Tag Archives: WASH nutrition integration

WASH & Stunting – open access articles from May 2016 Maternal & Child Nutrition

Maternal & Child Nutrition – Stop Stunting in South Asia. Improving Child Feeding, Women’s Nutrition and Household Sanitation. (This supplement was funded and made open access by UNICEF Regional Office for South Asia) mcn_centre

Selected articles include:

 

SuSanA discussion – The conceptual framework of under-nutrition

SuSanA discussion – The conceptual framework of under-nutrition. There are several interesting posts in this discussion forum about under-nutrition.

The first post discusses “What are the main causes of under-nutrition?” conceptualframework.png

The determinants of under-nutrition are complex and nutritional status is dependent on a wide range of diverse and interconnected factors. At the most immediate level, under-nutrition is the outcome of inadequate dietary intake and repeated infectious diseases.

The underlying causes include food insecurity, inappropriate care practices, poor health sector performance and unsafe environment including access to water, sanitation and hygiene. All these factors result in increased vulnerability to shocks and long term stresses.

The basic determinants of under-nutrition are rooted in poverty and involve interactions between social, political, demographic, and societal conditions. (below: Conceptual framework of undernutrition; ACF (2012) “The Essential: Nutrition and Health” adapted from UNICEF 1990))

 

Nutritionists report low-cost way to reduce global infant mortality

Nutritionists report low-cost way to reduce global infant mortality | Source: Medical Express, March 28 2016 |

Eating a biscuit fortified with resistant starch every day could prove a low-cost way to reduce infant mortality rates from malnutrition and common diseases around the world.

The answer could lie in maximising the efficiency of babies’ and children’s digestive systems with this special type of dietary fibre, say Flinders University researchers.

nutritionist

Flinders Master of Nutrition and Dietetics, 1998 graduate Elissa Mortimer, the project manager of the FCIC Global Gastrointestinal Health Unit research in Africa.

The global gastrointestinal health project is investigating how bacteria in the large intestine affect the utilisation of food, and whether improving gut health might help babies and children to flourish on an impoverished diet and survive common diseases.

The chief investigator, leading Australian gastrointestinal expert Professor Graeme Young, says the latest project is focusing on whether young children have the gut bacteria required to produce small chain fatty acids from resistant starch.

“Its conversion in the gut, however, is determined by many factors and is very different from children in Australia because of the environment, type of birth and the microflora of the mother.”

Under a Flinders School of Medicine partnership with the University of Malawi, researchers are testing small stool samples taken from the nappies of very young infants in a remote village near the country’s Mozambique border.

Read the complete article.

Videos from the Bonn WASH Nutrition Forum 2015

Bonn WASH Nutrition Forum 2015

  • Link to the videos – A playlist compiled by the Sustainable Sanitation Alliance (SuSanA)

High-level experts from the sanitation and nutrition sector gathered together in the headquarter of Germany’s international broadcaster Deutsche Welle, Bonn for the WASH and Nutrition Forum on November 11th and 12th to discuss strategies for integrating WASH and nutrition programming in development and humanitarian contexts.

The main aim of the forum was to bring together the relevant experts from both sectors. During so-called “mirror sessions”, relevant sector professionals in similar positions from both the WASH and Nutrition sector presented their work / perspective. Hearing about the other respective sector, allows for reflection of one’s own work (hence “mirror”) and inspires further discussion with other experts and participants on complementarity and collaboration between the sectors and the identification of joint indicators. Recommendations, next steps, approaches, research, policy and advocacy issues were some of the outcomes of those sessions.

Beyond the mirror session renowned speakers inspired outcome-oriented discussion, hereby helping the participants to a) assess the latest scientific evidence, b) define strategies and operational solutions and c) develop strategies to integrate the nexus into development and humanitarian policies.

Supported by the United Nations Secretary General’s Advisory Board on Water and Sanitation (UNSGAB) via its Chair, Dr. Uschi Eid, the conference was a key contribution to the UN World Toilet Day 2015, which bears the motto “Sanitation and Nutrition”.

Lack of water, sanitation and hygiene (WASH) and its effects on nutrition

Published on Feb 5, 2016

Video of Generation Nutrition about the link between WASH and Nutrition.

Are studies underestimating the effects of sanitation on child nutrition?

Are studies underestimating the effects of sanitation on child nutrition? – Authors’ reply. Lancet Global Health, Feb 1, 2016. Authors: Amy J Pickering, Maria Laura Alzua.

Should child growth replace diarrhoea as the primary child health outcome for sanitation trials? We appreciate Derek Headey’s comment in relation to our trial that the window of opportunity to plausibly affect growth faltering is from in utero up to 24 months, and therefore that sanitation trials should focus growth assessments in children with exposure to the intervention who are younger than 24 months.

Ongoing sanitation trials in rural Kenya (NCT01704105), Bangladesh (NCT01590095), and Zimbabwe (NCT01824940) have chosen to enrol target children in utero precisely because of the recognition that child stunting and environmental enteric dysfunction can begin before birth.

However, the effect of enteric pathogen exposure—either through reduced acute diarrhoea or asymptomatic infections—is likely to be one of many causes of linear growth faltering. In some settings, competing risks such as poor nutrition and non-enteric infections (eg, malaria) could overshadow improved sanitation’s contribution to growth.

Child growth is also unable to capture potential health benefits of sanitation interventions for children older than 2 years. For these reasons, it could be premature to rely exclusively on anthropometry measurement before additional sanitation intervention trials successfully show an effect on child growth.

Although we agree with Headey that caregiver-reported diarrhoea can be a biased outcome, we see value in measuring the effect of sanitation interventions on more objective indicators of enteric infections. Notably, recently developed molecular techniques allow for the simultaneous detection of many relevant diarrhoeal pathogens in stool samples, including bacteria, viruses, protozoans, and soil-transmitted helminths.

Antibody measures of infection in saliva, blood, and stools provide additional multiplex opportunities to objectively measure enteric pathogens. Continued advancements in molecular techniques are reducing costs and increasing the feasibility of their use in low-income settings.

Although the high incidence of asymptomatic infections precludes the use of pathogen presence as a direct indicator for clinical diarrhoea, enteric pathogen infection status would be a valuable outcome to understand the ability of sanitation interventions to interrupt transmission of diarrhoeal pathogens.

We propose that enteric pathogen detection be deemed a complementary outcome to child growth for a more comprehensive understanding of the potential benefits of sanitation trials.

Will better sanitaton and nutrition reduce stunting?

Zimbabwe SHINE trial - Cornell University

Photo: Cornell University

A trial is underway in Zimbabwe to measure the independent and combined effects of improved sanitation and hygiene (WASH) and improved infant diet on stunting and anemia among children 0-18 months old [Cornell University CENTIR Group blog].

The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial is led by the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe in collaboration with the Ministry of Health and Child Care/Government of Zimbabwe. Other contracted experts include Sandy Cairncross, Val Curtis and Peter Morgan.

The SHINE Trial is being undertaken in Chirumanzu and Shurugw, two districts with high HIV prevalence. Besides investigating the effects of sanitation and nutrition, SHINE will also test whether Environmental Enteric Dysfunction (EED)is a major cause of a major cause of child undernutrition. EED, also called environmental enteropathy, is a condition believed to be due to frequent intestinal infections.

SHINE is being being funded by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID). There are additional contributions from Wellcome Trust, National Institutes of Health, and the Swiss Development Cooperation.

A special open access supplement of Clinical Infectious Diseases is devoted to SHINE containing the following articles:

  • The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, doi:10.1093/cid/civ844
  • Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe, doi:10.1093/cid/civ845
  • The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe, doi:10.1093/cid/civ846
  • Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial, doi:10.1093/cid/civ847
  • Assessment of Environmental Enteric Dysfunction in the SHINE Trial: Methods and Challenges, doi:10.1093/cid/civ848
  • The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial, doi:10.1093/cid/civ849
  • Assessing the Intestinal Microbiota in the SHINE Trial, doi:10.1093/cid/civ850
  • Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health, doi:10.1093/cid/civ851
  • Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach, doi:10.1093/cid/civ716