Various studies found there is a link between sanitation and stunting. Click here to know more about the issue
India has much implications from the sanitation studies.
What are the links between Sanitation and stunting?
Stunting (low height for age) is driven by multiple factors, one of which is inflammation.
Inflammation is a normal biological response of body tissues to stimuli such as disease-causing bacteria (pathogens).
But ironically repeated exposure to high doses of bacteria that are not linked with diseases or diarrhoea also cause inflammation.
Children living in poor hygiene conditions are regularly exposed to high doses of bacteria that will not cause diarrhoea.
Inflammation down regulates growth factors, and thus impairs normal growth in children.
What are reason behind rejection of the sanitation study?
Studies about sanitation has been conducted in lower and middle income (LAMI) countries.
It had attracted considerable traction among health, nutrition and social researchers and policymakers around the world.
Water, Sanitation and Hygiene (WaSH) trials in countries like Kenya and Bangladesh ended, disappointingly, with no palpable reduction in stunting among children.
When the effect of poor sanitation is obviously passing on from one generation to the other, it might take at least a generation to adopt WaSH interventions before their outcomes can be seen.
Therefore, short-term trials like the ones in Kenya and Bangladesh are bound to show little or no effect.
What are the implications for India?
In India open defecation remains a persistent problem despite sustained and concerted efforts under the Swachh Bharat Abhiyan (SBA) campaign over the last few years.
About 52% of rural India still defecates in the open, India must understand SBA campaign is beyond mere construction of toilets.
Unlike in other countries taken for study, India has a large baseline of ODF (over 50% of open defecation against 1% in Bangladesh) even small improvements can demonstrate significant and palpable changes.
The difference in prevalence of open defecation in urban (7%) and rural (52%) India is large and the figures of stunting are much lower in urban children than among their rural counterparts.
This difference may not necessarily establish the cause-and-effect relationship but it certainly indicates that toilets and sanitation are important factors associated with stunting.
How Bangladesh managed sanitation woes?
It is indeed true that mere building of toilets cannot prompt people to use them as there are a lot of social, cultural and behavioural aspects attached to it.
Bangladesh has managed to bring down open defecation to less than 1% by 2016, from a whopping 42%, in 2006.
A huge chunk of public and charity money was spent on building toilets, and campaign volunteers slogged to change public attitudes and habits.
Children were used literally as whistle-blowers and agents of change while door-to-door campaigns were carried out.
It was done in a dogged campaign in mission mode supported by 25% of the country’s overall development budget.
