While child mortality rates have plummeted worldwide, . Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
Just last week estimates were released suggesting that (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:
World Toilet Day
The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell
A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).
World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.
Today marks the second annual UN World Toilet Day, an important opportunity to promote global efforts to achieve universal access to sanitation by 2030. With a focus on equality and dignity, this year, World Toilet Day aims to highlight sanitation as a global development priority, especially for women and girls who must compromise their dignity and put their safety at risk when lack of access to sanitation forces them to defecate in the open.
Junaid Ahmad, World Bank Group Senior Director for Water, and Caren Grown, World Bank Group Senior Director for Gender, wrote a blog for Thomson Reuters Foundation ahead of World Toilet Day. Read the blog below, which originally appeared in Thomson Reuters Foundation.
Advancing equality for women in developing countries is not only the right thing to do, it makes good economic sense.
Gender equality enhances productivity, improves well-being, and renders governing bodies more representative. And yet around the world, discriminatory laws, preferences, and social norms ensure that girls and women learn less, earn less, own less, enjoy far fewer opportunities to achieve their potential, and suffer disproportionately in times of scarcity or shock.
Sanitation brings numerous benefits such as reducing the burden of disease, improving quality of life, promoting the safety of women and girls, not to mention the excellent economic investment that sanitation represents. Yet, to realize these benefits, new approaches are needed that work at scale and promote equality of access. As Eddy Perez, Lead Sanitation Specialist at the World Bank’s Water and Sanitation Program, recently highlighted in his excellent blog posts, eliminating inequalities and achieving universal access requires transformational change and a departure from ‘business as usual’. (Read ‘How and Why Countries are Changing to Reach Universal Access in Rural Sanitation by 2030’ and ‘Fixing Sanitation Service Delivery for the Poor to Meet the Twin Goals’).
In the quiet village of Bantayanon in Negros Occidental, Ligaya Almunacid showed off her new toilet. “This is my dream toilet,” she told us. Hers is not the typical structure made of palm-thatched roof and walls commonly seen in the area, but rather made of concrete hollow blocks with galvanized iron roofing.
The 48-year old lady was all smiles throughout our conversation, telling us what she liked about the toilet. “I wanted my toilet to be durable especially since our house sits in the middle of a flood-prone area.” Ligaya recalled how difficult it was in the past when her family had to share their neighbor’s toilet, or take the risk of getting bitten by snakes in the field just to relieve themselves. On closer examination, it would seem that she made the right decision in building a hygienic and resilient structure in securing her family’s health and welfare.
Alassane Sow, World Bank Country Manager for Cambodia, and Rana Flowers, UNICEF Representative to Cambodia, wrote an op-ed for The Phnom Penh Post. Read the op-ed below, courtesy of The Phnom Penh Post.Did you know that in communities where a high proportion of people defecate outdoors, children are on average shorter than children living in communities where most people use toilets?
Happy belated 1st World Toilet Day! The newly designated UN day embodies the enormous development challenge of providing safe toilets to all. More than 2.5 billion people still don’t have access to adequate sanitation and 1 billion defecate in the open. It brings into sharp focus the need to foster innovation and dialogue on sanitation, especially given our straggler status on the sanitation MDG. From enhancing water management to ending open defecation, the wide ambit of influencing policy and behavior change can seem daunting at times.