SuSanA - Forum Kunena Site Syndication Thu, 11 Feb 2016 23:21:45 +0000 Kunena 1.6 SuSanA - Forum en-gb Re: ID4D - Ideas for Development, 17-11-2015 in Paris (France) - by: muench It's nice to see that AFD (French Development Agency (Agence Française de Développement) - see e.g. has also picked up on this topic of WASH and nutrition integration.

It would be good to know what impact this conference has had behind the scenes at AFD and other French organizations working in the WASH or nutrition sectors?

The conference summary in English, but from a French perspective, is quite interesting:

This part of the summary was interesting for me:

What are the reasons for this segmentation? The two sectors do not involve the same type of economic circuit: access to water and the sanitation activity involve “market-based relations between service providers and the beneficiary users”, whereas nutrition falls within a different sphere that does not require so much heavy infrastructure. The two sectors also work with different actors: sanitation involves working “with municipalities and the technical services of local governments [….] and nutrition “more with healthcare institutions than with municipalities” (Frédéric Naulet).

Furthermore, there is not total consensus on the degree to which water, sanitation and nutrition issues should be integrated. AFD advocates for a case-by-case approach, depending on the projects: “Otherwise there is a risk of blurring the lines, which partly prevents a scaling-up” (Cassilde Brenière). For GRET, integrated programs are relevant: “which is especially the case in territories that suffer from a combination of handicaps (extreme poverty, high nutritional prevalence, isolation”. However, in these areas where institutions are often weak, “it is extremely difficult to guarantee the permanence of sanitation services and sustainability of hygiene and nutrition awareness-raising programs”. GRET therefore advocates for “cross-fertilization”, which involves “identifying in each sector […] the common issues and innovations that can benefit one another” (Frédéric Naulet).

And I applaud the organisers for having filmed the event and for making the footage available (in a perfect world, there would be English subtitles to the French videos )

Nutrition and WASH Wed, 10 Feb 2016 07:15:31 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: CaitlinMcC
1. The project information mentions the need for 'cross-sectoral' policies to facilitate WATSAN. Has the work included any discussions with policy makers in agriculture and sanitation? How receptive are they to the idea of collaboration on inter-sectoral policies?

2. Are WATSAN approaches compatible with other approaches to recover sanitation organic waste and nutrients as agricultural fertiliser? This is another link between agriculture and sanitation, but perhaps with different requirements and objectives. I wonder if the two can be pursused at the same time.

Many thanks.]]>
Nutrition and WASH Thu, 04 Feb 2016 09:13:22 +0000
Re: WATSAN-AGRICULTURE: Improving on the Nexus among Water Quality and Quantity, Sanitation, Hygiene, and Agriculture - by: SDickin

-Elizabeth Korasare: Why is there a big gap for hand washing have you ascertain why people don't wash hands? and what did Bang. do to check open defecation?

-Penninah:Please explain a bit more how your Food Hygiene Education/promotion is structured. Who does the education sessions, apart from posters, how else do they do it?

-Penninah: I like that idea of showing people the results of the tests

-Henrietta: Can you give us some indication what the state of the communities is with regard to sanitation coverage when you bring the Food Hygiene Education to the community? are most communities ODF, do most HH have handwashing facilities already?

-darja.kragic: What is your experince/which approach would you take, when working with communities in (low income) urban areas?

-toyaz3112.naik: Apart from educating people what else we can do ?

You can watch Monirul Hasan's presentation and discussion in the webinar videos attached below:

and Monirul's powerpoint presentation is available here:]]>
Nutrition and WASH Mon, 01 Feb 2016 08:49:01 +0000
Re: Key documents for the sub-category on nutrition and WASH - by: F H Mughal
The paper: Beyond Malnutrition - The Role of Sanitation in Stunted Growth, is from volume 122 | number 11 | November 2014 • Environmental Health Perspectives.

Perhaps, other articles in this EHP issue must also be dealing with Sanitation and children.
Will it be possible for you to have the whole issue of EHP on this forum’s library?

F H Mughal]]>
Nutrition and WASH Wed, 27 Jan 2016 16:46:41 +0000
Re: Key documents for the sub-category on nutrition and WASH - by: AlexandraChitty
Thank you so much for the opportunity to input on this sticky note. We at SHARE think this is an excellent list and are really happy to see our policy brief (Velleman et al) made the cut!

Another very salient reading that would fit well on the list is Humphrey 2009, Child undernutrition, tropical enteropathy, toilets, and handwashing: * - thanks goes to Oliver Cumming, Lecturer at LSHTM, for the recommendation.

Best wishes,

* Available in the SuSanA library here: (comment added by moderator)]]>
Nutrition and WASH Tue, 26 Jan 2016 09:58:01 +0000
Video, factsheet & blog on WASH and nutrition (by Generation Nutrition) - by: Jona
I would like to draw your attention to some intersting material that Generation Nutrition has come up with on WASH and nutriton:

The short video clip was originally produced in French for the World Toilet Day 2015. It is now available in English as well thanks to the support from WASHplus.

Sanitation and nutrition: Let's break the vicious circle!

The Factsheet on WASH and nutrition can now be read in English, French and Spanish.

You can also have a look at the Generation Nutrition Blog here.

Enjoy watching and reading!

Nutrition and WASH Fri, 22 Jan 2016 10:02:17 +0000
Re: tropical enteropathy - key cause of child undernutrition? - by: F H Mughal ----------Zimbabwe’s Perspective

A post in IPS News Agency on “Zimbabwe: Poverty Stunting Minds and Growth,” ( gives somewhat different perspective on stunting of children in Zimbabwe. As in indicated in the post by Ignatius Banda, stunting in Zimbabwe is attributed to poverty.

While it is true that stunting among children can also be due to poverty, as according to the UNICEF:

“Child poverty has reduced (their) mental health and is reponsible for poverty when they are adults,” said Dr. Jane Muita, UNICEF’s deputy resident representative in Zimbabwe.

“It (child poverty) results in lower skills and productivity, lower levels of health and educational achievement,” Dr. Muita said.

Aspect of lack of toilets, as was the reflection in India’s case, is not mentioned in the post. This tends to suggest that either sanitation is good in Zimbabwe (improved sanitation, so to say), or the comments in the post confined purposely to poverty.

Poverty and lack of toilets are, beyond doubt, major reasons for stunting among children.
Could any user kindly give some information on sanitation in Zimbabwe?

F H Mughal]]>
Nutrition and WASH Mon, 18 Jan 2016 16:41:46 +0000
Stunting in Indian and Pakistani children (Sanjay attributes stunting mainly due to poor sanitation) - by: F H Mughal Stunting in Indian Children

An informative post of Sanjay Wijesekera, Chief of Water, Sanitation and Hygiene, and Associate Director of Programmes at UNICEF, appeared in The Huffington Post on 14 Jan 2016 (

Sanjay attributes stunting mainly due to poor sanitation – a lack of toilets, as he calls it.

“Open defecation has been a problem for a very long time in India. So common was the practice that almost 100 years ago Mahatma Gandhi urged his compatriots to stop it. It remains widespread to this day, practiced by 44% of the population in 2015. This runs to 569 million people, the highest number of people practicing open defecation of any country in the world. In part it is due to a lack of facilities, but not entirely. Significant numbers of Indians with toilets at home still defecate in the open."

Some of the points in the post are:

• There is open defecation in sub-Saharan Africa. Of the 700 million people in the region who do not have proper toilets around 230 million defecate in the open. What is different in India is the pervasiveness and the concentration of the practice.

• In India, a child is surrounded by feces. It is where babies crawl; where children play; where they eat; in the water they drink and bathe. It gets into their mouths; they ingest it from their own unwashed hands as well as those of their care-givers. And when it gets inside it does some very dirty work.

• Feces carry bacteria that in young children especially can lead to multiple episodes of diarrhea every year. Not only do these episodes prevent the retention of nutrients from food, we now know that they permanently alter the absorptive capacity of a child's guts, by lessening the number of the villi on intestinal walls which are meant to trap nutrients.

• Feces can also carry intestinal parasites - like hookworm, which causes anemia in pregnant women, leading to malnourished, underweight babies. These parasites rob infected children of even more nutrients.

• Stunting means children are not growing as they should, they are short and small for their age, and they can have permanent cognitive damage. That has implications on a country's economy. Stunted children grow up to be weaker and more susceptible to illness, bringing an extra burden to the public purse. They do less well in school, so they earn less as adults. The ramifications are far reaching.

• In India 4 out of 10 children under 5 years old are stunted. And around the world, 159 million children are stunted.

F H Mughal]]>
Nutrition and WASH Mon, 18 Jan 2016 06:26:07 +0000
Re: ID4D - Ideas for Development, 17-11-2015 in Paris (France) - by: Jona
- Read the conference synthesis in French ...
- ... and in English
- Have a look at the video documentation (French)

The debate was coordinated Emmanuelle Bastide, journalist at RFI. The speakers were Joséphine Ouédraogo, Ministry of Agriculture, water Resources, Sanitation and Food Security, Burkina Faso (in visioconference); Cassilde Brenière, Head of AFD’s Water and Sanitation Division at AF; Jean Lapègue, Technical Advisor for Water, Sanitation and Hygiene at the Scientific and Technical Department of Action Against Hunger (ACF) France; Frédéric Naulet Head of Drinking Water and Sanitation Programs at GRET.]]>
Nutrition and WASH Wed, 13 Jan 2016 15:21:28 +0000
Re: The rippling effect of WASH NUT integration - by: natysecond Yes! it is a bit complicated as I used some technical jargon that hard for readers. The main concept of the monogram is to explicitly highlight how a systematic integration of various activities will be conducted from the view of reducing hunger and malnutrition in a situation where comprehensive funding is not available. Or, in a situation where potential and specific donors are not yet convinced on the positives outcomes of integrating programs and projects to fight child and maternal malnutrition.

This monogram has been developed to channel program inputs towards the most vulnerable households, particularly susceptible to indices of malnutrition. As a strategy it is advisable to see and select an appropriate geographical area where the prevalence of child malnutrition and poverty are pervasive. In this realm, the use of nutrition causal analysis or contextual analysis is crucial. This allows us to concentrate inputs o resources in a given areas to maximize or optimize results.Hence,it is the first precondition of various programs to integrate geographically.

The next step is aligning activities to effectively address malnutrition in the area. for example, when a donor is interested in response to WASH activities and the other door is interested in food security (FS),then departments has to sit together and integrate activities to address the pressing problem of target households. In this regard,targeted integrated activities will focus on specific households (HH's) who are the most at risk for malnutrition.

The best of all is when programs concentrate to specific targeted households in a given area. I meant,households who fulfill the targeting criteria of FS, WASH and Nutrition/health/IYCF are the best one to alleviate the problem in a given situation. hence,food security will use either wealth ranking or food and income diversity score methods to target appropriate households, health and nutrition or IYCF program may use SMART survey following with screening to identify to HH's with malnutrition, whereas; WASH may use KAP and feasibility studies to identify risks and possibilities associated in a given area. Therefore; those poor and vulnerable households identified by FS and if they are also located in the nutrition and health screening data and located in unhealthy environment should get utmost attention by all departments.

This monogram summarized how we can cascade our interventions from the vast geographical area to specific households due considering some crosscutting issues relevant for the reduction of child malnutrition.

I guess these explanation may gives you some clues about the slide.

Nutrition and WASH Tue, 15 Dec 2015 13:09:02 +0000
Key documents for the sub-category on nutrition and WASH - by: muench For more information about why I am creating this new thread, please see here:


This thread is a "sticky thread" which means it will always remain at the top of this sub-category.
It contains a recommendation and orientation for newcomers regarding the most important five documents in the thematic area of "Nutrition and WASH".

The selection of documents is so far based on what I've seen coming up in people's posts and e-mails. I am open to feedback if others think that other documents or links should be selected here. Nowadays, WASH and nutrition publications seem to often have focus on stunted growth, so you'll see some documents and links dealing with that issue in particular.

Recommended top five documents in the thematic area of "Nutrition and WASH", in reverse chronological order:

Generation Nutrition (2015) The Role of Water, Sanitation & Hygiene in the fight against child undernutrition, Prevention Factsheet 01, produced by the Generation Nutrition global campaign team, WaterAid and End Water Poverty on behalf of Generation Nutrition.

This factsheet is the first in a series by generation nutrition looking at the different ways of preventing child undernutrition, and focuses on water, sanitation and hygiene (WASH). It explains how WASH and nutritional outcomes for children are intimately linked and how improved WASH reduces undernutrition, thereby helping to break the cycle of poverty and transform people’s lives.

WHO, UNICEF & USAID (2015). Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene - Practical Solutions for Policies and Programmes. World Health Organization (WHO). Geneva, Switzerland

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 programmes. It provides practical suggestions, targeted at nutrition programme managers and implementers, on both “what” WASH interventions should be included in nutrition programmes and “how” to include them. It also seeks to help the WASH community to better understand their 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.

Velleman, Y., Pugh, I. (2015). Under-nutrition and water, sanitation and hygiene - Water, sanitation and hygiene (WASH) play a fundamental role in improving nutritional outcomes. A successful global effort to tackle under-nutrition must include WASH. WaterAid and SHARE (Sanitation and Applied Research for Equity consortium), UK

This short briefing note is explaining the links between undernutrition and WASH. The relationship between nutrition and WASH is complex, with multiple and overlapping pathways. Unsafe water, poor sanitation and hygiene are directly linked to undernutrition in children through three key pathways: diarrhoea, intestinal worms (soil-transmitted helminths) and environmental enteric dysfunction (EED). Action and collaboration between the WASH and nutrition sectors are urgently needed at global, national and programmatic levels.

Concern Worldwide (2014). How to better link WASH and nutrition programmes, Concern Worldwide

The paper gives guidance and some practical suggestions on making WASH programmes more nutrition-sensitive and on how nutrition programmes can better incorporate WASH aspects. Made suggestions are divided into six categories: During the assessment phase; During counselling and health promotion activities; When strengthening overall community services; At institutional level (government, NGO); Under emergency response programmes; Through joint research projects

Chambers, R., von Medeazza, G. (2014). Reframing undernutrition: faecally-transmitted Infections and the 5 As. IDS Working Paper 450, Institue of Development Studies (IDS), Brighton, UK, ISBN: 978-1-78118-205-5

To reframe undernutrition for a better balance of understanding and interventions, we propose two inclusive concepts: the FTIs and the 5 As. The first two As – availability and access – are oral, about food intake, while the last three As – absorption, antibodies and allopathogens – are novel categories, anal and internal, about FTIs and what happens inside the body. These concepts have implications for research, professional teaching and training, and policy and practice.

You can find further important documents and website links dealing with this topic here:

Please provide your feedback. What do you think of this selection? We can update it from time to time.



P.S. Documents which I had earlier on considered to be in the Top-5 but have decided not to include in the most important 5 documents for newcomers (I will delete or edit this P.S. once I've received feedback from others):

(A) - not included as it's only a draft
Lapegue, J., Lozano , R., Lellouche, K., Onsurbe, J.I, Coerver,A. , Simon, S., Gensch, R., Schmidt, A. (2015). WASH in Nutrition - Factsheet of Working Group 12 (draft). SuSanA

This document is a compilation of main facts, existing evidence and remaining research gaps regarding the link between inadequate sanitary conditions and its underestimated impact on undernutrition and stunting, particularly for children under five years of age. This is a draft version.

(B )

Schmidt, C. W. (2014). Beyond Malnutrition - The Role of Sanitation in Stunted Growth. Environmental Health Perspectives Vol. 122 Number 11 November 2014 doi:10.1289/ehp.122-A298

Researchers are exploring the possibility that poor hygiene and a lack of sanitation induce a gut disorder called environmental enteropathy (EE) that diverts energy from growth toward an ongoing fight against subclinical infection. Nutritionists are now collaborating with experts in a field known as water, sanitation, and hygiene (WASH), and their combined efforts are helping to galvanize regional programs to improve hygiene in countries afflicted with high stunting rates.

(C) - I am very undecided about this one, perhaps it's more important than one of the 5 that I picked above?
Denis, C., Lapegue, J., Lellouche, K., Lozano, R., Rodriguez, E. (2014). WASH and Undernutrition - Briefing paper. ACF (Action contre La Faim), Paris, France

The first section of this document explains the links between WASH interventions and undernutrition as well as the important role the WASH sector has to play within a strategy to combat undernutrition. The second section highlights the low priority and poor funding that the WASH sector obtains within national and international nutrition programmes.
Nutrition and WASH Mon, 14 Dec 2015 02:23:02 +0000
Re: The rippling effect of WASH NUT integration - by: muench
I took a look at your slide but I find it a bit too complex. It's very hard to understand. To start with, I don't even know what all the abbreviations mean. Have you thought about options for making it clearer/simpler?

Also which session did you have in mind? I suppose it was part of the Bonn WASH and Nutrition conference ( or the Working Group 12 meeting (

Did you get any feedback on your question?

Nutrition and WASH Wed, 02 Dec 2015 02:44:40 +0000
Re: CALL FOR CONTRIBUTIONS - ACF/ UNICEF/ ECHO WASH in Nutrition Operational Manual - by: JovanaD
Many thanks for sending your contributions and examples of good practice around the world, you are just great! This is to inform you that we will be collecting your input until 15th of December 2015 so in case you still have something to share on WASH & Nutrition integration, please do so!

Also, I would like to ask you to share with us your experiences regarding challenges and obstacles you faced during the planning/ implementation/ monitoring and evaluation of an integrated WASH & Nutrition project. We believe this is extremely useful to have in an operational manual, so please share!

I am curious to hear from you not only what went well, but also what kind of challenges you faced and how did you overcome them!Please write to Jovana Dodos This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Many thanks once again and I look forward to hearing from you soon.]]>
Nutrition and WASH Sun, 29 Nov 2015 10:47:22 +0000
A short follow-up on the WTD in New York from an ACF-perspective (better sanitation for better nutrition) - by: Jona WTD in New York from an ACF-perspective:

Jean Lapegue, Senior WASH Advisor from ACF (SuSanA member), was invited at the World Toilet Day UN conference in New York panel, in order to present the WASH in Nutrition strategy from a field practitioner perspective and propose key recommendations to improve WASH in Nutrition in programmes. Those operational recommendations were done in parallel of research recommendations done by Robert Chambers (IDS). The Bonn meeting outcomes, especially the coordination of the WASH and Nutrition clusters, was presented by the moderator and UNSGAB chair, Uschi Eid . The 10 main recommendations proposed are:
  • Promote the integration of WASH interventions into national policies, strategies and action plans aiming at undernutrition reduction
  • Develop and reinforce multisectoral approaches as a preventive approach of undernutrition (nutrition security)
  • Promote multisectoral and multilateral undernutrition prevention funding mechanisms
  • Increase the share of WASH into Nutrition oriented investments, increase WASH and Nutrition ODA
  • Adopt a human right approach, especially based on 2010 Water and Sanitation Human Right declaration
  • Improve dialogue and coordination between Nutrition and WASH sectors, both in development and emergency contexts (reference to Bonn WASH Nutrition Forum 11th November 2015)
  • Promote programmatic integration of activities (such as WASH programmes in high undernutrition prevalence areas)
  • Ensure a "minimum WASH package" is available for Households, Health Centers and Communities of high undernutrition prevalence areas
  • Work specifically with the mother-child dyad, and promote environmental hygiene and behaviour change to ensure long lasting impact
  • Fund research, especially on the impact of WASH projects on SAM treatment, on the Sub-Saharan Africa region, and on the impact of environmental sanitation on Environmental Enteric Dysfunction

It has been said that ACF is supporting several advocacy projects connected to the subject, such as the SUN movement and Generation Nutrition. ACF is also a member of the SuSanA network, which gathers more than 1100 members and 59 countries on the WASH in Nutrition subject, and of various coordination groups supporting the WASH in Nutrition initiative, such as the French Water Coalition.]]>
Nutrition and WASH Mon, 23 Nov 2015 12:01:41 +0000
Re: WHO/USAID/UNICEF - document, called Improving Nutrition Outcomes With Better Water, Sanitation and Hygiene: Practical Solutions for Policies and Progr - by: F H Mughal
More than 90 percent of deaths from diarrheal illnesses in young children are attributed to unsafe or inadequate water, sanitation, and hygiene practices. Using simple hygiene practices and having access to safe water and adequate sanitation this could greatly reduce under 5 deaths and improve child nutrition (UNICEF).

The publication reviews water treatment methods, household water treatment, hygiene principles and sanitation principles. The publication is available at:

F H Mughal]]>
Nutrition and WASH Sun, 22 Nov 2015 06:28:19 +0000