Peer-reviewed article
The role of water and sanitation, diarrheal infection, and breastfeeding on child stunting: insights from a historical analysis of the Cebu longitudinal health and nutrition survey, 1984–1986
Rockli Kim, S. V. Subramanian, Endel John Orav, Wafaie Wahib Fawzi ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how access to improved water and sanitation relates to child stunting in the Philippines between 1984 and 1986, using data from 2,584 children followed from birth to age 2. More than half of the children were stunted, and only about one-quarter had access to improved water and sanitation. Children with improved water and sanitation access had significantly lower rates of stunting, whether or not they had experienced diarrhea. The protective effect of improved water and sanitation appeared stronger for children who were not breastfed.
Key points
- 53.9% of children were stunted at age 2 in the study population
- Only 26.8% of the sample had access to improved water and sanitation
- Improved water and sanitation was associated with 41% reduction in odds of stunting (OR 0.59, p<0.01)
- The protective effect of improved water and sanitation was consistent among children with and without diarrheal episodes
- Improved water and sanitation appeared more beneficial for non-breastfed children (marginal interaction p=0.10)
Limitations
This is historical data from 1984-1986 in one Philippine city, so findings may not reflect current conditions or other low- and middle-income settings. The cross-sectional analysis cannot definitively establish causation, and the authors acknowledge that WATSAN may operate through pathways other than clinically detectable diarrheal infection.
Abstract
Background: The association between improved water and sanitation (WATSAN) and child nutritional status may operate through diverse pathways and interact with other risk factors.We examined the joint association between WATSAN and child stunting in the Philippines during a historically critical period marked with substantial heterogeneity in WATSAN conditions.Methods: Data came from the Cebu Longitudinal Health and Nutrition Survey.Birth surveys and bi-monthly follow-up surveys from 1984-1986 were used for the final analytic sample of 2,584 children.We ran a series of logistic regression models for WATSAN and child stunting at age 2, before and after adjusting for a priori selected covariates.We performed stratified analysis by the child's experience of diarrhea in the first 2 years (never vs. at least 1 incidence), and tested for interaction with breastfeeding practices in the first 6 months (never vs. partial vs. predominant).Results: 53.9% of our sample were stunted at age of 2 and only 26.8% had access to improved WATSAN.In our final multivariate adjusted model, improved WATSAN was associated with a significantly reduced odds of stunting (odds ratio [OR], 0.59; P < 0.01).This was consistently found among children who have never experienced diarrheal incidence (OR, 0.38; P = 0.03) as well as those who have experienced diarrhea at least once (OR, 0.62; P < 0.05).A marginally significant interaction was found between WATSAN and breastfeeding (P = 0.10).Conclusion: Ensuring access to improved WATSAN has great potentials to reduce child stunting, and this could occur through diverse pathways that do not necessarily involve clinically detectable signs of infection.Improved WATSAN appears to be relatively more important for children who are not breastfed.Future studies should explore these associations using more recent data and in the context of other low-and middle-income countries.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Improved water and sanitation access
- Population
- 2,584 children in Cebu, Philippines, followed from birth to age 2 during 1984-1986
Key finding
Improved WATSAN was associated with significantly reduced odds of stunting at age 2 (OR 0.59, p<0.01)
Kim et al. · OpenAlex · 1 Jan 2019