Menu ENN Search

Is exposure to animal faeces harmful to child nutrition and health outcomes?

Summary of research1

Location: Ethiopia, Bangladesh and Vietnam

What we know: Sub-clinical environmental enteric disorder (EED) is an important causal pathway from poor sanitation and hygiene to stunting; exposure to animal faeces may be an important risk factor for EED.  

What this article adds: ‘Alive and Thrive’ survey data were used for 2,214, 1,750 and 2,104 children age 6-23.9 months of age in Bangladesh, Vietnam and Ethiopia respectively to examine relationships between exposure to animal faeces and stunting, wasting and child morbidity. Animal faeces were visible in 38-42% of household compounds in all three countries. A significant association was found between observed animal faeces and maternal and child cleanliness (odds ratios between 0.52 and 0.71) and between the presence of animal faeces and child height-for-age z (HAZ) scores in Ethiopia (β = -0.22), Bangladesh (β = -0.13) and all countries (β = -0.11). An association between hygiene indicators and diarrhoea was found in Bangladesh only. Findings are consistent with an infection/EED pathway to stunting and suggest that this can be mediated by exposure to animals and their faeces. Behaviour-change communication (BCC) strategies should aim to reduce exposure to animal as well as human excreta and should aspire to “total sanitation”.

It has recently been hypothesised that exposure to livestock constitutes a significant risk factor for diarrhoea and environmental enteric disorder (EED) in young children, which may significantly contribute to undernutrition (Zambrano et al, 2014); however to date very little research has documented the extent of exposure to animal faeces and whether this exposure is associated with child nutritional status in large samples and diverse settings. This study uses data from large-scale nutrition surveys conducted in Ethiopia, Bangladesh, and Vietnam to address three research questions within these quite different socioeconomic contexts: how prevalent are observable animal faeces in household compounds; what factors are most strongly associated with observable animal faeces; and is the presence of animal faeces significantly associated with child height for age, child weight for height, and child morbidity symptoms?

The data for this study are drawn from baseline and endline surveys conducted in rural areas of Bangladesh, Ethiopia, and Vietnam in 2010 and 2014 as part of the ‘Alive and Thrive’ project aimed at reducing undernutrition and death caused by sub-optimal infant and young child feeding (IYCF) practices. The surveys include high-quality data, using large samples on child anthropometry, morbidity symptoms and their determinants, including hygiene spot-checks for the presence of animal faeces in the homestead compound as well as more standard indicators of household hygiene, such as cleanliness of mothers, young children and the homestead environment.2As the primary research interest was infants who are more likely to be left on the ground by themselves and more likely to engage in exploratory mouthing behaviours or geophagy, only the sub-sample of children 6–23.9 months of age was used. Data on anthropometry and hygiene indicators were available for 2,214, 1,750, and 2,104 mother and child dyads in Bangladesh, Vietnam, and Ethiopia, respectively. Statistical models controlled for a wide array of child, maternal and household factors known to be associated with child anthropometry/undernutrition or child illness. In order to explore external validity issues, these data were analysed for each country separately using regression models that pooled data from all three countries.


Results of the study show that animal faeces were visible in 38-42% of household compounds across the three countries and were positively associated with household livestock ownership and negatively associated with maternal and child cleanliness. Results show highly significant and robust associations between observed animal faeces and maternal and child cleanliness (with odds ratios that vary between 0.52 and 0.71), although there are no significant associations with toilet or water facilities (except in the case of hygienic toilets in Vietnam). One-sided tests from multivariate least squares models for children 6-24 months of age indicate that the presence of animal faeces is significantly and negatively associated with child height-for-age z (HAZ) scores in Ethiopia (β = -0.22), Bangladesh (β = -0.13), and in a pooled sample for all three countries (β = -0.11), but not in Vietnam. No significant associations were found between weight-for-height z (WHZ) scores and animal faeces in any of the countries. An association between hygiene indicators and diarrhoea was found in Bangladesh only, the odds ratio for which suggests that the presence of animal faeces increases the risk of diarrhoea by 25%.

Discussion and conclusions

Livestock ownership may have positive effects on child growth through improvements in household socioeconomic status, animal-sourced food consumption and other mechanisms (transportation, social status, women’s empowerment, collateral for credit), but negative impacts through increased risk of infections and/or EED. Consistent with an infection/EED pathway, in Bangladesh and Ethiopia the presence of animal faeces in the compound is negatively associated with child HAZ. In Ethiopia, livestock ownership was also positively associated with child HAZ outcomes. However, there were no similar associations in the Vietnam sample; this may be due to lower prevalence of EED or diarrhoeal infection in general and better care practices for children.

The authors conclude that these findings contribute to a growing body of evidence suggesting that child anthropometry and health outcomes in developing countries may be adversely affected by exposure to animals and their faeces. This risk stems from several factors, including the widespread ownership of livestock and pets in developing countries; the lack of housing and enclosure structures for livestock that separate animals from household members (e.g. scavenging poultry systems); poor hygiene knowledge and practices; the common practice of leaving children to sit or play on homestead floors with little monitoring (especially in warmer climates); and the very high concentration of potentially harmful bacteria in animal faeces.

This literature points to the need to re-evaluate several core features of conventional water, sanitation and hygiene (WASH) strategies. First, most WASH strategies have focused on influencing diarrhoea and morbidity outcomes rather than on sub-clinical EED. Second, most WASH strategies have focused behaviour-change communications on a small number of key messages with emphasis on reducing exposure to human faeces, assuming this poses a greater health burden (to children especially) than exposure to animal faeces. While open defecation remains a major health concern in much of the developing world, exposure to animal faeces is probably more common and potentially also hazardous for child nutrition and health outcomes. Behaviour-change communications strategies should therefore consider reducing exposure to all excreta, human and animal, and aspire to genuine “total sanitation.”


1Headey DD, Nguyen PH, Kim SS, Rawat R, Ruel MT and Menon P. Is exposure to animal feces harmful to child nutrition and health outcomes?: A multicountry observational analysis. The American Journal of Tropical Medicine and Hygiene. Article in Press. First available online December 19, 2016.

2Interviewers recorded observations of cleanliness of the mother and her child (hair, hands, faces and clothing) on a three-point scale of clean, dusty or dirty and yes/no observations of household cleanliness (based on presence of human faeces, rubbish, dirty clothes and a cover on the main drinking water container).


Zambrano LD, Levy K, Menezes NP, Freeman MC, 2014. Human diarrhea infections associated with domestic animal husbandry: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 108: 313–325



More like this

FEX: Livestock and nutrition: Summary of a discussion paper for the Livestock Emergency Guidelines and Standards

View this article as a pdf By Kate Sadler Dr Kate Sadler is a public nutritionist with over 20 years of experience in the design, management, evaluation and research of...

FEX: Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali

Summary of research1 Location: Mali What we know: Community-led total sanitation (CLTS) is being scaled up, but there is limited evidence on child health impacts. What this...

FEX: Links between household agricultural production and nutrition

Summary of research1 Location: Nigeria, Uganda, Ethiopia, Zambia, Mozambique, Tanzania and Nepal What we know: It is generally accepted that agricultural development will...

FEX: Early is best but it is not always too late. Young Lives evidence on nutrition and growth in Ethiopia, India, Peru and Vietnam

View this article as a pdf Summary of report Location: Ethiopia, India, Peru and Vietnam What this article is about: Anthropometric data, taken from 12,000 children across...

FEX: Deterioration of children with MAM who have no access to supplementary feeding programmes

James P, Sadler K, Wondafrash M, Argaw A, Luo H, Geleta B, et al. (2016) Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience...

FEX: Independent and combined effects of improved WASH and improved complementary feeding on child stunting and anaemia in rural Zimbabwe

Summary of research1 Location: Zimbabwe What we know: Stunting and anaemia remain prevalent in children; plausible interventions have shown limited or inconsistent...

FEX: Factors influencing maternal nutrition practices in a large scale maternal, neonatal and child health programme in Bangladesh

View this article as a pdf Research snapshot1 Improving maternal nutrition practices during pregnancy is essential to reduce the high burden of maternal, infant and child...

FEX: A systematic review of nutrition interventions for mobile pastoralists

View this article as a pdf By Natasha Lelijveld and Emily Mates Natasha Lelijveld is a Senior Nutritionist at Emergency Nutrition Network (ENN). She previously worked at the...

FEX: Use of a two-stage approach to identify intervention priorities for reduction of acute undernutrition in Abaya district of Ethiopia

By Katja Siling, Asrat Dibaba and Mark Myatt Katja Siling is an independent consultant helping organisations increase their learning capability and fulfil their mandate...

FEX: Impact of maternal mental health on recovery from severe acute malnutrition in Malawi

View this article as a pdf MSc summer project1 By Mphatso Nancy Chisala Mphatso Chisala is a medic by profession with an interest in the prevention and treatment of child...

FEX: Nutrition-sensitive WASH programming to improve the nutritional status of women and children in Nepal

View this article as a pdf By Keshab Shrestha, Dhruba Dhital, Yubraj Shrestha, Dipak Raj Sharma and Dr Kenda Cunningham Keshab Shrestha is water, sanitation and hygiene...

FEX: Using trials of improved practices to shift nutrition and hygiene behaviours in Sierra Leone

By Jennifer Pietropaoli, Philip Moses and Heather Forrester View this article as a pdf Jennifer Pietropaoli is the Outreach and Communications Officer for the SPRING Project....

FEX: WASH interventions and their effects on the nutritional status of children

Summary of research1 Location: Global What we know: Water, sanitation and hygiene (WASH) interventions are frequently implemented to improve health and reduce infectious...

FEX: Seasonal Trends in Pastoral Malnutrition in Somalia

By Louise Masese Mwirigi and Joseph Waweru Ms Lousie Masese-Mwirigi works as a Nutrition Analyst for the Food and Agriculture Organization of the United Nations (UNFAO) - Food...

FEX: Child height gain is associated with consumption of animal-source foods in livestock-owning households in Western Kenya

Research snapshot1 Animal-source foods (ASF) such as meat, milk and eggs are nutrient-dense and excellent sources of protein, calcium, B vitamins, vitamin A and iron. The use...

FEX: Universal appreciation for women’s involvement in food aid

Summary of a report1 School in the Dagahaley camp, Ethiopia. Most men and women stated that they observed that households with educated daughters did not suffer the full...

FEX: Cash transfers and child nutrition

Summary of research1 Location: Global What we know: Cash transfer (CT) programming is an expanding form of social protection that has potential to improve child...

FEX: Link NCA offers a new opportunity to study drivers of concurrent wasting and stunting (WaSt)

View this article as a pdf By Lenka Blanárová and Grace Heymsfield Lenka Blanárová is Senior Nutrition Assessment Coordinator at Action Against...

NEX: Post-infancy growth, schooling, and cognitive achievement: Young Lives

Summary of research paper: Crookston, B.G. et al. American Journal of Clinical Nutrition. 2013 Sep; 1-9 Early life growth failure and resulting cognitive deficits are often...

FEX: Evaluation of an integrated health-nutrition-WASH project to reduce malnutrition prevalence in children under two in Bangladesh

By Monsurul Hoq and John Brogan Monsurul Hoq was working as a Statistician Epidemiologist during the study. He has experience in monitoring and evaluation of community-based...


Reference this page

Is exposure to animal faeces harmful to child nutrition and health outcomes?. Field Exchange 55, July 2017. p31.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.