Water and sanitation associated with improved child growth

Eur J Clin Nutr. 2003 Dec;57(12):1562-8. doi: 10.1038/sj.ejcn.1601725.


Objective: To examine the relation between household water and sanitation, and the risk of stunting and reversal of stunting in Khartoum and Crezira regions, Sudan.

Design: Prospective cohort study.

Setting: A total of 25 483 children aged 6-72 months from rural Sudan enrolled in an 18-month field trial in 1988 to study the effect of vitamin A supplementation on child health and survival.

Results: The mean height-for-age z-scores at baseline and the end of study were -1.66 and -1.55, respectively, for the group with water and sanitation facilities, and -2.03 and -1.94 for the group without water and sanitation, after adjustment for age, region, gender, mother's literacy, intervention group (vitamin A vs placebo), family wealth, breastfeeding and cleanliness. Among children of normal height-for-age at baseline, the risk of stunting (<-2 height-for-age z-score) was lowest in the group that came from homes that had both water and sanitation compared to children from homes without these facilities (multivariate RR=0.79, 95% CI 0.69-0.90). Among children stunted at baseline, those coming from homes with water and sanitation had a 17% greater chance of reversing stunting than those coming from homes without either facility (adjusted RR=1.17, 95% CI 0.99-1.38). We did not detect a synergistic association between access to water and sanitation.

Conclusions: Water and sanitation are independently associated with improved growth of children.

Sponsorship: None.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Body Height*
  • Breast Feeding
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diet
  • Dietary Supplements
  • Double-Blind Method
  • Female
  • Growth Disorders / drug therapy
  • Growth Disorders / prevention & control*
  • Growth* / drug effects
  • Growth* / physiology
  • Humans
  • Hygiene
  • Infant
  • Male
  • Placebos
  • Prospective Studies
  • Sanitation*
  • Sudan
  • Vitamin A / administration & dosage*
  • Vitamin A / therapeutic use
  • Water Supply*


  • Placebos
  • Vitamin A