Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications
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Stunting is a complex and enduring challenge with far-reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high-burden settings, such as South Asia and sub-Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.
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There might be multiple additional mechanisms by which WASH could contribute to undernutrition, such as via parasitic infections, asymptomatic carriage of certain enteric pathogens, and environmental enteric dysfunction.
“There might be multiple additional mechanisms by which WASH could contribute to undernutrition, such as via parasitic infections,53 the asymptomatic carriage of certain enteric pathogens,48 and environmental enteric dysfunction.12, 54”
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Chakravarty, N., Tatwadi, K., & Ravi, K. (2019) · International Journal of Medicine and Public Health · doi:10.5530/ijmedph.2019.4.24 · Cited by 17 · see citing works
Sahiledengle, B., Mwanri, L., Blumenberg, C., & Agho, K. (2023) · BMC Public Health · doi:10.1186/s12889-023-16907-x · Cited by 17 · see citing works
Wirth, J. P., Sesay, F., Mbai, J., Ali, S. I., Donkor, W. E. S., Woodruff, B. A., Pilane, Z., Mohamud, K. M., Muse, A., Yussuf, H. O., et al. (2022) · Maternal & Child Nutrition · doi:10.1111/mcn.13254 · Cited by 17 · see citing works
Chen, B., Jin, F., & Zhu, Y. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1026714 · Cited by 16 · see citing works
- Authors
- Cumming, O., & Cairncross, S.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Cumming, Oliver
- Venue
- Maternal & Child Nutrition
- Publisher
- Wiley
- Published
- 2016-05
- Volume
- 12
- Issue
- S1
- Pages
- 91-105
- ISSN
- 1740-8695 (ISSN-L)
- 1740-8709
- PMC
- PMC5084825
- OpenAlex
- W2396904246
- Cited by
- 338
- References
- 109
- Citations by year
- 2026: 38 · 2025: 26 · 2024: 37 · 2023: 32 · 2022: 39 · 2021: 44 · 2020: 58 · 2019: 30 · 2018: 20 · 2017: 11 · 2016: 3
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Maternal and Child Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- UNICEF
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- stunting, water, sanitation and hygiene, WASH interventions, child undernutrition, enteric pathogens, child growth and development, Sustainable Development Goals, South Asia, sub-Saharan Africa
- MeSH terms
- Asia, Child Development, Child Nutritional Physiological Phenomena, Child, Preschool, Female, Growth Disorders, Humans, Hygiene, Infant, Infant, Newborn, Infections, Pregnancy, Sanitation, Socioeconomic Factors, Water Supply, Infection Control, Africa South of the Sahara
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