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Open defecation may affect your child’s height — Experts

Diarrhoea disease, often due to poor sanitation, is another leading cause of stunting. In this report by SADE OGUNTOLA, experts say that diarrhoea illnesses can lead to malnutrition, thus impair weight as well as height gains in children when it is recurrent.


C LEANLINESS is next to Godliness” is a proverbial adage that is commonly used by many people. But, it is an adage that many people never understood its importance in ensuring that children attain good heights.

New evidence is suggesting that open defecation and lack of proper hygiene is leaving children vulnerable to the stunting effects of diseases like diarrhoea and worm infestation that stems from poor sanitation.

Open defecation refers to the practice whereby people go out in fields, bushes, forests, open bodies of water, or other open spaces rather than using the toilet to defecate. They do so because either they do not have a toilet readily accessible or due to traditional cultural practices.

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Water, Sanitation and Hygiene (WASH) Specialist, UNICEF-Nigeria, Bioye Ogunjobi quoted the National Outcome Routine Mapping (WASH-NORM) 2018 Survey indicating that on the average 24.4 per cent of households in Nigeria still practice open defecation.

He spoke during a Media Dialogue on Water Sanitation and Hygiene (WASH), organised by the Child Rights Information Bureau (CRIB) of the Federal Ministry of Information in collaboration with UNICEF with support from the European Union (EU) and the UK Department for International Development (UKaid), in Ibadan, recently.

At the same time, another 33 million citizens use unimproved toilets. Also, one in three Nigerians do not have access to potable water, with 90 per cent of households using contaminated water.

“We noticed  that in some Local  Government Areas, incidence of some diseases had reduced. For example, since they stopped open defecation and all of them have toilets in Dasi Local Government in Bauchi State, the incidence of cholera stopped. About three years ago, cholera usually occurs between September and October,” said Mr Ogunjobi.

Now, researchers found that children living in households with no electricity, unimproved water quality or toilet facilities are more likely to suffer from diarrhoea in comparison to non-stunted children.

This first study that looked at WASH practices and household conditions and its association with diarrhoea among under-five children in Nigeria was based on data that were collected from the 2013 Nigeria Demographic and Health Survey (NDHS).

The 2018 study, published in the Tropical Medicine and Infectious Disease journal, had included 28,596 mother-child pairs collected from the 2013 Nigeria Demographic and Health Survey (NDHS).

It considered influences of household construction material for wall, floor, and ceiling, access to electricity, and improved water and toilet on diarrhoea outcomes for under-five children that are living in these households.

Not having access to improved toilet and water facilities were associated with 14 per cent and 16 per cent higher odds of diarrhoea, respectively, as compared to those who had improved access to these facilities.

Additionally, fixed estimates from this review indicated that children in households with access to a flush toilet showed 17 per cent lower odds for diarrhoea than those using open defecation.

The national survey also indicated that the safe and proper disposal of children’s faeces is highly important in preventing the spread of disease, as direct contact with human faeces can cause diarrhoea and/or other related infectious diseases.

Dr Babatunde Ogunbosin, a consultant paediatrician at the University College Hospital (UCH), Ibadan stated “open defecation has a lot to do with diarrhoea diseases. As you know, diarrhoea diseases are one of the five leading causes of children under five deaths.”

Dr Ogunbosin added that higher incidence of other health problems like worm infestation, thyroid fever and hepatitis also occur in communities involved with open defecation and all of these impact on the health of a child.

Unfortunately, according to the Federal Ministry of Water Resources (FMWR), more than 100,000 children under five die each year due to diarrhoea, of which 90 per cent is directly attributable to unsafe water and sanitation.

Open defecation comes with many risks. It can lead to waterborne diseases, cause preventable deaths, and hamper education and economic growth. It also infringes on people’s privacy and dignity.

Professor Jerome Elusiyan, a consultant paediatrician at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife, Osun State stated that frequent episodes of diarrhoea and other diseases in a child with a poor diet are one of the reasons for acute malnutrition.

Elusiyan stated that while acute malnutrition can cause weight loss, stunting can result from long term malnutrition.

He declared, “diarrhoea will cause more of acute malnutrition and weight loss in a child because it drains the child’s vital nutrients. If diarrhoea is recurrent, particularly in a child with congenital issues of malabsorption, it may lead to stunting.

“So,  a child that stays in an unhygienic environment,  is exposed to many disease-causing germs, including that which causes diarrhoea. Given that the child is also exposed to poverty, the diet will not be adequate.

“Ultimately, that child ends up with a short stature for his  age later in life. It is the cumulation of many factors, not just diarrhoea alone that eventually leaves the child stunted.”

Researchers in a study said children of poor parents are three times more likely to be stunted than those whose parents earned a middle-class or upper-class income.

The World Health Organisation estimates that 50 per cent of malnutrition is associated with repeated diarrhoea or intestinal worm infections from unsafe water or poor sanitation or hygiene.

Also, other underlying causes of malnutrition in Nigeria include poverty, inadequate food production, inadequate food intake, ignorance and uneven distribution of food, improper preparation of foods and food restrictions and taboos.

In technical terms, stunting refers to a failure to reach expected height for one’s age. Stunting, or chronic malnutrition, is a type of growth failure that occurs in the first two years of a child’s life and is largely irreversible.

It is accompanied by a host of problems—weak immune systems, risk of sickness and disease, arrested cognitive and physical development, and a greater risk of dying before age five.

Now, open defecation — a major problem in Nigeria — has a strong correlation with child stunting as faeces in the environment contaminate hands and surroundings and spread disease and infection.

According to the Federal Ministry of Water Resources, one in four children under five years of age exhibit severe stunting while one in 10 is wasted due to frequent episodes of diarrhoea and Water and Sanitation and Hygiene (WASH) related illnesses in Nigeria.

Additionally, it is estimated that each diarrhoea episode that is experienced by a child before his or her second birthday increases the risk of being stunted by five per cent.

Furthermore, experiences of diarrhoea disease in early childhood are associated with long-term adverse cognitive effects and decreased work productivity later in life.

Diarrhoea and other problems associated with the ingesting and exposure to human waste affect children under the age of 5 years the most since they are very susceptible to diseases.


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