Caught Short: Role of WASH in Nutrition

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India is home to a staggering 48 million stunted children under age five – the highest in the world. Stunting reflects chronic undernutrition during the most critical periods of growth and development in early life and is defined as children having low height for age. Stunting is commonly associated with lack of adequate food or nutrition. But few know the impact that toilets and clean water have on children’s growth and development.

Ningraj (8), Shivaganga (8), Yellapa (8), Manjula (9), Ayyanna (8), Sridevi (8), Nagaratna (8) (L-R) at Government Higher Primary School, Ooti, Raichur, Karnataka, India, September 2016.
WaterAid/ Ronny Sen

Children stand underneath a chalk mark showing the global average height for an eight-year-old at a primary school in Ooti Village, Karnataka, India. India is home to a staggering 48 million stunted children under age five – the highest in the world. Stunting reflects chronic undernutrition during the most critical periods of growth and development in early life and is defined as children having low height for age. Globally, 159 million children under the age of five are stunted – one in four children.

65 year old Yellamma feeding her 9 year old granddaughter Manjula at her house in Ooti village, Karnataka, India. Stunting, a major manifestation of undernutrition results from severe and persistent undernutrition
WaterAid/ Ronny Sen

65 year old Yellamma feeding her 9 year old granddaughter Manjula at her house in Ooti village, Karnataka, India. Stunting, a major manifestation of undernutrition results from severe and persistent undernutrition. Ask any parent what influences their child’s physical and mental development and most will answer their genes, environment and the food they eat. But few know the impact that toilets and clean water have on children’s growth and development.

Manjula, 8, stands outside her WaterAid-installed toilet in Gonnigannur, Raichur, Karnataka, India, September 2016.
WaterAid/ Ronny Sen

8 year old Manjula outside her newly constructed toilet in Gonnigannur village, Karnataka, India. 6 million people in India do not have access to safe water and 774 million live without adequate sanitation. The World Health Organisation estimates that 50% of undernutrition – a major form of malnutrition – is associated with infections caused by unsafe water, poor sanitation and unhygienic practices, including not washing hands with soap.

Pushpa, 9, points towards the field where she normally goes to the toilet in K Hanchinal Camp, Raichur, Karnataka, India, September 2016.
Ronny Sen

9 year old Pushpa pointing towards her open defecation site in K Hanchinal Camp, Karnataka, India. Diarrhoeal diseases caused by dirty water and poor sanitation are the second biggest killer of children under five after pneumonia, taking 140,000 young lives in India every year. Even those children who survive severe bouts of diarrhoea are at risk of having their lives, and life chances, forever changed. Getting ill with diarrhoea, intestinal worms and other infections stops children from being able to absorb the nutrients they need to grow physically and mentally.

Headmaster Kotresha Hiremath, 36, teaches children at a Primary School in Gonnigannur, Raichur, Karnataka, India, September 2016.
Ronny Sen

Kids studying at a primary school in Gonnigannur village, Karnataka, India. The time wasted from being sick with diseases has a huge impact on education. Children are more likely to fall behind in school or even drop out altogether. Regular bouts of diarrhoea not only mean children struggle to keep up at school because they are often absent, it can also affect the makeup of the brain and prevents children from reaching their potential.

Anganwadi worker taking weight of kids in Undral Doddi village, Karnataka, India
Ronny Sen

Anganwadi worker taking weight of kids in Undral Doddi village, Karnataka, India. Malnutrition also inflicts a big economic burden. This year’s Global Nutrition Report has found that the impact of malnutrition costs 11% of GDP annually across Africa and Asia. The impact, and costs, of low weight, poor child growth and deficiencies in vitamins and minerals add to the burden on health systems and affect development. Making sure communities are healthy can increase productivity and lead to more economic opportunities.

Children sit on the floor at a children's development centre in Undral Doddi, Raichur, Karnataka, India. September 2016.
Ronny Sen

Kids waiting for food at the Anganwadi centre in Undral Doddi village, Karnataka, India. The Government of India has made concerted efforts to get food to children and their families through various initiatives. India has undoubtedly made progress with regard to child undernutrition with stunting rates dropping from 48% in 2006 to 38.7% in 2015. To completely eradicate stunting, nutrition-sensitive interventions that tackle the underlying drivers of nutrition such as clean water, safe sanitation and good hygiene, among others, are critical.

Kids washing hands before meal at Government Lower Primary School, Puchaldinni, Raichur, Karnataka, India, September 2016.
Ronny Sen

Kids washing hands with soap before midday meal at a primary school in Puchaldinni village, Karnataka, India. We need to invest in solutions that will improve the lives of millions of the country’s most vulnerable children. Good food will only get us part of the way to the finishing line. We need clean water, clean toilets and clean hands to finish this race and end undernutrition altogether.