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

Some 2.4 billion people globally do not have toilets and 946 million – roughly 1 in 8 of the world’s population – defecate in the open. Meanwhile, an estimated 159 million children under 5 years old are stunted (short for their age) and another 50 million are wasted (low weight for age).

Pakistan has a reached a tipping point - toilet use is fast becoming the new norm!  In 2015 against considerable challenges the country achieved the Millennium Development Goal to halve the proportion of people who in 1990 did not have access to improved sanitation. Using Pakistan Approach to Total Sanitation-PATS, entire communities abandoned the practice of open defecation, leading to improved health and nutrition indicators among their children.

The fact remains that in Pakistan, 25 million people (or 13 percent of the population) practice open defecation and are largely residing in poor rural dwellings and insecure urban informal settlements, making them the most difficult to reach. The country has the fifth highest number of open defecators in the world.

In Pakistan, 110 children under the age of five die every day from diarrheal-related disease, due to poor water and sanitation and 43.7 % children are stunted.

“We cannot afford to let the future of Pakistan, our children, die or those, who survive, live without reaching their full mental and physical potential,” said Angela Kearney, UNICEF Representative in Pakistan, on the eve of the World Toilet Day.

A report issued today, Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene, from UNICEF, USAID and the World Health Organization, for the first time brings together years of research and case studies which demonstrate the link between sanitation and malnutrition. More importantly, it provides guidance for action.

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

“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.”

Some countries have made significant progress in addressing both access to sanitation and the nutritional status of their children. Many have successfully used UNICEF’s Community Led Total Sanitation (CTLS) approach, in which the affected populations themselves devise local solutions to the problem of open defecation