London School of Hygiene & Tropical Medicine, London, England.
The Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
BMC Pediatr. 2020 Mar 23;20(1):134. doi: 10.1186/s12887-020-2010-9.
Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition.
Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to understand the association between height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores and WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined.
The mean z-score [standard deviation] for children's WAZ, HAZ and WHZ scores were - 1.33 [1.1], - 1.52 [1.3] and - 0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12 to 0.48) for WAZ and 0.28 (95%CI: 0.001 to 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07 to 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04 to 0.25) in WAZ and 0.13 (95%CI: 0.01 to 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction = 0.02).
Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.
水、环境卫生和个人卫生（WASH）行为对儿童营养状况的影响的证据不一致。很少有研究检验过它们的交互作用。本研究旨在检验 WASH 变量与学龄前儿童营养不良之间的关联和相互作用。
本研究分析了来自 2016 年尼泊尔全国代表性样本的 2352 名儿童的数据，这些儿童在尼泊尔人口与健康调查期间接受了评估，采用多变量线性回归来了解身高年龄别（HAZ）、体重身高别（WHZ）和体重年龄别（WAZ）Z 分数与 WASH 变量之间的关系。还检验了 WASH 变量、性别和居住地之间对儿童营养状况的相互作用。
儿童的 WAZ、HAZ 和 WHZ 评分的平均 Z 分数[标准差]分别为-1.33[1.1]、-1.52[1.3]和-0.65[1.1]。集群卫生设施覆盖率每增加一个单位，WAZ 和 HAZ 评分分别增加 0.30（95%CI：0.12 至 0.48）和 0.28（95%CI：0.001 至 0.56）。家庭水净化实践与 WHZ 评分增加 0.24（95%CI：0.07 至 0.41）有关。用肥皂和水洗手与 WAZ 评分增加 0.15（95%CI：0.04 至 0.25）和 WHZ 评分增加 0.13（95%CI：0.01 至 0.24）有关。水净化实践的效果在农村地区比在城市地区对 HAZ 评分更高（交互作用 p 值=0.02）。
与南亚其他国家的研究结果一致，本研究的结果强调了良好的 WASH 实践的重要性，因此 WASH 干预措施有可能改善尼泊尔农村地区的营养状况。
