Peer-reviewed article

Effects of mothers' water, sanitation and hygiene habits on diarrhoea and malnutrition among children under 5 years in Nepal.

Dhital SR, Chojenta C, Loxton D · 3 Sept 2025

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study examined how mothers' water, sanitation and hygiene practices affect diarrhoea and malnutrition in children under 5 in Nepal, using data from the 2016 Demographic and Health Survey. The research found that lacking a fixed place for handwashing increased the risk of diarrhoea and wasting, while not having access to an improved toilet was linked to stunting and underweight. Combined WASH facilities showed benefits for reducing diarrhoea but mixed results for preventing malnutrition forms.

Key points

7.6% of children under 5 had diarrhoea; 35.6% had stunting, 9.8% had wasting, and 27.1% were underweight
Absence of a fixed handwashing place increased diarrhoea risk by 63% (aOR=1.63, 95%CI 1.20-2.22)
No access to improved toilet was associated with stunting (aOR=1.78) and being underweight (aOR=1.45)
No fixed handwashing place was associated with wasting (aOR=1.52, 95%CI 1.00-2.30)
Combined WASH components had positive effects on diarrhoea control but mixed effects on malnutrition prevention

Limitations

This is a cross-sectional analysis of survey data, so it cannot establish causation or determine the direction of relationships. The study cannot account for unmeasured confounding factors or explain the mechanisms by which WASH practices affect child health outcomes.

Abstract

Introduction Diarrhoea and malnutrition (stunting, wasting and underweight) are major public health problems in developing countries, including Nepal. Improved water, sanitation and hygiene (WASH) may reduce the global disease burden by as much as 10.0%. This paper aims to examine the effects of the WASH components on diarrhoea and malnutrition rates among children under 5 years in Nepal. Methods The 2016 Nepal Demographic and Health Survey datasets were examined. The sample included children with outcome measures of diarrhoea (n=4846) and malnutrition (n=2363 for stunting, n=2360 for wasting and n=2370 for underweight). The study participants were mothers aged 15-49 with children under 5 years on the survey day. A multivariate logistic regression analysis was performed. The potential confounders were identified through Directed Acyclic Graphs software. Results Among children under 5 years of age, 7.6% were suffering from diarrhoea, 35.6% from stunting, 9.8% from wasting and 27.1% from underweight. The absence of a fixed place for handwashing was associated with diarrhoea (adjusted OR (aOR)=1.63; 95%CI 1.20 to 2.22). Having no access to an improved toilet arrangement was associated with stunting and being underweight (aOR=1.78; 95%CI 1.25 to 2.55 and aOR=1.45; 95%CI 1.03 to 2.06, respectively). Having no fixed place for handwashing was associated with wasting (aOR=1.52; 95%CI 1.00 to 2.30). Conclusions There is a significant relationship between diarrhoea and combined WASH facilities and mixed effects of an individual WASH components for malnutrition. A fixed place for handwashing can increase the rate of handwashing with soap practices. Importantly, combined WASH components can have positive effects on the control of diarrhoea but not necessarily on the prevention of malnutrition. Further, the results for individual WASH components in the prevention of malnutrition were also mixed. Therefore, further studies are needed to examine the association between combined WASH components and malnutrition.