The State of the World's Children 1998: Focus on Nutrition

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Panel 5

Growth and Sanitation:
What can we learn from chickens?

Photo: Unsanitary living conditions cause illnesses that threaten children's health and growth. New research now suggests that growth is harmed in unhygienic surroundings even before acute infection occurs. In Egypt, a girl amid mounds of garbage and animal waste.

Poultry farmers have known for some time that a chicken living in a dirty environment is a chicken that grows poorly. Even if it is not overtly sick all the time, it gains little weight.

Is there a message here about the growth of children? Because growth, like other nutrition outcomes, is deter mined most immediately by diet and illness status, the answer, at least in part, may be yes. Infectious illness - which spreads more easily in unsanitary conditions - leads to poorer dietary intake and poor use of the nutrients ingested. This, in turn, leads to lower resistance to infection, and so on, in a vicious diet-infection cycle (Fig. 6).

Now studies suggest that an unsanitary environment may have effects beyond those associated with particular bouts of illness. Research ers believe that children living in such conditions may suffer from a fairly constant, low-level challenge to their immune systems that impairs their growth, as has been shown in domestic fowl. Dr. Noel Solomons of the Centre for Studies of Sensory Impairment, Aging and Metabolism and colleagues suggest that along with classifying children as healthy (having no clinical illness) and acutely infected (with signs of illness readily detectable), there is also a category of "inapparently infected." Children who are inapparently infected have no signs of clinical illness but do have abnormal levels of some immunological indicators. Such inapparent infections and the chronic low-level stimulation of the immune system associated with life in unsanitary conditions may mean that nutrients go to support the body's immune response rather than growth.

Poverty occurs in both South Asia and sub-Saharan Africa, but rates of malnutrition, especially stunting, are much higher in South Asia. A number of hypotheses have been advanced to explain this difference, and one is that it is due to poorer sanitation and hygiene practices, the much greater population density and degree of overcrowding in South Asia.

Certainly, the dangers posed by poor access to potable water are well known. A recent review of data collected by the Dem o graphic and Health Surveys, a USAID-supported project, indicates that health and nutrition benefits from improved sanitation, especially improved ex creta disposal, may be even greater than those associated with better access to safe water alone.

A group led by Dr. Reynaldo Martorell of Emory University (US) has designed a study to shed light on the relationship between sanitation and growth stunting. This study would follow 800 children in two locations in South Asia and 800 more in two locations in sub-Saharan Africa from the time their mothers become pregnant to when they are two years old and would collect a wide range of informa tion on sanitation, hygiene practices and other aspects of the house hold environment. The children's growth would be meas ured frequently along with indicators of feeding practices, diet quality, illness and many other factors. UNICEF is helping to secure funds for this study.

Establishing a link between sanitation conditions and child growth in a cause-and-effect way will go a long way to clarifying priorities for action in this area. Such a link will also reveal just how useful the 'dirty chicken' model is for understanding stunted growth among children.

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