Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As

Despite many initiatives to assure food access, and growing economies, high levels of undernutrition persist in much of Asia.  In this Working Paper Robert Chambers and Gregor von Medeazza explore the increasing evidence that this is due to the continuing high incidence open defecation (OD), combined with population density, which has mulitiple debilitating outcomes.  With the focus on diarrhoea-related ill health, there has been a relative neglect of other often subclinical and continuously debilitating faecally-transmitted infections (FTIs) including environmental enteropathy (EE), other intestinal infections, and parasites. The authors show how institutional, psychological and professional factors interact to perpetuate a blind spot to understanding that OD affects health in many different ways and is a key factor in tackling undernutrition.