Poor Sanitation and Stunting in Guyana

Sep 03, 2014 Letters

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Dear Editor,
After the first letter was published in your newspapers on Saturday 16 August, 2014 on the possible impact of poor sanitation on stunting, it appears that several persons in Guyana have not conceived that there might be a linkage between poor sanitation and stunting, hence based on the interactions and discussions on the topic, I have decided to write this follow up letter.
In that letter it was stated that 54% of international variation in child height is explained by poor sanitation while, Gross Domestic Product (GDP) only explains 29 percent.  It was also stated that stunting is linked to lower scholastic achievement and intellectual function, reduced lifetime earnings, short adult stature, and in the case of women, adverse pregnancy outcomes.  Additionally, it reflects under-nutrition during infancy and early childhood which are critical periods of physical and cognitive growth. The letter therefore emphasized the need for a research to be conducted to determine how far is poor sanitation responsible for stunting in Guyana.
In addition to the points made in the previous letter another aspect of the research could investigate specifically, whether the increase in academic performance of some persons, adults and children migrating from Guyana to the United States or Canada is related to a change in environment? For example, moving from a country with poor sanitation to countries with better sanitation. Whether the variation in height in children who were born in Guyana and migrated to the United States or Canada is also due to a change from an environment with poorer sanitation, to an environment with better sanitation?
Many Guyanese children who migrate to the United States and Canada grow tall and increase in their academic performance; for many years it was believed that this was due to GDP, nutrition and genetics, however my question is, could it also be as a result of the change in environment?
Gut dysfunction is known as Environmental Enteropathy (EE) and affects up to 50% of children globally. It reduces nutrition absorption and contributes significantly to stunting in children. It has been recently stated as the single most important barrier to achieving normal growth and development in children worldwide.
In the 1970s: “tropical enteropathy” also known as environmental enteropathy (EE) was identified in South and Southeast Asia and Africa and both children and adults were affected, subsequently, it was epidemiologically linked to living in an unsanitary environment.
Environmental Enteropathy which is gut mucosal damage shows that people living in contaminated environments have leaky, chronically inflamed intestines and proper water, sanitation and hygiene (WASH) can reduce pathogen transmission. It is important to note that twenty five percent of stunting is attributed to five or more episodes of diarrhea during a child’s first two years.
Studies show that volunteers from the United States Peace Corps develop environmental enteropathy when they live in rural African villages and it goes away when they return to the US. Therefore one of the conclusions is that, environmental enteropathy goes away when the contaminated environment is removed. It should be noted also that the absence of fecal material, human or animal in the environment can prevent exposure to environmental enteropathy.
Thus, the assumption is whether some Guyanese children and even adults become affected by environmental enteropathy and when they migrate from Guyana to the United States or Canada for e.g., away from a contaminated environment the environmental enteropathy is removed from their system allowing for greater physical and cognitive growth and development.
Based on the emerging evidence in this area, I am once again reiterating the call for a research to be done to determine how far is poor sanitation responsible for stunting in Guyana? The United States Agency for International Development (USAID) has done some work in this area and can perhaps provide assistance to Guyana (Ministry of Health) to have this study done with support from the US Centre for Disease Control (CDC) as well as the Pan American Health Organisation/World Health Organisation (PAHO/WHO) The World Bank has also conducted a much reported study in this area.
It is very important that a better understanding be developed in Guyana of the causes of our challenges in sanitation and the impact of those challenges, so that adequate solutions could be developed.
As stated in the previous letter based on the findings of the research, this can become a post – 2015 Millennium Development Goals (MDGs) target for Guyana under the Sanitation Goal and create an opportunity for a more strategic approach to better wastewater and solid waste management and for resources to accelerate a programme to reduce and address stunting in Guyana and foster a clean environment which prevents environmental enteropathy.
Audreyanna Thomas

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