackling the underlying factors including inadequate housing and poverty.”