Water, sanitation and hygiene interventions and the prevention and treatment of childhood acute malnutrition: A systematic review.

Undernutrition is more prevalent among children living in unsanitary environments with inadequate water, sanitation and hygiene (WASH). Despite good evidence for the effect of WASH on multiple infectious diseases, evidence for the effect of WASH interventions on childhood undernutrition is less well established, particularly for acute malnutrition. To assess the effectiveness of WASH interventions in preventing and treating acute childhood malnutrition, we performed electronic searches to identify relevant studies published between 1 January 2000 and 13 May 2019. We included studies assessing the effect of WASH on prevention and treatment of acute malnutrition in children under 5 years of age. Data were extracted by two independent reviewers. We included 26 articles of 599 identified references with a total of 43,083 participants. Twenty-five studies reported on the effect of WASH on prevention, and two studies reported its effect on treatment of acute malnutrition. Current evidence does not show consistent associations of WASH conditions and interventions with prevention of acute malnutrition or with the improvement of its treatment outcomes. Only two high-quality randomized controlled trials (RCTs) demonstrated that improved water quality during severe acute malnutrition treatment improved recovery outcomes but did not prevent relapse. Many of the interventions consisted of a package of WASH services, making impossible to attribute the effect to one specific component. This highlights the need for high-quality, rigorous intervention studies assessing the effects of WASH interventions specifically designed to prevent acute malnutrition or improve its treatment.

Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study.

BACKGROUND: Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district. METHODS: A matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6-59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models. RESULTS: At the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2-27.3)], fever [AOR (95% CI) = 8.4 (3.1-22.8)], vomiting [AOR (95% CI) = 7.6 (3.0-19.7)], being stunted [AOR (95% CI) = 5.3 (1.7-16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0-19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2-5.5)], caretaker's hand washing habits [AOR (95% CI) = 1.9 (1.2-3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1-3.6)], caretaker's marriage status [AOR (95% CI) = 7.7 (2.0-30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0-3.1)]. CONCLUSION: The present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women's nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.