Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development: Making the Links

January 2014

… it is also important to broaden the conceptual structure of WASH as an aspect of child nutrition and development interventions, and not simply as the sum of toilets, caregiver handwashing, and water purification.

There is scarce research and programmatic evidence on the effect of poor water, sanitation and hygiene (WASH) conditions on early child cognitive, sensorimotor, and socioemotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first three years of life, when gut health and linear growth are established.

We review evidence linking WASH, anemia,and child growth, and highlight pathways through which WASH may affect early child development (ECD), primarily through inflammation, stunting and anemia. Environmental enteropathy, a prevalent sub-clinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits.

Current ECD research and programmes lack evidence-based interventions to provide a clean play and infant feeding environment, in addition to established priorities of nutrition, stimulation, and child protection.

Solutions to this problem will require appropriate behaviour change, and technologies that are adapted to the social and physical context and conducive to infant play and socialisation. We propose the concept of BabyWASH as an additional component of ECD programmes.

Additional details

PublisherAnnals of the New York Academy of Sciences
ThemesChild faeces, Health, Hygiene

Ngure, F.M.; Reid, B.; Humphrey, J.; Mbuya, M.; Pelto, G. and Stoltzfus, R. (2017) ‘Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development: Making the Links’, Annals of the New York Academy of Sciences 1308: 118-128


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