Since the 1960s, it has been known that poor water and sanitation causes
diarrhea, which consequently compromises child growth and leads to undernutrition.
Ample evidence shows that poor water and sanitation causes diarrhea,
but there is a growing body of knowledge discussing the magnitude of the impact
of diarrhea on undernutrition. A recent hypothesis by Humphrey (2009), for
example, states that the predominant impact of contaminated water and poor
sanitation on undernutrition is via tropical/environmental enteropathy (triggered
by exposure to fecal matter) rather than mediated by diarrhea. This new hypothesis
has generated much debate, especially in the South Asia region, on the contribution
of water and sanitation to the South Asian Nutrition Enigma. The
region is characterized by unusually high rates of child undernutrition relative to
its income level, as well as a slow reduction in undernutrition. Practitioners have
struggled to decipher the reasons behind this “anomaly.”
This report provides a systematic review of the evidence to date, both published
and grey literature, on the relationship between water and sanitation and
nutrition. We also examine the potential impact of improved water, sanitation,
and hygiene (WASH) on undernutrition. This is the first report that undertakes
a thorough review and discussion of WASH and nutrition in Bangladesh. The
report is meant to serve two purposes. First, it synthesizes the results/evidence
evolving on the pathway of WASH and undernutrition for use by practitioners
working in the nutrition and water and sanitation sectors to stimulate technical
discussions and effective collaboration among stakeholders. Second, this report
serves as an advocacy tool, primarily for policy makers, to assist them in formulating
a multisectoral approach to tackling the undernutrition problem.