Water, sanitation, and hygiene (WASH) are critical to ensuring health and preventing disease in Tanzania where approximately one-third of childhood deaths are related to poor hygiene. This study explored associations between WASH practices and childhood illness. Data came from a cross-sectional survey of 5000 female caregivers living in the Lake Zone region of Tanzania. Measures included self-reported presence of fever, diarrhea, cough and various WASH factors. Multiple logistic regressions were used. Thirty-seven percent of children experienced fever, 26% diarrhea, and 11% cough in the previous two weeks. Unimproved toilets were positively associated with fever (OR 1.25, CI 1.03 - 1.53, p < 0.05) and animal enclosures were negatively associated with diarrhea (OR 0.76, CI 0.61 - 0.96, p < 0.05). Unsafe disposal of a child’s stool was associated with both fever (OR 0.77, CI 0.67 - 0.89, p < 0.05) and diarrhea (OR 1.18, CI 1.0 - 1.38, p < 0.05). Eating soil was associated with both fever (OR 2.02, CI 1.79 - 2.29, p < 0.05) and diarrhea (OR 2.23, CI 1.95 - 2.57, p < 0.05). Eating chicken feces was associated with both fever (OR 2.07, CI 1.66 - 2.58, p < 0.05) and diarrhea (OR 2.38, CI 1.9 - 2.98, p < 0.05). Water shortages were associated with fever (OR 1.21, CI 1.07 - 1.36, p < 0.05) and cough (OR 1.48, CI 1.22 - 1.81, p < 0.05). Policy makers and program designers should consider increasing access to water and sanitation to improve children’s health.
References
[1]
Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., de Onis, M., Ezzati, M., Mathers, C. and Rivera, J. (2008) Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. The Lancet, 371, 243-260.
https://doi.org/10.1016/S0140-6736(07)61690-0
[2]
Dewey, K.G. and Mayers, D.R. (2011) Early Child Growth: How Do Nutrition and Infection Interact? Maternal and Child Nutrition, 7, 129-142.
https://doi.org/10.1111/j.1740-8709.2011.00357.x
[3]
Berkman, D.S., Lescano, A.G., Gilman, R.H., Lopez, S.L. and Black, M.M. (2002) Effects of Stunting, Diarrhoeal Disease, and Parasitic Infection during Infancy on Cognition in Late Childhood: A Follow-Up Study. The Lancet, 359, 564-571.
https://doi.org/10.1016/S0140-6736(02)07744-9
[4]
Crookston, B.T., Dearden, K.A., Alder, S.C., Porucznik, C.A., Stanford, J.B., Merrill, R.M., Dickerson, T.T. and Penny, M.E. (2011) Impact of Early and Concurrent Stunting on Cognition. Maternal and Child Nutrition, 7, 397-409.
https://doi.org/10.1111/j.1740-8709.2010.00255.x
[5]
Crookston, B.T., Schott, W., Cueto, S., Dearden, K.A., Engle, P., Georgiadis, A., Lundeen, E.A., Penny, M.E., Stein, A.D. and Behrman, J.R. (2013) Postinfancy Growth, Schooling, and Cognitive Achievement: Young Lives. American Journal of Clinical Nutrition, 98, 1555-1563. https://doi.org/10.3945/ajcn.113.067561
[6]
Georgiadis, A., Benny, L., Crookston, B.T., Duc, L.T., Hermida, P., Mani, S., Woldehanna, T., Stein, A.D. and Behrman, J.R. (2016) Growth Trajectories from Conception through Middle Childhood and Cognitive Achievement at Age 8 Years: Evidence from Four Low- and Middle-Income Countries. SSM Population Health, 2, 43-54. https://doi.org/10.1016/j.ssmph.2016.01.003
[7]
Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J. and Cairncross, S. (2014) Burden of Disease from Inadequate Water, Sanitation and Hygiene in Low- and Middle-Income Settings: A Retrospective Analysis of Data from 145 Countries. Tropical Medicine & International Health: TM & IH, 19, 894-905. https://doi.org/10.1111/tmi.12329
[8]
Unicef, W. (2013) WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation.
[9]
Kane, A.V., Dinh, D.M. and Ward, H.D. (2015) Childhood Malnutrition and the Intestinal Microbiome. Pediatric Research, 77, 256-262.
https://doi.org/10.1038/pr.2014.179
[10]
Arnold, B.F., Null, C., Luby, S.P., Unicomb, L., Stewart, C.P., Dewey, K.G., Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H.N., Fernald, L.C.H., Haque, R., Hubbard, A.E., Kariger, P., Leontsini, E., Lin, A., Njenga, S.M., Pickering, A.J., Ram, P.K., Tofail, F., Winch, P.J. and Colford, J.M. (2013) Cluster-Randomised Controlled Trials of Individual and Combined Water, Sanitation, Hygiene and Nutritional Interventions in Rural Bangladesh and Kenya: The WASH Benefits Study Design and Rationale. BMJ Open, 3, e003476.
https://doi.org/10.1136/bmjopen-2013-003476
[11]
Scrimshaw, N., Taylor, C. and Gordon, J. (1968) Interactions of Nutrition and Infection. World Health Organization, Geneva.
[12]
McDade, T.W. (2003) Life History Theory and the Immune System: Steps toward a Human Ecological Immunology. American Journal of Physical Anthropology, 122, 100-125. https://doi.org/10.1002/ajpa.10398
[13]
Acosta, A.M., et al. (2014) The MAL-ED Study: A Multinational and Multidisciplinary Approach to Understand the Relationship between Enteric Pathogens, Malnutrition, Gut Physiology, Physical Growth, Cognitive Development, and Immune Responses in Infants and Children up to 2 Years of Age in Resource-Poor Environments. Clinical Infectious Diseases, 59, 193-206.
[14]
Humphrey, J.H., Jones, A.D., Manges, A., Mangwadu, G., Maluccio, J.A., Mbuya, M.N.N., Moulton, L.H., Ntozini, R., Prendergast, A.J., Stoltzfus, R.J. and Tielsch, J.M. (2015) The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods. Clinical Infectious Diseases, 61, 685-702.
[15]
Ngure, F.M., Humphrey, J.H., and Mbuya, M. (2013) Formative Research on Hygiene Behaviors and Geography among Infants and Young Children and Implications of Exposure to Fecal Bacteria. American Journal of Tropical Medicine and Hygiene, 89, 709-716. https://doi.org/10.4269/ajtmh.12-0568
[16]
Humphrey, J.H. (2009) Child Undernutrition, Tropical Enteropathy, Toilets, and Hand Washing. The Lancet, 374, 1032-1035.
https://doi.org/10.1016/S0140-6736(09)60950-8
[17]
Marquis, G.S., Ventura, G., Gilman, R.H., Porras, E., Miranda, E., Carbajal, L. and Pentafiel, M. (1990) Fecal Contamination of Shanty Town Toddlers in Households with Non-Corralled Poultry, Lima, Peru. American Journal of Public Health, 80, 146-149. https://doi.org/10.2105/AJPH.80.2.146
[18]
Young, S.L., Sherman, P.W., Lucks, J.B. and Pelto, G.H. (2011) Why on Earth? Evaluating Hypothesis about the Physiological Functions of Human Geography. The Quarterly Review of Biology, 86, 97-120. https://doi.org/10.1086/659884
[19]
Alexander, C.C., Shrestha, S., Tounkara, M.D., Cooper, S., Hunt, L., Hoj, T., Dearden, K., West, J.H., Crookston, B. and Hall, P.C. (2018) The Impact of Media Access on Knowledge of WASH Practices: Addressing Stunting in Tanzania.
[20]
Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A. and Bartram, J. (2014) Global Assessment of Exposure to Faecal Contamination through Drinking Water Based on a Systematic Review. Tropical Medicine & International Health: TM & IH, 19, 917-927.
https://doi.org/10.1111/tmi.12334
[21]
Bank, W. (2018) Reaching for the SDGs: The Untapped Potential of Tanzania’s Water Supply, Sanitation, and Hygiene Sector. World Bank, Washington DC.
