More than 60 percent of one’s total body weight is water. Besides major functions like maintaining body temperature, processing important chemical reactions and transporting materials in and outside body, water has integral contribution in maintaining the nutritional status of the human body.
Unsafe drinking water and poor hygiene practices and sanitation conditions are the major underlying determinants of malnutrition. Poor WASH (Water, Sanitation and Hygiene) conditions lead to diarrheal diseases, which are said to be responsible for a major toll of deaths in children in Asia. It also has adverse effects on growth in the form of childhood stunting. Stunting generally occurs before age two, and its effects are largely irreversible.
Lack of access to safe water, inadequate sanitation facilities and compromised hygiene practices result in repeated exposure to infectious diseases like diarrhoea leading to stunting and other indicators of under nutrition. Disease, especially infectious diseases, often increases nutrient requirements and prevents the body from absorbing nutrients – establishing a vicious cycle or negative feedback of diet, disease and malnutrition, even when food consumption is sufficient.
The National Nutrition Survey of 2011 found that only 50 percent of the population has access to piped water and that the majority of households (90 percent) do not treat their drinking water, resulting in diseases and epidemics. The World Bank Water and Sanitation Program (WSP) study estimated that 36 percent population in Pakistan either practised open defecation or had access to shared toilets. In rural areas, 45 percent of the population still practice open defecation. All these facts and figures contribute to an unhealthy population.
As is evident that the majority of the total disease burden of under-nutrition is attributable to environmental factors, including inadequate water, sanitation and hygiene practices, there is a need to take a holistic approach to address the issue. As preventive measures, there is a need to prioritise advocacy to secure political support for access to quality and clean water, a need to ensure an open-defecation-free environment, and other WASH measures. Moreover, research and development to identify optimal technologies for the provision of clean drinking water and improved sanitation should also be focused on. Collaboration with other government agencies as well as the private sector for building water and sanitation projects, particularly in remote areas, can definitely bring about a change.
It is estimated that 15-20 litres of water per person per day is needed for human consumption, food preparation, cleaning, laundering and personal hygiene (WHO, 2003). Although improving access to safe drinking water remains an essential development goal, low-cost strategies to treat and safely store drinking water at the point of consumption can provide an intermediate solution. For example, improving access to safe drinking water involves constructing or improving water supply systems or services, such as providing piped water on-site, public standpipes, boreholes, protected dug wells, protected springs and rainwater.
The collaboration of various public departments can also uplift water and sanitation indicators and can enhance access to safe drinking water and hygienic facilities with priority accorded to far-flung areas. The WASH sector and the education department should work together to ensure safe water and sanitation facilities in schools. Key messages should be added in their curriculum regarding drinking clean water, washing hands, avoiding open defecation etc. Health promotion activities and sessions should be conducted frequently to reinforce these messages.
Similarly, the health department has a pivotal role in addressing the issue. Their outreach staff should be fully trained to deliver WASH messages at the community level. In many countries, zinc supplementation as a treatment has shown to have both curative (reduction in diarrhoea) and preventive (fewer future episodes) effects. Ensuring the continuous supply of zinc and ORS among children aged 6-24 months will definitely gain the required outcomes. In addition to that, a behaviour change at the level of the community is critical for practising positive health and water-related interventions. There is a need to disseminate information regarding healthy safe behaviour using the media, health staff, teachers, community leaders etc.
Above all these interventions, creating an enabling environment through instituting policy and strategy is the most significant input. There is a need to formulate and implement WASH services through development/strengthening of new or already existing laws, policies and standards. In order to gain this target, there is a need to sensitise politicians, policymakers and opinion leaders as a high priority agenda with regard to the urgency of providing improved water and sanitation services and linking it with the economic growth of the country.
Following a comprehensive approach, it is not impossible to decrease the stress of childhood illness including diarrhoea, and promote household sanitation, which will in turn result in the improved nutrition and health status of the population, and so directly impact the economic growth and productivity of the country.
The writer is a public health specialist. Email: fauziawaqar_28hotmail.com