Environmental Enteropathy (EE): A Critical Challenge in Indian Public Health

There is strong causal relationship between stunting and Environmental Enteropathy, a subclinical condition of the small intestines. The biological plausibility for Environmental Enteropathy being a strong causal pathway for stunting has important policy implication in improving WASH in India, which has the highest incidence of stunting in the world. Four states of India namely, Uttar Pradesh, Jharkhand, Bihar and Assam have high incidence of stunting. This paper focuses on the association of WASH with stunting in these states. Review of literature and statistical analysis of data from IMIS of the MDWS, GOI provide certain critical findings in this respect. It was observed that all these states have low sanitation facilities and low coverage of piped water supply. Also, there is little surveillance of bacteriological quality of water in these states. Further, sanitary survey of the water sources to assess the risk of contamination of the sources have also been very poor. It is likely that children in these states face higher incidence of Environmental Enteropathy, which being asymptotic makes it difficult to identify the children living in such condition for child specific interventions.