Background Stunting affects 165 million children worldwide, with repercussions on their survival and development. A contaminated environment is likely to contribute to stunting: frequent faecal-oral transmission possibly causes environmental enteropathy, a chronic inflammatory disorder that may contribute to faltering growth in children. This study's objective was to assess the effect of contaminated environment on stunting in Burkina Faso, where stunting prevalence is persistently high.
Methods Panel study of children aged 1–5 years in Kaya. Household socioeconomic characteristics, food needs and sanitary conditions were measured once, and child growth every year (2011–2014). Using multiple correspondence analysis and 12 questions and observations on water, sanitation, hygiene behaviours, yard cleanliness and animal proximity, we constructed a ‘contaminated environment’ index as a proxy of faecal-oral transmission exposure. Analysis was performed using a generalised structural equation model (SEM), adjusting for repeat observations and hierarchical data.
Results Stunting (<2 SD height-for-age) prevalence was 29% among 3121 children (median (IQR) age 36 (25–48) months). Environment contamination was widespread, particularly in rural and peri-urban areas, and was associated with stunting (prevalence ratio 1.30; p=0.008), controlling for sex, age, survey year, setting, mother's education, father's occupation, household food security and wealth. This association was significant for children of all ages (1–5 years) and settings. Lower contamination and higher food security had effects of comparable magnitude.
Conclusions Environment contamination can be at least as influential as nutritional components in the pathway to stunting. There is a rationale for including interventions to reduce environment contamination in stunting prevention programmes.
- CHILD HEALTH
- DEVELOPING COUNTR
- INTERNATIONAL HLTH
Statistics from Altmetric.com
Contributors SH FF and KS conceived and designed the study. TD, AL, SH and SK organised and performed data collection. FF and SH analysed the data. TD, FF, SD and SH contributed analysis tools. FF, KS and SH contributed by writing the manuscript. FF, KS TD, AL, SK, SD and SH made suitable changes and approved the final version of the manuscript.
Funding This work was carried out with various grants from the Canadian Institutes of Health Research (CIHR) (GIR-127070, GIR-229157, ROH-115213). FF is the recipient of a fellowship from the Global Health Research Capacity Strengthening Programme, funded by CIHR, Le Réseau de Recherche en Santé des Populations du Québec (RRSPQ) and the International Development Research Centre (of Canada). The funding agencies were not involved in any way in designing or conducting the study, nor in the analysis and interpretation of results.
Competing interests None declared.
Patient consent Obtained.
Ethics Approval was obtained from the Burkina Faso Health Research Ethics Committee and the Ethical Committee of the Centre de Recherche du CHUM in Montreal.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data can be consulted on agreement with the Kaya Health and Demographic Surveillance System.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.