Improved Sanitation Facilities Are Associated with Higher Body Mass Index and Higher Hemoglobin Concentration among Rural Cambodian Women in the First Trimester of Pregnancy

Multiple factors contribute to undernutrition in Cambodian women. Our aim was to determine if type of household sanitation facility was associated with body mass index (BMI) and hemoglobin (Hb) concentration among pregnant women. Women (N = 544) from 75 villages in Kampong Chhnang Province had their height, weight, and Hb measured (HemoCue Hb 201(divided by)) in the first trimester. Sociodemographic and household characteristics were collected. Multivariable linear and logistic regression models were used for analyses. Approximately 40% (N = 221) of women reported primarily using an 'improved' sanitation facility (closed pit latrine) and similar to 60% (N = 323) used 'non-improved' facilities (open defecation). Mean +/- standard deviation (SD) BMI was higher among women with improved versus non-improved facilities (19.9 +/- 3.0 kg/m(2) versus 19.4 +/- 2.3 kg/m(2); P = 0.01). Mean +/- SD Hb concentration was also higher among women with improved versus non-improved facilities (118 +/- 12 g/L versus 114 +/- 14 g/L; P = 0.001). Anemia prevalence (Hb < 110 g/L) was higher among women with non-improved facilities (34% versus 25%; P = 0.04). An improved sanitation facility was a positive predictor of BMI (beta = 0.57 kg/m(2); 95% confidence interval [CI] = 0.10, 1.04) and Hb concentration (beta = 2.94 g/L; 95% CI = 0.53, 5.35), adjusting for age, parity, household size, village, gestation week, source of drinking water, and iron folic acid supplementation. Poor sanitation was associated with lower BMI and Hb concentration among pregnant Cambodian women. This warrants multisectoral approaches involving the health, nutrition, water, and sanitation sectors to effectively improve maternal health in Cambodia.