evidence-based blog of Filippo Dibari

Posts Tagged ‘water sanitation’

Stunting: latest evidence (open source)

In Under-nutrition on May 19, 2016 at 8:42 pm

Stop stunting: improving child feeding, women’s nutrition and household sanitation in South Asia.

Víctor M. Aguayo and Purnima Menon



Childhood stunting: a global perspective.

Mercedes de Onis and Francesco Branca



Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities.

Kathryn G. Dewey



Feeding practices for infants and young children during and after common illness. Evidence from South Asia.

Kajali Paintal and Víctor M. Aguayo



Improving women’s nutrition imperative for rapid reduction of childhood stunting in South Asia: coupling of nutrition specific interventions with nutrition sensitive measures essential.

Sheila C. Vir



Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications.

Oliver Cumming and Sandy Cairncross



Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries.

Mduduzi N. N. Mbuya and Jean H. Humphrey



Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra’s comprehensive nutrition survey.

Víctor M. Aguayo, Rajilakshmi Nair, Nina Badgaiyan and Vandana Krishna



Achieving behaviour change at scale: Alive & Thrive’s infant and young child feeding programme in Bangladesh.

Tina Sanghvi, Raisul Haque, Sumitro Roy, Kaosar Afsana, Renata Seidel, Sanjeeda Islam, Ann Jimerson and Jean Baker



Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting.

Nancy J. Haselow, Ame Stormer and Alissa Pries



Estimating the cost of delivering direct nutrition interventions at scale: national and subnational level insights from India.

Purnima Menon, Christine M. McDonald and Suman Chakrabarti



The costs of stunting in South Asia and the benefits of public investments in nutrition.

Meera Shekar, Julia Dayton Eberwein and Jakub Kakietek



Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation.

William Joe, Ramaprasad Rajaram and S. V. Subramanian



Drivers of nutritional change in four South Asian countries: a dynamic observational analysis.

Derek Headey, John Hoddinott and Seollee Park



Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy.

S V Subramanian, Iván Mejía-Guevara and Aditi Krishna


Sanitation and nutrition: Let’s break the vicious circle!

In Under-nutrition on May 15, 2016 at 8:44 pm

The nutritional value of toilets: How much international variation in child height can sanitation explain?

In Under-nutrition on May 4, 2014 at 7:39 am

by Dean Spears (World Bank). From the Rice Web Site – June 2013

(download the entire doc)


Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. In particular, children in India are shorter, on average, than children in Africa who are poorer, on average, a paradox called \the Asian enigma” which has received much attention from economists.

 Could toilets help children grow tall, while disease externalities from poor sanitation keep children from reaching their height potentials? This paper provides the first identification of a quantitatively important gradient between child height and sanitation, which can statistically explain a large fraction of international height differences.

I apply three complementary empirical strategies to identify the association between sanitation and child height: country-level regressions across 140 country-years in 65 developing countries; within-country analysis of differences over time within Indian districts; and econometric decomposition of the India-Africa height difference in child level data.

 The effect of sanitation on human capital is quantitatively robustly estimated across these strategies, and does not merely reflect wealth or other dimensions of development. Open defecation, which is exceptionally widespread in India, can account for much or all of the excess stunting in India.

Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts

In Under-nutrition on October 5, 2013 at 1:12 pm

Spears D, Ghosh A, Cumming O (2013) Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts. PLoS ONE 8(9): e73784

(download here)


Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population. We conducted an ecological regression analysis to assess the association between the prevalence of open defecation and stunting after adjustment for potential confounding factors. Data from the 2011 HUNGaMA survey was used for the outcome of interest, stunting; data from the 2011 Indian Census for the same districts was used for the exposure of interest, open defecation. After adjustment for various potential confounding factors – including socio-economic status, maternal education and calorie availability – a 10 percent increase in open defecation was associated with a 0.7 percentage point increase in both stunting and severe stunting. Differences in open defecation can statistically account for 35 to 55 percent of the average difference in stunting between districts identified as low-performing and high-performing in the HUNGaMA data. In addition, using a Monte Carlo simulation, we explored the effect on statistical power of the common practice of dichotomizing continuous height data into binary stunting indicators. Our simulation showed that dichotomization of height sacrifices statistical power, suggesting that our estimate of the association between open defecation and stunting may be a lower bound. Whilst our analysis is ecological and therefore vulnerable to residual confounding, these findings use the most recently collected large-scale data from India to add to a growing body of suggestive evidence for an effect of poor sanitation on human growth. New intervention studies, currently underway, may shed more light on this important issue.

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Where Hunger and Thirst Meet

In Under-nutrition on September 22, 2012 at 7:50 am

by Barbara Frost – Chief Executive of WaterAid

(reblogged from the Huffingtonpost – 31/08/2012)

The key theme at this year’s Stockholm World Water Week is water and food security: how do we meet the ever developing needs of a growing population with an increasing demand for resources?

At WaterAid, we believe the answer lies in providing water and sanitation for basic human needs, and that targeting the poorest communities will have the greatest impact on overcoming poverty and achieving global water and food security.

The figures shared at this annual event are concerning. In the past 100 years, global population has increased 3.6 times, while the amount of water withdrawn has increased 6.8 times. This reflects a shift in diet as we consume more water-intensive food, highlighting that it’s not just about population; it’s about trends.

Meanwhile, today, more than 900 million people suffer from hunger while 783 million people have no access to a clean, safe water source.

WaterAid/GMB Akash/PanosBut there is a positive message here; we have made a lot of progress – over 2billion people have accessed drinking water in the last two decades – showing that we should be capable of making the necessary changes to manage future growth more equitably.

The global population is set to reach nine billion by 2050 and demand for food willincrease by 70%, placing yet more pressures on water supplies. So the challenge is how to meet those demands.

As explained in our new Water security framework, launched at the global water event, clean water, improved toilets, and hygiene have a considerable impact on livelihoods, the environment and agriculture. Consequently, there is little hope of achieving food security and overall wellbeing without ensuring water security at a local level.

Dirty water and poor sanitation have serious implications on health – according to the UN half the hospital beds in developing countries are filled with people suffering from diseases caused by poor water, sanitation and hygiene. This affects people’s ability to farm and work, with a knock-on effect on both the availability of food and the ability to buy it. Similarly, relieving women and girls of the burden of water collection allows time for them to have an education and earn a living, leading to greater economic freedom and prosperity.

Improved water sources close to the home can be used to irrigate household kitchen gardens, providing additional nutrition in times of food shortages, while the bi-products of ecological sanitation can greatly enhance soil fertility and crop yields.

By improving access to clean, safe water and adequate toilets at a community level, the wider impacts will in turn spread to water and food security on a national and international level.

However, the majority of the money dedicated to improving access to water and sanitation in the developing world is currently spent in middle-income countries, meaning some of the poorest communities are being overlooked.

In fact, water and sanitation aid provided to sub-Saharan Africa amounts to less than the price of a cup of coffee per person – just $2.39 a year, according to another of our new reports: Addressing the shortfall. As a result, many of these least developed countries in the region become trapped in a vicious cycle of poverty.

Through thorough analysis of donor aid, our report shows that water and sanitation aid is not well targeted. Between 2008 and 2010, the 27 countries accounting for 90% of diarrhoeal deaths (primarily caused by dirty water, inadequate sanitation and poor hygiene), received only 39% of water and sanitation aid. The 28 countries accounting for 90% of the world’s population without basic sanitation received just less than half of the aid.

The analysis is clear; developing countries and their development partners need to significantly increase their investments and target those investments better if the world’s poorest people are to gain access to safe water to drink and adequate sanitation.

Furthermore, as covered through the many discussions and sessions in Stockholm, strong leadership, good governance, increased capacity, and effective monitoring are vital if we are to achieve sustainable change and turn promises into action.

With diarrhoea claiming the lives of more children every year than AIDS, malaria and measles combined, all governments need to take urgent action to ensure sufficient funding gets to the one person in every ten lacking safe water in this world and the two in five without access to adequate sanitation.

There is enough food and water to feed the world’s population. Now we must work together to ensure everyone has access to it as we strive for water and sanitation for all.

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