Impact of Adequate Hydration on Stunting among Under-five Children: A Review Article

Abstract

Stunting remains a significant global health challenge affecting 149 million children under five years old as of 2022. While nutrition interventions have been the primary focus, the role of adequate hydration in preventing stunting is less understood. This review aims to synthesize current evidence on the impact of adequate hydration on stunting among children under five years of age and explore its potential as a complementary intervention to existing nutrition strategies. A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar databases. Studies published between 2000 and 2024 addressing hydration, water intake, or water, sanitation, and hygiene (WASH) interventions in relation to child growth and stunting were included. From 487 initially identified studies, seven met the inclusion criteria after screening. Analysis of large-scale studies (n=1,520,526) demonstrated that access to improved water was associated with a 27% reduction in odds of stunting (adjusted OR: 0.73; 95% CI: 0.68-0.77). Children in households with improved water sources showed significantly lower stunting prevalence (38.2% vs 46.5%, p<0.001) in regional studies. When combined with nutrition interventions, WASH programs demonstrated modest but significant improvements in linear growth (difference in HAZ scores: 0.25; 95% CI: 0.07 to 0.44). However, the review identified important limitations, including heterogeneous measurement approaches across studies, limited direct assessment of hydration status, and potential publication bias favoring positive results. Despite methodological limitations, evidence suggests that adequate hydration, particularly when integrated with WASH interventions, plays a crucial role in stunting prevention. We strongly recommend that policymakers prioritize 1) integration of hydration monitoring into nutrition surveillance systems, 2) investment in clean water infrastructure in high-risk regions, and 3) implementation of combined WASH-nutrition interventions. Future research should focus on longitudinal studies directly measuring hydration status and growth outcomes, particularly in resource-limited settings where stunting prevalence remains high.