Sanitation, height and child development

A study by Dean Spears shows that there is a correlation between toilet conditions and children's height. In places where people defecate openly without a latrine or toilet, their children tend to be shorter than average. Even India which is wealthier than many Sub-Saharan countries but where a high proportion of people defecate in the open, has comparably shorter children.

The connection between open defecation and height is very obvious, sanitation and health. Faeces disposed in the open carry diseases that can spread through contact. Diseases such as diarrhoea attack intestinal linings, reducing their ability to absorb nutrients. Inadequate nutritional intake affects the child's development, including height. Latrines or toilets help to dispose the faeces and keep them away from contact, in particular by children who are less cautious compared to adults.

It is also important to note in this study, what the difference in height between Indian and Sub Saharan children suggest, that sanitation may have a bigger effect on child development than nutrition. Indian children may be better nourished but they grow up in a less sanitary environment, therefore tend to suffer more from diseases and consequently are shorter (stunted) on average compared to Sub Saharan children. The poorer Sub Saharan children may have to struggle more to get nourishment but are taller on average because they don't have to deal with diseases spread by exposed faeces.

Toilet conditions are correlated to children's height. (Source: World Bank)

It's something to ponder in Timor-Leste as we look at child development woes almost exclusively as a consequence of malnutrition. While the country has put some effort into erecting mother-child health programs, less attention is being given to healthcare at home, for example how to properly deal with bodily waste.

As far as I know, people in Timor-Leste generally maintain the habit of keeping faecal matter a good distance away from their living areas. In poor rural households, toilets are usually constructed at a some distance from the house. Open defecation is not a common practice. However, I am more concerned with the urban areas. Overcrowding in areas like Dili is making it difficult to avoid contact between people and their bodily waste. For example, many people, if not most, in Dili use ground water which is usually pumped from not too far from their toilets using a pipe sunk to the ground or from a well. Although most households maintain a sceptic tank to contain toilet wastes in the absence of a sewerage system, many of these tanks are not properly sealed to stop the effluent from contaminating the soil, and the groundwater. In fact it is designed exactly this way to allow it to drain, e.g. with open base. And water deposits underground sit very close to the surface, perhaps no more than 6 metres deep. I wonder how this is affecting the health of the children growing up in Dili. Be interesting to compare their heights against children growing up in rural areas.