Syndicate content

Helping children survive and thrive: How toilets play a part

Claire Chase's picture



While child mortality rates have plummeted worldwide, nearly one-third of all children under 5 in developing countries are stunted. 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 poor sanitation is the second leading cause of child stunting worldwide (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:

Addressing the urban sanitation crisis: Time for a radical shift

Martin Gambrill's picture

Co-authors:

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

Children in Maputo, Mozambique 
Photo credit: 
Isabel Blackett/The World Bank

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.

Looking ahead towards a water-secure world for all

Guangzhe CHEN's picture

To many people, it is a surprise to learn that in an age of such advanced technology, at least 663 million people still lack access to basic needs, like safe drinking water, or that 2.5 billion people lack access to sanitation, such as a toilet or latrine. And while much progress has been made, receiving safe drinking water 24 hours a day, seven days a week simply by turning a tap is still a dream for many in the developing world.
 
Even fewer realize this is not just a problem for families, but also for those on which families rely and that also need water: the farmers who grow the families’ food, the environment that protects and sustains their homes and communities, the businesses that employ them, the cities that house them, the schools that educate their children, the clinics and hospitals that treat them, and even the power plants that generate their electricity.
 
Why does this challenge persist? How can this challenge be met? And an increasingly urgent question: is there enough water to go around?

Targeting urban sanitation: Looking behind aggregated city-level data

Peter Hawkins's picture
Also available in: Español

In our previous blogs: Fecal Sludge Management: the invisible elephant in urban sanitation,  5 lessons to manage fecal sludge better, and A tale of two cities: how cities can improve fecal sludge management, we outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing urban sanitation challenges and how they can be used. Today, on World Cities Day, we are looking more deeply into a city — Lima, Peru, to shed light on how cities around the world can meet opportunities and address challenges of urbanization including providing improved sanitation for a rapidly growing number of urban residents.

Korea: A model for development of the water and sanitation sector

Alexander Danilenko's picture
Cheonggyecheon Stream, Seoul, Korea 
Photo: Mark Pegrum

Can a sustainable water sector be developed simultaneously with a country’s growth? Can the water sector continue to expand and achieve comprehensive coverage and financial sustainability goals to become a recognized global model for water sector management and performance? Can a country without a single sewer line in 1958 have 90 percent of its wastewater treated by 2012?

The answer is yes! The example is Korea.

New directions in the economics of agricultural water conservation

Susanne M. Scheierling's picture

A challenging area in agricultural water management is the assessment of policy and investment options in irrigated agriculture for conserving water and adapting to increasing water scarcity, in particular when the linkages to groundwater resources and their management are to be considered and incorporated. 

However, this is an increasingly important area of research for a number of reasons.  First, irrigated agriculture accounts for about 70% of global freshwater withdrawals, and is a major contributing factor to the water scarcity situation in many countries.  Second, with almost a quarter of freshwater withdrawals for irrigated agriculture being made up of groundwater supplies—corresponding to 70% of total groundwater withdrawals—, agricultural water use is also a major contributing factor to aquifer overexploitation.  And, third, surface water and groundwater are closely linked in most parts of the world, with groundwater discharge contributing to the base flow of streams and surface water contributing to groundwater recharge, and these interactions are intensified by human action, in particular water withdrawals for irrigated agriculture.  Even in cases where irrigated agriculture depends mostly on surface water, groundwater impacts therefore need to be accounted for when assessing water conservation efforts (and vice versa).

Eight things we know about water and electricity utilities in Africa

Luis Andres's picture

Infrastructure is one of the most important forces driving economic growth and poverty reduction.Yet Africa’s infrastructure networks lag increasingly behind those of other developing countries in providing telecom, electricity, and water supply and sanitation services. Two-thirds of the population in the region lacks access to electricity and five out of six people don't have access to piped water. The people and industries that do have services pay twice as much as those outside Africa, further reducing regional competitiveness and growth. As cities continue to flood with migrants looking for better economic opportunities, power and water utilities are being challenged to improve the services offered to existing and new users. Given scarce resources and competing development priorities, it is essential to establish ways of using resources (and knowledge!) more effectively. 

How we help countries track and report on the Sustainable Development Goals on water, sanitation and hygiene

Ana María Oviedo's picture
Enumerators in Ecuador collecting water sample
for water quality test.
Credit: World Bank team in Ecuador

Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
 
From MDGs to SDGs: What’s New for Water and Sanitation?
 
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.

How can cities reduce water-energy nexus pressures?

Robert C. Brears's picture
Credit: Water & Sanitation Program 

Cities over the past century have become the driving force of the global economy. Accounting for over half the world’s population and generating around 80% of global GDP, cities provide numerous opportunities for development and growth. Cities however bring about risks and challenges to people and the environment. By 2050, demand for water is projected to increase by 55% mainly due to increased demand from urban populations. At the same time demand for energy in providing water and wastewater treatment services will increase.

Delivering water and sanitation services in Niger: challenges and results

Taibou Adamou Maiga's picture

Niger is one of the world’s poorest countries (44.5% of poverty incidence in 2014). The country faces a number of challenges in meeting the national (PROSEHA, the National Program for sustainable development) and global targets to increase access to sanitation and potable water, particularly in rural areas where the access to water is 44.2% and 7% for sanitation (2015 Ministry of Water and Sanitation data).

Overcoming these challenges while satisfying increasing demands for better or expanded service, the government began investigating options that bring in the know-how of the private sector. This has led to a growing domestic private sector provision of services in Niger.

Pages