Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links

Ann N Y Acad Sci. 2014 Jan;1308:118-128. doi: 10.1111/nyas.12330.


There is scarce research and programmatic evidence on the effect of poor water, sanitation, and hygiene (WASH) conditions of the physical environment on early child cognitive, sensorimotor, and socioemotional development. Furthermore, many common WASH interventions are not specifically designed to protect babies in the first 3 years of life, when gut health and linear growth are established. We review evidence linking WASH, anemia, and child growth, and highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. We propose the concept of baby WASH as an additional component of early childhood development programs.

Keywords: anemia; child development; environmental enteropathy; hygiene; nutrition; sanitation; stunting; water.

Publication types

  • Review

MeSH terms

  • Anemia / etiology
  • Child Development*
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Developmental Disabilities / etiology
  • Early Medical Intervention
  • Environment
  • Gastrointestinal Diseases / etiology
  • Humans
  • Hygiene
  • Infant
  • Malnutrition / etiology
  • Poverty
  • Risk Factors
  • Sanitation*
  • Water Quality