Environmental Hygiene, Food Safety And Growth In Less Than Five Year Old Children In Zimbabwe And Ethiopia

Abstract

Childhood stunting remains a significant public health challenge with adverse developmental and health outcomes in life and over generations. Efficacious dietary interventions have not achieved full linear growth in height deficient children. This dissertation explores novel causes of poor growth in young children by: identifying pathways of fecal-oral transmission of fecal bacteria in rural Zimbabwean infants using in-depth observation methods (chapter 2), examining the role of poor water, sanitation and hygiene in predicting stunting, in the context of infant and young child feeding, in Ethiopia (Chapter 3) and assessing the extent of aflatoxin exposure in Zimbabwean women and its association with stunting in young children (Chapter 4). In chapter 2, soil and chicken feces ingestion were identified as key pathways for fecal-oral transmission of bacteria in rural Zimbabwean infants. In Chapter 3, poor environmental hygiene was associated with linear growth faltering, independent of socio-economic status, infant feeding and recent morbidity, in Ethiopian children 24-59 months of age. In chapter 4, significant aflatoxin exposure was associated with severe stunting in a dose response manner in rural Zimbabwean children 6 to 59 months of age. The combined results from the three research projects identified environmental hygiene and aflatoxin exposure as two novel causes of stunting in African infants. Existing water, hygiene and sanitation interventions are not sufficient to protect infants and young children from fecal bacteria ingestion through soil and poultry feces. In addition, existing hygiene interventions do not directly address improving household environmental hygiene. Designing effective hygiene interventions will require in-depth understanding of the context and how caregivers and infants interact with their environment. Effective aflatoxin exposure control might also be critical in achieving full growth potential in young children. Our findings raise the need for low cost strategies for aflatoxin control and a holistic approach in designing context- and agespecific hygiene interventions to prevent childhood stunting.