Children risk malnutrition with open defecation

OPEN defecation is the human practice of defecating outside (in the open) rather than into a toilet. Over a billion people worldwide defecate in the open. People may choose fields, bushes, forests and ditches to defecate. Now, a diverse, rigorous range of evidence is accumulating, indicating that open defecation kills infants and contributes to the incidence of diarrhoea and to the spread of intestinal parasites, which in turn cause malnutrition.

In 2015, United Nations Children’s Emergency Fund (UNICEF) report on Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene, pointed to emerging evidence of links between inadequate sanitation and malnutrition. Lack of sanitation, and particularly open defecation contributes to the incidence of many waterborne diseases.

Nigeria has a plan to end open defecation in all 36 states by 2025.  However, as laudable as the declaration, a recent report by The Oyo State Fact sheet in the Water, Sanitation and Hygiene-National Outcome Routine Mapping (WASH-NORM) 2021, report from the National Bureau of Statistics had rated Oyo State as one of the states that have the most open “defecators” across Nigeria.

It rated the state also high in access to basic water supply services but scored it very low in the areas of sanitation and hygiene. The breakdown revealed that 14 per cent of the population has access to safely managed sanitation and 8 per cent have access to basic hygiene services.

“There is great evidence that many children die before age 5 from basic preventable diseases. The primary cause in Nigeria is malaria and the second is diarrheal diseases, which are mostly water-related and sanitation that we can prevent through safe sanitation and safe hygiene,” said Chief of Water, Sanitation and Hygiene (WASH), UNICEF Nigeria, Dr Jane Bevan.

She spoke at the one-day media dialogue on the launch of open defecation free (ODF) Roadmap in Oyo State, in Ibadan. It was organized by Oyo State Rural Water Supply and Sanitation Agency (OYORUWASSA) in collaboration with UNICEF.

According to her, “in a city like Ibadan, where I have seen a lot of open defecation, there is a higher risk of faecal-oral transmission of infections because of its more dense population. Statistics are that about 50 per cent of all the water in Oyo State is contaminated with E.coli unfortunately and partly due to open defecation.

“Faeces filter through the all drains and get into the watercourse then into the water supply. So we really need to think carefully about household water treatment. People will need to treat their water at a minimum, to boil it or put chlorine before it is drunk.

“Various studies have revealed that, with safe defecation and appropriate hand washing, it is possible to break more than 50 per cent of the faecal-oral transmission routes and would be able to prevent diseases like typhoid, worm infestations, conjunctivitis, cholera, and diarrheal diseases.”

This first study that looked at WASH practices and household conditions and their 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, included 28,596 mother-child pairs collected from the 2013 Nigeria Demographic and Health Survey (NDHS).

It considered the influences of household construction material for walls, floors, and ceilings, 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 was 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.

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.”

He added that frequent episodes of diarrhoea and other diseases in a child with a poor diet are one of the reasons for acute malnutrition, which can cause weight loss. But over the long term, stunting can result from long-term malnutrition.

“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 short stature for his age later in life. It is the accumulation of many factors, not just diarrhoea alone that eventually leaves the child stunted.”

The World Health Organization 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.

Howbeit, the Chairman of RUWASSA, Mr Najim Omirinde said that the open defecation campaign to start in the state will jumpstart Oyo state’s journey towards ending open defecation while it also stops children from being affected by the negative impact of the exercise.