Some 50 million Nigerians are among the 946 million people around the world who do not have access to toilets and are obliged to defecate in the open, , UNICEF said today, noting that this makes Nigeria to be among the five countries in the world with the greatest rates of open defecation.

Lack of access to toilets is endangering millions of the world’s poorest children, UNICEF said, pointing to emerging evidence of links between inadequate sanitation and malnutrition.

Lack of sanitation, and particularly open defecation, contributes to the incidence of diarrhoea and to the spread of intestinal parasites, both of which cause malnutrition.

More than 7 million Nigerian children under five years old are stunted – short and underdeveloped for their age as a result of malnutrition – a staggering 37 per cent of the country’s under five population. They are among the estimated 159 million under-fives globally who are stunted.

A global report issued to today to coincide with World Toilet Day, for the first time brings together years of research and case studies that demonstrate the link between sanitation and malnutrition. The report, Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene, from UNICEF, USAID and the World Health Organization, also provides guidance for action.

“We need to bring concrete and innovative solutions to the problem of where people go to the toilet, otherwise we are failing millions of our poorest and most vulnerable children,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes. “The proven link with malnutrition is one more thread that reinforces how interconnected our responses to sanitation have to be if we are to succeed.”

Worldwide, diarrhoea accounts for 9 per cent of the deaths of children under 5 years old each year. It is essentially a faecal-oral disease, where germs are ingested due to contact with infected faeces. Every year, Nigeria loses over 150,000 children to diarrhoea. After pneumonia, it is the biggest killer of Nigeria’s under-fives; 88 per cent of diarrhoea cases in Nigeria are attributed to unsafe water and sanitation. Where rates of toilet use are low, rates of diarrhoea tend to be high.

The highest frequency of diarrhoea is in children under 2 years old, who are weakest and most vulnerable. Multiple episodes of diarrhoea permanently alter the gut and prevent the absorption of essential nutrients, putting children at risk of stunting and even death.

Intestinal parasites such as roundworm, whipworm and hookworm are transmitted through contaminated soil in areas where open defecation is practiced. Hookworm is a major cause of anaemia in pregnant women, leading to malnourished, underweight babies.

Nigeria has made major progress in addressing both access to sanitation and the nutritional status of its children. “In 2008, we had only 15 rural communities that were free of open defecation. Today, thanks to concerted efforts by the Government and partners, including UKAID, the EU and UNICEF, there are more than 12,000,” noted Jean Gough, UNICEF Representative in Nigeria. “That is wonderful progress, but there is still a very long way to go. We continue to work with communities to encourage rural Nigerians to build and use toilets, which can be simple and made from local materials. For a small investment of just 200 Naira per person per year, we could eliminate open defecation in Nigeria by 2025.”

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