Improved toilets are associated with higher hemoglobin concentrations among rural Cambodian women in the first trimester of pregnancy

Abstract Number Theme Presentation Type Cover Approved
0100 Other micronutrient-related interventions (e.g. agriculture, biofortification, education, social protection) Poster Not Approved


Abstract Content


Dietary quality, infection, and genetic factors affect hemoglobin (Hb) concentrations in Cambodian women. Our objective was to determine whether a household’s type of sanitation facility is associated with hemoglobin concentration among pregnant women in Cambodia.


Women (n=547) between 4-12 weeks gestation from 75 villages in Kampong Chhnang province who participated in an efficacy trial involving a prenatal food supplement had their height, weight and hemoglobin measured (HemoCue Hb 201+) at study baseline. Information on socio-demographic and household characteristics was also collected. Cluster-adjusted multivariable linear mixed effect models were used to examine factors associated with hemoglobin concentration (g/L).


Approximately 40% (n=222) of women reported using an ‘improved’ sanitation facility (flush toilet or pit latrine with slab) and ~60% (n=325) used an open field/pit or river/pond as their primary toilet (‘non-improved’). Mean Hb ± SD concentration was 118 ± 12 g/L among women with an improved toilet and 114 ± 14 g/L among those with an inadequate facility (p=0.02). Women with a non-improved facility had a higher prevalence of anemia as compared to women with improved facilities (34% vs. 25%; p=0.03). The proportion of women with moderate anemia was also higher among women with a non-improved facility as compared to women with improved facilities (16% vs. 6%; p=0.001).


Improved household sanitation facilities may reduce the risk of anemia in rural Cambodian women. This warrants multisectoral approaches involving the health, nutrition, water, and sanitation sectors to effectively reduce anemia in Cambodia and beyond.

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