Below is a bibliography that we are compiling on WASH and stunting so please email USAID Water CKM if you have other recent studies or reports that should be added.
The NOURISH Evaluation: Can WASH and Nutrition Boost Kids’ Growth? Global Waters, May 2016. Link
To better understand the possible benefits of improved water, sanitation, hygiene and nutrition on reducing childhood stunting, USAID is undertaking an impact evaluation in Cambodia as part of its anti-stunting intervention under the U.S. Government’s Feed the Future initiative, the NOURISH project. The evaluation’s principal investigator shares what is hoped to be learned from the Agency’s first randomized control trial for WASH programs.
Can Water, Sanitation and Hygiene Help Eliminate Stunting? Current Evidence and Policy Implications. Maternal & Child Nutrition, May 2016. Authors: Oliver Cumming and Sandy Cairncross. Link
This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.
Preventing Environmental Enteric Dysfunction through Improved Water, Sanitation and Hygiene: An Opportunity for Stunting Reduction in Developing Countries. Maternal & Child Nutrition, May 2016. Authors: Mduduzi N.N. Mbuya and Jean H. Humphrey. Link
The unhygienic environments in which infants and young children live and grow must contribute to, if not be the overriding cause of environmental enteric dysfunction. We suggest that a package of baby-WASH interventions (sanitation and water improvement, handwashing with soap, ensuring a clean play and infant feeding environment and food hygiene) that interrupt specific pathways through which feco-oral transmission occurs in the first two years of a child’s life may be central to global stunting reduction efforts.
Improving Nutrition Outcomes with Better Water, Sanitation, and Hygiene: Practical Solutions for Policies and Program, 2015. World Health Organization (WHO), UNICEF, and USAID. Link.
This publication summarizes the current evidence on the benefits of WASH for improving nutrition outcomes and describes how WASH interventions can be integrated into nutrition programs. It provides practical suggestions, targeted at nutrition program managers and implementers, on what WASH interventions should be included in nutrition programs and how to include them. It also seeks to help the WASH community to better understand its role, both as providers of technical expertise in WASH interventions and in prioritizing longer-term improvements to WASH infrastructure, in areas where undernutrition is a concern.
WASH and Nutrition Implementation Brief, 2015. USAID. Link
Positive nutritional outcomes are dependent upon WASH interventions and nutrition actions. Poor WASH conditions create an additional burden of undernutrition. Opportunities for co-programming WASH in nutrition programs exist and are discussed in this brief.
USAID WASH and Nutrition Webinar, 2015. Link
Elizabeth Jordan and Katherine Dennison of USAID discuss the connection between undernutrition and lack of access to water, sanitation, and hygiene (WASH) services and highlight opportunities for integrated programming to achieve better health outcomes.
Learning Brief on WASH and Nutrition, 2016. WASHplus. Link
When an integrated program is designed at the outset with related project indicators for both WASH and nutrition equally emphasized, then results can be clearly targeted and measured. Despite the best intentions of sector and program managers, a primary challenge is that in most nutrition programs, WASH is considered after the project’s initial design, so projects improvise by identifying strategic opportunities as they arise and incorporating one or two WASH components into an established nutrition program, often without the accompanying indicators appropriate to those interventions
Multisectoral Approaches to Improving Nutrition: Water, Sanitation, and Hygiene, 2016. C Chase. Link.
This World Bank paper is intended to support task teams and senior management to integrate WASH into nutrition-specific programs (as well as nutrition-sensitive social protection, livelihoods, and community-driven development programs), and to make WASH interventions more nutrition-sensitive, and thus more impactful on nutrition.
The Impact of Poor Sanitation on Nutrition, 2015. SHARE; UNICEF. Link.
This policy brief summarizes the evidence on the impact of poor sanitation on nutritional outcomes and highlights the potential offered by greater integration of WASH within nutrition policy and programs. The systematic review of 14 studies on WASH interventions in 10 low and middle income countries found, for example, suggestive evidence that WASH interventions positively affect height-for-age scores in children under 5 years of age.
Water, Sanitation, Hygiene, and Nutrition in Bangladesh: Can Building Toilets Affect Children’s Growth? 2015. I Mahmud. Link.
Issued early in 2016, this World Bank study provides a systematic review of the evidence on the relationship between water and sanitation and nutrition in Bangladesh. The report is intended to accomplish two things. First is to synthesize the results/evidence evolving on the pathway of WASH and undernutrition for practitioners working in the nutrition and water and sanitation sectors to stimulate technical discussions and effective collaboration among stakeholders. Second, the report can serve as an advocacy tool to assist policy makers in formulating a multisectoral approach to tackling the undernutrition problem.
Preventing Environmental Enteric Dysfunction through Improved Water, Sanitation and Hygiene: An Opportunity for Stunting Reduction in Developing Countries. Matern Child Nutr, Nov. 2015. Authors: Mbuya MN, Humphrey JH. Link
We suggest that a package of baby-WASH interventions (sanitation and water improvement, handwashing with soap, ensuring a clean play and infant feeding environment and food hygiene) that interrupt specific pathways through which feco-oral transmission occurs in the first two years of a child’s life may be central to global stunting reduction efforts.
Healthy Start: Child Nutrition and Water, Sanitation and Hygiene (WASH), 2015. WaterAid. Link
This is an infographic on how undernutrition affects children and actions that can be taken to prevent WASH-related causes of undernutrition
The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial. Clinical Infectious Diseases, December 2015. Link
The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH). This journal issue contains articles on SHINE studies.
The Power of WASH: Why Sanitation Matters for Nutrition, 2015. D Spears. Link
This chapter concludes that water, sanitation, and hygiene can have a profound effect on health and nutrition. A growing base of evidence on the link among sanitation, child height, and well-being has come at an opportune time, when the issue of sanitation and nutrition in developing countries has moved to the top of the post-2015 development agenda.
Effect of a Community-Led Sanitation Intervention on Child Diarrhoea and Child Growth in Rural Mali: A Cluster-Randomized Controlled Trial. Lancet Global Health, Nov. 2015. Authors: Dr Amy J Pickering, Prof Habiba Djebbari, PhD, Carolina Lopez, et al. Link
In villages that received a behavioral sanitation intervention with no monetary subsidies, diarrheal prevalence remained similar to control villages. However, access to toilets substantially increased and child growth improved, particularly in children <2 years. CLTS might have prevented growth faltering through pathways other than reducing diarrhea.
USAID Water Communications and Knowledge Management (CKM) Project
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