Access to Improved Sanitation and Nutritional Status among Preschool Children in Nouna District, Burkina Faso

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  • 1 Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso;
  • 2 Francis I Proctor Foundation, University of California, San Francisco, California;
  • 3 Department of Ophthalmology, University of California, San Francisco, California;
  • 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, California

Access to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6–59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in children living in households with an unimproved latrine than those with an improved latrine (adjusted odds ratio: 1.60; 95% CI: 1.11–2.31). Children in households with unimproved latrines and households that practiced open defection had approximate 0.15 cm reduced MUAC compared with those in households with an improved latrine. There was a small, but statistically significant, association between improved latrine and nutritional status in preschool children as measured by MUAC.

Author Notes

Address correspondence to Catherine E. Oldenburg, Francis I Proctor Foundation, University of California, San Francisco, 513 Parnassus Ave., Rm. S309 San Francisco, CA 94611. E-mail:

Disclosure: The study was reviewed and approved by the Comité National d’Ethique pour la Recherche (National Ethics Committee of Burkina Faso) in Ouagadougou, Burkina Faso, and the Institutional Review Board the University of California, San Francisco, in the United States. Written informed consent was obtained from each head of households for participation in the household survey and census and from each child’s caregiver for participation in the study.

Financial support: The CHAT study was supported by the Bill & Melinda Gates Foundation (OPP1187628).

Authors’ addresses: Mamadou Bountogo, Mamadou Ouattara, Ali Sié, Guillaume Compaoré, Clarisse Dah, Valentin Boudo, and Alphonse Zakane, Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso, E-mails:,,,,,, and Elodie Lebas, Jessica M. Brogdon, William W. Godwin, Ying Lin, Benjamin F. Arnold, and Catherine E. Oldenburg, Francis I, Proctor Foundation, University of California, San Francisco, CA, E-mails:,,,,, and