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Water, sanitation and hygiene (WASH) in sub-Saharan Africa and associations with undernutrition, and governance in children under five years of age: a systematic review

Published online by Cambridge University Press:  06 January 2020

D. J. Momberg Open the ORCID record for D. J. Momberg [Opens in a new window] ,
B. C. Ngandu Open the ORCID record for B. C. Ngandu [Opens in a new window] ,
L. E. Voth-Gaeddert ,
K. Cardoso Ribeiro ,
J. May ,
S. A. Norris  and
R. Said-Mohamed
D. J. Momberg*
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa DST-NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
B. C. Ngandu
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
L. E. Voth-Gaeddert
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa DST-NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
K. Cardoso Ribeiro
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
J. May
Affiliation:
DST-NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
S. A. Norris
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
R. Said-Mohamed
Affiliation:
SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa DST-NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
*
Address for correspondence: D. J. Momberg, SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; DST-NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa. Email: douglas.momberg@wits.ac.za
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Abstract

Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700). The search terms returned 15,351 articles for screening, with 46 articles included. This is indicative of a limited body of knowledge; however, the number of publications on this topic has been increasing, suggesting burgeoning field of interest. Targeted research on the governance of WASH through the identification of the various role players and stakeholders at various levels, while understanding the policy environment in relation to particular health-related outcomes is imperative to address the burden of child undernutrition.

Keywords

Policynutritional statuschildrenAfricaWASH
Type
Review
Information
Journal of Developmental Origins of Health and Disease , Volume 12 , Issue 1 , February 2021 , pp. 6 - 33
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© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2020

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References

de Onis, M, Blössner, M, Borghi, E. Prevalence and trends of stunting among pre-school children, 1990–2020. Public Health Nutr. 2011; 15(1), 142–148.Google Scholar
Victora, CG, Adair, L, Fall, C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008; 371(9609), 340–357.CrossRefGoogle ScholarPubMed
WHO/UNICEF/USAID. Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene: Practical Solutions for Policies and Programmes, 2015. Geneva.Google Scholar
Spears, D, Ghosh, A, Cumming, O. Open Defecation and Childhood Stunting in India : An Ecological Analysis of New Data from 112 Districts. PLoS One. 2013; 8(9), 1–9.CrossRefGoogle ScholarPubMed
Piper, J, Chandna, J, Allen, E, et al. Water, sanitation and hygiene (WASH) interventions: effects on child development in low- and middle-income countries (Protocol). Cochrane Database Syst Rev. 2017; (3), 1–42.Google Scholar
Hoffman, DJ. Growth retardation and metabolic programming: implications and consequences for adult health and disease risk. J Pediatr (Rio J). 2014; 90(4), 325–328.CrossRefGoogle ScholarPubMed
Black, RE, Victora, CG, Walker, SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382(9890), 427–451.CrossRefGoogle ScholarPubMed
Said-Mohamed, R, Micklesfield, LK, Pettifor, JM, Norris, SA. Has the prevalence of stunting in South African children changed in 40 years? A systematic review. BMC Public Health 2015; 15:534.CrossRefGoogle ScholarPubMed
Members of the WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards, 2006. Geneva, Switzerland.Google Scholar
Mbuya, MNN, Humphrey, JH. Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr. 2016; 12, 106–120.CrossRefGoogle ScholarPubMed
Cumming, O, Cairncross, S. Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications. Aguayo VM, Menon P, editors. Matern Child Nutr. 2016; 12(Suppl. 1), 91–105.CrossRefGoogle ScholarPubMed
McDade, TW. Early environments and the ecology of inflammation. Proc Natl Acad Sci. 2012; 109(Suppl. 2), 17281–17288.CrossRefGoogle ScholarPubMed
Guerrant, RL, DeBoer, MD, Moore, SR, Scharf, RJ, Lima, AAM. The impoverished gut – a triple burden of diarrhoea, stunting and chronic disease. Nat Rev Gastroenterol Hepatol. 2014; 10(4), 220–229.CrossRefGoogle Scholar
McDade, TW, Hoke, M, Borja, JB, Adair, LS, Kuzawa, C. Do environments in infancy moderate the association between stress and inflammation in adulthood? Initial evidence from a birth cohort in the Philippines. Brain Behav Immun. 2012; 1–8.Google ScholarPubMed
McDade, TW, Leonard, WR, Burhop, J, et al. Predictors of C-reactive protein in Tsimane’ 2 to 15 year-olds in lowland Bolivia. Am J Phys Anthropol. 2005; 128(4), 906–913.CrossRefGoogle ScholarPubMed
Burgner, DP, Cooper, MN, Moore, HC, Stanley, FJ, Thompson, PL, De Klerk, NH, et al. Childhood hospitalisation with infection and cardiovascular disease in early-mid adulthood: a longitudinal population-based study. PLoS One 2015; 10(5), 1–12.Google ScholarPubMed
Fink, G, Günther, I, Hill, K. The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Int J Epidemiol. 2011; 40(5), 1196–1204.CrossRefGoogle ScholarPubMed
Markle, A, Donnenfeld, Z. Refreshing Africa’s Future: Prospects for Achieving Universal WASH Access by 2030, 2016.Google Scholar
Arnold, BF, Null, C, Luby, SP, et al. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 2013; 3(8), e003476–e003476.CrossRefGoogle ScholarPubMed
Humphrey, JH, Jones, AD, Manges, A, et al. The sanitation hygiene infant nutrition efficacy (shine) trial: rationale, design, and methods. Clin Infect Dis. 2015; 61(Suppl. 7), S685–S702.Google Scholar
Pickering, AJ, Djebbari, H, Lopez, C, Coulibaly, M, Alzua, ML. Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial. Lancet Glob Heal. 2015; 3(11), e701–e711.CrossRefGoogle ScholarPubMed
Brown, J, Cumming, O, Bartram, J, et al. A controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children: research protocol for the Maputo Sanitation (MapSan) study, Mozambique. BMJ Open 2015; 5(6), e008215–e008215.CrossRefGoogle ScholarPubMed
Null, C, Stewart, CP, Pickering, AJ, et al. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. Lancet Glob Heal. 2018; (18), 1–9.Google ScholarPubMed
Dangour, A, Watson, L, Cumming, O, et al. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children (Review). Cochrane Databse Syst Rev. 2013; (8), 1–87.Google Scholar
World Health Oragnisation. Global Nutrition Targets 2025: Stunting Policy Brief, 2012. Geneva.Google Scholar
Mwebaza, R, Kotze, JL. Environmental Governance and Climate Change in Africa: Legal Perspectives, 2009 (November).Google Scholar
The UN General Assembly. Transforming Our World: The 2030 Agenda for Sustainable Development, 2015. Vol. A/RES/70/1. New York.Google Scholar
UN Statistical Expert Group. Final list of goal indicators proposed sustainable development Annex IV final list of proposed sustainable development, 2016 (E/CN.3/2016/2/Rev.1), 1–25.Google Scholar
Jiménez, A, Kjellén, M, Le Deunff, H. WASH and Accountability: Explaining the Concept, 2015. New York.Google Scholar
World Health Assembly. Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition, 2012. Geneva.Google Scholar
The United Nations Children Fund (UNICEF). United Nations Children Fund (UNICEF) Conceptual Framework, Adapted from United Nations Children’s Fund (UNICEF), Strategy for Improved Nutrition of Children and Women in Developing Countries, 1990. New York.Google Scholar
Somerville, K. Africa after the cold war: Frozen out or Frozen in time? In The Third World Beyond the Cold War: Continuity and Change (eds. Fawcett, L, Sayigh, Y), 2000; pp. 1–41. Oxford University Press, Oxford.Google Scholar
Omaswa, F. Global health disruptors: the end of the Cold War. BMJ 2018; 1–6.Google Scholar
Irwin, A, Scali, E. Action on the social determinants of health: a historical perspective. Glob Public Health 2007; 2(3), 235–256.Google ScholarPubMed
Bhutta, ZA, Das, JK, Rizvi, A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 2013; 382, 452–477.Google ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, The PRISMA groups. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009; 6(7), e1000097.CrossRefGoogle Scholar
PROSPERO. International Prospective Register of Systematic Reviews. University of York Centre for Reviews and Dissemination and National Institute for Health Research.Google Scholar
World Health Oragnisation. Global Database on the Implementation of Nutrition Action (GINA) [Internet]. Available from: https:extranet.who.int/nutrition/gina.Google Scholar
World Health Oragnisation. Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS).Google Scholar
The New York Academy of Medicine. Grey Literarture Report [Internet]. Available from: http://www.greylit.org/.Google Scholar
World Health Organisation. African Index Medicus [Internet]. Available from: http://indexmedicus.afro.who.int/.Google Scholar
World Health Organisation. Virtual Health Sciences Library [Internet]. Available from: http://www.emro.who.int/information-resources/vhsl/.Google Scholar
United nations Joint Monitoring Programme (JMP). JMP Green Paper: Global Monitoring of Water, Sanitation and Hygiene post-2015, 2015.Google Scholar
Balshem, H, Helfand, M, Schunemann, H, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64(4), 401–406.CrossRefGoogle ScholarPubMed
Guyatt, G, Oxman, A, Akl, E, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64(4), 383–394.CrossRefGoogle ScholarPubMed
Gilson, L. Health policy and systems research. Health Policy (New York). 2012; 104(3), 18–40.Google Scholar
Walt, G, Gilson, L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994; 9(4), 353–370.CrossRefGoogle ScholarPubMed
de Onis, M, Branca, F. Childhood stunting: a global perspective. Matern Child Nutr. 2016; 12(Suppl. 1), 12–26.Google Scholar
Guerrant, RL, Oriá, RB, Moore, SR, Oriá, MOB, Lima, AA. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev. 2008; 66(9), 487–505.Google ScholarPubMed
Akombi, BJ, Agho, KE, Hall, JJ, Merom, D, Astell-Burt, T, Renzaho, AMN. Stunting and severe stunting among children under-5 years in Nigeria: a multilevel analysis. BMC Pediatr. 2017; 17, 15.CrossRefGoogle ScholarPubMed
Pongou, R, Ezzati, M, Salomon, JA. Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health 2006; 6, 98.CrossRefGoogle ScholarPubMed
Chirande, L, Charwe, D, Mbwana, H, et al. Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2010 cross-sectional household survey. BMC Pediatr. 2015; 15, 165.CrossRefGoogle ScholarPubMed
Danaei, G, Andrews, KG, Sudfeld, CR, et al. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS Med. 2016; 13(11), e1002164–e1002164.CrossRefGoogle ScholarPubMed
Hoffman, D, Cacciola, T, Barrios, P, Simon, J. Temporal changes and determinants of childhood nutritional status in Kenya and Zambia. J Health Popul Nutr. 2017; 36, 27.CrossRefGoogle ScholarPubMed
Griffiths, P, Madise, N, Whitworth, A, Matthews, Z. A tale of two continents: a multilevel comparison of the determinants of child nutritional status from selected African and Indian regions. Health Place. 2004; 10(2), 183–199.CrossRefGoogle ScholarPubMed
Habaasa, G. An investigation on factors associated with malnutrition among underfive children in Nakaseke and Nakasongola districts, Uganda. BMC Pediatr. 2015; 15, 134.CrossRefGoogle ScholarPubMed
Yarnoff, BO, Allaire, BT, Detzel, P. Associations between infant feeding practices and length, weight, and disease in developing countries. Front Pediatr. 2013; 1, 21.CrossRefGoogle ScholarPubMed
Kimani-Murage, EW, Muthuri, SK, Oti, SO, Mutua, MK, van de Vijver, S, Kyobutungi, C. Evidence of a double burden of malnutrition in urban poor settings in Nairobi, Kenya. PLoS One. 2015; 10(6), e0129943–e0129943.CrossRefGoogle ScholarPubMed
Nabwera, HM, Fulford, AJ, Moore, SE, Prentice, AM. Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study. Lancet Glob Heal. 2017; 5(2), e208–216.CrossRefGoogle ScholarPubMed
Keusch, GT, Rosenberg, IH, Denno, DM, et al. Implications of acquired environmental enteric dysfunction for growth and stunting in infants and children living in low- and middle-income countries. Food Nutr Bull. 2013; 34(3), 357–364.CrossRefGoogle ScholarPubMed
Brown, J, Cairncross, S, Ensink, JHJ. Water, sanitation, hygiene and enteric infections in children. Arch Dis Child. 2013; 98(8), 629–634.CrossRefGoogle ScholarPubMed
Derso, T, Tariku, A, Biks, GA, Wassie, MM. Stunting, wasting and associated factors among children aged 6–24 months in Dabat health and demographic surveillance system site: a community based cross-sectional study in Ethiopia. BMC Pediatr. 2017; 17, 96.CrossRefGoogle ScholarPubMed
Dearden, KA, Schott, W, Crookston, BT, Humphries, DL, Penny, ME, Behrman, JR. Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam. BMC Public Health. 2017; 17(1), 1–19.CrossRefGoogle Scholar
Prendergast, AJ, Rukobo, S, Chasekwa, B, et al. Stunting is characterized by chronic inflammation in zimbabwean infants. PLoS One. 2014; 9(2), 1–5.CrossRefGoogle ScholarPubMed
Ngure, FM, Reid, BM, Humphrey, JH, Mbuya, MN, Pelto, G, Stoltzfus, RJ. Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: Making the links. Ann N Y Acad Sci. 2014; 1308(1), 118–28.CrossRefGoogle ScholarPubMed
Kinyoki, DK, Kandala, N-B, Manda, SO, et al. Assessing comorbidity and correlates of wasting and stunting among children in Somalia using cross-sectional household surveys: 2007 to 2010. BMJ Open. 2016; 6(3), e009854–e009854.CrossRefGoogle ScholarPubMed
Van de Poel, E, Hosseinpoor, AR, Speybroeck, N, Van Ourti, T, Vega, J. Socioeconomic inequality in malnutrition in developing countries. Bull World Health Organ. 2008; 86(4), 282–291.CrossRefGoogle ScholarPubMed
Crane, RJ, Jones, KDJ, Berkley, JA. Environmental enteric dysfunction: an overview. Food Nutr Bull. 2015; 36(10), S76–S87.CrossRefGoogle ScholarPubMed
Kinyoki, DK, Berkley, JA, Moloney, GM, Odundo, EO, Kandala, N-B, Noor, AM. Environmental predictors of stunting among children under-five in Somalia: cross-sectional studies from 2007 to 2010. BMC Public Health. 2016; 16, 654.CrossRefGoogle ScholarPubMed
Altare, C, Delbiso, TD, Mutwiri, GM, Kopplow, R, Guha-Sapir, D. Factors associated with stunting among pre-school children in southern highlands of Tanzania. J Trop Pediatr. 2016; 62(5), 390–408.Google ScholarPubMed
Alemu, ZA, Ahmed, AA, Yalew, AW, Birhanu, BS, Zaitchik, BF. Individual and community level factors with a significant role in determining child height-for-age Z score in East Gojjam Zone, Amhara Regional State, Ethiopia: a multilevel analysis. Arch Public Heal. 2017; 75, 27.CrossRefGoogle Scholar
Van de Poel, E, Hosseinpoor, AR, Jehu-Appiah, C, Vega, J, Speybroeck, N. Malnutrition and the disproportional burden on the poor: the case of Ghana. Int J Equity Health 2007; 6, 21.CrossRefGoogle ScholarPubMed
Hathi, P, Haque, S, Pant, L, Coffey, D, Spears, D. Place and child health: The interaction of population density and sanitation in developing countries. Demography. 2017; 54(1), 337–360.CrossRefGoogle ScholarPubMed
Kinyoki, DK, Berkley, JA, Moloney, GM, Kandala, N-B, Noor, AM. Predictors of the risk of malnutrition among children under the age of 5 years in Somalia. Public Health Nutr. 2015.CrossRefGoogle ScholarPubMed
Medhin, G, Hanlon, C, Dewey, M, et al. Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: The P-MaMiE Birth Cohort. BMC Public Health 2010; 10, 27.CrossRefGoogle ScholarPubMed
Fernandez, ID, Himes, JH, de Onis, M. Prevalence of nutritional wasting in populations: building explanatory models using secondary data. Bull World Health Organ. 2002; 80(4), 282–291.Google ScholarPubMed
Hagos, S, Hailemariam, D, WoldeHanna, T, Lindtjørn, B. Spatial heterogeneity and risk factors for stunting among children under age five in Ethiopia: a Bayesian geo-statistical model. PLoS One 2017; 12(2), e0170785–e0170785.Google ScholarPubMed
Semali, IA, Tengia-Kessy, A, Mmbaga, EJ, Leyna, G. Prevalence and determinants of stunting in under-five children in central Tanzania: remaining threats to achieving Millennium Development Goal 4. BMC Public Health 2015; 15, 1153.CrossRefGoogle ScholarPubMed
Anand, A, Roy, N. Transitioning toward sustainable development goals: The role of household environment in influencing child health in Sub-Saharan Africa and South Asia using recent demographic health surveys. Front Public Heal. 2016; 4, 87.Google ScholarPubMed
Alemayehu, M, Tinsae, F, Haileslassie, K, Seid, O, Gebregziabher, G, Yebyo, H. Undernutrition status and associated factors in under-5 children, in Tigray, Northern Ethiopia. Nutrition 2015; 31(7–8), 964–970.CrossRefGoogle ScholarPubMed
Bourne, L, Pilime, N, Behr, A. Food hygiene and sanitation in infants and young children: a paediatric food-based dietary guideline. South African J Clin Nutr. 2013; 26(3), S156–S164.Google Scholar
Knoblauch, AM, Hodges, MH, Bah, MS, et al. Changing patterns of health in communities impacted by a bioenergy project in Northern Sierra Leone. Int J Environ Res Public Health 2014; 11(12), 12997–13016.Google ScholarPubMed
Balk, D, Storeygard, A, Levy, M, Gaskell, J, Sharma, M, Flor, R. Child hunger in the developing world: an analysis of environmental and social correlates. Food Policy 2005; 30(5–6), 584–611.CrossRefGoogle Scholar
Hangoma, P, Aakvik, A, Robberstad, B. Explaining changes in child health inequality in the run up to the 2015 Millennium Development Goals (MDGs): the case of Zambia. PLoS One. 2017; 12(2), e0170995–e0170995.CrossRefGoogle ScholarPubMed
Motarjemi, Y, Käferstein, F, Moy, G, Quevedo, F. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ 1993; 71(1), 79–92.Google Scholar
Stevens, GA, Finucane, MM, Paciorek, CJ, et al. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet 2012; 380, 824–834.CrossRefGoogle ScholarPubMed
Darteh, EKM, Acquah, E, Kumi-Kyereme, A. Correlates of stunting among children in Ghana. BMC Public Health 2014; 14, 504.CrossRefGoogle ScholarPubMed
Salam, RA, Das, JK, Bhutta, ZA. Current issues and priorities in childhood nutrition, growth, and infections. J Nutr. 2015; 145(5), 1116S–1122S.CrossRefGoogle Scholar
Syed, S, Ali, A, Duggan, C. Environmental enteric dysfunction in children: a review. J Pediatr Gastroenterol Nutr. 2016; 63(1), 6–14.CrossRefGoogle Scholar
Bhutta, ZA, Ahmed, T, Black, RE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008; 371(9610), 417–440.CrossRefGoogle ScholarPubMed
Black, RE, Allen, LH, Bhutta, ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371, 243–260.CrossRefGoogle ScholarPubMed
UN-Water Global Analysis. Financing universal water, sanitation and hygiene under the sustainable development goals, 2017.Google Scholar
The United Nations Children Fund (UNICEF). Strategy for water, sanitation and hygiene 2016–2030, 2016. New York.Google Scholar
Karns, M. International Organisations, The Politics and Processes of Global Governance, 2004. Lynne Rienner Publishers, Inc., Boulder.Google Scholar
Government of the Republic of South Africa. The Presidency: Department of Planning, Monitoring and Evaluation [Internet]. Available from: www.dpme.gov.za.Google Scholar
Moise, I. Clean Household Approach to Reduce Stunting and Improve Child Health, 2000. Save the Children, Washington, DC.AQ12Google Scholar
United Nations Joint Monitoring Programme (JMP). WASH Post-2015. 2015.Google Scholar
WHO/UNICEF. Core questions on drinking-water. World Heal Organ. 2006; 25.Google Scholar
Cumming, O, Curtis, V. Implications of WASH Benefits trials for water and sanitation. Lancet Glob Heal. 2018; 6(6), e615.Google ScholarPubMed
Biswas, AK. Drawers of water, domestic water use in East Africa. JAWRA J Am Water Resour Assoc. 1972; 8(6), 1280–1280.CrossRefGoogle Scholar