Hand hygiene predicts stunting among rural children in Armenia

Abstract

ackground Evidence suggests a relation between poor sanitation and hygiene and childhood stunting. The underlying mechanism is a subclinical condition, environmental enteric dysfunction (EED), triggered by increased bacterial load and characterized by intestinal mucosal inflammation and systemic immune and inflammatory response. In developing countries, EED affects up to 73-95% of children. Since 1990s, the prevalence of stunting in Armenia more than doubled with higher rates in rural areas. This study sought to identify the relation between hand hygiene practices and stunting, as well as the predictors of hand washing among rural children. Methods In a predominantly rural region (Talin), anthropometric measurements were carried out among a representative community sample of 739 under-five children; 94 stunted children and 100 randomly selected normally growing controls were identified from this pool for a case-control study. Mothers of cases with stunting and controls were interviewed and, among other data, provided information on child’s hand hygiene practices. The relation of the latter to stunting and the predictors of hand washing were studied in regression models. Results In the adjusted logistic regression model controlled for possible confounders (child’s age, gender, food diversity score, family size, and socioeconomic status score), each additional hand washing during a day decreased the odds of stunting by 14% (p = 0.033). In the linear regression model of predictors of hand washing, the latter was positively related to family’s socioeconomic status score (95% CI = 0.01-0.15), presence of meat (95% CI = 0.51-1.89) and chocolate (95% CI = 0.14-1.55) in a child’s 24-hour diet Conclusions In rural Armenia, poor hand hygiene practices are important risk factors for stunting. Therefore, anti-stunting interventions should include sanitation and hygienic measures along with improving nutrition and socioeconomic environment of young children