Investigating the Relationship Between Sanitation Infrastructure and Undernutrition Among Children Under Five in Kebbi State, North West Nigeria

The WASH-nutrition nexus has gained increasing attention as a pathway through which poor sanitation contributes to child growth failure through environmental enteropathy and infectious disease burden. This study investigated the relationship between sanitation infrastructure availability and stunting, wasting, and underweight prevalence among children under five in Kebbi State, North West Nigeria, an area with consistently high child undernutrition rates. A cross-sectional household survey was administered to 650 caregivers of children under five, with anthropometric measurements taken from all children. Household sanitation infrastructure was assessed using a standardized scoring index covering latrine type, hygiene behavior, handwashing facilities, and open defecation status. Poisson regression was employed to estimate the association between sanitation scores and nutritional status, controlling for household food security, maternal education, child feeding practices, and healthcare access. Results showed an overall stunting prevalence of forty-one percent, wasting prevalence of eighteen percent, and underweight prevalence of thirty-three percent. Children in households with low sanitation scores had a forty-four percent higher risk of stunting and a sixty-two percent higher risk of wasting compared to children in high sanitation score households. The association was strongest among children in the twelve-to-twenty-three-month age group. The study makes an original empirical contribution by linking sanitation infrastructure quality scores to multiple nutrition outcomes in a single Nigerian state study. Recommendations include integrated WASH and nutrition programming and community-led total sanitation initiatives. Keywords: sanitation, child undernutrition, stunting, Kebbi State, WASH-nutrition nexus.