SuSanA - Forum Kunena Site Syndication Sun, 23 Apr 2017 23:30:50 +0000 Kunena 1.6 SuSanA - Forum en-gb Putting a stop to open defecation: A Behavior Change Model - by: yaib
I intend to work on sanitation(open defecation)in Gushegu District of Northern Ghana for my thesis and probably roll the project out to cover the entire District with the aim of putting an end open defecation.

In the mist of inadequate water supply to the District, there has been the practice of open defecation by the people. A report in 2010 on population census revealed that nine(9) in every ten(10) people did not have toilets in the District, based on this the government of Ghana in collaboration with NGOs implemented a program called Community Led Total Sanitation Project(CLTPS) where people were supported to construct household toilets. In its ranking of the 216 Districts in Ghana on Sanitation,health,education and governance, UNICEF ranked Gushegu District the 210th in 2016. Poor sanitation is part of the reasons why the District has scored such a low mark.

The question now is;
How many households has a toilet after(CLTPS)?
Those who have household toilets, are they using it?
why are people still practicing open defecation upon the implementation of total led community sanitation program?
how effective will behavior change model put a stop to open defecation?

What support do I need for this project?
1. Health Education materials
2. funds to support data collection and health education campaigns
3. hand washing equipment to be placed at public toilets
4. Any relevant resources that can help this project.

I therefore put this up for discussions, supports and ideas on how this project could be achieved.

Thank you.

Yakubu Ibrahim
Health Tutor(MOH)Ghana
RN Dip(GN),B.ed(Health Science), Msc Health Education(Candidate)
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Research Thu, 20 Apr 2017 09:10:48 +0000
Re: Important study on sanitation and stunting - by: JKMakowka
I find it a bit confusing that they have a risk category that is called "Maternal nutrition and infection" (but with rather limited scope: height, underweight, malaria and hemoglobin/iron deficiency), and then another rather ambiguous category of "Fetal growth restrictions". The latter being defined as something like being "born small & underweight", but with no causal effect-relation explained.

It seems like they were aware of this logical hole in their categories and later refer to other studies for possible causes (maternal malnutrition of proteins & miro-nutrients), but then their initial categorization is somewhat misleading:

The large burden of stunting attributable to FGR is perhaps unsurprising given that prenatal restricted growth is logically strongly related to postnatal restricted growth; nevertheless, our findings serve to further emphasize the importance of early intervention during pregnancy. Several recent reviews have identified maternal iron, balanced protein-energy, and multiple micronutrient supplementation as the most effective interventions to alleviate FGR [17,47]. However, providing these interventions before pregnancy or in its early months is logistically difficult because in many developing countries, the majority of pregnant women start attending antenatal clinics in their second or third trimester.

In addition I think we really need to be more careful with keeping indicators separate from actual causes or negative effects. This paper makes it sound like stunting (basically defined as "being short for your age") by itself is something negative, but it is just an easy to measure indicator with a strong correlation to a series of childhood development deficiencies.

We run the risk of having the same effect as with hand-washing which is often promoted as a mean to itself, while likely only having a smaller positive effect on hygiene by itself. It is much more of an indirect indicator for generally improved hygiene behavior and awareness.]]>
Research Wed, 09 Nov 2016 01:21:33 +0000
Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis - by: campbelldb Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Medicine, November 2016.

Background - Stunting affects one-third of children under 5 y old in developing countries, and 14% of childhood deaths are attributable to it. A large number of risk factors for stunting have been identified in epidemiological studies. However, the relative contribution of these risk factors to stunting has not been examined across countries. We estimated the number of stunting cases among children aged 24–35 mo (i.e., at the end of the 1,000 days’ period of vulnerability) that are attributable to 18 risk factors in 137 developing countries.

Methods and Findings - We classified risk factors into five clusters: maternal nutrition and infection, teenage motherhood and short birth intervals, fetal growth restriction (FGR) and preterm birth, child nutrition and infection, and environmental factors. We combined published estimates and individual-level data from population-based surveys to derive risk factor prevalence in each country in 2010 and identified the most recent meta-analysis or conducted de novo reviews to derive effect sizes. We estimated the prevalence of stunting and the number of stunting cases that were attributable to each risk factor and cluster of risk factors by country and region.

The leading risk worldwide was FGR, defined as being term and small for gestational age, and 10.8 million cases (95% CI 9.1 million–12.6 million) of stunting (out of 44.1 million) were attributable to it, followed by unimproved sanitation, with 7.2 million (95% CI 6.3 million–8.2 million), and diarrhea with 5.8 million (95% CI 2.4 million–9.2 million). FGR and preterm birth was the leading risk factor cluster in all regions. Environmental risks had the second largest estimated impact on stunting globally and in the South Asia, sub-Saharan Africa, and East Asia and Pacific regions, whereas child nutrition and infection was the second leading cluster of risk factors in other regions.

Although extensive, our analysis is limited to risk factors for which effect sizes and country-level exposure data were available. The global nature of the study required approximations (e.g., using exposures estimated among women of reproductive age as a proxy for maternal exposures, or estimating the impact of risk factors on stunting through a mediator rather than directly on stunting). Finally, as is standard in global risk factor analyses, we used the effect size of risk factors on stunting from meta-analyses of epidemiological studies and assumed that proportional effects were fairly similar across countries.

Conclusions - FGR and unimproved sanitation are the leading risk factors for stunting in developing countries. Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition.]]>
Research Tue, 08 Nov 2016 16:58:41 +0000
Re: Engaging Households in Dialogue to Design WASH and Nutrition Interventions in Sierra Leone - by: Esther
I read SPRING WEBSITE 'TIPS' with interest and congratulate you with the findings. It certainly proved the knowledge to consult user of the WASH project first before implementing it. We have been conducting WASH in 88 villages since 2012 here in Henganofi district of Papua New Guinea.

If I may introduce you to CLTS hub/ website. It is called Community Led Total Sanitation. the sites has training manuals we have been using to effect the behaviour of communities to initiate sanitary facilities and hygiene practises. I hope you find the site and the materials useful in your work.

Wish you well and success in your work.

Cheers from
Research Sat, 22 Oct 2016 06:08:34 +0000
Engaging Households in Dialogue to Design WASH and Nutrition Interventions in Sierra Leone - by: jpietropaoli
In May-June 2016, SPRING used Trials of Improved Practices (TIPs), a qualitative research methodology, to allow household members in the Tonkolili district of Sierra Leone to select improved WASH and nutrition behaviors for trial in their households.

The TIPs approach provides an opportunity to pretest behaviors at the household level before they are widely promoted. By focusing on behavior—what people do—rather than on knowledge—what people know or believe—TIPs provides an in-depth understanding of families' preferences and capabilities, as well as the barriers and enablers they encounter when they try new behaviors.

Read more about this activity on the SPRING website.]]>
Research Fri, 19 Aug 2016 15:40:26 +0000
WASH & Stunting - open access articles from May 2016 Maternal & Child Nutrition - by: campbelldb
Link to the issue - Maternal & Child Nutrition, May 2016

Stop Stunting in South Asia. Improving Child Feeding, Women's Nutrition and Household Sanitation.

Some of the article titles include:

- Stop stunting: improving child feeding, women's nutrition and household sanitation in South Asia
- Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications
- Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries]]>
Research Thu, 19 May 2016 13:15:25 +0000