Safely managed sanitation practice and childhood stunting among under five years old children in Myanmar

In 2020, 149 million children under the age of five were estimated to be stunted globally. Around half of deaths among children under 5 years of age are related to under-nutrition. The objective of this study is to determine the association between safely managed sanitation and childhood stunting among under-five-year-old children in Myanmar. This cross-sectional analytical study was conducted in 16 townships across three regions and five states in Myanmar. Multiple logistic regression analyses were performed to determine the associations. This study found that 327 (27.09%) under-five children were stunted among a total of 1207 children in Myanmar. Children with unsafely managed sanitation were 2.88 times more likely to be stunting compared with children who had access to safely managed sanitation services (AOR=2.88, 95% CI: 2.16 to 3.85; p-value <0.01). Other associated factors for childhood stunting were: needs 1–15 minutes for water collection (AOR=2.07, 95% CI: 1.46 to 2.94; p-value <0.01), 15–60 minutes for water collection times (AOR=1.55, 95% CI: 1.08 to 2.23; p-value 0.02), unproper waste water disposal (AOR=1.99, 95% CI: 1.47 to 2.70; p-value <0.01), male children (AOR=4.49, 95% CI: 3.30 to 6.12; p-value <0.01), did not take vitamin A supplements(AOR=1.64, 95% CI: 1.22 to 2.20; p-value <0.01), mothers height shorter than 153.4cm (AOR=1.94, 95% CI: 1.45 to 2.58; p-value <0.01), and the lower minimal diet diversity (AOR=1.53, 95% CI: 1.11 to 1.87; p-value 0.02). More access to safely managed sanitation facilities, technical sharing for proper wastewater disposal, promoting household water supply system, health promotion for children's diet eating patterns, and regular support for Vitamin A supplementation are critical to reduce childhood stunting among children under the age of five in Myanmar.

Methods
Samples were chosen using multistage sampling. First, 16 townships were chosen from eight targeted Myanmar states and regions. Then, using simple random sampling, 1 ward was chosen from the urban context, and 2 villages for rural settings were chosen from these townships. The household numbers, together with the names of the household leaders, were obtained from the township's year-end health count data. Following that, 1207 sample houses with children under the age of five were chosen using a systematic random selection technique. Finally, the height of selected children, their mothers and fathers were measured using conventional instruments, and their mothers were interviewed using preformed questionnaires. The data was collected from September 27, 2022, to December 26, 2022. Microsoft MS Excel was used to record the raw data of 1207 respondents.  Microsoft MS Excel was used to record the raw data of 1207 respondents.  The data were inverted using Stata version 13.1.