Community-level sanitation was associated with improved health outcomes among children, including lower odds of stunted growth, anemia and diarrhea, even among households with adequate access to sanitation facilities.
“A previous examination … found a decreased risk of child mortality, diarrhea and stunting for children living in households with access to improved sanitation,” David A. Larsen, PhD, MPH, from the Syracuse University Department of Public Health, Food Studies and Nutrition, and colleagues wrote. “However, limiting sanitation to a household-level risk factor while ignoring the community effect may greatly underestimate the impact that sanitation has on human health.”
Larsen and colleagues also stress that fecal exposure within the community leads to increased exposure for all individuals within the community.
To examine the influence that community-level sanitation access has on children who may or may not have household sanitation access, the researchers conducted a meta-analysis of 301 two-stage cross-sectional surveys concerning demographic health.
The survey analyses, which were conducted between 1990 and 2015, assisted in the calculation of community facilities by providing the proportion of households in the sampled cluster that had access to any type of facility. The researchers later observed the relation between the outcomes of stunted growth, any anemia, moderate or severe anemia, and diarrhea in the previous 2 weeks and community sanitation access.
Residing within a community with 100% access to sanitation was associated with decreased odds of all outcomes for children who live in a home with independent sanitation access. Those who had less than 30% access to facilities in their community and household access were more prone to these outcomes. Those with no house access or community sanitation had higher odds of stunted growth, any anemia, moderate or severe anemia, but not diarrhea, when compared with those with 1% to 30% sanitation access.
“The association between higher community-level sanitation access and the outcomes of anemia and stunting — at lower levels of community access — are consistent with the theory that environmental enteropathy is a significant risk factor for child malnutrition and health,” Larsen and colleagues wrote.
Disclosure: Please see the study for a full list of relevant financial disclosures.