Risk of environmental enteropathy and stunting among rural Ethiopian children Open Access

Rahman, Sheikh (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/bz60cx00c?locale=en


Introduction/Background: Child undernutrition is a major public health problem globally. Stunting is linear growth retardation among children under 3 years of age which results from a range of multifaceted factors. Poor sanitation, hygiene and water quality collectively constitute a household environment which can predispose young children to the risk of developing environmental enteropathy (EE). There is limited evidence documented from research or programs on the effect of the household environment on child nutritional outcomes. Objective: The objective of this study is to assess the relationship between the household WASH (water quality, sanitation and hygiene) environment and stunting among children 6-36 months of age from rural Ethiopia. Method: Data were analyzed from the baseline survey of a cross sectional observation study conducted by the Nutrition at Center (N@C) project of CARE Ethiopia . This project is currently working in the north east part of Ethiopia. A total 2123 children age 0-36 months and their mothers or primary caregivers were included in this survey. A logistic regression model was employed to run the analysis. Both bivariate and multivariate regressions were performed using IBM SPSS Statistics Version 20 and WHO Anthro version 3.2.2. Results: About 55% children are stunted (HAZ <-2SD) and have poor household WASH indicators. The latter are key constituents of EE risk. A summative index of EE components was used in the binary logistic regression. Results of logistic regression indicates that households with a higher risk of EE [OR 1.273, p value= 0.007, CI (91.067-1.518)] are more likely to have stunted children. Conclusion: The household WASH environment constitutes a risk of developing EE and mediates its effect on health and nutrition outcomes. Improvement of household WASH environment along with nutrition interventions can potentially prevent stunting among young children.

Table of Contents

Table of Contents Chapter I: Introduction Context of project Problem Statement Objectives Chapter II: Literature review Global child undernutrition Child undernutrition in Ethiopia Determinants of stunting Figure 2.1: UNICEF Child Undernutrition Framework Household WASH environment and risk of EE Environmental Enteropathy EE's Pathological Pathways Diagnostic criteria of Environmental Enteropathy (EE) Reversibility of EE among individuals Association of EE with stunting among children Figure 2.2: Environmental Enteropathy Pathological Pathway and Stunting Socioeconomic status and EE EE, nutrition and WASH interventions Key Study Premise Chapter III: Methodology, variables and model development Study area location Fig 3.1: Map of "Nutrition at Center" Ethiopia project baseline and control districts Intervention district characteristics Survey methodology Sampling frame Sample size Table 3.1: Survey sample size included in the analysis by age group Study design Selection of participants Survey tool Enumerator training Data collection Data entry quality control protocol Data analysis Statistical model Figure 3.1: Proposed Theoretical Model Variables and measures Table 3.2: Concepts and measures on anthropometry and mother's literacy Table 3.3: Concept and measures on HH toilet facilities Table 3.4: Concepts and measures of child defecation Table 3.5: Concept and measures on handwashing at the three critical times Table 3.6: Concept and measures on soap and water availability at HH for handwashing Table3.7: Concepts and measures on water quality Table 3.8: Variable Final Categories CHAPTER IV: RESULTS Table 4.1: Characteristics of study sample Table 4.2: Final measures for bivariate and multivariable analyses Bivariate analysis Table 4.3: Final measures and stunting - bivariate analysis Multivariate analysis Table 4.4: Logistic regression-1 results: Children stunted at (6-36) months of age compared to those who are not Table 4.5: Logistic regression-2 results: Children stunted at (6-36) months of age compared to those who are not CHAPTER V: DISCUSSION AND CONCLUSION Policy implications Contribution Limitations Reference Appendix-1 Table of content of survey questionnaire A. Household identification and summary B. Child Information C. Mother's Information D. Basic information of household characteristics E. Agriculture production, access to food F. Food preservation and storage G. Agriculture Extension I. Household Hunger Scale J. Women's Diet Diversity Score K. Maternal health/pregnancy L. Infant and Young Child Feeding Practices (IYCF) M. Responsive Feeding N. Childhood illness O. Drinking water P. Hand washing, sanitation and disposal of child's feces Q. Women's Empowerment Mobility Community Social Capital Household Decision-making Gender Attitude and Belief: Tolerance of Intimate Partner Violence R. Community group and Government safety net participation S. Mother's Anthropometry (Part I) Z. Child's Anthropometry (Part I) S. Mother's Anemia (Hemoglobin) Part II Z. Child's Anemia (Hemoglobin) Part II

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