By Samantha Chivers, RESULTS Australia’s Campaign Manager (Maternal, Child and Neonatal Health)

Today, November 19th, the world comes together to think about toilets. World Toilet Day is an event that brings together advocates, the United Nations and organisations working in the field to give attention to the fact that billions of people around the world go every day without basic toilets. Important in itself, this lack of water and sanitation is also essential to consider when talking about undernutrition.

The burden of undernutrition around the world is high, and a major deterrent to development and health. As an indicator of long-term poverty and inequality, stunting – or having a low height for your age – serves a grim picture: around one quarter of children under five in the world are stunted. In the least developed countries, this rate rises to thirty-seven percent.

Undernutrition carries such a large burden that its impacts can be seen today, as well as tomorrow. Globally, around seven million children under five die every year from mostly preventable diseases such as pneumonia and diarrhoea. Astonishingly, undernutrition is the underlying contributing factor in nearly half of these deaths.

Undernutrition is a major barrier to families and nations escaping poverty. Stunting is a huge public health problem not only because it leaves children more susceptible to infectious diseases, but also because stunted growth in the first months of a child’s life means stunted development of the brain and thus, of cognitive capacity. Permanently. It limits the ability of children to learn and earn, and develop into adults who can lead healthy and productive lives. By keeping adults out of work and limiting their opportunities, undernutrition has a huge impact on the social and economic development of families, and of countries.

While undernutrition can come about from many causes, one that may not be so obvious is the link between undernutrition and hygiene. Clean water, access to toilets, and hygiene practices such as exclusive breastfeeding and handwashing are incredibly important for preventing disease, and thus, for preventing undernutrition. It turns out that half of undernutrition is associated with intestinal parasitic infections and repeated diarrhoeal episodes. Diseases transmitted from water contaminated by sewage, including worms, intestinal parasites, and bacterial infections like environmental enteropathy and typhoid, actually play a very large role in undernutrition. Some diseases, like diarrhoea, literally flush nutrients from the body, as well as depleting stores while mounting an immune response. Others, such as environmental enteropathy, cause an infection that damages the wall of the small intestine and limits the ability to absorb nutrients, slowly causing stunting. Contracting these infections from poor hygiene, defecating in the open, or not having access to clean water, is a strong contributing factor to being undernourished despite what you eat.

This year, RESULTS Australia is marking World Toilet Day. Our nutrition and child health campaigns focus on implementing interventions that are based on what works. The United Nations estimates that there are 2.5 billion people who still do not use an improved sanitation facility and a little over 1 billion practising open defecation. As a single gram of poo can contain 10 million viruses, one million bacteria and 1,000 parasite cysts, open defecation can cause serious infection and raise the prevalence of undernutrition. Working to integrate nutrition interventions with increased access to toilets and clean water and using basic hygiene practices such as handwashing, can have a major reduction in child undernutrition. It’s as simple, and as complicated, as that. So if you “give a shit” about child undernutrition, please appreciate the clean water that comes straight out of the tap the next time you wash your hands, and join us to learn how you can make a difference on this important issue.

@World Toilet Day