title: Water and sanitation associated with improved child growth.
abstract: OBJECTIVE
  To examine the relation between household water and sanitation, and the risk of stunting and reversal of stunting in Khartoum and Crezira regions, Sudan.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A total of 25 483 children aged 6-72 months from rural Sudan enrolled in an 18-month field trial in 1988 to study the effect of vitamin A supplementation on child health and survival.
  
  
  RESULTS
  The mean height-for-age z-scores at baseline and the end of study were -1.66 and -1.55, respectively, for the group with water and sanitation facilities, and -2.03 and -1.94 for the group without water and sanitation, after adjustment for age, region, gender, mother's literacy, intervention group (vitamin A vs placebo), family wealth, breastfeeding and cleanliness. Among children of normal height-for-age at baseline, the risk of stunting (<-2 height-for-age z-score) was lowest in the group that came from homes that had both water and sanitation compared to children from homes without these facilities (multivariate RR=0.79, 95% CI 0.69-0.90). Among children stunted at baseline, those coming from homes with water and sanitation had a 17% greater chance of reversing stunting than those coming from homes without either facility (adjusted RR=1.17, 95% CI 0.99-1.38). We did not detect a synergistic association between access to water and sanitation.
  
  
  CONCLUSIONS
  Water and sanitation are independently associated with improved growth of children.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA. amerchan@hsph.harvard.edu
authors.forename: A T
authors.initials: AT
authors.lastname: Merchant
authors.forename: C
authors.initials: C
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: Kiure
authors.forename: R
authors.initials: R
authors.lastname: Kupka
authors.forename: G
authors.initials: G
authors.lastname: Fitzmaurice
authors.forename: M G
authors.initials: MG
authors.lastname: Herrera
authors.forename: W W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D001827:Body Height; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006128:Growth / Q000187:drug effects / Q000502:physiology; D006130:Growth Disorders / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D010919:Placebos; D011446:Prospective Studies; D012499:Sanitation; D013397:Sudan; D014801:Vitamin A / Q000008:administration & dosage* / Q000627:therapeutic use; D014881:Water Supply
chemical_list: D010919:Placebos; D014801:Vitamin A