Tag Archives: WASH nutrition integration

Sanitation & nutrition: WaSH Policy Research Digest, August 2016

Sanitation & nutrition: WaSH Policy Research Digest, August 2016. UNC Water Institute.

Detailed Review of a Recent Publication: Improved sanitation results in taller children in Mali. Pickering, A.J. et al., 2015. Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: A cluster-randomised controlled trial. The Lancet Global Health, 3(11), pp.e701–e711. wi_header595x70

Key Policy and Programmatic Takeaways

  • Well-implemented Community Led Total Sanitation can increase latrine use: A sanitation program in Mali led to the construction and use of latrines that were affordable and acceptable to the users.
  • Sanitation improvements decrease stunting: The intervention resulted in reductions in stunting among children, measured by height and weight data.
  • Stunting can be considered a useful measure of health impact: Use of height and weight data demonstrated health impacts not shown by diarrhea data alone.

WaterAid – Caught Short: how a lack of access to clean water and decent toilets plays a major role in child stunting

Caught Short: how a lack of access to clean water and decent toilets plays a major role in child stunting, 2016. WaterAid.

WaterAid’s new report reveals the extent of the global stunting crisis and the impact a lack of clean water and decent toilets is having on the futures of millions of children suffering from malnutrition.


Sisters Manjula, 9, and Gouramma, 13, stand in front of a blackboard at their school in Karnataka State, India, showing how their height compares to the average for their age. Gouramma also suffers from hypothyroidism, which doctors say may in part explain her height.

50% of malnutrition cases are linked to chronic diarrhoea caused by lack of clean water, decent sanitation and good hygiene, including handwashing with soap.

For a child, experiencing five or more cases of diarrhoea before the age of two can lead to stunting. Beyond this age, the effects are largely irreversible.

“Stunting not only makes children shorter for their age, but affects their emotional, social and cognitive development, meaning their lives and life chances are forever changed,” says Barbara Frost, WaterAid’s Chief Executive.

The Caught Short report reveals that:

  • India has the highest number of children suffering from stunting in the world – 48 million, or two in every five.
  • Nigeria and Pakistan rank second and third with 10.3 and 9.8 million children suffering from stunting respectively.
  • Timor-Leste has the highest percentage of children who are stunted, at 58%.


WASH & stunting: an annotated bibliography

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

Continue reading

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.


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”.