SuSanA - Forum Kunena Site Syndication http://forum.susana.org/ Fri, 24 Oct 2014 12:00:23 +0000 Kunena 1.6 http://forum.susana.org/components/com_kunena/template/default/images/icons/rss.png SuSanA - Forum http://forum.susana.org/ en-gb Re: Sector Wide Approach to Strengthen Health (SWASTH) in Bihar, India: helping communities to help themselves - by: muench http://forum.susana.org/forum/categories/92-nutrition-and-wash/7976-sector-wide-approach-to-strengthen-health-swasth-in-bihar-india-helping-communities-to-help-themselves#10138 http://forum.susana.org/forum/categories/92-nutrition-and-wash/7976-sector-wide-approach-to-strengthen-health-swasth-in-bihar-india-helping-communities-to-help-themselves#10138
And who knows, perhaps someone from this forum will even be part of the winning team for this consultancy work?

We had a related discussion here on the forum called "The elusive effect of water and sanitation on the global burden of disease":
forum.susana.org/forum/categories/26-hea...al-burden-of-disease

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From: Paromita Mukhopadhyay, India
Date: 2014-08-28 20:17 GMT+02:00
To: HIFA2015 - Healthcare Information For All by 2015 < This e-mail address is being protected from spambots. You need JavaScript enabled to view it >


3ie RFQ: Impact evaluation of community-based health programmes in Bihar, India

3ie RFQ for designing impact evaluations for Gram Varta and Nodal Anganwadi Centre initiatives under SWASTH, Bihar, India

3ie requests qualifications from research teams for impact evaluation of Gram Varta and Uddeepan community mobilisation initiatives of the Sector Wide Approaches to Strengthen Health (SWASTH) programme implemented by the Government of Bihar. The key objective of these initiatives is to improve health, nutrition, and water, sanitation and hygiene-related outcomes among the population, particularly the poor and excluded, in the State of Bihar. Teams are invited to submit applications for impact evaluation of one or both of the initiatives.

The impact evaluation of the Gram Varta initiative will address knowledge gaps and findings from the evaluation will (a) improve programme accountability; (b) inform policy and decision making on scaling it up; and (c) contribute to the national and global evidence base.

The impact evaluation of the Uddeepan initiative will assess the impact of the programme on a range of child and maternal health outcomes especially nutritional outcomes. Findings from this study will also have implications for scaling-up this initiative in other states of India.

Please note that

1. Only legally registered organisations and consortia of registered organisations, not individuals, may apply.
2. 3ie will award a maximum of 2 proposal preparation grants under this call.
3. The maximum budget for each proposal preparation grant is US$20,000.
4. A study team can apply for proposal preparation grants for the impact evaluation of one or both of the initiatives.
5. The lead grant-holding organisations making the application must be located in India, with researchers of Indian nationality as the lead principal investigator(s).
6. The application may include other researchers, including those from outside India who are not employees of that organisation.
7. Applicants are encouraged to include a researcher with a demonstrated global reputation as one of the principal investigators (PI).

For more information, visit:
www.3ieimpact.org/en/funding/policy-wind...h-initiatives-bihar/

For all correspondence, please email This e-mail address is being protected from spambots. You need JavaScript enabled to view it with ‘Bihar’ in the subject line. The deadline for submitting applications is 23:59 GMT, 23 September 2014.

HIFA profile: Paromita Mukhopadhyay is Online Communications Officer at the International Initiative for Impact Evaluation, India.
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Nutrition and WASH Fri, 12 Sep 2014 08:37:44 +0000
Re: WASH in Nut research project: comparative study on the effects of Ready to Use Therapeutic Food + P&G Purifier of Water in DRC - by: KeithBell http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9878 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9878 prebiotic, meaning we're not the only ones consuming what's placed in our mouths translating toward good health. We also need to feed our microbes and that's the power of ready-to-use therapeutic food (RUTF). Poor sanitation shifts flora in the wrong direction resulting in malnutrition due to malabsorption syndrome.

This landmark 2013 paper reveals underlying microbial imbalance as cause of kwashiorkor, temporarily relieved with RUTF:
Gut microbiomes of Malawian twin pairs discordant for kwashiorkor
www.ncbi.nlm.nih.gov/pmc/articles/PMC3667500/

Here's a nice article about the study:
Gut Microbes Contribute to Mysterious Malnutrition
phenomena.nationalgeographic.com/2013/01...iorkor-malnutrition/

The problem is, nutrition alone isn't enough, as the paper Carlotta shared suggests. Nutrition temporarily helps by feeding commensal (good) gut flora, thereby creating balance through a process called competitive exclusion. But it's not so simple as we can also feed imbalance. Remission is common in treating gut imbalances.

Thanks, Carlotta, for sharing the paper!]]>
Nutrition and WASH Mon, 25 Aug 2014 18:57:41 +0000
Re: WASH in Nut research project: comparative study on the effects of Ready to Use Therapeutic Food + P&G Purifier of Water in DRC - by: JKMakowka http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9872 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9872
I wonder though if the focus on short term SAM treatment combined with water treatment will really give much results, in fact I was surprised to read that you actually got some significant (but small and not cost efficient) effect.

As far as I can tell, the current research seems to indicate that WASH interventions (not limited to water treatment, but rather general household hygiene) will have a much larger effect on longer term child development (prevention of stunting and non-impaired brain development) which becomes significant after a few years and not 4 months as done in this study.

Never the less very interesting work ACF is doing there.]]>
Nutrition and WASH Mon, 25 Aug 2014 09:00:59 +0000
WASH in Nut research project: comparative study on the effects of Ready to Use Therapeutic Food + P&G Purifier of Water in DRC - by: carlottadenis http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9870 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9870-wash-in-nut-research-project-comparative-study-on-the-effects-of-ready-to-use-therapeutic-food--pag-purifier-of-water-in-drc#9870
I would like to inform you about a study Action Against Hunger (ACF-USA) recently conducted in the Democratic Republic of Congo (DRC), and whose final report was published in September, 2013. It took place in the Health Zone of Popokabaka, located in Bandundu Province, DRC, where there is limited access to safe drinking water, and where hygiene practices and sanitation facilities also remain poor.

This study evaluated the efficacy of P&G Purifier of Water, a point-of-use water treatment product produced and provided by Procter & Gamble. The evaluation was conducted by comparing the efficiency of using Ready-to-use-Food (RUTF) and treating domestic water with P&G Purifier of Water versus RUTF alone in the nutrition treatment of severe acute malnutrition (SAM) children under the age of 5 years without medical complications.

The study was conducted in 7 health centers divided into 2 groups: a control group in the Southern part of the province (3 health centers, 102 children) and an intervention group in the Eastern part of the province (4 health centers, 105 children). Data collection lasted 4 months (from December, 2012 until March, 2013), and a total of 207 children were followed during their treatment and until 4 months after their discharge. The regular nutrition protocol was respected (ambulatory treatment with weekly follow-up at the health center). At the household level, a questionnaire was facilitated every two weeks on dietary consumption, hygiene practices and the use of P&G Purifier of Water.

The study was based on two hypotheses:

1) SAM cases without medical complications consuming RUTF + P&G Purifier of Water have a lower prevalence of waterborne diseases during the course of their treatment.

2) SAM children consuming RUTF + P&G Purifier of Water have better outcomes in terms of treatment time (shorter) and weight gain (higher).

Ultimately, the study determined the importance of promoting P&G Purifier of Water as part of the standard nutrition treatment of SAM children without medical complications, in areas with difficult or no access to clean drinking water.


Results:

The study showed a reduction of the length of treatment of 13% in the intervention group (26.4 days compared to 30.4 days in the control group). However, considering the price of P&G Purifier of Water vs. the price of RUTF, the reduction of 4 days treatment time would be able to cover 90.90% of the supplementary cost, and a reduction of 25% is needed for the intervention to be totally cost-effective.

Children in the intervention group also had a higher daily weight gain; however the difference is not statistically significant.

Water treatment was reported to be almost non-existent in the control group, while P&G Purifier of Water was used by more than 95% of the households in the intervention group, showing a very strong acceptance of the product.

In conclusion, there are significant results towards the reduction of length of stay; however additional studies are needed to improve the result validity (with larger sample sizes, in context with longer average treatment time, including additional alternative intervention options to improve water quality).

You will find attached the report of the study.




Please do not hesitate to share your comments on this study and its results. Do you know about similar studies that may have similar or different results?


Regards,
Carlotta]]>
Nutrition and WASH Mon, 25 Aug 2014 08:03:53 +0000
Re: The ACF WASH in Nutrition team is developing 3 posters which aim at explaining the links between WASH and Nutrition - by: Taber http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9847 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9847 Nutrition and WASH Fri, 22 Aug 2014 06:07:19 +0000 Re: The ACF WASH in Nutrition team is developing 3 posters which aim at explaining the links between WASH and Nutrition - by: KeithBell http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9842 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9842 An evolving perspective about the origins of childhood undernutrition and nutritional interventions that includes the gut microbiome
onlinelibrary.wiley.com/doi/10.1111/nyas.12487/abstract

The world is only beginning to understand the relationship between poor sanitation and malnutrition. This and previous papers by the same authors reveal gut dysbiosis/infection (using genetic tools such as PCR stool testing) as cause of malnutrition, not a simple matter of lack of food as we've wrongly believed for decades.

So, how is this relevant to sustainable sanitation (Rule 8 of the forum)? Open defecation and mixing our waste with drinking water is negatively affecting general health which begins in the intestines. This problem is associated with decline in cognitive health and diabetes, hardly a sustainable choice.

Carlotta, I stumbled on this drawing of leaky gut you may find useful; here it is attached.]]>
Nutrition and WASH Thu, 21 Aug 2014 16:26:54 +0000
Re: WASH and Nut research project: Impact of Household WASH package to nutrition program in Chad. - by: rob# http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9821 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9821
That's excellent and it would be a good opportunity if Karl or someone else from ACF could present this briefly as part of the SuSanA WG12 "WASH-Nutrition" meeting in Stockholm during World Water Week (Thursday, Sept. 4, 11:30, room t.b.a.).

What do you think?

Best

rob]]>
Nutrition and WASH Wed, 20 Aug 2014 13:38:49 +0000
Re: WASH and Nut research project: Impact of Household WASH package to nutrition program in Chad. - by: JKMakowka http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9820 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9820
It might not actually show a lower prevalence of diarrhea though as those on/off heavy events are often caused by other reasons than polluted water, and hygiene is never perfect.

For water treatment you seem to be planning to use chlorine tablets or a combined product like PUR? Have these been pre-tested for acceptability (smell and taste of chlorine) and effectiveness (not too high turbidity)?]]>
Nutrition and WASH Wed, 20 Aug 2014 13:25:33 +0000
WASH and Nut research project: Impact of Household WASH package to nutrition program in Chad. - by: carlottadenis http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9816 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9816-wash-and-nut-research-project-impact-of-household-wash-package-to-nutrition-program-in-chad#9816
I would like to inform you about a research project Action contre la Faim (ACF) will be conducting in the next months, called Benefits of a household WASH package to Community Management of Acute Malnutrition (CMAM) program in Chad.

The ‘WASH in Nut’ strategy for Sahel led to the introduction of a list of specific WASH activities for CMAM beneficiaries aiming at protecting malnourished children against worsening of their nutritional status, and potential relapses caused by WASH related infections. ACF now considers crucial to evaluate the effect of this package in a Sahelian context characterized by high prevalence of severe acute malnutrition, through a research project.

This research project will start in September, 2014 in the Kanem region in Chad, where ACF is already intervening in WASH and Nutrition. It will consist in assessing the benefit of adding a “home WASH package” (water treatment and hygiene kit + hygiene promotion) to nutritional rehabilitation of children under 5 suffering from Severe Acute Malnutrition (SAM) without medical complications receiving OTP (Outpatient Therapeutic Program) treatment.

The study design is a Randomized Controlled Trial with a total of 2500 children in 10 different areas: 50% in the control group (receiving OTP treatment) and 50% in the intervention group (receiving OTP treatment + the household WASH package).

Household Wash package is composed of a household water treatment and hygiene kit (water container, water disinfection consumables, soap, cup, hygiene promotion leaflet), hygiene promotion sessions to the child caregiver at health center level (hygiene kit and water treatment demonstrations, hygiene related care practices messages), and a household visit during the treatment (inclusing a hygiene refresh training).

3 hypotheses will guide the study:

1) Children affected by Severe Acute Malnutrition receiving OTP treatment and benefiting from a “home WASH package” have a lower prevalence of diarrhea during the course of their treatment.

2) They have better outcomes in terms of weight gain during treatment.

3) They are less at risk of relapse after successful treatment.

Please do not hesitate to share your comments on this study or to share other similar studies you might know about.

Regards,
Carlotta]]>
Nutrition and WASH Wed, 20 Aug 2014 09:25:54 +0000
Re: Wash in Nut Posters - by: KeithBell http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9747 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9747 carlottadenis wrote:

I also quite like the two drawings in this article (health villi vs. atrophied villi), however I regret they only show the consequences of having atrophied villi for nutrients absorption and not for intestine permeability (allowing microbs to enter the body)
duncanmarasanitation.blogspot.fr/2009/09...l-enteropathy-3.html


Yes, Carlotta, those are great drawings, very simple. And, I agree, they don't convey microbial translocation or what is commonly known as "leaky gut" which includes toxins and undigested food particles slipping between what would otherwise be tight junctions into general circulation. There are many leaky gut diagrams available.

It may be good to convey how a healthy mix of microbes actually tend the gut lining to preserve tight junctions, i.e., bifidobacteria and lactobacillus. And also how certain nutrients, especially zinc and butyrate (product of flora, especially clostridium clusters IV and XIVa), enhance tight junctions.
www.zincsaveskids.org/]]>
Nutrition and WASH Thu, 14 Aug 2014 22:55:23 +0000
Re: Wash in Nut Posters - by: carlottadenis http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9724 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9724
Thank you very much for your useful comments and suggestions.

Keith, I like the NIH article's illustration. I don't think the endoscopy images will be clear to people who don't have any WASH neither health background.

I also quite like the two drawings in this article (health villi vs. atrophied villi), however I regret they only show the consequences of having atrophied villi for nutrients absorption and not for intestine permeability (allowing microbs to enter the body)
duncanmarasanitation.blogspot.fr/2009/09...l-enteropathy-3.html

Arno, I think the F diagram is complementary to what we are trying to produce, but shows rather different things. It might be useful to include it in a corner of our poster then.

Best,
Carlotta]]>
Nutrition and WASH Wed, 13 Aug 2014 13:35:01 +0000
Re: Wash in Nut Posters - by: KeithBell http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9680 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9680 canaday wrote:

Please check the link to this NIH article, as it did not open.

There is no text associated with the 4 photos you linked to from Nature. What does each one represent?


The link works here, thanks. The 4 Nature photos are Celiac images as example. But now I've found an "Endoscopic appearance of environmental enteropathy" in this paper. The image is from Zambia. Please click on the image for larger view.
Enteropathies in the Developing World: Neglected Effects on Global Health
www.ncbi.nlm.nih.gov/pmc/articles/PMC3335677/

Endoscopic appearance of environmental enteropathy. Endoscopic view of second part of the duodenum showing villi with characteristic changes of environmental enteropathy: fusion of villi so that instead of a finger-like appearance they take on a leaf-shaped appearance. Sometimes villous fusion goes further and takes on a cerebriform (sulcus and gyrus) appearance. Endoscopic image from Endoscopy Unit, University Teaching Hospital, Lusaka (P. Kelly).
]]>
Nutrition and WASH Fri, 08 Aug 2014 15:41:31 +0000
Re: The ACF WASH in Nutrition team is developing 3 posters which aim at explaining the links between WASH and Nutrition - by: arno http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9678 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9678 I think the three diagrams would be difficult to use for communication and learning among stakeholders. The first diagram is an excellent mapping of the ontogeny that lies behind the symptoms. And is very useful for practitioners and experts.

It is difficult to communicate the specific risk surrounding nutrition without also including some of the more better known vectors of disease related to faecal contamination. So it might be worthwhile to start with the well-used F diagram (siteresources.worldbank.org/INTTOPSANHYG...es/The_F_Diagram.jpg) and then add the nutrition impact thread to that. The F diagram can also be made much more living with addition of graphics as can be seen here:
www.infonet-biovision.org/res/res/files/3899.700x600.png

Regards
--Arno]]>
Nutrition and WASH Fri, 08 Aug 2014 12:22:57 +0000
Re: Wash in Nut Posters - by: canaday http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9670 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9270-the-acf-wash-in-nutrition-team-is-developing-3-posters-which-aim-at-explaining-the-links-between-wash-and-nutrition?limit=12&start=12#9670
Please check the link to this NIH article, as it did not open.

There is no text associated with the 4 photos you linked to from Nature. What does each one represent?

I agree that this is a big issue, but it is also cutting-edge science, so this is new to everyone. It is also a very uncomfortable and upsetting concept that many may not like to face up to, especially if they live in densely populated countries.

Best wishes,
Chris]]>
Nutrition and WASH Fri, 08 Aug 2014 09:22:51 +0000
Re: Wash in Nut in Sahel: Capitalization report of the Wash in Nut regional strategy and Strategy revision workshop in Dakar - by: sweta http://forum.susana.org/forum/categories/92-nutrition-and-wash/9590-wash-in-nut-in-sahel-capitalization-report-of-the-wash-in-nut-regional-strategy-and-strategy-revision-workshop-in-dakar#9669 http://forum.susana.org/forum/categories/92-nutrition-and-wash/9590-wash-in-nut-in-sahel-capitalization-report-of-the-wash-in-nut-regional-strategy-and-strategy-revision-workshop-in-dakar#9669
Will look forward to that as we are trying to attempt something similar here in India. Warm regards.]]>
Nutrition and WASH Fri, 08 Aug 2014 05:15:02 +0000