埃塞俄比亚营养暴露、饮水、环卫和讲卫生运动干预措施与儿童学业成绩之间的关联：系统综述和荟萃分析

Yimer MihretieAdugna1*†, AbebeAyelign1†and Tadesse AlemuZerfu2† Abstract BackgroundPoor nutrition and inadequate WASH (water, sanitation, and hygiene) practices significantly impactchildren’s health, nutrition, and cognitive development, especially in low-income settings. These factors furtheraggravate the incidence of undernutrition, weaken the immune system, increase susceptibility to illnesses and reducecognitive performance. Evidence on the effectiveness of existing WASH interventions is needed. ObjectiveThis review evaluated the effectiveness of nutritional and WASH interventions on the academicperformance of children in Ethiopia. MethodsA systematic search of Cochrane, DOAJ, Google Scholar, and PubMed (2010–2024) was conducted usingMeSH terms and keywords related to WASH. Two independent reviewers screened studies and extracted data.Eligible studies included cross-sectional and cohort studies on Ethiopian schoolchildren with quantifiable academicoutcomes. The JBI SUMARI was used to assess bias, and the GRADE approach was used to evaluate evidence quality.The meta-analysis used a random-effects model in Stata and reported pooled RRs with 95% CIs. Subgroup andsensitivity analyses examined moderators such as study design, intervention type, and sample size. ResultsA total of 19 studies, 16 cross-sectional (n= 16) and three prospective (n= 3) cohort studies with a totalof 9034 participants, were included. The random effects model revealed a significant improvement in academicperformance among students receiving both nutrition and WASH, with a pooled large positive effect size of 2.05 (95%CI: 1.26, 2.28; I2=). In the subgroup meta-analysis, the effect of the intervention was more positive among those whoskipped breakfast (3.47, 95% CI: 0.47, 6.47), chronic iodine deficiency (4.49, 95% CI: 4.08, 4.90), food insecurity (2.810,95% CI: 1.281, 4.339), and underweight (0.61, 95% CI: 0.46, 0.75). © The Author(s) 2026.Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) andthe source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in thisarticle are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not includedin the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you willneed to obtain permission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by/4.0/. ConclusionDespite moderate variability and some risk of bias, the evidence supports the integration ofcomprehensive nutrition and WASH programs into school health initiatives. Future research should focus on long-term effects and cost-effectiveness. Trial registrationThis systematic review and meta-analysis were registered in the International Prospective Registerof Systematic Reviews (PROSPERO) under the ID CRD42024567265. Key messageWhat is already known? • Malnutrition (including undernutrition), breakfast skipping, iodine deficiency, poor hand washing practices, inadequate sanitation, and related diseases are key factors that impact cognitive development and academicperformance.• Previous studies in low-income countries, including Ethiopia, have confirmed these associations.What are the findings of this study? • Few or no high-quality studies have been conducted to evaluate the effects of nutrition and wash interventions on Ethiopian schoolchildren's academic performance.• While many studies have examined nutrition or WASH separately, none have explored their combined effects—particularly among school-age children in Ethiopia.What are the implications of the new findings? • Our research revealed that WASH and nutrition have a major influence on Ethiopian students' academic achievement.• Skipping breakfast and having a chronic iodine shortage have detrimental effects on learning, impairing focus andcognitive function. KeywordsAcademic performance, Ethiopia, Nutrition interventions, Systematic review, Water, sanitation, andhygiene interventions, WASH academicperformance remains underexplored,espe-cially in Ethiopia. Given the widespread malnutrition andinadequate sanitation in the country, understanding howthese factors affect children’s ability to perform well inschool is crucial.Considering the complex relationships among nutri- Introduction Malnutrition and poor water, sanitation, and hygiene(WASH) conditions are significant public health chal-lenges in many low-income countries, including Ethiopia[1]. These issues profoundly impact the health and devel-opment of particularly vulnerable children. Malnutritionhas been shown to impair physical and cog