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Environmental enteropathy and stunting children.

Byline: Syed Mohammad Ali

How can any country hope to prosper when well over a third of its children are stunted, which can cause numerous health, cognition and long-term productivity risks? This is one of the most serious challenges facing our country.

Statistics from the recent Demographic and Health Survey concerning children's health make for sombre reading. An alarming 38 per cent of children in Pakistan today are stunted. A recent World Bank research has brought to light important yet undiscussed aspects underlying the problem of stunting. It notes that modest progress has been made on a range of related issues due to recent gains in poverty alleviation. There is evidence of improved dietary diversity, even among the poorest, and the number of household which now have toilets has also increased. Curative care has expanded, with the mainstreaming of basic health units and the lady health worker programme. However, despite this progress, virtually no dent has been made in stunting rates.

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The unrecognised threat behind our dismal stunting rates is due to something known as environmental enteropathy, a process by which fecal pathogens like E. coli permanently damage the intestines of young children, which makes it difficult for them to absorb nutrients even during periods when there are no signs of diarrhoea. EE leads to both stunting and a compromised immune system, implying lifelong health challenges.

A major factor behind stunting thus has to do with the quality of water. While there is no systematic mechanism to frequently test water or soil quality across the country, the Pakistan Council for Research in Water Resources does conduct sporadic water quality tests which invariably reveal high levels of E. coli. contamination.

Water tests done in rural Punjab and Sindh by the World Bank have shown more than one-third of the water samples drawn directly from hand and motorised pumps, as well as from piped water supply systems, to be heavily contaminated. The rate of bacterial contamination is worse when water storage devices within the home are tested.

While toilet-use and water supply have improved over time, there is a dearth of public investment in water or sanitation systems, especially across rural Pakistan. Instead, households have been left to fend for themselves. As a result, toilets are no more than holes in the ground in many rural areas, technically referred to as leaching pit latrines, which have been built by communities themselves or due to NGO mobilisation. These pit latrines, or else, open drain toilets, often lie near water pumps.

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Untreated wastewater is routinely mixed with ground and surface water for crop irrigation.

This chain of contamination multiplies the channels through which oral transmission of fecal bacteria can occur. The fact that diarrhea has become a major problem amongst more affluent households in big cities like Karachi and Hyderabad, demonstrates how EE have spread.

Dietary or curative improvements alone will not solve this problem unless the total fecal burden in the environment is reduced. The treatment of water and adequate sanitation needs to be prioritised and the use of untreated wastewater for crop irrigation must also be controlled.

The World Bank has done important research on this issue. It now needs to rethink its decades-long engagement with Pakistan, with its emphasis on curbing public expenditures, and its emphasis on privatisation, which has created alternative market-based solutions, such as proliferation of bottled water. However, the contamination of water via the food we eat is catching up with us all, even those who can afford to buy bottled water.

It was encouraging to note the Prime Minister mention the alarming stunting rates of Pakistani children during his very first address to the nation. One hopes that the current government will take evident steps needed to address the long-neglected water and sanitation sector, without which the problem of child stunting cannot be resolved either.
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Publication:The Express Tribune (Karachi, Pakistan)
Geographic Code:9PAKI
Date:Jan 4, 2019
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