Peer-reviewed article
Sociodemographic Factors and Childhood Growth: Associations with Environmental Sanitation Phases.
Morejón-Terán Y, Campos ACP, Parise-Vasco JM, Amorim LDAF, Rodrigues LC et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed 1,429 children in Brazil from 1997 to 2013 across three time periods representing different phases of a sanitation program to understand how environmental sanitation improvements affect child growth. Children born after the sanitation intervention showed better height growth compared to earlier cohorts. Key factors affecting growth included birth weight, household overcrowding, breastfeeding practices, and mode of delivery, with effects varying between time periods.
Key points
- Post-intervention children showed improved height-for-age trajectories compared to pre-intervention and intervention cohorts
- Birth weight positively associated with height-for-age across all cohorts (0.34-0.49 kg increase per z-score)
- Household overcrowding consistently reduced height-for-age by 0.34 to 0.63 z-score
- Children never exclusively breastfed in the post-intervention phase had higher BMI-for-age (0.76 z-score increase)
- Caesarean delivery associated with higher BMI-for-age in pre- and intervention cohorts
Limitations
The study cannot isolate the specific effect of sanitation improvements alone from other concurrent economic and societal changes in Brazil during the study period. The authors note that experimental or quasi-experimental designs would be needed to determine the independent contribution of sanitation to improved child growth.
Abstract
Background Early childhood growth trajectories can influence the risk of chronic diseases in adulthood. Improvements in environmental sanitation may affect child development in low-resource settings. Objective to examine the associations among socioeconomic factors with nutrition indicators, and trajectories of anthropometric indicators across three epidemiological cohorts that reflect different phases of environmental sanitation implementation. Methods A longitudinal study was conducted in Salvador, Brazil, from 1997 to 2013. A total of 1429 children were recruited across three epidemiological cohorts, corresponding to the phases of a sanitation program: pre-intervention (n = 299), intervention (n = 1007), and post-intervention (n = 123). Height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were assessed at four time points. Multilevel linear models were used to adjust for socioeconomic factors. Results A total of 992 children (68.7%) completed follow-up. Post-intervention children showed improved HAZ trajectories, with sex-specific patterns that varied across cohorts. Birth weight is positively associated with HAZ across all cohorts (0.34-0.49 kg increase per z-score). Household overcrowding (>2 persons/room) is consistently associated with lower HAZ (-0.34 to -0.63 z-score reduction). Children who were never exclusively breastfed in the post-intervention phase had a higher BAZ (0.76 z-score increase). Caesarean delivery is associated with higher BAZ in the pre-intervention (0.23) and intervention (0.27) cohorts. Conclusions Children born in later time periods showed better growth trajectories, which may reflect the combined effects of sanitation improvements, economic development, and other societal changes in Brazil during this period. Further research using experimental or quasi-experimental designs is needed to isolate the specific contribution of sanitation to child growth.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Environmental sanitation program implementation over time
- Population
- 1,429 children in Salvador, Brazil across three cohorts: pre-intervention (n=299), intervention (n=1,007), and post-intervention (n=123); 992 children (68.7%) completed follow-up
Key finding
Post-intervention children showed improved height-for-age trajectories with sex-specific patterns across cohorts