The NY Times posted an article today about India’s sanitation issues. The thought is, that most children get enough food to eat, and sanitation and hygiene are the real issues that impact nutrition outcomes. Open defecation is widely practiced in India and certainly does contribute to childhood illness, diarrhea, poor nutrient absorption and burden of infectious disease. However there is still the issue of access to quality, nutritious diets. It isn’t just enough to ensure children have sufficient calories. Quality calories need to be accounted for. However, children need to be able to digest and absorb those quality calories and if parasites, and “environmental enteropathy” (insult to the intestinal tract) are present, this make it quite hard.
Dean Spears out of Princeton University is credited with really bringing the open defecation issue to light, particularly in India through a series of blogs and published papers. This paper in Plos One showed that open defecation is correlated with stunting (low height for age), a measure of chronic undernutrition. And was we know India has some of the highest open defecation rates in the world, along with the highest burden of stunting in children under five. See the below figure from the NY Times article.
The key to addressing this is a three pronged WASH program: water, sanitation, and hygiene. One component is access and availability of clean water, important for drinking water consumption, washing, and preparing food. Another component is basic sanitation, allowing for open-defection-free communities and a less contaminated environment. The third component is hygiene, including hand washing and food preparation, particularly important in contaminated environments.