Effects of poor water, sanitation, and hygiene on child health in Godawari Municipality, Lalitpur, Nepal, with special reference to diarrheal disease and nutritional status: a cohort study

Malnutrition is one of the global burdens of disease affecting children under-five in the developing world and has a bidirectional relation with diarrhea. This study aimed to determine the water, sanitation, and hygiene (WASH) effects on diarrhea and to assess its relationship with the nutritional status among exposed and non-exposed children under the age of five years. A prospective cohort of 434 children under-five was recruited and followed up for 12 months in Lalitpur. Socio-demographic, clinical, and anthropometric measurements of the participants were recorded using the World Health Organization (WHO) AnthroPlus. The observed incidence of diarrheal illness was 1.81 episodes per child/year (95% Confifence Interval (CI):1.75–1.87). Among poor WASH exposures, 63 (29.2%) children had diarrhea and among non-exposures, 59 (27.1%) had diarrhea. A total of 183 children (42.2%) had linear growth retardation (stunted), and 270 (62.2%) were malnourished. Hazards of diarrhea among exposed groups were 1.235 (95% CI: 0.785-1.943) times higher than in non-exposed groups. Based on the findings, it is recommended that the government and health organizations should plan Safe WASH activities or interventions for local communities. Moreover, they should encourage social support and promote behavioral change for adopting safe WASH practices.