Can a dirty environment contribute to child stunting?

Let’s talk about Environmental enteric dysfunction

Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psycho-social stimulation. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median (WHO, 2018). Some of the consequences of stunting include poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life.

 

Initially, it was believed that malnutrition could be caused by two main factors; inadequate dietary intake and disease, however, interventions targeted towards these two factors only haven’t proved  as effective as expected as the rate of malnutrition globally in children remained high.

The concept of environmental enteric dysfunction was brought about by research efforts into the possible relationship of the state of the environment in which a child lives and the impact on the child’s nutritional status. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering.

The resulting condition has been termed environmental or tropical enteropathy or more recently environmental enteric dysfunction (EED), an apparently seasonal, reversible disorder marked by gut mucosal cell villous atrophy, crypt hyperplasia, increased permeability, and inflammatory cell infiltrate. It is not clear that EED is present at birth, but by infancy it can affect children across the developing world. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation can occur in infants across the developing world (i.e. AFRICA) and is proposed as an immediate causal factor connecting poor sanitation and stunting.

Studies have shown that EED could be reversible, if an affected child is taken out of the dirty environment for a sustained period of time. This shows that interventions targeting malnutrition should cover the area of ADEQUATE DIETARY INTAKE, PREVENTION AND MANAGEMENT OF DISEASE and ENSURING THAT A CHILD’S ENVIRONMENT IS CLEAN.

Epidemiological studies suggest that continuous exposure to bacteria from feces is one principal cause of EED, but it is still unclear how enteric pathogens trigger the development of EED. In Nigeria, for example, the country that ranks highest in the open defecation rate in the world, it is important that nutrition interventions target the environment and ensure that children are not exposed to feces in their homes, school, public places, etc. as this could contribute to stunting.

So, yes, a dirty environment can definitely lead to child stunting.

 

Adejoke Adewusi for Impact Nutrition Africa

REFERENCES

• Environmental enteric dysfunction and child stunting. Sophie Budge,1 Alison H Parker,1 Paul T Hutchings,1 and Camila Garbutt2
• Environmental enteric dysfunction pathways and child stunting: A systematic review Kaitlyn M. Harper, Maxine Mutasa, Andrew J. Prendergast, Jean Humphrey, Amee R. Manges
• https://www.unicef.org/nigeria/water-sanitation-and-hygiene