Don’t flush the nutrients down the toilet

By Katrin Glatzel

When you think of clean water and hygienic toilets, it’s not usually concerns about nutrition that come to mind first. Well, you might want to reconsider.

Poor sanitation, limited hygiene practices and unsafe water sources expose billions of people, particularly children and other vulnerable groups, to a wide range of preventable diseases and consequently high mortality rates in many countries. According to UNWater and the World Health Organisation, two and a half billion people do not have access to basic sanitation and 783 million people have no access to clean water.

Diseases and Diarrhoea lead to preventable child deaths


Credit: UN, Albert Gonzalez Farran

As a result, around four million people die from waterborne diseases every year; just over two million of these deaths are due to diarrhoea and one million of those are children under the age of five. Despite that these young children suffer from dehydration and infection, malnutrition is the root cause of more than one-third of all under-five child deaths globally.  Malnutrition results from not enough food or not enough nutrient-rich foods or both. The likelihood that a child will die from diarrhoea if he or she is severely underweight is almost ten times higher than a child of average weight for height and age.

Diarrhoea or repeated intestinal worm infections are primarily caused by unsafe drinking water, poor sanitation facilities and inadequate hygiene practices. Consequently, many people who live in extreme poverty and hunger are not able to absorb the nutrients in the scarce food that is available to them. Valuable calories are lost, with children most affected by the consequences leading to stunting and wasting. Scientific evidence shows that poor hygienic conditions not only cause diseases and lead to malnutrition, but also trigger crucial developmental disorders in children. For example, environmental enteropathy is a condition of the child’s intestine caused by living in an unhygienic environment and a recurrence of fecal-oral-transmitted intestinal infections and can lead to chronic problems with absorbing nutrients.  Environmental enteropathy and other diarrheal diseases are responsible for child stunting and irreversible cognitive damage.

Stunting damages economies, not just lives


Credit: European Commission DG ECHO


Stunted children are shorter than they could have been with proper nutrition, and have weaker immune systems that make them more susceptible and less able to fight diseases. Brain development is set back and translates to a loss of between two to three years of learning. Evidence shows that when stunted children enter the workforce, their diminished physical and cognitive development can reduce their earning capacity by as much as 22%. The cumulative effect of stunted children causes measurable GDP losses to countries and presents real limitations to countries’ economic growth and development. For example, in India, productivity losses caused by stunting are estimated at more than 10% of lifetime earnings, and GDP loss to undernutrition runs as high as 3–4%.  The scale of global stunting has major implications for future development, with dozens of countries reporting up to 40% of children suffering from stunting, and five countries exceeding 50%.  Addressing childhood stunting can help break the cycle of poverty and increase a country’s GDP by at least 2-3%.


Collaboration and cross-cutting programs are key

Overcoming malnutrition is already great challenge and it will require strong collaboration between the WASH (Water, Sanitation and Hygiene) and the nutrition sectors for policy interventions to be most impactful. Last week the German WASH Network met in Bonn, bringing together experts and stakeholders from NGOs, research institutions and government. Their aim is to strengthen the WASH sector in humanitarian emergency and rehabilitation aid as well as in development cooperation, contribute to implementing the human right to water and basic sanitary services and highlight the topic as an essential global challenge by civil society, the private sector and governments.

As the Sustainable Development Goals (SDGs) are being implemented, it is crucial that nutrition-sensitive agricultural interventions take a comprehensive approach to addressing hunger, nutrition and WASH. Failure to address WASH can severely undermine both nutrition and food security. It will be important to recognise that these issues are inextricably linked and that substantial effort will need to be made to ensure that SDG goals #2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and #6 (ensure availability and sustainable management of water and sanitation for all) are mutually reinforcing.  Let’s hope that as global leaders work over the coming years to implement and finance the SDGs they’ll find smart ways of reducing malnutrition and prevent countries from draining themselves of an economically prosperous future.

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