LINKAGE BETWEEN GUT HEALTH AND NUTRITIONAL STATUS AMONG CHILDREN AGED 12-15 MONTHS WITH COMPROMISED WATER, SANITATION AND HYGIENE ACCESS IN SIAYA COUNTY, KENYA

Abstract

The Kenyan government has implemented programs to improve child nutrition, yet malnutrition persists in Siaya County, where stunting affects 19% of children, higher than in other regions. Poor access to water, sanitation, and hygiene (WASH) in these areas exposes children to enteric pathogens, leading to environmental enteric dysfunction (EED). Characterized by gut inflammation, impaired absorption, and increased permeability, EED significantly impacts nutritional status, contributing to persistent undernutrition, particularly in rural areas. Despite the critical role of gut health, it is often overlooked in managing childhood malnutrition. This study investigated the relationship between gut health and nutritional status among children aged 12-15 months compromised access WASH in Siaya County, Kenya. The study assessed the WASH situation, gut health and nutrition status among the children. A cross-sectional analytical study was conducted among 100 children at Siaya County Referral Hospital, selected purposively for its referral role. Children were recruited via simple random sampling during child clinics. WASH data was collected using a semi-structured questionnaire, while nutritional status was assessed through anthropometric measurements. Gut health was evaluated using the lactulose and rhamnose sugars ratio and the 13-carbon sucrose breath test to diagnose EED. Descriptive analysis employed percentages, means and standard deviations while inferential statistics used chi-square tests, Pearson’s correlation, independent t-tests, ANOVA, and simple linear regression analysis were used for inferential statistics. Most respondents were married (80%), with 19% single. Education levels showed concerning trends with 40% having only primary education, 42% secondary, and with smaller proportion (18%) attaining tertiary level. Overall, 76% of the households had improved sources of water indicating some access to safe and protected water sources. However, 22% utilized surface water, increasing the risk to enteric infections. Further, sanitation was the major concern with 90% having unimproved toilet facilities. Additionally, 62% had no separate room as kitchen, and 69.2% lacked a handwashing facilities, with only 30% using soap. The prevalence of EED was high at 53%, with a mean lactulose and rhamnose ratio of 3.03 ± 4.32, indicating significant gut impairment. The 13-carbon sucrose breath test further revealed intestinal damage, with a mean change of -0.45 in the 13-carbon recovered between baseline and 90 minutes, suggesting impaired intestinal mucosa. High rates of malnutrition were observed, with 45% of children affected by wasting, 20% by stunting, and 14% by underweight. Significant negative correlations were found between soap use (p=0.02), handwashing stations (0.029), and gut health status, implying that availability of these sanitation facilities in households reduced risk of gut impairment. Regression analysis indicated significant link between water sources for households and impaired gut health (p=0.039). However, gut health was not significantly related to nutritional status indicators (p>0.05), indicating a brush border effect on the gut. In conclusion, poor WASH contributes to impaired gut health, affecting children's nutritional status. Nutrition interventions by stakeholders and policy makers should consider gut health in developing guidelines for management of undernutrition.