The Effect of Improved Sanitation on Linear Growth Amongst Children Living in Developing Countries: a Systematic Review


  • Elton Chavura Mzuzu University, Faculty of Environmental Science, Mzuzu, Malawi
  • Wales Singini Mzuzu University, Faculty of Environmental Science, Mzuzu, Malawi
  • Russel Chidya Mzuzu University, Faculty of Environmental Science, Mzuzu, Malawi
  • Balwani Chingatichifwe Mbakaya University of Livingstonia, Department of Public Health, Malawi


Systematic review, WaSH, Linear Growth, Environmental Enteric Dysfunction


Constant exposure to poor sanitation contributes to the environmental enteric dysfunction-a disorder that is frequently implicated as a cause of linear growth failure. We aimed to evaluate the efficacy of water, sanitation, and hygiene (WaSH) interventions on linear growth amongst children aged 0-24 months. We reviewed fourteen studies retrieved from AMED, CINAHL, DOAJ, PubMed, PsycINFO, Google Scholar, and EMBASE databases following guidelines developed by PROSPERO and COCHRANE. The screening process was summarized using a PRISMA flow diagram, and the methodologies were critically appraised by a Mixed Method Appraisal Tool. No difference was seen in mean height for age Z-score (0.01, 95% CI0.16 to 0.18) between children who received WaSH interventions and those who did not. Only 5 studies reported a significant association between WaSH and child linear growth (P < 0.001). All combination intervention studies include in this review did not establish any significant benefit of WaSH and nutrition integration. Although robust sanitation coverage could be an important component amongst proven interventions to stimulate linear growth, stunted growth is embedded within myriad determinants beyond improved sanitation. More research is needed to quantify the complementary effect of WaSH and nutrition co-programming. This systematic review was registered in the PROSPERO database with registration number CRD42022322462.