Title: Don’t discount WaSH
(It is too early to reject the link between sanitation and stunting)
• The recent article “Can sanitation reduce stunting?” (The Hindu, February 15) brought forth an important and interesting debate on sanitation that has been attracting considerable traction among health, nutrition and social researchers and policymakers around the world, more so in the lower and middle income (LAMI) countries.
•The article touched upon many dimensions and possible reasons to explain why Water, Sanitation and Hygiene (WaSH) trials in countries like Kenya and Bangladesh ended, disappointingly, with no palpable reduction in stunting among children.
Problem of open defecation
While these countries are dramatically different from India, and open defecation remains a persistent problem despite sustained and concerted efforts under the Swachh Bharat Abhiyan (SBA) campaign over the last few years, the very fact that over half (about 52%) of rural India still defecates in the open is still a reason why it may be too early to quash or discount SBA.
The campaign is beyond mere construction of toilets. The importance it accords to cleanliness, hygiene and sanitation can go a long way in India’s fight against not only stunting (low height for age) but also many other forms of malnutrition.
Stunting is driven by multiple factors, one of which is inflammation.
Inflammation is a normal biological response of body tissues to stimuli such as disease-causing bacteria (pathogens), but ironically repeated exposure to high doses of bacteria that are not linked with diseases or diarrhoea also cause inflammation.
Children living in environments where hygiene is poor and open defecation is common are regularly exposed to high doses of bacteria that will not cause diarrhoea or frank gastrointestinal infections, but certainly stimulate low-grade chronic inflammation.
Inflammation down regulates growth factors, and thus impairs normal growth in children. Mothers with inflammation in the gestation tissues had smaller babies in our study.
When the effect of poor sanitation is obviously passing on from one generation to the other, it might take at least a generation to adopt WaSH interventions before their outcomes can be seen.
Therefore, short-term trials like the ones in Kenya and Bangladesh are bound to show little or no effect. In addition, in India, where the baseline, unlike in those countries, is so large (over 50% of open defecation against 1% in Bangladesh) even small improvements can demonstrate significant and palpable changes.
The Bangladesh way
ü It is indeed true that mere building of toilets cannot prompt people to use them as there are a lot of social, cultural and behavioural aspects attached to it. What we need to learn from Bangladesh is how they have managed to bring down open defecation to less than 1% by 2016, from a whopping 42%, in a little over a decade.
ü Bangladesh’s sanitation victory definitely did not come easy. A huge chunk of public and charity money was spent on building toilets, and campaign volunteers slogged to change public attitudes and habits.
Vocabulary words:
Sanitation (noun) = Hygiene (स्वच्छता)
Stunting (noun) = Inhibit, hamper (वृद्धि को रोक)
Bring forth (phrasal verb) = To produce (सामने लाना)
Palpable (adj) = Visible, noticeable (स्पर्शनीय, स्पष्ट)
Defecation (noun) = The discharge of faeces from the body (शौच)
Concerted (adj) = Collaborative, collective (ठोस, सम्मिलित)
Quash (verb) = Cancel, surpass (समाप्त करना)
Discount (verb) = Dismiss, degrade (समाप्त करना)
Mere (adj) = Used to emphasize how small or insignificant someone or s something is (मात्र)
Accord (verb) = Grant, agree (सहमत होना)
Malnutrition (noun) = Lack of proper nutrition, not having enough to eat (कुपोषण)
Inflammation (noun) = A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection (सूजन)
Stimuli (noun) = Incentive, encouragement (उत्तेजना)
Gastrointestinal (adj) = Relating to stomach and the intestines
Gestation (noun) = The period of developing baby inside the womb (गर्भकाल)
Intervention (noun) = Involvement (हस्तक्षेप)
Prevalence (noun) = Dispersion (प्रसार)
Counterpart (noun) = Equivalent, equal (समकक्ष)
Whopping (adj) = Huge, massive (विशाल)
Last Note:-
Given its vastness, diversity and varied views, India may take time to change, but let us not think all is pointless with WaSH, and nothing is working.
• The recent article “Can sanitation reduce stunting?” (The Hindu, February 15) brought forth an important and interesting debate on sanitation that has been attracting considerable traction among health, nutrition and social researchers and policymakers around the world, more so in the lower and middle income (LAMI) countries.
•The article touched upon many dimensions and possible reasons to explain why Water, Sanitation and Hygiene (WaSH) trials in countries like Kenya and Bangladesh ended, disappointingly, with no palpable reduction in stunting among children.
Problem of open defecation
While these countries are dramatically different from India, and open defecation remains a persistent problem despite sustained and concerted efforts under the Swachh Bharat Abhiyan (SBA) campaign over the last few years, the very fact that over half (about 52%) of rural India still defecates in the open is still a reason why it may be too early to quash or discount SBA.
The campaign is beyond mere construction of toilets. The importance it accords to cleanliness, hygiene and sanitation can go a long way in India’s fight against not only stunting (low height for age) but also many other forms of malnutrition.
Stunting is driven by multiple factors, one of which is inflammation.
Inflammation is a normal biological response of body tissues to stimuli such as disease-causing bacteria (pathogens), but ironically repeated exposure to high doses of bacteria that are not linked with diseases or diarrhoea also cause inflammation.
Children living in environments where hygiene is poor and open defecation is common are regularly exposed to high doses of bacteria that will not cause diarrhoea or frank gastrointestinal infections, but certainly stimulate low-grade chronic inflammation.
Inflammation down regulates growth factors, and thus impairs normal growth in children. Mothers with inflammation in the gestation tissues had smaller babies in our study.
When the effect of poor sanitation is obviously passing on from one generation to the other, it might take at least a generation to adopt WaSH interventions before their outcomes can be seen.
Therefore, short-term trials like the ones in Kenya and Bangladesh are bound to show little or no effect. In addition, in India, where the baseline, unlike in those countries, is so large (over 50% of open defecation against 1% in Bangladesh) even small improvements can demonstrate significant and palpable changes.
The Bangladesh way
ü It is indeed true that mere building of toilets cannot prompt people to use them as there are a lot of social, cultural and behavioural aspects attached to it. What we need to learn from Bangladesh is how they have managed to bring down open defecation to less than 1% by 2016, from a whopping 42%, in a little over a decade.
ü Bangladesh’s sanitation victory definitely did not come easy. A huge chunk of public and charity money was spent on building toilets, and campaign volunteers slogged to change public attitudes and habits.
Vocabulary words:
Sanitation (noun) = Hygiene (स्वच्छता)
Stunting (noun) = Inhibit, hamper (वृद्धि को रोक)
Bring forth (phrasal verb) = To produce (सामने लाना)
Palpable (adj) = Visible, noticeable (स्पर्शनीय, स्पष्ट)
Defecation (noun) = The discharge of faeces from the body (शौच)
Concerted (adj) = Collaborative, collective (ठोस, सम्मिलित)
Quash (verb) = Cancel, surpass (समाप्त करना)
Discount (verb) = Dismiss, degrade (समाप्त करना)
Mere (adj) = Used to emphasize how small or insignificant someone or s something is (मात्र)
Accord (verb) = Grant, agree (सहमत होना)
Malnutrition (noun) = Lack of proper nutrition, not having enough to eat (कुपोषण)
Inflammation (noun) = A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection (सूजन)
Stimuli (noun) = Incentive, encouragement (उत्तेजना)
Gastrointestinal (adj) = Relating to stomach and the intestines
Gestation (noun) = The period of developing baby inside the womb (गर्भकाल)
Intervention (noun) = Involvement (हस्तक्षेप)
Prevalence (noun) = Dispersion (प्रसार)
Counterpart (noun) = Equivalent, equal (समकक्ष)
Whopping (adj) = Huge, massive (विशाल)
Last Note:-
Given its vastness, diversity and varied views, India may take time to change, but let us not think all is pointless with WaSH, and nothing is working.
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