title: Improved Sanitation Facilities are Associated with Higher Body Mass Index and Higher Hemoglobin Concentration Among Rural Cambodian Women in the First Trimester of Pregnancy.
abstract: Multiple factors contribute to undernutrition in Cambodian women. Our aim was to determine if type of household sanitation facility was associated with body mass index (BMI) and hemoglobin (Hb) concentration among pregnant women. Women (N = 544) from 75 villages in Kampong Chhnang Province had their height, weight, and Hb measured (HemoCue Hb 201+) in the first trimester. Sociodemographic and household characteristics were collected. Multivariable linear and logistic regression models were used for analyses. Approximately 40% (N = 221) of women reported primarily using an 'improved' sanitation facility (closed pit latrine) and ∼60% (N = 323) used 'non-improved' facilities (open defecation). Mean ± standard deviation (SD) BMI was higher among women with improved versus non-improved facilities (19.9 ± 3.0 kg/m2versus 19.4 ± 2.3 kg/m2; P = 0.01). Mean ± SD Hb concentration was also higher among women with improved versus non-improved facilities (118 ± 12 g/L versus 114 ± 14 g/L; P = 0.001). Anemia prevalence (Hb < 110 g/L) was higher among women with non-improved facilities (34% versus 25%; P = 0.04). An improved sanitation facility was a positive predictor of BMI (β = 0.57 kg/m2; 95% confidence interval [CI] = 0.10, 1.04) and Hb concentration (β = 2.94 g/L; 95% CI = 0.53, 5.35), adjusting for age, parity, household size, village, gestation week, source of drinking water, and iron folic acid supplementation. Poor sanitation was associated with lower BMI and Hb concentration among pregnant Cambodian women. This warrants multisectoral approaches involving the health, nutrition, water, and sanitation sectors to effectively improve maternal health in Cambodia.
authors.affiliation: Department of Food, Nutrition and Health, University of British Columbia, Vancouver, Canada.
authors.forename: Amynah
authors.initials: A
authors.lastname: Janmohamed
authors.affiliation: Department of Food, Nutrition and Health, University of British Columbia, Vancouver, Canada.
authors.forename: Crystal D
authors.initials: CD
authors.lastname: Karakochuk
authors.affiliation: Department of Food, Nutrition and Health, University of British Columbia, Vancouver, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: McLean
authors.affiliation: South Australian Health and Medical Research Institute, Women's and Children's Hospital, North Adelaide, Australia. tim.green@sahmri.com.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Green
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology*; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002160:Cambodia; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D060766:Drinking Water / Q000382:microbiology; D005191:Family Characteristics; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000097:blood; D019266:Iron, Dietary / Q000008:administration & dosage; D016014:Linear Models; D016015:Logistic Models; D015999:Multivariate Analysis; D009752:Nutritional Status; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012424:Rural Population; D012499:Sanitation; D012959:Socioeconomic Factors; D014038:Toilet Facilities / Q000592:standards; D055815:Young Adult
chemical_list: D060766:Drinking Water; D006454:Hemoglobins; D019266:Iron, Dietary; D005492:Folic Acid; D007501:Iron