Child undernutrition, tropical enteropathy, toilets, and handwashing.

This article explores the importance of toilets and hand hygiene in ensuring children grow normally in the developing world. The paper hypothesise that that improvements in this area could reduce the prevalence of tropical enteropathy, a condition in which the small intestine becomes inflamed and functions poorly due to bacterial infestation. Dr Humphrey uses an analogy of chickens to illustrate her point. Controlled studies have shown that chicks in dirty conditions can grow normally if they are fed antibiotics to stave off the bacteria they are exposed to in that environment; whereas chicks in the same conditions not given antibiotics do not grow as well. In both children and chickens, biological markers of inflammation increase substantially in unhygienic conditions, indicating that both children and chickens enter a ‘near-continuous state of growth-suppressing immune response’, in which dietary nutrients are directed away from growth into providing energy and building materials for the immune response. The consequences on growth in children can be immense, especially in the first two years of life when growth demands are high. Lancet. 2009 Sep 19;374(9694):1032-5.