Poor water, sanitation, hygiene cause childhood stunting: Study

Poor water, sanitation and hygiene cause Environmental Enteric Dysfunction (EED), which results in childhood stunting, according to a study.

The ongoing USAID's Research for Decision Makers (RDM) Activity with icddr,b has found the fact.

Assistant Scientist at Maternal and Child Nutrition, icddr,b, Dr Shah Mohammad Fahim, who is leading the study with Dr Mustafa Mahfuz and Dr Tahmeed Ahmed from the same organisation, revealed this on a virtual policy seminar on Environmental Enteric Dysfunction on Thursday.

The seminar was aimed to inaugurate and disseminate a policy brief titled "Poor Water, Sanitation and Hygiene are causes of Environmental Enteric Dysfunction that results in Childhood Stunting. ''

In the seminar, Dr Shah Mohammad Fahim said environmental enteric dysfunction, previously known as tropical or environmental enteropathy, is a symptom-free small intestinal disorder highly prevalent among children and adults living in tropical and sub-tropical countries.

He also said, "Adverse consequences of the EED, for example, malabsorption, poor nutrition and micronutrient deficiencies are also evident in adults living in poor environmental conditions. A recent research in Dhaka using endoscopy showed features of the EED in undernourished adults compared to their healthy counterparts. Another study on adults conducted in a slum setting in Dhaka revealed that the EED is associated with low body mass index and anaemia."

Dr Shah Mohammad Fahim said the EED was characterised by chronic inflammation, reduced intestinal area for nutrient absorption and disruption of the barrier function in the small intestine.

Thus it causes impaired nutrient absorption and contributes to compromised growth in young children.

Recent evidence confirms the EED's negative impact on the childhood growth and mental development, particularly during the first two years of life.

A number of studies done in different geographic locations, including Bangladesh, have documented the EED as an immediate cause of linear growth failure.

Recent evidence confirms that the EED is a consequence of sustained contact with enteric pathogens due to poor sanitary practices and consumption of contaminated food and water.

Frequent contact with intestinal germs induces abnormal activation of the immune system, resulting in inflammation and gut damage.

Ultimately, malabsorption of nutrients and malnutrition occur.

"Our recent research has shown a causal relationship between components of germs that inhabit the small intestine, the EED and childhood stunting. The condition is also associated with anaemia and iron deficiency in children, and it results in poor impact of vaccines in children. It has also been suggested that childhood EED may lead to the development of non-communicable diseases in later life," said Dr Tahmeed Ahmed, Executive Director, icddr,b.

In an African study, maternal EED was found to be associated with a shorter period of pregnancy and reduced length of new-born infants.

The gold standard to diagnose the EED is endoscopy and histopathology of a biopsied specimen. The condition is evidenced by typical histological changes in the small intestine.

The recommendations for prevention are: improving water, sanitation and hygiene practices at both the individual and household levels; reducing faecal contamination of food and water; limiting exposure to poultry and other animals; and ensuring breastfeeding of children.

The treatment recommendations are: using therapeutic interventions that can increase the number of beneficial gut germs; providing anti-inflammatory therapy, for example, 5-aminosalicyclic acid; and using antimicrobials in the context of acute malnutrition and infection.

The condition of the EED was first identified and described more than 60 years ago among the US Peace Corps volunteers stationed in Thailand and in Bangladesh.

The volunteers suffered unexplained weight loss and abnormal changes in small intestinal biopsy samples upon returning to their home country.

However, the symptoms resolved within several months. It was therefore hypothesised that the role of the environment is crucial in the development of the EED.