How far is poor sanitation responsible for stunting in Guyana?

Dear Editor,

Research shows that poor sanitation accounts for 54% of international variation in child height or stunting. Much of the research material in this area focused on open defecation but has nevertheless prompted me to write this letter on the possible need for a study in Guyana to determine whether poor sanitation – poor solid and wastewater management is impacting on growth and development and more specifically, on stunting and cognitive abilities.

A child’s height is one of the most important indicators of their well-being. Height reflects the accumulated total of early-life health and diseases. Problems that prevent children from growing tall also prevent them from growing into healthy, productive, smart adults. Physical height is a significant economic variable that reflects health and human capital; in addition, it predicts adult economic outcomes.

The height of a child is reflective of a combination of their genetic potential as well as the extent to which their early-life health and nutrition will allow them to achieve that potential. Generally, a stunted child is short for his or her age.

In wealthier countries, genetics is a relatively more important determinant of differences in height; however, in poorer countries net nutrition and the disease environment matter.

Research shows that countries where there is poor sanitation, specifically, where many people defecate in the open are the countries where most children are stunted and the average child is the shortest. It shows that cross-country differences in sanitation explain 54 per cent of the variation in average child height.

Open defecation introduces germs from faeces into the environment; poor sanitation makes growing children sick. With specific reference to India, children are shorter on average, than children in Sub-Saharan Africa, even though Indians are richer on average.

Fifty four per cent of international variation in child height is explained by open defecation while, Gross Domestic Product (GDP) only explains 29 per cent. It should be noted that the association between sanitation and stunting is not driven by wealth, genetics, or other coincidental differences. Open defecation and a lack of sanitation in a household, along with country GDP, predict child height more than mother’s height or education, governance, or infrastructure.

Stunting is also linked to lower scholastic achievement and intellectual function, reduced lifetime earnings, short adult stature, and in the case of women, adverse pregnancy outcomes. It also reflects under-nutrition during infancy / early childhood which are critical periods of physical and cognitive growth.

Therefore stunting is relevant to cognitive achievement and economic productivity. Research shows in India, that taller children are much more likely to be able to read and do mathematics. This correlation is partially determined by early-life exposure to proper sanitation.

Based on the researched evidence on the impact of poor sanitation on stunting and the significant challenges Guyana has been experiencing over the years in solid waste and wastewater management, a study should be conducted to determine to what extent is stunting a problem in Guyana and the extent to which poor sanitation is a reason for stunting in Guyana.

Additionally, focus for such study could examine whether stunting is affecting cognitive ability in Guyana. Guyanese students have been having challenges with Mathematics for many years. The report from the Ministry of Education on the 2014 results from the Caribbean Secondary Examination Council (CSEC) stated the overall performances in Mathematics and English A were once again unsatisfactory. The Grades One to Three passes in Mathematics and English A were less than 50%. In Mathematics, the Grades One to Three pass rate is 38.7%. Mathematics recorded about a 39% pass rate which is reported to be the highest Guyana has ever seen. Similarly, the results for English A could be significantly improved. The Grade One to Three performances in English A were 46.98% in 2014.

Is stunting affecting cognitive ability, specifically in Mathematics and English A (reading)? Are taller children performing better in Mathematics and English A than shorter children? Is stunting the reason for low percentages in passes in Mathematics and English A? Are children who live in areas in Guyana where sanitation is poorer, such as Georgetown, shorter than children in relatively cleaner areas? Are children in areas where the sanitation is poorer performing at a lower level in Mathematics and English A than children who live under better sanitary conditions and in cleaner communities?

Are children in other Caribbean countries where percentages in Mathematics and English A are higher, living in better sanitary conditions than children in Guyana who perform more poorly in Mathematics and English A? This research could examine the period from 1984 to 2014, a 30-year period.

If it is found that sanitation has a significant impact on stunting in Guyana, this could then become a policy consideration and perhaps a post-2015 Millennium Development Goals (MDGs) target for Guyana under the Sanitation Goal. It will also create the opportunity for a more strategic approach to better wastewater and solid waste management in Guyana and for funding support to accelerate a programme to reduce and address stunting in Guyana.

A recommended research document for further information on sanitation and stunting is the World Bank 2013 study on ‘How much international variation in child height can sanitation explain?’ by Dean Spears.

Yours faithfully,

Audreyanna Thomas