Tag Archives: WASH nutrition integration

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

Livestream of Bonn WASH Nutrition Forum – November 11 & 12, 2015

The Bonn WASH Nutrition Forum is going to have a livestream on the 11th and 12th November. It will start at 10am CET on the 11th November.

Why should I watch the livestream of the Bonn WASH Nutrition Forum on 11th & 12th November, 10am CET? This innovative forum that will bring WASH experts and their Nutrition Expert counterparts together, but not only in the audience. washnut2015_logo_151020_jr

Overcoming malnutrition is a great challenge that will require true collaboration between the WASH and nutrition sectors. The main aim of the forum is to bring together the relevant experts from both sectors.

We intend to have an effective mix of thematic inputs and discussions during so-called “mirror sessions”. Here, relevant sector professionals in similar positions from both the WASH and Nutrition sector will be asked to present their work / perspective.

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Water, Sanitation, Hygiene, and Nutrition in Bangladesh:

Water, Sanitation, Hygiene, and Nutrition in Bangladesh” Can Building Toilets Affect Children’s Growth? 2015.

Authors: Iffat Mahmud and Nkosinathi Mbuya. World Bank.

This report provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition. bangladesh-wash-1

We also examine the potential impact of improved water, sanitation, and hygiene (WASH) on undernutrition. This is the first report that undertakes a thorough review and discussion of WASH and nutrition in Bangladesh.

The report is meant to serve two purposes. First, it synthesizes the results/evidence evolving on the pathway of WASH and undernutrition for use by practitioners working in the nutrition and water and sanitation sectors to stimulate technical discussions and effective collaboration among stakeholders.

Second, this report serves as an advocacy tool, primarily for policy makers, to assist them in formulating a multisectoral approach to tackling the undernutrition problem.

USAID WASH & Nutrition Webinar

USAID WASH and Nutrition Webinar, May 2015

Overcoming undernutrition is a great challenge that will require both WASH and nutrition interventions. usaid

USAID’s Elizabeth Jordan and Katherine Dennison 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.

WASHplus Weekly: Focus on WASH & Nutrition

Issue 179| Feb 20, 2015 | Focus on WASH & Nutrition

This weekly contains recent webinars, articles, and reports on issues related to WASH and nutrition integration. Included are a policy brief on food hygiene, a handwashing and sanitation study in Tanzania, an overview of the nutrition situation in Asia, a review of the health impact of household water treatment, and other resources.

UPCOMING EVENTS

Global Maternal Newborn Health Conference, Oct. 18–21, 2015, Mexico City. Link
The year 2015 is a critical milestone in international development: the deadline for the Millennium Development Goals (MDGs) and the anticipated adoption of an ambitious new agenda, the Sustainable Development Goals. This USAID– and Government of Mexico–sponsored conference will offer the first opportunity for the global maternal and newborn health communities to discuss and strategize the new goals. The conference will have a technical focus, highlighting strategies and lessons from programs, policies, research, and advocacy for improving both maternal and newborn health.

WEBINARS/BLOG POSTS/TRAINING MATERIALS

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. WASHplus. Link
The overall objective of this resource pack is to facilitate the training of village health teams, community knowledge workers, peer support groups, and other outreach workers on how they can help household and community members overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.

Webinar on Multi-Sectoral Approaches to Improve Child Growth through WASH, Nutrition, and Early Childhood Development, Jan 2015. WASHplus; CORE Group; Clean, Fed & Nurtured. Link
WASHplus collaborated with the CORE Group’s Nutrition and Social and Behavior Change working groups to host a one-hour webinar on multisectoral approaches to improve child growth and development, with a focus on improving the community knowledge of practice and sharing integration efforts for early childhood development, nutrition, and WASH integration. The Clean, Fed & Nurtured community of practice explained why WASH, nutrition, and early childhood development should be integrated.

Progress in Reducing Child Under-Nutrition: Evidence from Maharashtra. Economic & Political Weekly, Jan 2015. S Jose. Link
Assessing the progress made in reducing under-nutrition among children who are less than 2 years old in Maharashtra between 2005–2006 and 2012, this article points out that child under-nutrition, especially stunting, declined significantly in the state during this period. It holds that this decline can be associated with the interventions initiated through the Rajmata Jijau Mother-Child Health and Nutrition Mission, which began in 2005, and that this indicates the critical role the state can play in reducing child under-nutrition in India.

REPORTS

Policy Brief: Complementary Food Hygiene—An Overlooked Opportunity in the WASH, Nutrition and Health Sectors, 2015. SHARE. Link
This policy brief highlights the often overlooked opportunity to improve health outcomes by addressing complementary food hygiene. It outlines SHARE’s contribution to narrowing the evidence gap concerning the relationship between food hygiene and child health, indicates opportunities for future research, and offers insights that could influence policy and improve programming in the WASH, nutrition, and health sectors globally.

WASH and Nutrition Case Studies, 2014. WASHplus. Link
These 12 case studies were collected as part of putting together a joint donor document on Integrating Water, Sanitation, and Hygiene into Nutrition Policies and Programmes, which will soon be published by UNICEF, USAID, and the World Health Organization. In selecting these case studies, priority was given to activities that achieved measurable nutrition-related impact.

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WASHplus Weekly: Focus on WASH & Nutrition

WASHplus Weekly | Issue 171| Dec 12, 2014 | Focus on WASH & Nutrition

This issue provides updates on new resources since the September 2014 WASHplus Weekly on WASH and nutrition with links to a December 15, USAID webinar; the recently published Global Nutrition Report; presentations at the UNICEF Stop Stunting Conference in India; and just-published studies on stunting, environmental enteropathy, and other WASH and nutrition topics.

EVENTS

December 15, 2014, Draft Guidance for USAID-Funded Nutrition-Sensitive ProgrammingLink
During this webinar, Richard Greene, senior deputy assistant administrator with USAID’s Bureau for Food Security, will share a two-page draft guidance document that will assist implementers in applying the new USAID Multi-Sectoral Nutrition Strategy to nutrition-sensitive agriculture programs.

November 19–21, 2014, The Second International Conference on Nutrition
(ICN2)
Link | Vision statement
The Second International Conference on Nutrition (ICN2) was a high-level intergovernmental meeting that focused global attention on addressing malnutrition in all its forms. The two main outcome documents—the Rome Declaration on Nutrition and the Framework for Action—were endorsed by participating governments at the conference, committing world leaders to establishing national policies aimed at eradicating malnutrition and transforming food systems to make nutritious diets available to all.

November 10–12, 2014, UNICEF Stop Stunting Conference, India. Link
The Stop Stunting regional conference provided a knowledge-for-action platform where state-of-the-art evidence, better practices, and innovations were shared to accelerate sectoral and cross-sectoral policies, programs, and research in nutrition and sanitation to reduce the prevalence of child stunting in South Asia.

REFERENCE MANUALS

Global Nutrition Report, 2014. International Food Policy Research Institute. Link | WaterAid review of the Global Nutrition Report
The first-ever Global Nutrition Report provides a comprehensive narrative and analysis on the state of the world’s nutrition. The Global Nutrition Report convenes existing processes, highlights progress in combating malnutrition, and identifies gaps and proposes ways to fill them. Through this, the report helps to guide action, build accountability, and spark increased commitment for further progress toward reducing malnutrition much faster.

Water, Sanitation and Hygiene in Nutrition Efforts: A Resource Guide, 2014. WASH Advocates. Link
This resource guide includes manuals, reports, academic studies, and organizations working on WASH and nutrition. The guide can serve as a tool for implementers and advocates in the WASH/Nutrition nexus looking to pursue and promote integrated programming.

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