SuSanA - Forum Kunena Site Syndication Wed, 28 Jan 2015 01:22:50 +0000 Kunena 1.6 SuSanA - Forum en-gb Webinar on Multi-Sectoral Approaches to Improve Child Growth, through WASH, Nutrition, and Early Childhood Development - by: campbelldb
Link to webinar

Presenters discuss the evidence for integrating these three sectors and the evolution of the CF&N Community of Practice.
- Renu Bery, WASHplus, FHI 360
- Katherine Merseth, Save the Children
- Ann Jimerson, Alive & Thrive, FHI 360
- Rica Rosario, Alive & Thrive, FHI 360]]>
Nutrition and WASH Fri, 09 Jan 2015 15:40:37 +0000
Re: Gut dysbiosis/malabsorption syndrome is rampant due to poor sanitation - by: KeithBell infant and maternal mortality and poor sanitation:
A matter of birth and death: unsafe conditions still killing new mothers and newborns

The companion paper about Tanzania is interesting as I've recently learned about the Hazda people of Tanzania practicing open defecation while suffering high infant mortality rates. This is somewhat counterintuitive since the Hazda are famously studied for their diverse intestinal microbiomes and ancestral diet associated with good health (lack of chronic illness seen in developed nations). There are currently no efforts I'm aware of to improve sanitation. Instead, the Hazda are beginning to submit to vaccination, a grand experiment which may lead to injuries.

And here we have another new paper about maternal and reproductive health:
Getting the basics right – the role of water, sanitation and hygiene in maternal and reproductive health; a conceptual framework
It's good to see focus on this issue from a microbial standpoint as the womb has previously and wrongly been considered a sterile environment, a fallacy promoted in peer-reviewed papers without evidence for decades.

Lastly for now, this recent NYT article (also posted in a thread here about antibiotic resistance) where it's surmised infant mortality associated with poor sanitation is a matter of microbial prediposition where microbes are transmitted from mother to child in the birthing process, though placental transmission should be the concern.
‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat]]>
Nutrition and WASH Mon, 22 Dec 2014 14:39:26 +0000
Gut dysbiosis/malabsorption syndrome is rampant due to poor sanitation - by: KeithBell Note by moderator: This post was originally in this thread but has been moved to here to keep the other thread more focussed.

Susannah, the "hygiene hypothesis" doesn't hold much weight in view of high rates of infant and maternal mortality now associated with poor sanitation. Gut dysbiosis/malabsorption syndrome is rampant due to poor sanitation, finally being acknowledged in mainstream media.

But I still like your point and believe we should also focus on how a toxic, polluted environment shifts flora in the wrong direction and out of balance.

Here's a 2014 study about organic pollutants in septic waste (not about pathogens):
Pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds in public drinking water wells in a shallow sand and gravel aquifer.
Septic systems appear to be the primary source of OWCs in Cape Cod groundwater, although wastewater treatment plants and other sources were potential contributors to several wells.
Nutrition and WASH Sun, 21 Dec 2014 17:19:41 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: franckconcern Wherever relevant, promoting locally-made rugs to be used as playground should definitely be considered as an option for our WASH/Nut teams.
Nutrition and WASH Wed, 26 Nov 2014 15:54:11 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: franckconcern Please find below the answer to your questions:

1/ Who were the main actors of the " WASH and nut" discussion at the last WEDC conference: It was a side event organised by WEDC. For more details, you can contact: Anne Blikinshopp / WEDC conference manager.

2/ Would you agree with using the term faecally transmitted infections (FTI) instead of waterborne diseases : I would say it depends of the context and objectives of the programme you are working on. For global environmental enteropathy, it clearly makes sense as the contamination pathways are not necessary implying water.

3/ Do you have examples of terms that have led to confusion before or terms that are not common to both nutrition and WASH groups?
My colleague, Anne Bauby, WASH PM in Chad, who raised this point, stressed the fact that for instance the age classification in use in the nutrition sector were new to her WASH team.

Regarding the 8 activities proposed: do you have any other ideas about practical aspects that should be taken into account when promoting further integration between WASH and nutrition programmes ?


Nutrition and WASH Wed, 26 Nov 2014 15:47:15 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: jcbarbiche while visiting well rehab project

Otherwise, there is always the promotion to wash the toddlers regularly with soap (hands, butts...)]]>
Nutrition and WASH Mon, 03 Nov 2014 17:02:00 +0000
New IDS Working Paper on Re-framing Undernutrition - by: Petra Re-framing Undernutrition: Faecally-Transmitted Infections and the 5 As

In this IDS Working Paper, Robert Chambers and Gregor von Medeazza argue for a more inclusive framework for thinking about and dealing with undernutrition. One concept is FTIs (faecally-transmitted infections). This is designed to avoid the reductionisms of faecal-oral infections, waterborne diseases, and the focus on the diarrhoeas to the neglect of less dramatic and less measurable FTIs especially environmental enteropathy. A second concept is the 5 As – availability and access which both have oral associations, and absorption, antibodies and allopathogens which have anal associations.]]>
Nutrition and WASH Fri, 31 Oct 2014 12:38:47 +0000
Conference: Hidden Hunger, Childhood Development and Long-Term Prospects for Society and Economy (Stuttgart, Germany, March 2015) - by: bracken During a recent visit to the Uni Hohenheim I saw flyers for this upcoming congress on hidden hunger, which will be concentrating particularly on a child's first 100 days:

From the preliminary programme there is absolutely nothing there regarding sanitation, which could actually fit into all 3 topics of the congress (Topic 1: Reasons for micronutrient inadequacy; Topic 2: Fetal-neonatal development and hidden hunger and Topic 3: Nutrition and brain development). I think some kind of presence here would be extremely worthwhile and enable certain knowledge and communication bridges to be built.]]>
Nutrition and WASH Wed, 29 Oct 2014 15:24:13 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: muench
I really like your list of ideas on "what can a WASH Programme Manager plan to work towards more integration between WASH and nutrition?". It's great to think about such easy practical steps.

You mentioned the WEDC conference: was WASH & nutrition a big topic there? Who were the main actors?

Were you also part of this WASH & nutrition meeting in Stockholm where Rob recently posted the minutes here:

One thing that struck me from these minutes (I am a firm believer in using the right terminology):

Robert Chambers (IDS): Plea to use the term faecally transmitted infections (FTI) instead of waterborne diseases, diarrheas etc. as it is more inclusive (incl. worm infections, tropical enteropathy, asymptomatic diseases etc.)

Would you agree with this?
I noticed your 8th point said something similar:

8 In general, planning joint meeting between nutrition/Health and WASH team to share vocabulary: WASH practitioners having usually an engineering background and Nutrition/Health practitioners a medical one, they tend to talk different languages and are working within different frameworks.

Do you have some examples of such terms that have led to confusion before or terms that are not common to both groups?

Nutrition and WASH Wed, 08 Oct 2014 13:04:33 +0000
8 practical ideas to link more WASH and Nutrition programmes - by: franckconcern
It’s great to see that we are slowly building up on this idea that WASH and nutrition should be more linked and integrated within the same programmes.

As a WASH technical advisor in regular contact with 19 WASH programmes, I’m more particularly interested in the practicalities: what can a WASH Programme Manager plan to work towards more integration between WASH and nutrition?

Following different exchanges at the recent WEDC conference, find below a summary of some ideas for discussion:

1. Because the growth of children is a strong concern for parents, it can be used as an argument when promoting latrine - as now the link is well established between stunting and oral-faecal contamination/environmental enteropathy.

2. Hygiene promotion activities: When possible, prioritize activities to prevent contamination of children through soil/dirty hands. In this regard, innovative activities still need to be defined as the main recommendations – that is to say: focus on hand washing with soap for children under 2, promote the delimitation of space for children to play (=close playgrounds), animals containment - are unfortunately irrelevant when compared to the reality of people’s conditions of life in many countries (=children being carry in different places, animals being left free to find food on their own).

One simple measure could be to increase access to rugs as children playground: rugs marketing approach, with or without subsidisation, or free distribution (according to the context of intervention).

Innovative activities could include specific games/stories for young children to increase their negative perception of touching animals faeces.

3. Stronger focus on safe disposal of children faeces as young children usually defecate in the direct surroundings of the household where they spend a lot of time: work with children caretakers to promote the habit of bringing children faeces to the latrine pit.

4. When available, use Child height as an indicator: stunting is a sensitive and useful outcome measure of the impact of a WASH intervention(not diarrhea)

5. Minimum joint activities to be planned are for the WASH team to ensure access to safe water and safe disposal of excreta in nutrition/health centres where the organisation is already developing its nutrition/health activities => WASH facilities to be built in each of these health/nutrition centres.

6. Idea of using nutrition/health centres as a place to identify priority households or communities to be visited by the hygiene promotion team: if a family has a lot of children with stunting, they will be prioritised for the door-to-door campaign on hygiene promotion/ If a community has a higher percentage of stunting children they will be prioritised for hygiene promotion campaigns.

7. Promote the idea of one single hygiene promotion team for both nutrition, health and WASH programmes activities. IF not possible and at least, ensure that the content of the messages used by the different teams is consistent. For instance, situations were reported where the nutrition and WASH teams were not promoting the same number of critical moments for hand washing, which can be confusing.

8 In general, planning joint meeting between nutrition/Health and WASH team to share vocabulary: WASH practitioners having usually an engineering background and Nutrition/Health practitioners a medical one, they tend to talk different languages and are working within different frameworks.

Please let me know what you think of these ideas and feel free to be critical and/or propose others.
Franck Flachenberg
Concern Worldwide environmental health technical advisor]]>
Nutrition and WASH Mon, 06 Oct 2014 14:38:18 +0000
Re: Concern’s technical brief on “How to better link WASH and nutrition programmes” - by: stesi Nutrition and WASH Thu, 18 Sep 2014 11:15:23 +0000 WASH Nutrition Literature Updates - Sept 2014 - by: campbelldb

This issue contains some of the most recent studies on stunting, open defecation, nutritional interventions, and other WASH and nutrition issues. Recent reports from the World Bank Water and Sanitation Program discuss the impacts of improved sanitation on child growth in Vietnam and Lao PDR. Training materials include the new Global Handwashing Day guide from the Global Public-Private Partnership on Handwashing and a WASHplus infographic on tippy taps.

BLOG POSTS WASHPlus_HTMLbanner_weekly_600x159

Left, Right, and Toilets. Ideas for India, Aug 2014. D Spears. (Link)
Eliminating open defecation in India is a policy priority. This column contends that successful strategies for reducing open defecation may not fit policy stereotypes of the left or the right. While rural sanitation policy in states where this practice is most concentrated has been focused on latrine construction, promotion of latrine use is what will make a difference.

What Do Toilets Have To Do with Nutrition? More Than You Might Think. IFPRI Blog, July 2014. L Haddad. (Link)
A new working paper from the Institute of Development Studies has looked 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. This reflects two things: the fact that water and sanitation are strongly linked to stunting reduction, and that both water and sanitation coverage have increased strongly in the past four decades.


The Effect of India’s Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial. PLoS Medicine, Aug 2014. R Sumeet. (Link)
The objective of this study is to measure the effect of the Total Sanitation Campaign implemented with capacity building support from The World Bank’s Water and Sanitation Program in Madhya Pradesh on availability of individual household latrines (IHLs), defecation behaviors, and child health (diarrhea, highly credible gastrointestinal illness [HCGI], parasitic infections, anemia, and growth). The intervention led to modest increases in availability of IHLs and even more modest reductions in open defecation. These improvements were insufficient to improve child health outcomes. The results underscore the difficulty of achieving adequately large improvements in sanitation levels to deliver expected health benefits within large-scale rural sanitation programs.

Noncommunicable Diseases in HIV Infection in Low- and Middle-Income Countries: Gastrointestinal, Hepatic, and Nutritional Aspects. Journal of Acquired Immune Deficiency Syndrome, Sep 2014. P Kelly. (Full-text)
The purpose of this review is to outline the interaction between HIV and noncommunicable diseases affecting the gastrointestinal tract, liver, and nutritional disorders in low- and middle-income countries, and to identify research priorities. HIV interacts strongly with environmental enteropathy, exacerbating malabsorption of nutrients and drugs. HIV and nutritional care need to be better integrated, but many questions on how best to do this remain unanswered.

An Evolving Perspective about the Origins of Childhood Undernutrition and Nutritional Interventions that Includes the Gut Microbiome. Annals of the New York Academy of Sciences, Aug 2014. T Ahmed. (Link)
This paper summarizes work on mechanisms underlying the varied manifestations of childhood undernutrition and discusses current gaps in knowledge and challenges to our understanding of undernutrition and infection/immunity throughout the human life cycle, focusing on early childhood growth. It proposes a series of basic and clinical studies to address this global health challenge.

Early Childhood Diarrhoeal Diseases and Cognition: Are We Missing the Rest of the Iceberg? Paediatrics and International Child Health, Aug 2014. J MacIntyre. (Abstract)
This paper reviews the burden of early childhood diarrheal diseases globally and the emerging evidence of their relationship with global disparities in neurocognitive development. The strength of evidence indicating that the severe childhood diarrheal burden may be implicated in cognitive impairment of children from low- and middle-income countries is discussed. Findings suggest that greater investment in multi-site, longitudinal enteric infection studies that assess long-term repercussions are warranted.

Climate Change, Crop Production and Child Under Nutrition in Ethiopia: A Longitudinal Panel Study. BMC Public Health, Aug 2014. S Hagos. (Link)
The amount and distribution of rainfall and temperature influence household food availability, thus increasing the risk of child undernutrition. However, few studies examined the local spatial variability and the impact of temperature and rainfall on child undernutrition at a smaller scale. We conducted this study to evaluate the effect of weather variables on child undernutrition and the variations in effects across the three agro-ecologies of Ethiopia.

Addressing Chronic Malnutrition through Multi-Sectoral, Sustainable Approaches: A Review of the Causes and Consequences. Frontiers in Nutrition, Aug 2014. K Reinhardt.(Link)
The objective of this paper is to review current knowledge on the causes and consequences of chronic malnutrition and their relationship with multiple sectors. Understanding the causes includes approaching chronic malnutrition from the basic, underlying, and immediate levels. The causes reach from macro-level environmental influences to specific micronutrient intake.

Why Worry About the Politics of Childhood Undernutrition? World Development, Vol. 64 2014. N Nisbett. (Link)
Undernutrition affects over 2 billion people, but most of the global policy focus has been on technical solutions rather than on understanding nutrition politics. This paper reviews existing literature on nutrition politics and policy. It identifies a number of recurring themes surrounding knowledge, politics, and capacities.

Undernutrition’s Blind Spot: A Review of Fecally Transmitted Infections in India.Journal of Water, Sanitation and Hygiene for Development, July 2014. R Chambers.(Abstract)
With relevance to India and more widely, this review article examines links between fecally transmitted infections (FTIs) and undernutrition, presents a new framework for understanding the relative nutritional significance of FTIs, and draws practical implications for professionals and for future research.


Global Handwashing Day Planner’s Guide: 3rd Edition, 2014. PPPHW. (Link)
In addition to background information, the top five facts about hand washing you should know, and insights from the latest in hand washing research, this newly revised Planner’s Guide features: detailed celebration ideas designed to help religious organizations, schools, health care centers, and more plan effective messaging and events, and an event checklist that helps planners organize and make sure their event planning is on track.

How to Make Other Types of Tippy Taps, 2014. WASHplus. (Link)
This card has instructions on how to make tippy taps from mineral water bottles, tin cans, gourds, and jerry cans.

Investing in the Next Generation: Children Grow Taller, and Smarter, in Rural, Mountainous Villages of Vietnam Where Community Members Use Improved Sanitation, 2014. Water and Sanitation Program. (Link)
The use of unimproved latrines in rural villages in mountainous regions of Vietnam leads to 5-year-old children being 3.7 cm shorter than healthy children living in villages where everybody practices improved sanitation. This difference in height is irreversible and matters a great deal for a child’s cognitive development and future productive potential. A child remains at risk of stunting if community members use unimproved sanitation facilities, even when the child’s family uses improved latrines. Community-wide sanitation interventions should be considered for integration into nutrition and poverty programs to support stunting prevention.

Investing in the Next Generation: Children Grow Taller, and Smarter, in Rural Villages of Lao PDR Where All Community Members Use Improved Sanitation, 2014. Water and Sanitation Program. (Link)
This brief summarizes research examining whether open defecation and unimproved sanitation in a rural community are related to stunted children of different age groups. Among the key findings: what happens today in terms of sanitation behaviors will affect the country’s future. Improving sanitation in rural communities of Lao PDR is thus a development priority that requires resources for a National Rural Sanitation Program.

Maharashtra’s Child Stunting Declines: What is Driving Them? Findings of a Multidisciplinary Analysis, 2014. L Haddad, Institute of Development Studies. (Link)
Between 2006 and 2012, Maharashtra’s stunting rate among children under 2 years of age was reported to decline by 15 percentage points—one of the fastest declines in stunting seen anywhere at any time. This was seemingly more remarkable because it occurred within a context where Indian stunting levels nationally are regularly characterized as stuck or static.

What Are the Factors Enabling and Constraining Effective Leaders in Nutrition? A Four Country Study, 2014. N Nisbett, Institute of Development Studies. (Link)
This study of individuals identified as influential within the nutrition sector in Bangladesh, Ethiopia, Kenya, and India examines why particular individuals champion nutrition policy, and how they operate in the wider policy and political environments of their countries.

SQUAT Survey: Sanitation Quality, Use, Access and Trends, 2014. RICE Institute.(Link)
SQUAT is a quantitative survey that was conducted in rural areas of Rajasthan, Madhya Pradesh, Uttar Pradesh, Haryana, and Bihar. In each state, researchers visited two or three districts that had changes in household open defecation between the 2001 and 2011 censuses that were similar to the state as a whole. Within districts, villages were randomly selected, and within villages, they used an in-field randomization procedure to select households. The researchers interviewed 3,235 adults about their defecation practices and views on latrines and latrine use, and collected individual-level latrine use data for 22,787 household members.

Connecting Water, Sanitation, and Hygiene with Fresh Water Conservation and Climate Resilience: The Need to Facilitate Integration in Development Assistance, 2014. E Shope, National Resources Defense Council. (Link)
Currently, the development sector all too often addresses WASH, climate resilience, and fresh water conservation as separate issues. Fortunately, though, awareness about the importance of integrated efforts to solve these challenges in development projects is increasing. USAID has publicly spoken about and financially supported some efforts to promote integrated solutions for addressing WASH, conservation, and climate.

Care Groups—An Effective Community-Based Delivery Strategy for Improving Reproductive, Maternal, Neonatal and Child Health in High-Mortality, Resource-Constrained Settings, 2014. H Perry. (Link)
Care Groups are an innovation in reproductive, maternal, neonatal, and child health programming that is gaining increasing recognition because of their effectiveness in promoting behavior change and expanding population coverage of key interventions. This paper provides policy makers and donors with an introduction to the Care Group approach and an overview of the evidence of their effectiveness.]]>
Nutrition and WASH Thu, 11 Sep 2014 19:49:56 +0000
Re: Concern’s technical brief on “How to better link WASH and nutrition programmes” - by: sweta Nutrition and WASH Thu, 11 Sep 2014 19:23:03 +0000 Re: Concern’s technical brief on “How to better link WASH and nutrition programmes” - by: AquaVerde
Thanks for sharing with us this great development.

My only comment (or wish) to you and your colleagues, which is not a criticism on your paper:
If going for R&D's (Research and Development), please keep your results short and simple (plain English:;

R&D tend to fly high and higher and often lost in increasing complexities (over-engineered), leaving behind the future "users" of R&D results. Then being surprised about rejection of very important work done.

In short, please try to keep everything as concrete and tangible as possible.

Good Luck and Happiness with your work,

Nutrition and WASH Thu, 11 Sep 2014 08:19:32 +0000
Re: Concern’s technical brief on “How to better link WASH and nutrition programmes” - by: franckconcern
Nutrition and WASH Wed, 10 Sep 2014 07:36:00 +0000