Water, Sanitation, and Hygiene for Improved Nutritional Outcomes

This edition of the Technical eUpdate is dedicated to a specific area of impact within WASH programming: Nutrition. Although we have touched on this as part of first newsletter looking at the benefits of integrating WASH services in HIV-prevalent contexts, this month is dedicate to providing your organizations with the tools and resources to better understand and improve the nutritional outcomes of the communities you serve. Inadequate and under nutrition affects all the communities your programs reach. It is a key marker of poverty, with the most devastating effects on children. Undernutrition is the underlying cause of 3.5 million child deaths each year (Black, 2008, The Lancet).

Undernutrition covers three primary anthropometric measures: stunting, which is low height for age; wasting, which is low weight for height; and underweight, which is low weight for age. Despite targeted and comprehensive nutrition-specific interventions, the persistent presence of undernutrition globally has caused a renewed focus on underlying causes that go beyond lack of nutrients. Undernutrition is not just lack of food. A vicious cycle exists between diarrhea and undernutrition: children with diarrhea eat less and are less able to absorb the nutrients from their food; malnourished children are more susceptible to diarrhea when exposed to fecal material from their environment. Further, often the most vulnerable children do not have access to the health services that can mean the difference between life and death in the case of acute diarrhea.

New research is underway to document the evidence base for the connection between WASH and under nutrition. Currently, USAID, with WHO and UNICEF, is collecting existing evidence and documenting concrete programming actions that integrate WASH and nutrition to prevent diarrheal disease and undernutrition and improve child health outcomes. Three factors are important as combined interventions to support adequate nutrition:

• Improving access to food
• Improved maternal and child care practices
• Improved access to water, sanitation, and hygiene (WASH) to prevent diarrhea

The following resources a provide more in depth research and programming on how WASH interventions can be targeted to improve nutritional outcomes. They have been selected to provide a combination of research, policy and practice that can support your teams to review your current work improving access to WASH against one of the desired impacts: Improved nutrition and health statuses.

• WASH in Nutrition Efforts: A Resource Guide:

  This exhaustive reference document, published by the WASH advocates is a critical one-stop-shop of materials to support technical improvements in WASH programming for improved Nutritional outcomes. 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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• Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development: Making the Links:

  This study reviews evidence linking WASH, anemia, and child growth, and highlights pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key-mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence- based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. The authors propose the concept of baby WASH as an additional component of early childhood development programs.
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• Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era:

  As the post-MDG era approaches in 2016, reducing child undernutrition is gaining high priority on the international development agenda, both as a maker and marker of development. This is a new working paper from the Institute of Development Studies. It looks at data from 116 low- and middle-income countries from 1970 to 2012. It found that access to safe water (20 percent) and improved sanitation (15 percent) explained 35 percent of the variation in stunting rates across countries and time periods. The paper makes recommendations on programmatic accelerations, which need to be taken up in order to make long-lasting strides in under-nutrition globally.
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• Integrating Water, Sanitation, and Hygiene into Nutrition Programming:

  WASHplus. Diarrhea, pneumonia and birth complications are the top three killers of children under age 5 worldwide. Diarrhea is also a leading cause of undernutrition in this age group and one-third to one-half of all child mortality cases are linked to undernutrition. If mothers and other caregivers used basic hygiene practices and had better access to safe water and adequate sanitation this could greatly reduce under 5 deaths and improve child nutrition. This technical brief highlights the for Improved Nutrition relationship between WASH and Nutrition with recommendations on how to incorporate linkages into programs successfully.
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• Designing and Implementing a Hygiene Awareness-raising and Sanitation Promotion Strategy:

  Over the last few years, the sanitation sector has developed and improved two fundamental and complementary approaches: hygiene awareness-raising to improve people’s hygiene behaviors and sanitation promotion to encourage households to install sanitation facilities, particularly toilets, showers and sinks, in their homes. This document is intended for all sector stakeholders interested in learning more about these approaches. It provides an overview of the most commonly used hygiene awareness-raising and sanitation promotion methods and tools, as well as a rational and methodical approach to implementing these.
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• Global Food Policy Report (Chapter 3) The Power of WASH: Why Sanitation Matters for Nutrition:

  This is the fourth in an annual series that provides a comprehensive overview of major food policy developments and events. In this report, distinguished researchers, policymakers, and practitioners review what happened in food policy in 2014 at the global, regional, and national levels, and—supported by the latest knowledge and research—explain why. Chapter 3 focuses on WASH. The Chapter looks at the links between WASH (mostly sanitation) and nutrition through different types of evidence, research implications and implications for policy.
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• How to Better Link WASH and Nutrition Programs:

  This is a strategy document published by Concern Worldwide. It recognizes the need for improving integration both between the various health sub-sectors and the other sectors in which Concern works. It is hoped that, with better integration, programs will be more cost- effective and sustainable, and will show increased impact (Concern, 2011). This paper aims to provide some practical guidance on how water sanitation and hygiene (WASH) programs can be more be useful for all project staff working in nutrition and WASH programs when WASH and/or a nutrition programs are in operation.
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• Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programs: A Training and Resource Pack for Uganda

  The training was adapted from previous work of the WASHplus project in other countries by team members of the USAID/WASHplus Project. It is the intent that this training helps to strengthen key competencies of a range of stakeholders to support and carryout initiatives integrating WASH into nutrition programs, with the overall goal of improving the growth and well-being of Uganda’s infants and young children; leaving them strong and resilient to grow and thrive into innovative, educated, and productive adults. A packet of job aids accompanies this training to facilitate outreach workers and counselor to integrate WASH into nutrition initiatives.
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