Roundup: Without toilets, childhood is even riskier due to malnutrition: UNICEF

Lack of access to toilets is endangering millions of the world's poorest children, the UN Children's Fund (UNICEF) said here Wednesday, pointing to emerging evidence of links between inadequate sanitation and malnutrition.

Some 2.4 billion people globally do not have toilets and 946 million, roughly one in eight of the world's population, defecate in the open, the UN agency said in a press release.

Meanwhile, an estimated 159 million children under five years old are stunted (short for their age) and another 50 million are wasted (low weight for age), it said.

A report issued Wednesday by UNICEF, USAID and the World Health Organization for the first time brings together years of research and case studies which demonstrate the link between sanitation and malnutrition.

"More importantly, it provides guidance for action," UNICEF said, referring to the report entitled "Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene."

The report was released to mark World Toilet Day, which falls on Nov. 19 and is to raise awareness about people in the world who don't have access to a toilet, despite the fact that it is a human right to have clean water and sanitation.

This year, World Toilet Day is focusing on the link between sanitation and nutrition, drawing the world's attention to the importance of toilets in supporting better nutrition and improved health.

Lack of access to clean drinking water and sanitation, along with the absence of good hygiene practices, are among the underlying causes of poor nutrition, according to the report.

"We need to bring concrete and innovative solutions to the problem of where people go to the toilet, otherwise we are failing millions of our poorest and most vulnerable children," said Sanjay Wijesekera, head of UNICEF's global water, sanitation and hygiene programmes.

"The proven link with malnutrition is one more thread that reinforces how interconnected our responses to sanitation have to be if we are to succeed," he said.

Diarrhoea accounts for 9 percent of the deaths of children under five years old each year and is essentially a faecal-oral disease, where germs are ingested due to contact with infected faeces. Where rates of toilet use are low, rates of diarrhoea tend to be high.

Children under five years old suffer 1.7 billion cases of diarrhoea per year. Those in low income countries are hit hardest, with an average of three episodes per year. The highest frequency is in children under two years old, who are weakest and most vulnerable.

Multiple episodes of diarrhoea permanently alter their gut, and prevent the absorption of essential nutrients, putting them at risk of stunting and even death.

Some 300,000 children under five years old die per year -- more than 800 every day -- from diarrhoeal diseases linked to inadequate water, sanitation and hygiene. The poorest children in sub-Saharan Africa and South Asia are particularly at risk.

Intestinal parasites, such as roundworm, whipworm and hookworm, are transmitted through contaminated soil in areas where open defecation is practised. Hookworm is a major cause of anaemia in pregnant women, leading to malnourished, underweight babies.

Some countries have made significant progress in addressing both access to sanitation and the nutritional status of their children.

Many have successfully used UNICEF's Community Led Total Sanitation (CLTS) approach, in which the affected populations themselves devise local solutions to the problem of open defecation.

Pakistan met the 2015 Millennium Development Goal to halve the proportion of people who in 1990 did not have access to improved sanitation.

Using CLTS, entire communities abandoned the practice of open defecation, leading to improved health and nutrition indicators among their children.

Ethiopia mobilized community workers and achieved the largest decrease globally in the proportion of the population who defecate in the open. Despite population growth, the practice reduced from 92 percent (44 million people) in 1990 to 29 percent (28 million people) in 2015.

In Mali, the CLTS approach was also used in communities with high malnutrition rates, exacerbated by drought in the Sahel region. Improved access and use of latrines ensued, and improved health and nutrition in children.

During the emergency linked to conflict in the Democratic Republic of Congo, integrated nutrition and WASH interventions were used for displaced communities.

Children under five years old saw significantly reduced undernutrition and waterborne diseases. Around 60 percent of the population constructed latrines and some 90 percent of malnourished children returned to normal weight during a 12-month period.

"There are no excuses not to act on access to toilets, even in the poorest communities, or during emergencies," Wijesekera said.

"On the other hand, there are millions of reasons -- each one a child who is stunted or wasted, or worse, who sickens and dies -- to treat this with the urgency it deserves," he said. Endite