The first proponents of ecosan systems had a strong focus on increasing agricultural productivity (via the reuse of excreta as fertilizers) and thus improving the nutritional status of the people at the same time as providing them with safe sanitation. Disease reduction was meant to be achieved not only by reducing infections transmitted via the fecal-oral route but also by reducing malnutrition in children. This link between WASH, nutrition, a disease called environmental enteropathy (or tropical enteropathy) as well as stunted growth of children has risen to the top of the agenda of the WASH sector since about 2013.