title: Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links.
abstract: There is scarce research and programmatic evidence on the effect of poor water, sanitation, and hygiene (WASH) conditions of the physical environment on early child cognitive, sensorimotor, and socioemotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first 3 years of life, when gut health and linear growth are established. We review evidence linking WASH, anemia, and child growth, and highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. We propose the concept of baby WASH as an additional component of early childhood development programs.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Ngure
authors.affiliation: Department of Design and Environmental Analysis, Cornell University, Ithaca, New York.
authors.forename: Brianna M
authors.initials: BM
authors.lastname: Reid
authors.affiliation: Zvitambo Research Trust, Harare, Zimbabwe.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.affiliation: Zvitambo Research Trust, Harare, Zimbabwe.
authors.forename: Mduduzi N
authors.initials: MN
authors.lastname: Mbuya
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Gretel
authors.initials: G
authors.lastname: Pelto
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
mesh_terms: D000740:Anemia / Q000209:etiology; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology; D061345:Early Medical Intervention; D004777:Environment; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D006920:Hygiene; D007223:Infant; D044342:Malnutrition / Q000209:etiology; D011203:Poverty; D012307:Risk Factors; D012499:Sanitation; D060753:Water Quality
keywords: anemia; child development; environmental enteropathy; hygiene; nutrition; sanitation; stunting; water