Announcement

Collapse
No announcement yet.

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

    ..............
    Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

    By GARDINER HARRISJULY 13, 2014

    http://www.nytimes.com/2014/07/15/wo...tion.html?_r=0

    SHEOHAR DISTRICT, India — He wore thick black eyeliner to ward off the evil eye, but Vivek, a tiny 1-year-old living in a village of mud huts and diminutive people, had nonetheless fallen victim to India’s great scourge of malnutrition.

    His parents seemed to be doing all the right things. His mother still breast-fed him. His family had six goats, access to fresh buffalo milk and a hut filled with hundreds of pounds of wheat and potatoes. The economy of the state where he lives has for years grown faster than almost any other. His mother said she fed him as much as he would eat and took him four times to doctors, who diagnosed malnutrition. Just before Vivek was born in this green landscape of small plots and grazing water buffalo near the Nepali border, the family even got electricity.

    It is a question being asked about children across India, where a long economic boom has done little to reduce the vast number of children who are malnourished and stunted, leaving them with mental and physical deficits that will haunt them their entire lives. Now, an emerging body of scientific studies suggest that Vivek and many of the 162 million other children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation.
    Continue reading the main story
    Poor Sanitation Linked to Malnutrition in India

    New research on malnutrition, which leads to childhood stunting, suggests that a root cause may be an abundance of human waste polluting soil and water, rather than a scarcity of food.

    Afghanistan

    60%

    Percentage of children under 5 who are stunted

    Burundi

    50

    Ethiopia

    India

    India

    Pakistan

    Nepal

    Bangladesh

    40

    Nigeria

    Uganda

    30

    Togo

    Ghana

    Haiti

    20

    Senegal

    10

    Number of people who defecate outdoors

    0

    per square kilometer

    0

    50

    100

    150

    200

    Hannah Fairfield/The New York Times
    Sources: Demographic and Health Surveys, USAID (stunting data, latest year available); World Health Organization, Unicef (defecation data, 2012)

    Like almost everyone else in their village, Vivek and his family have no toilet, and the district where they live has the highest concentration of people who defecate outdoors. As a result, children are exposed to a bacterial brew that often sickens them, leaving them unable to attain a healthy body weight no matter how much food they eat.

    “These children’s bodies divert energy and nutrients away from growth and brain development to prioritize infection-fighting survival,” said Jean Humphrey, a professor of human nutrition at Johns Hopkins Bloomberg School of Public Health. “When this happens during the first two years of life, children become stunted. What’s particularly disturbing is that the lost height and intelligence are permanent.”

    Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problems.

    “Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

    This research has quietly swept through many of the world’s nutrition and donor organizations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?

    A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families.

    This disconnect between wealth and malnutrition is so striking that economists have concluded that economic growth does almost nothing to reduce malnutrition.

    Half of India’s population, or at least 620 million people, defecate outdoors. And while this share has declined slightly in the past decade, an analysis of census data shows that rapid population growth has meant that most Indians are being exposed to more human waste than ever before.

    In Sheohar, for instance, a toilet-building program between 2001 and 2011 decreased the share of households without toilets to 80 percent from 87 percent, but population growth meant that exposure to human waste rose by half.

    “The difference in average height between Indian and African children can be explained entirely by differing concentrations of open defecation,” said Dean Spears, an economist at the Delhi School of Economics. “There are far more people defecating outside in India more closely to one another’s children and homes than there are in Africa or anywhere else in the world.”

    Not only does stunting contribute to the deaths of a million children under the age of 5 each year, but those who survive suffer cognitive deficits and are poorer and sicker than children not affected by stunting. They also may face increased risks for adult illnesses like diabetes, heart attacks and strokes.

    “India’s stunting problem represents the largest loss of human potential in any country in history, and it affects 20 times more people in India alone than H.I.V./AIDS does around the world,” said Ramanan Laxminarayan, vice president for research and policy at the Public Health Foundation of India.

    India is an increasingly risky place to raise children. The country’s sanitation and air quality are among the worst in the world. Parasitic diseases and infections like tuberculosis, often linked with poor sanitation, are most common in India. More than one in four newborn deaths occur in India.

    Open defecation has long been an issue in India. Some ancient Hindu texts advised people to relieve themselves far from home, a practice that Gandhi sought to curb.

    “The cause of many of our diseases is the condition of our lavatories and our bad habit of disposing of excreta anywhere and everywhere,” Gandhi wrote in 1925.

    Other developing countries have made huge strides in improving sanitation. Just 1 percent of Chinese and 3 percent of Bangladeshis relieve themselves outside compared with half of Indians. Attitudes may be just as important as access to toilets. Constructing and maintaining tens of millions of toilets in India would cost untold billions, a price many voters see no need to pay — a recent survey found that many people prefer going to the bathroom outside.

    Few rural households build the sort of inexpensive latrines that have all but eliminated outdoor waste in neighboring Bangladesh.
    Photo
    Clothes washers work near a sewage pipe in the Ganges in Varanasi, India, where no city has a comprehensive treatment system. Credit Daniel Berehulak for The New York Times

    One analysis found that government spending on toilets pays for itself in increased tax receipts from greater productivity, but the math works only if every member of a family who gets a toilet uses it.

    “We need a cultural revolution in this country to completely change people’s attitudes toward sanitation and hygiene,” said Jairam Ramesh, an economist and former sanitation minister.

    India’s government has for decades tried to resolve the country’s stubborn malnutrition problems by distributing vast stores of subsidized food. But more and better food has largely failed to reverse early stunting, studies have repeatedly shown.

    India now spends about $26 billion annually on food and jobs programs, and less than $400 million on improving sanitation — a ratio of more than 60 to 1.

    “We need to reverse that ratio entirely,” Dr. Laxminarayan said.

    Lack of food is still an important contributor to malnutrition for some children, and some researchers say the field’s sudden embrace of sanitation has been overdone. “In South Asia, a more important factor driving stunting is diet quality,” said Zulfiqar A. Bhutta, a director of the Center for Global Child Health at the Hospital for Sick Children in Toronto.

    Studies are underway in Bangladesh, Kenya and Zimbabwe to assess the share of stunting attributable to poor sanitation. “Is it 50 percent? Ninety percent? That’s a question worth answering,” said Dr. Stephen Luby, a professor of medicine at Stanford University who is overseeing a trial in Bangladesh that is expected to report its results in 2016. “In the meantime, I think we can all agree that it’s not a good idea to raise children surrounded by poop.”

    Better sanitation in the West during the 19th and early 20th centuries led to huge improvements in health long before the advent of vaccines and antibiotics, and researchers have long known that childhood environments play a crucial role in child death and adult height.

    The present research on gut diseases in children has focused on a condition resulting from repeated bacterial infections that flatten intestinal linings, reducing by a third the ability to absorb nutrients. A recent study of starving children found that they lacked the crucial gut bacteria needed to digest food.

    In a little-discussed but surprising finding, Muslim children in India are 17 percent more likely to survive infancy than Hindus, even though Muslims are generally poorer and less educated. This enormous difference in infant mortality is explained by the fact that Muslims are far more likely to use latrines and live next to others also using latrines, a recent analysis found.

    So widespread housing discrimination that confines many Muslims to separate slums may protect their children from increased exposure to the higher levels of waste in Hindu communities and, as a result, save thousands of Indian Muslim babies from death each year.

    Just building more toilets, however, may not be enough to save India’s children.

    Phool Mati lives in a neighborhood in Varanasi with 12 public toilets, but her 1-year-old grandson, Sandeep, is nonetheless severely malnourished. His mother tries to feed him lentils, milk and other foods as often as she can, but Sandeep is rarely hungry because he is so often sick, Ms. Mati said.

    “We all use the bathroom,” she said.

    The effluent pipe that served the bathroom building is often clogged. Raw sewage seeps into an adjoining Hindu temple, and, during the monsoon season, it flooded the neighborhood’s homes. The matron of the toilet facility charges two rupees for each use, so most children relieve themselves directly into open drains that run along a central walkway.

    No Indian city has a comprehensive waste treatment system, and most Indian rivers are open sewers as a result. But Varanasi, India’s oldest and holiest city, is so awash in human waste that its decrepit condition became a national issue in recent elections. The city’s sewage plants can handle only about 20 percent of the sewage generated in the city, said Ramesh Chopra of Ganga Seva Abhiyanam, a trust for cleaning the river. The rest sloshes into the Ganges or fetid ponds and pits.

    Millions of pilgrims bathe in the Ganges along Varanasi’s ancient riverfront, but a stream of human waste — nearly 75 million liters per day — flows directly into the river just above the bathing ghats, steps leading down to the river. Many people wash or brush their teeth beside smaller sewage outlets.

    Much of the city’s drinking water comes from the river, and half of Indian households drink from contaminated supplies.

    “India’s problems are bigger than just open defecation and a lack of toilets,” Dr. Laxminarayan said.

    Suhasini Raj contributed reporting.
    To sit down with these men and deal with them as the representatives of an enlightened and civilized people is to deride ones own dignity and to invite the disaster of their treachery - General Matthew Ridgway

  • #2
    We have someone in charge who said over eight months back that toilets should be built before temples. The aspiration, promise is by 2019.

    Speaking at a function organized here for the youth, Modi said he dared to say so even though his image as a Hindutva leader did not allow him.

    "I am known to be a Hindutva leader. My image does not permit to say so, but I dare to say. My real thought is — Pehle shauchalaya, phir devalaya' (toilet first, temple later)," he said.

    Touting the slogan of development that could take the country on the path of speedy progress, Modi said lakhs of rupees were spent on temples in villages, but there were no toilets there.

    Invoking Mahatma Gandhi's thoughts, he lamented that it was ironic that women in the country had to go in the open for easing themselves in the absence of toilets.
    Budget speech | Jul 10 2014

    Swatchh Bharat Abhiyan

    30. The need for sanitation is of utmost importance. Although the Central Government is providing resources within its means, the task of total sanitation cannot be achieved without the support of all. The Government intends to cover every household by total sanitation by the year 2019, the 150th year of the Birth anniversary of Mahatma Gandhi through Swatchh Bharat Abhiyan.
    They've been at it for some time now, previous program was started in 1999 which replaced a still earlier porgram.

    Rural sanitation coverage (state wise) as of 2011

    Spoiler!
    Last edited by Double Edge; 20 Jul 14,, 10:10.

    Comment


    • #3
      The issue here clearly isn't just to do with the availability of plumbing. It is neither difficult nor expensive to construct toilets that, absent serious flooding, keep the user & the effluent separate. European societies managed it long before they became wealthy or well plumbed. Poorer societies in other parts of the world manage it now. There is a clear cultural issue here that needs to be addressed in tandem with a technical one.

      These sorts of changes are not necessarily easy, but they are certainly achievable over the space of a generation or two with sustained work from government, religious & civil society groups. The payoff for India will be huge. This is one of those less obvious issues that is actually hugely important.
      sigpic

      Win nervously lose tragically - Reds C C

      Comment


      • #4
        Community-led total sanitation - Wikipedia, the free encyclopedia

        Used in bangaldesh

        At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease.

        In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilisation instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for change, propels them into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.
        Last edited by Double Edge; 20 Jul 14,, 01:54.

        Comment


        • #5
          Peer pressure & shovels will go a long way toward dealing with this. Programs like this are ideal. Get village elders, priests & teachers involved. Get the entire community invested in this. Government can play an important role in many respects, one of which is to fund programs like this.

          As an aside. the house I live in now was built before houses in Melbourne were plumbed for sewage (well, before houses for poor people were). The houses here were built with this in mind. The rear of the houses in my street can be accessed via a laneway. Toilets were at the rear of the property on the back fence. A 'night soil man' would come by periodically and empty the toilets into a cart. Fortunately the house had a toilet when I got it. As a child living in rural Australia I regularly visited homes & farms - some of them not far from mine - with no sewage connected. Some had septic tanks, but others had an outdoor toilet over a hole in the ground. Even in affluent societies like Australia sewage connections were far from universal even 30 years ago.
          sigpic

          Win nervously lose tragically - Reds C C

          Comment


          • #6
            I think I've said before in WAB that I've dealt with water quality issues in India - we had a successful program which could and (should) have been implemented nation wide

            unfort the biggest problem was dealing with corrupt local officials and companies who were more interested in how they could maximise profits

            get rid of corrupt officials and you'll start to make headway - the tech exists to fix this
            Last edited by gf0012-aust; 20 Jul 14,, 02:29.
            Linkeden:
            http://au.linkedin.com/pub/gary-fairlie/1/28a/2a2
            http://cofda.wordpress.com/

            Comment


            • #7
              Circa 2010

              Last edited by Double Edge; 20 Jul 14,, 02:41.

              Comment


              • #8
                You have got it right. An outside observer has finally got it right!!

                Originally posted by Bigfella View Post
                It is neither difficult nor expensive to construct toilets
                Yes. "Toilets" are not a political or peoples issue here in india. Most families in india don't think it's important to invest in a toilet.

                Originally posted by Bigfella View Post
                There is a clear cultural issue
                Yes it is. The running thought is "why would someone like to poop in their own house?". Those homes that do have a toilet room in rural india have it built away from the house.

                Originally posted by Bigfella View Post
                Get village elders, priests & teachers involved. Get the entire community invested in this.
                Why?
                Last edited by anil; 20 Jul 14,, 05:59.

                Comment


                • #9
                  Originally posted by Double Edge View Post
                  Circa 2010

                  I'm sure the staff of DNA have done this themselves quite many times during a train ride to their native places. Yet it doesn't stop them from printing sound bites to attract attention.

                  Comment


                  • #10
                    Originally posted by anil View Post
                    I'm sure the staff of DNA have done this themselves quite many times during a train ride to their native places. Yet it doesn't stop them from printing sound bites to attract attention.
                    its all good if it brings in the punters. Some more & here.

                    A high-profile advertising campaign with the tagline, "Speak up, it's in your DNA", preceded the birth of Daily News and Analysis in 2005. The context into which the publication was introduced was described by the Indian media as tumultuous, with price cuts and competitive activity occurring.
                    Last edited by Double Edge; 20 Jul 14,, 09:09.

                    Comment


                    • #11
                      Originally posted by anil View Post
                      You have got it right. An outside observer has finally got it right!!
                      At this point I'm going to assume you are being straight with me & not a sarcastic dick, so thank you.


                      Yes. "Toilets" are not a political or peoples issue here in india. Most families in india don't think it's important to invest in a toilet.
                      Definite need for educational campaigns.

                      Yes it is. The running thought is "why would someone like to poop in their own house?". Those homes that do have a toilet room in rural india have it built away from the house.
                      Also an educational issue. As I explained in my post, toilets in houses were not even the norm in urban Australia until the construction of complex sewage networks. The house I live in now was not built with an indoor toilet. There is not even a need for every home to have its own toilet initially. Villages can build numbers of public toilets designed with whatever cultural sensitivities are relevant in mind.

                      Why?
                      Because changing culture is more than just some guy from the state or federal government telling someone what to do. It is about people being persuaded that it is the right thing to do. One of the best ways to do this is for people who already have status & respect, yet are accessible. it is also about communities changing behaviour, and community leaders are ideally placed to lead this. People who may not see the point of indoor defecation may still decide to stop defecating outside because it becomes socially unacceptable. You get a sort of momentum building up.
                      sigpic

                      Win nervously lose tragically - Reds C C

                      Comment


                      • #12
                        Why not make it a security issue? Why not pointing out the risks for going out in the wild? Why not mentioning the security of the kids. There was this rape and hang incident that started with not having toilet around.

                        If my grand grand grand parents could do it on their own without a manual, it is only will and good explanation that's lacking.


                        BF, I see you are still in the Anger phase. Stay strong mate and try to channel it into something productive if you can.
                        No such thing as a good tax - Churchill

                        To make mistakes is human. To blame someone else for your mistake, is strategic.

                        Comment


                        • #13
                          Originally posted by gf0012-aust View Post
                          I think I've said before in WAB that I've dealt with water quality issues in India - we had a successful program which could and (should) have been implemented nation wide
                          Found your posts

                          It's not clear to me why the projects did not work. Was the funding present or as you said going through the motions trying to look like they were doing something. Without funding nothing goes forward. And that comes down to priorities.

                          Originally posted by gf0012-aust View Post
                          unfort the biggest problem was dealing with corrupt local officials and companies who were more interested in how they could maximise profits

                          get rid of corrupt officials and you'll start to make headway - the tech exists to fix this
                          Over the last couple of years we got to hear the word 'corruption' on a daily basis. What it did was result in a complete paralysis of action as nobody was willing to work for fear of being caught in some witchhunt or net.

                          There was a complete public emotional over reaction over how things have worked and will continue to work. Notions of purity and clean start being foisted and balanced discussions were difficult to hear.
                          Last edited by Double Edge; 20 Jul 14,, 09:39.

                          Comment


                          • #14
                            Originally posted by Doktor View Post
                            Why not make it a security issue? Why not pointing out the risks for going out in the wild? Why not mentioning the security of the kids. There was this rape and hang incident that started with not having toilet around.

                            If my grand grand grand parents could do it on their own without a manual, it is only will and good explanation that's lacking.


                            BF, I see you are still in the Anger phase. Stay strong mate and try to channel it into something productive if you can.
                            Not at all doc, just covering my bases. Some of a our subcontinental brethren don't like us white folks commenting on their fine nation. Just trying to gauge where Anil is coming from. If he is being straight then we are good. :)
                            sigpic

                            Win nervously lose tragically - Reds C C

                            Comment


                            • #15
                              Originally posted by Bigfella
                              It is about people being persuaded that it is the right thing to do.
                              The bedroom and the bathroom are both private rooms. Public interest in the former is seen as creepy while interest in the later will send most indians into head scratching and confusion. The concept of sanitation is different for indians.

                              IMO, modern sanitation is a trend and it'll spread on its own pace. I don't see a "sanitation revoultion" happening anytime soon.

                              Comment

                              Working...
                              X