Environmental Hygiene, Food Safety and Growth in less than Five Year Old Children in Zimbabwe and Ethiopia

Childhood stunting remains a significant public health challenge with adverse developmental and health outcomes in life and over generations. This study explored novel causes of poor growth in infants and young children. Using in‐depth observation methods, soil and chicken feces ingestion were identified as key pathways for fecal‐oral transmission of bacteria in infants and young children in rural Zimbabwe. In a cross‐sectional survey, poor environmental hygiene was associated with linear growth faltering (p =0.032), independent of socioeconomic status, infant feeding and recent morbidity, in 24–59 month old Ethiopian children. Significant aflatoxin exposure in mothers was associated with severe stunting in 6 to 59 months old Zimbabwean children in a dose response manner (p=0.035). We identified poor environmental hygiene and aflatoxin exposure as two novel causes of stunting in African children. Existing WASH interventions are not sufficient to protect infants and young children from fecal bacteria ingestion through soil and poultry feces. In addition, existing hygiene interventions do not directly address improving household environmental hygiene. Our findings raise the need for low cost strategies for aflatoxin control and a holistic approach in designing context‐ and age‐specific hygiene interventions to prevent childhood stunting.