Open research questions in Child Nutrition and Water Access

What the literature leaves open

• that Based on the findings of this study, it is recommended the government strengthen investments in sanitation infrastructure and access to clean drinking water, particularly in regions with high stunting prevalence. Stunting reduction interventions should be integrated across sectors, with an emphasis on the development of adequate basic environmental infrastructure. The use of spatial and demographic data is also essential to ensure that interventions are more targeted and effective. Additionally, public education on clean and healthy living behaviors must be improved to enhance the impact of environmental interventions.

  Environmental Infrastructure and Child Stunting in Indonesia: A Quantitative Study of Sanitation and Drinking Water Access in three High-Risk Districts · 2026 · DOI

• and (1), 8, Satriawan, E. (2018). National Strategy for Accelerating Stunting Prevention 2018-2024. National Team for Accelerating Poverty Reduction (TNP2K) Secretariat of the Vice President of the Republic of Indonesia, November, 1–32. http://tnp2k.go.id/filemanager/files/Rakornis 2018/Sesi 1_01_RakorStuntingTNP2K_Stranas_22Nov2018.pdf Smith, L. C., & Haddad, L. (2015). Reducing Child Undernutrition: Past Drivers and Priorities 180–204. Era.

  The Influence of Economic Growth, Socio-Economics and Food Security on the Incidence of Stunting in Toddlers in Indonesia · 2026 · DOI

• The findings revealed that CHWs and MMs demonstrated differing levels of knowledge and understanding of maternal nutrition. Participants described nutrition-related concepts, identified key food groups, and outlined approaches to daily meal planning during pregnancy. They also emphasised the role of maternal nutrition in supporting maternal health and foetal development. The reported benefits of optimal maternal nutrition foetal growth and blood for production. Two subthemes were identified from the data: (1) included support Participants described common dietary practices among pregnant women in their communities, including the types of foods and beverages consumed. Several participants reported that pregnant women frequently consumed foods such as kota, chips, and sugar-sweetened beverages. In response to these practices, both CHWs and MMs reported advising pregnant women to limit the consumption of such foods. They described recommending a balanced diet consisting of a variety of food groups, including vegetables, staple carbohydrates, meat, milk, eggs, and legumes. Participants also emphasised the inclusion of Frontiers in Global Women’s Health 05 frontiersin.org Ngwenya et al. 10.3389/fgwh.2026.1850855 TABLE 2 Themes and subthemes based on the HBM.

  Understanding maternal nutrition through the voices of community health workers and mother mentors in Limpopo Province, South Africa · 2026 · DOI

• These biological and behavioural constraints may lead parents to rely on less effective practices such as exerting pressure to eat or modelling food behaviours, which, as demonstrated here, are insufficient to overcome intergenerational nutritional deficits. Additionally, intervention-based studies incorporating parental nutrition education, feeding skill development, and maternal health support are warranted to evaluate sustainable strategies for improving child nutritional outcomes.

  Prevalence and factors associated with undernutrition among preschoolers in low-income urban households in Malaysia · 2026 · DOI

• The study also did not account for potential disruptions to sanitation behaviours and data collection arising from the COVID-19 pandemic during 2020–2022, which may have affected observed trends in that period. The study relied on secondary aggregated data and could not assess household-level determinants or causal pathways.

  Trends, Rural-Urban Inequalities and Forecasts of Open Defecation in Ghana Using Joinpoint Regression and ARIMA Analysis, 2000-2030 · 2026 · DOI

• Under-reporting by the respondents was a major limitation in the study, this was minimized by assurance of confidentiality and arrangement of the questions were patterned starting from less embarrassing to more sensitive CONCLUSION The study has shown high prevalence of malaria and low prevalence of HBV and HIV infections among the studied population.

  Association Between Seroprevalence of HIV, HBV, Malaria and Food Diversity with Anaemic Status Among Pregnant Women Attending Antenatal Clinics at Edo State University Teaching Hospital Auchi, Edo North, Nigeria · 2026 · DOI

• limitations inherent in a secondary-data, single- This study has several strengths. It analysed a centre design. Standardised measurement protocols complete set of qualifying records over a full calendar and instrument calibration reduced measurement year, applied objectively measured anthropometric error in the principal exposure and outcome; pre- and clinical variables rather than self-report, and specified eligibility criteria and exclusion of records advanced beyond the descriptive orientation of much with severe maternal pathology limited confounding of the existing Indonesian literature by reporting by serious illness; and the use of multiple, prevalence with confidence intervals, multiple effect- complementary statistical approaches guarded size measures, the population attributable risk, and against over-reliance on any single estimator. The a multivariable model with formal assessment of fit. transparent reporting of confidence intervals and The use of the nationally validated MUAC threshold effect sizes, in line with contemporary enhances comparability and the operational epidemiological standards, allows readers to weigh relevance of the findings for primary care.

  Maternal Mid-Upper Arm Circumference and the Risk of Low Birth Weight Among Pregnant Women in Tana Toraja, Indonesia · 2026 · DOI

• While the MAL-ED study undertook painstaking data collection based on standardised protocols, predictor and outcome data included in this analysis are likely to suffer from varying levels of measurement error. In particular, infectious disease occurrence relied on caregiver report and syndromic case definitions; anthropometric measurements are error-prone, especially length in young children; the 24-hour recall method for measuring caloric intake is complicated to administer, relies on local and approximate measurements of food quantities, and is generally known to yield inaccuracy; the FIES questionnaire also relies on accurate responses by households and, despite the method replicated here to standardise food insecurity variables across different countries, may feature unaccounted-for biases, e.g. due to perceptions of desirable responses by households.

  Food insecurity, caloric intake and nutritional status among children under 5 years old: a predictive modelling analysis of the MAL-ED multi-country cohort · 2026 · DOI

• However, because this finding emerged from exploratory analyses and was not accompanied by broader changes in community structure, diversity, or biomarkers of EED and inflammation, its biological significance remains uncertain and thus should be interpreted cautiously.

  Gut Microbiome and Environmental Enteric Dysfunction Are Unchanged by 18 Months of Small-Quantity Lipid-Based Nutrient Supplementation among Young Children in Lusaka, Zambia · 2026 · DOI

• Science, 4(3), on Urbee, A. J., Hasan, M. A., Ridwan, M., & Dewan, M. F. (2025). Adaptation and Resilience in the Face of Climate-Induced Migration: Exploring Coping Strategies in the Urban Economy of Barishal Metropolitan City. Environment, Innovation and Management. https://doi.org/10.1142/S306090112550005X 22 IDRiM (2026) 16 (1) DOI10.5595/001c.158881 ISSN: 2185-8322 Vins, H., Bell, J., Saha, S., & Hess, J. J. (2015). The mental health outcomes of drought: A systematic review and causal process diagram. International Journal of Environmental Research and Public Health, 12(10), 13251–13275. World Health Organization (WHO). (2001). The World Health Report 2001: Mental Health – New Understanding, New Hope. WHO. Zaman, S. B. (2024). Socio-Economic Impacts of Disaster-Induced Displacement on Coastal in Bangladesh. Asian Review of Social Sciences, 13(2), 63-74.

  Does Farmers’ Yard Waterlogging or Displacement From Houses Affect Social Health? Insights From Social Participation and Support Perspectives of Waterlogged Farmers in Bangladesh · 2026 · DOI

• Although public-works programs such as high-intensity manual labor (HIMO) have been implemented to develop infrastructure and sustain livelihoods, the multi-dimensional associations between these programs and household-level health and hygiene outcomes remain poorly quantified.

  Assessing the associations between public works participation, household water and sanitation conditions, and child nutrition in Southern Madagascar: a mediation analysis · 2026 · DOI

• Severe acute malnutrition (SAM) remains one of the most urgent yet persistently underrecognized threats to child survival in low-income countries, affecting approximately 13 million children under five years of age and contributing to 1–2 million preventable deaths each year.

  Community‐Based Therapeutic Care for Severe Acute Malnutrition: Rethinking Clinical Paradigms, Health Systems, and the Moral Imperative of Decentralised Treatment · 2026 · DOI

• The analyses were bivariate and did not control for potential confounding factors between maternal age, education level, occupation, household size, and child characteristics. These findings should be interpreted cautiously because they were not derived from adjusted models and did not account for cluster effects. These results are useful for local planning, although they remain limited by the cross- sectional design, the absence of multivariable analysis, and the lack of adjustment for cluster effects.

  Nutritional Status of Children Aged 6–23 Months in The Komanda Health Zone, Democratic Republic of The Congo · 2026 · DOI

• Nutrition education programs and food assistance initiatives were valued but limited by accessibility, consistency. Confidentiality and anonymity were maintained by using unique codes instead of names on the questionnaires, and all data were securely stored with access limited to the research team.

  Prevalence and factors of acute malnutrition among children under five years in Kaaran District, Mogadishu, Somalia: A cross-sectional study · 2026 · DOI

• This review has limitations. It is narrative rather than meta-analytic, so it does not estimate pooled effect sizes. The review prioritized accessible indexed sources from 2025-2026, meaning that some relevant local reports, theses, or non-indexed studies may have been excluded. Differences in design and measurement also limit direct comparison between studies. Nevertheless, the reviewed sources provide a useful picture of current Indonesian evidence and identify determinant domains that are consistent with both national policy and global conceptual frameworks.

  Determinants of stunting among children under five years of age in Indonesia: A narrative review of indexed evidence published in 2025-2026 · 2026 · DOI

• settings, emphasising alcohol-based hand rub (ABHR) as the preferred agent in most clinical contexts due to its superior skin-integrity profile and microbiological efficacy. for hand hygiene SHEA/IDSA/APIC guidelines this among healthcare workers programme. Despite A longitudinal study at a Chinese geriatric hospital employing the WHO Plan-Do-Check-Act (PDCA) cycle reported a reduction in hospital infection incidence from 2.63% to 0.90% over six years of a multimodal hand hygiene evidence, remains compliance suboptimal globally, and community-level compliance is even lower. A scoping review of 51 international guidelines by Chidziwisano et al. (2023) found that fewer than 10% of recommendations for community hand hygiene were supported by cited evidence, highlighting a persistent evidence-practice gap. Figure 2 presents the The WHO Five Moments for Hand Hygiene framework as applied in healthcare settings. Figure 2: The WHO Five Moments for Hand Hygiene framework as applied in healthcare settings. Caption: A clean medical infographic depicting the WHO 'Five Moments for Hand Hygiene' framework in a hospital ward setting. Show a healthcare worker in scrubs at the centre, with five labelled arrows pointing outward: (1) Before touching a patient, (2) Before a clean/aseptic procedure, (3) After body fluid exposure risk, (4) After touching a patient, (5) After touching patient surroundings.

  THE INFLUENCE OF ENVIRONMENTAL HYGIENE AND SANITATION ON THE CONTROL AND PREVENTION OF INFECTIOUS DISEASES · 2026 · DOI

• to long-term Sustained infrastructure rehabilitation. Federal, State, and Local Government authorities should commit rehabilitation of water distribution infrastructure in Gashua, including pipe replacement, community borehole installation with solar-powered pumping, and small-scale reservoir development. have failed; budgeted and accountable consistently maintenance the minimum requirement. interventions programs One-off are face should Water governance accountability. State water boards transparent performance reporting and civil society oversight to ensure maintenance discharged. Community-based water management committees, and with representation across income groups, should be established and resourced. gender-equitable responsibilities membership are Gender-responsive intervention design. Given women's primary role in water collection and household water management, interventions should locate water points in safe and accessible areas, include women in governance committees, and measure outcomes through gender-disaggregated access and burden indicators. Integrated WASH and health education. Public health education programs should address the full water-disease nexus, indirect relationship between water storage and vector-borne disease, and should be delivered in local languages through community channels. including the Regulation of informal water markets. The water board and local government should develop a basic quality monitoring and certification framework for water vendors operating in Gashua, protecting low- income consumers who have no alternative but to use vendor water. Future research priorities. Subsequent studies should employ gender-stratified sampling; use the HWISE scale to allow cross-community and cross- country comparison; extend analysis to neighboring communities in Bade LGA for regional comparative data; and use longitudinal designs to track changes following any interventions implemented.

  A Sociological Analysis of Coping Strategies on Poor Water Supply among the Residents of Gashua Community in Yobe State, Nigeria · 2026 · DOI

• Several limitations warrant acknowledgment. The sample of 150 for respondents descriptive analysis but does not support generalized inferential conclusions; findings should be read as is adequate community-level and exploratory. The gender composition, 65.3% male and 34.7% female, is a substantive limitation: women are the primary water collectors in most West African households (Sorenson et al., 2011; Graham et al., 2016), and their relative to underrepresentation may underestimation of the gendered burden of water insecurity. With only four key informants, the contextual qualitative saturation.

  A Sociological Analysis of Coping Strategies on Poor Water Supply among the Residents of Gashua Community in Yobe State, Nigeria · 2026 · DOI

• 1) Prioritize functionality, maintenance, and continuity of WASH services, not infrastructure presence alone. Institutionalize routine maintenance, reliable supply chains, and resilient low- cost technologies to prevent reversion to unsafe practices during disruptions. 2) Shift from general awareness to habit formation using practical demonstrations, repeated reinforcement, and context-specific messaging. Engage influential community actors to challenge norms that normalize diarrhea and delay preventive action. 3) Ensure schools and health facilities consistently reinforce hygiene behaviors through adequate sanitation infrastructure, reliable supplies, and clear accountability. Strengthen student- led WASH platforms and IPC supervision to normalize and sustain healthy practices. 4) Formalize collaboration with local governments, health and education sectors, and community structures to clarify roles and ensure long-term maintenance. Leverage existing platforms such as CLTS, VHTs, and school health clubs to support scale-up and ownership. 5) Integrate routine surveillance with household and qualitative data to detect underreported burden and seasonal risks early. Institutionalize community feedback mechanisms to support adaptive programming and accountability.

  Waterborne diseases burden, determinants and health system gaps in Eastern Uganda: a mixed-methods baseline study in the Busoga region · 2026 · DOI

• Based on the results of this research there is need for nutrition education to be emphasized through community healthcare and all other possible opportunities should be utilized more effectively to increase awareness of healthy nutrition amongst market women to improve their feeding habit and practice. This would reduce malnutrition and other related disease such as hypertension, diabetes mellitus etc. Nutrition education should be in all areas that contributes to poor nutrition which may include agriculture, food shortage and marketing, health, hygiene, cultural problem, customs and taboos. Also, the study underscores the need for educational campaigns regarding healthier lifestyles, diversification of diet, weight management and control to be conducted regularly in various markets. Regular Health check-up programme should be conducted for women in the community as well as in the market. Production of food crops with particular focus on livestock, legumes and vegetables should be promoted as well as improved method of food processing, preservation, preparation and consumption.

  IMPACT OF SOCIOECONOMIC STATUS ON NUTRITIONAL STATUS AND NUTRITION KNOWLEDGE OF MARKET WOMEN IN EDE TOWN, OSUN STATE · 2026 · DOI

• Based on the difficulties facing rural primary schools in Limpopo in relation to the poor quality of food supplied to learners, the following recommendations are offered: 639 Volume 03 Issue 05 May 2026 Corresponding Author: MC Rammutla Assessing the Effectiveness and Challenges of Feeding Schemes in Primary Schools in Limpopo Province…

  Assessing the Effectiveness and Challenges of Feeding Schemes in Primary Schools in Limpopo Province, South Africa · 2026 · DOI

• This study has notable strengths, including a large nationally representative sample (n=201,017) from the 2024 SSGI, which provides robust statistical power and generalizability across all 38 provinces in Indonesia. However, several limitations should be considered. The cross-sectional design prevents causal inference, as exposure and outcome were measured simultaneously. Additionally, potential reporting bias may exist because pneumonia diagnoses relied on recall of healthcare workers’ maternal than direct medical diagnoses verification, to potentially underreporting or misclassification of cases.

  Crowded Housing and Urban Residence as Risk Factors for Under-Five Children’s Pneumonia in Indonesia: Analysis of SSGI 2024 Data · 2026 · DOI

• The study benefited from a large sample size drawn from both formal and informal settlements across the entire Nairobi County, allowing for comparisons across diverse urban settings while maintaining precision in the estimates. This is one of the few studies that have focused on the critical growth window, often masked in under-five analyses. Anthropometric measurements were taken following the WHO standardized protocol, minimizing measurement error and enhancing data accuracy. Validated study instruments were used to assess key psychosocial and household factors, including the PHQ-9 and GAD-7 for caregiver mental health and the HFIAS for household food insecurity, strengthening the reliability of study findings. However, the study had several limitations. First, its cross- sectional design limits the ability to infer causal relationships. Some variables, such as ANC attendance, illness history, and pregnancy complications, were self-reported by caregivers, introducing potential recall and social desirability biases. Furthermore, the study did not capture detailed information on dietary intake, severity of childhood illnesses, or environmental contamination, which could result in low predictive power and low outcome variance explained by the predictor variables (Adjusted R2) of the regression models. Indeed, although the study identified statistically significant factors associated with HAZ and WAZ, the adjusted R2 values of 12.7% and 7.9% suggested that substantial variability remained unexplained in HAZ and WAZ, respectively. Future studies should consider additionally including these variables that were not captured in the present study.

  Factors associated with stunting and underweight indices among children 0–3 years in Nairobi, Kenya: a cross-sectional study · 2026 · DOI

• To address the high prevalence of malnutrition among children under five in Iware, Taraba State, it is essential to strengthen nutrition education at the community level. Caregivers, particularly mothers, should be equipped with knowledge about optimal infant and young child feeding practices. This includes promoting exclusive breastfeeding for the first six months and introducing diverse, nutrient-rich complementary foods thereafter. Community health workers and local leaders can play a pivotal role in delivering culturally appropriate nutrition messages through home visits, group sessions, and local media. Improving dietary diversity and household food security is another critical intervention. Many families in Iware rely on monotonous diets lacking essential nutrients. Encouraging home gardening, small-scale poultry farming, and the use of locally available foods can enhance access to protein, vitamins, and minerals. Government and non- governmental organizations should support these efforts by providing seeds, tools, and training. Additionally, integrating nutrition-sensitive agriculture into local development plans can help reduce seasonal food shortages and improve child nutrition outcomes. Access to quality healthcare and sanitation must also be prioritized. Frequent illnesses such as diarrhea and respiratory infections significantly contribute to malnutrition by impairing nutrient absorption. Strengthening primary healthcare services, ensuring routine immunizations, and providing deworming and vitamin A supplementation can reduce disease burden. Moreover, improving water, sanitation, and hygiene (WASH) infrastructure—such as clean water sources and latrines—will help prevent infections and support overall child health. Socioeconomic empowerment of caregivers, especially women, is vital for sustainable improvements in nutrition. Many households in Iware live below the poverty line, limiting their ability to purchase nutritious food or access healthcare. Introducing conditional cash transfer programs, microfinance initiatives, and vocational training can enhance household income and food purchasing power. Empowered caregivers are more 142 African Journal of Biochemistry and Molecular Biology Research Isaac John Umaru, Solomon O. Asare, Tyem Lawal Danjuma, Atsu Ayi, Ingwu Joseph Akem, Usenobong Morgan Akpan, Julius Ishaya Salman, George Okra Hassan, Maryam Usman Ahmed, Hauwa A. Umaru likely to make informed decisions about their children’s health and nutrition, breaking the cycle of poverty and undernutrition. Monitoring and evaluation systems should be established to track progress and guide program adjustments. Community-based growth monitoring programs can help identify at-risk children early and provide timely interventions. Health workers should be trained to collect and analyze data on child growth, feeding practices, and household conditions. Regular feedback loops between communities and health authorities will ensure that interventions remain responsive to local needs and challenges. Finally, a multi-sectoral approach is essential to tackle the root causes of malnutrition. Collaboration between health, agriculture, education, and social protection sectors can create a supportive environment for child nutrition. Policymakers should prioritize nutrition in local and state budgets, and stakeholders must work together to implement integrated strategies. By aligning efforts across sectors and engaging communities, Iware can make meaningful progress toward reducing malnutrition and improving the well-being of its youngest residents. Conflict of Interest: The authors confirm that they have no conflicts of interest concerning the content or publication of this manuscript. Authors’ Declaration: The authors affirm that the research is wholly original, unpublished elsewhere, and they accept full accountability for its accuracy and integrity. REFERENCES Abdullahi, Z. M., Otutu, M. O., & Nwose, E. U. (2024). Protocol for the assessment of child malnutrition status using World Health Organization standard measurements in Niger protocols.io.

  Prevalence of Malnutrition Among Children Under Five in Iware, Taraba State · 2026 · DOI

• Standardization of nutritional indicator measurement and reporting across malnutrition studies in Nigeria is lacking, limiting comparability; future research must establish consistent protocols for measuring stunting, wasting, and underweight in under-5 populations.

  Prevalence of Malnutrition Among Under 5 Years Children in Nigeria: A Review of Urgent Calls for Public Health Interventions · 2026 · DOI

Most-cited papers in Child Nutrition and Water Access

• Why Does Mother's Schooling Raise Child Health in Developing Countries? Evidence from Morocco · The Journal of Human Resources · 1999 · 370 citations
• Review: Meta-analysis of the association between production diversity, diets, and nutrition in smallholder farm households · Food Policy · 2018 · 310 citations
• Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. · American Journal of Public Health · 1993 · 278 citations
• Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021 · The Lancet Infectious Diseases · 2024 · 165 citations
• Agricultural transformation and food and nutrition security in Ghana: Does farm production diversity (still) matter for household dietary diversity? · Food Policy · 2018 · 137 citations
• Poverty and child health in the UK: using evidence for action · Archives of Disease in Childhood · 2016 · 133 citations
• Water and Wastewater Treatment in Africa – Current Practices and Challenges · CLEAN - Soil Air Water · 2013 · 133 citations
• Review: Time Use as an Explanation for the Agri-Nutrition Disconnect: Evidence from Rural Areas in Low and Middle-Income Countries · Food Policy · 2018 · 113 citations
• Women’s empowerment boosts the gains in dietary diversity from agricultural technology adoption in rural Kenya · Food Policy · 2020 · 95 citations
• Affordability of nutritious diets in rural India · Food Policy · 2020 · 89 citations

Most recent work

• Short stature and food habits as determining factors for the low productivity of sugarcane labourers in the State of Alagoas, north-eastern Brazil · Archivos Latinoamericanos de Nutrición · 2026
• Impact pathways of a homestead food production programme on women’s dietary diversity in Bangladesh · Nature Food · 2026
• The physiology of poverty: gut microbiome and pathways to child stunting · Philosophical Transactions of the Royal Society B Biological Sciences · 2026
• A meta-analysis of gut microbiome research in malnourished African populations: a natural language processing approach · Philosophical Transactions B · 2026
• Double burden of malnutrition by mid-childhood in an Indian birth cohort: a longitudinal study (2010–2021) · The Lancet Regional Health - Southeast Asia · 2026
• Improved water access may not reduce women's time burdens: Evidence from Kenya and Honduras · medRxiv · 2026
• Risk Factors for Stunting among Children Aged 24-59 Months: A Case-Control Study in Rural Stunting Hotspots, Yogyakarta, Indonesia · Social medicine · 2026
• Childhood starvation and elderly poverty in rural China: the mediating effect of human capital in adulthood · BMC Public Health · 2026
• Health-related quality of life among parents of malnourished children under five in Herat, Afghanistan: A cross-sectional study · World Journal of Biology Pharmacy and Health Sciences · 2026
• Physicochemical and microbiological quality of improved well water in Nkol-Afamba subdivision (Centre Region, Cameroon) · World Journal of Biology Pharmacy and Health Sciences · 2026

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