SuSanA - Forum Kunena Site Syndication http://forum.susana.org/ Sun, 01 Mar 2015 19:17:38 +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: Malnutrition’s Links to Sanitation in India - and Wikipedia pages on stunting, helminthiasis and EE - by: muench http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12273 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12273 causes (prompted by what Henk had said above and the edits made by Kris).

It now reads like this:
en.wikipedia.org/wiki/Stunted_growth#Causes

Causes

Most stunting happens during the 1,000-day period that spans from conception to a child's second birthday.[citation needed] Whilst malnutrition used to be seen as the main and only caase of stunting, the actual causes are more complex and inter-twined. The three main causes of stunting in South Asia, and probably in most developing countries, are poor feeding practices, poor maternal nutrition, and poor sanitation.

Feeding practices
Inadequate complementary child feeding and a general lack of vital nutrients beside pure caloric intake is one cause for stunted growth. Children need to be fed diets which meet the minimum requirements in terms of frequency and diversity.

Maternal nutrition
Poor maternal nutrition during pregnancy and breastfeeding can lead to stunted growth of their children. Women who are underweight or anemic during pregnancy, are more likely to have stunted children which perpetuates the inter-generational transmission of stunting.

Water, sanitation and hygiene practices
There is most likely a link between children's linear growth and household sanitation practices. The ingestion of high quantities of fecal bacteria by young children through putting soiled fingers or household items in the mouth leads to intestinal infections. This affect children's nutritional status by diminishing appetite, reducing nutrient absorption, and increasing nutrient losses.

The diseases recurrent diarrhoea and intestinal worm infections (helminthiasis) which are both linked to poor sanitation have been shown to contribute to child stunting. The evidence that a condition called environmental enteropathy also stunts children is not inconclusively available yet, although the link is plausible and several studies are underway on this topic.[4] Environmental enteropathy is a syndrome causing changes in the small intestine of persons and can be brought on due to lacking basic sanitary facilities and being exposed to faecal contamination on a long-term basis.[4]

Research on a global level has found that the proportion of stunting that could be attributed to five or more episodes of diarrhoea before two years of age was 25%.[5] Since diarrhoea is closely linked with water, sanitation and hygience (WASH), this is a good indicator for the connection between WASH and stunted growth. To what extent improvements in drinking water safety, toilet use and good handwashing practices contribute to reduce stunting depends on the how bad these practices were prior to interventions.


I am not yet fully satisfied with it. I would like to add the right references at the right points. The new content that I added today was inspired by what I read on this website (careful: takes a while to load):
stopstunting.org/

But I can't cite the website as a source. I know it's written somewhere in some documents but it's faster if someone who works in this field points me to the best sources to cite for which statement.

I also added two external links as follows:
Stop stunting conference website
Alive and Thrive

The second link I became aware of thanks to a posting by Hanna here.

If anyone has further feedback or feels like editing this Wikipedia article further, please tell me or go ahead. Thanks.]]>
Nutrition and WASH Fri, 27 Feb 2015 09:16:26 +0000
Feb 20, 2015 WASHplus Weekly on WASH & Nutrition - by: campbelldb http://forum.susana.org/forum/categories/92-nutrition-and-wash/12253-feb-20-2015-washplus-weekly-on-wash-a-nutrition#12253 http://forum.susana.org/forum/categories/92-nutrition-and-wash/12253-feb-20-2015-washplus-weekly-on-wash-a-nutrition#12253
]Link]]>
Nutrition and WASH Wed, 25 Feb 2015 14:20:10 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: WASHanna http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12217 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12217
Thank you for sharing this information and the outputs from WEDC. We have been working on a Community of Practice that you might find interesting called Clean Fed & Nurtured. It seeks to explore integrations between WASH, Nutrition, and Early Childhood Development. In fact, safe child play spaces has been a topic that we have discussed. I think joining this group might be of interest to you.

More info here: aliveandthrive.org/clean-fed-nurtured-event-highlights/
Email sign up here: globalhandwashing.us3.list-manage.com/su...d1&id=99d2b28a55]]>
Nutrition and WASH Mon, 23 Feb 2015 21:46:03 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: milli http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12163 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12163
I don't have practical experience but I understand your point that organizations that are not specialized in reuse of excreta might not have enough resources for implemeting the reuse strategy successfully.

Actually I would be very interested in your mid-term results which you mentioned (piloting the use of excreta for agriculture purpose in Dar-ed-Sila region in Chad). I could imagine other forum users too.

Furthermore, I am working with Elisabeth to improve the wikipedia page on reuse of excreta and am curious about any additional information that I could use...(or to know about things that you think are missing)

en.wikipedia.org/wiki/Reuse_of_excreta
(see also here on the discussion forum: forum.susana.org/forum/categories/17-fer...ossible-improvements)

Best regards,
milli]]>
Nutrition and WASH Fri, 20 Feb 2015 11:46:03 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: franckconcern http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12116 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#12116
Regarding the use of excreta for agriculture: i'm far from being a specialist in such domain but although I'm a big fan of the idea (closed loop system) I must admit, at least for Concern, we haven't yet managed to implement successful pilots in this matter (we tried in Uganda and Haiti). So I agree that any team that aims at linking more WASH with other sectors should consider it but from my side, i'm still looking for successful experiences implemented by generalist INGOs. Otherwise, I know that NGOs specialised in this domain, such as SOIL in Haiti,do have good results but they do spend a lot of means (financial,human ressource expertise) and can allow long time to the process for it to be successful. I'm not sure one could do the same in a integrated programme with many other objectives to link WASH and nut and agriculture. Well, this is an open debate of course!

We (=Concern) are currently piloting the use of excreta for agriculture purpose in Dar-ed-Sila region in Chad (based on past lessons learned)but only at a very small scale.
If interested, I'll ask our WASH PM, Anne Bauby, to let us know what the results are as the mid-review took place recently.

As for your other question: Do you have any information on how much malnutrition could be reduced by if we could eradicate helminth infections?
Unfortunately, I don't know the answer but I will ask my nutrition colleagues. Unless someone else on the forum can answer it?

Amicalement
franck]]>
Nutrition and WASH Tue, 17 Feb 2015 12:38:02 +0000
Re: Malnutrition’s Links to Sanitation in India - and Wikipedia pages on stunting, helminthiasis and EE - by: KeithBell http://forum.susana.org/forum/categories/92-nutrition-and-wash/11439-gut-dysbiosismalabsorption-syndrome-is-rampant-due-to-poor-sanitation#12060 http://forum.susana.org/forum/categories/92-nutrition-and-wash/11439-gut-dysbiosismalabsorption-syndrome-is-rampant-due-to-poor-sanitation#12060 www.pbs.org/newshour/updates/in-worlds-p...a-childs-playground/

The text of the article is mainly about sanitation while most of the photos seem to convey solid waste issues. Perhaps it's difficult to communicate the problem of poor sanitation leading to malabsorption syndrome in photos.

Regarding tropical sprue, there appears to be much overlap in the medical literature with now rampant gut diseases such as IBS and Celiac disease, where Celiac disease now affects one in 100 people in the developed world.
www.nature.com/ajg/journal/v108/n5/full/ajg201345a.html
www.ncbi.nlm.nih.gov/pubmed/22315745

The problem may be that Celiac disease was once predominantly considered of genetic origin, but that's changing rapidly where the field is finally embracing probiotic therapy when it was shunned in the past. The only treatment until recently was the gluten-free diet which can actually feed the problem based on high sugar. Recent studies now confirm gut dysbiosis including abundance of Proteobacteria (E. coli, Klebsiella, etc.) in Celiac disease.
www.ncbi.nlm.nih.gov/pubmed/23478804
www.nature.com/ajg/journal/v109/n12/abs/ajg2014355a.html
www.cureceliacdisease.org/who-we-are/video (first video, The Celiac Microbiome Research Initiative)

I tend to doubt Celiac disease is much different than tropical sprue.]]>
Nutrition and WASH Sat, 14 Feb 2015 18:48:06 +0000
Re: Malnutrition’s Links to Sanitation in India - and Wikipedia pages on stunting, helminthiasis and EE - by: WikiDocJames http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12057 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12057 www.ncbi.nlm.nih.gov/pubmed/24781741

J]]>
Nutrition and WASH Sat, 14 Feb 2015 13:02:35 +0000
Re: Malnutrition’s Links to Sanitation in India - and Wikipedia pages on stunting, helminthiasis and EE - by: Marijn Zandee http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12018 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12018 ),

I have some more info for the Tropical Sprue lemma, but you may want to try verify this before putting it on-line.

The sprue, as it is called here, is quite common among expats in Kathmandu. Probably also among Nepalese people, but they probably don't get officially diagnosed. The main clinic here in KTM that expats go to is CIWEC (ciwec-clinic.com), their method of diagnoses (if I remember correctly) is to give the patient a specific sugar solution and measure the absorption of the sugars from urine samples.]]>
Nutrition and WASH Thu, 12 Feb 2015 08:19:02 +0000
Re: Malnutrition’s Links to Sanitation in India - and Wikipedia pages on stunting, helminthiasis and EE - by: JKMakowka http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12013 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12013 Nutrition and WASH Thu, 12 Feb 2015 01:52:03 +0000 Re: ‘Stop Stunting’, which examined the linkages with child food/feeding, maternal nutrition and sanitation - by: muench http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12005 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#12005
Thanks for making us aware about this conference website. It is a really nice website which includes the presentations of the guest speakers as well as filmed interviews. I observed only one problem: the front page of the website takes a terribly long time to load. When I tried to load it while in Hanoi, I gave up. Even with my faster internet connection here in Germany, it took much longer than I would normally expect from a website. It's worth the wait, although perhaps you could give this feedback to the IT guys who set up this page.

I was interested in this interview with Shaun Baker, Director of Nutrition at the Bill and Melinda Gates Foundation who provided general thoughts on why stunting needs to be tackled with urgency:

vimeo.com/111600322

Watching the interviews made me realised (again) that stunting really is a grave concern as it affects the future of the population in many countries, and it is not just about shorter children but about "mal-development" - including mental capacities - and that's really serious and irreversible.

Sanitation is one of three prime causes, which was highlighted nicely on the conference website:

It is acknowledged that most stunting happens during the 1,000-day period that spans from conception to children's second birthday and that the three main causes of stunting in South Asia are poor feeding practices, poor maternal nutrition, and poor sanitation:

[...]

- Household sanitation: Growing evidence suggests that there is a link between children's linear growth and household sanitation practices. The ingestion of high quantities of fecal bacteria by young children through mouthing soiled fingers and household items leads to intestinal infections which affect children's nutritional status by diminishing appetite, reducing nutrient absorption, and increasing nutrient losses. Although the proportion of people using improved sanitation in South Asia increased by 18 percentage points between 1990 and 2011, the pace of this improvement has not kept up with population growth; as a result, the region accounts for almost two thirds of the global population practising open defecation.


Thank you also for your inputs regarding the Wikipedia article on stunted growth.

You mentioned that the section on causes could do with improvements:
en.wikipedia.org/wiki/Stunted_growth#Causes

At present it reads:
Causes [edit source | editbeta]

Whilst the principal cause for stunted growth in children used to be regarded as simply malnutrition, there is increasing agreement that lack of sanitation (open defecation) and associated diseases, such as recurrent diarrhoea, intestinal worm infections (helminthiasis) and a condition called environmental enteropathy all are important causes, too.[4] Environmental enteropathy is a syndrome causing changes in the small intestine of persons and can be brought on due to lacking basic sanitary facilities and being exposed to faecal contamination on a long-term basis.[4]

Research on a global level has found that the proportion of stunting that could be attributed to five or more episodes of diarrhoea before two years of age was 25%.[5] Since diarrhoea is closely linked with water, sanitation and hygience (WASH), this is a good indicator for the connection between WASH and stunted growth. The understanding of the complex interdependence between nutrition, stunted growth and WASH has increased in recent years.


You said:
Regarding the Wikipedia page on stunting, en.wikipedia.org/wiki/Stunted_growth, perhaps the section on ‘causes’ could better explain the ‘mix’ of causes: child food and feeding, maternal nutrition and water/sanitation/hygiene practices. Poor WASH practices result in diarhoea, intestinal worms and environmental enteric dysfunction (env enteropathy). While diarrhoea and helminths have been shown to contribute to child stunting, the evidence that env enteropathy stunts children is not inconclusively available yet, although the link is plausible. Several studies are underway on this topic.

To what extent improvements in drinking water safety, toilet use and good handwashing practices contribute to reduce stunting depends on the how bad these practices were prior to interventions.


I am going to try and improve this section in the Wikipedia article in the coming week, however if anyone beats me to it, I would not be upset either. Maybe we have people on this forum who work with capable students and interns on the topic of WASH, nutrition and stunting who could probably more easily and efficiently insert the latest content and thinking on this page than I could? It does get 100-200 views per day (stats.grok.se/en/latest90/Stunted_growth) so wouldn't hurt to have good content on there.

Greetings,
Elisabeth]]>
Nutrition and WASH Wed, 11 Feb 2015 14:46:27 +0000
Re: Image for flipchart WASH in Nut - by: JKMakowka http://forum.susana.org/forum/categories/92-nutrition-and-wash/11959-image-for-flipchart-wash-in-nut#11967 http://forum.susana.org/forum/categories/92-nutrition-and-wash/11959-image-for-flipchart-wash-in-nut#11967 www.cawst.org/en/resources/pubs
It is under a creative commons license so you can also legally adapt these to your needs (if you do, please share them again with us).]]>
Nutrition and WASH Mon, 09 Feb 2015 14:40:37 +0000
Re: 8 practical ideas to link more WASH and Nutrition programmes - by: milli http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#11964 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10392-8-practical-ideas-to-link-more-wash-and-nutrition-programmes#11964
I like the idea of integrating WASH and nutrition and working interdisciplinary since the subjects are overlapping. Both of them deal with health issues and the implementation of health centers that cover both seems reasonable to me.

Another link could be the use of excreta in agrigulture. This could be interesting in communities that grow their own food. Promoting WASH and applying methods that improve soil fertility and agricultural earnings could represent a synergy too.

Reuse in agriculture can have positive effects on nutrition (more food security) as well as negative effects (if untreated excreta is used, it could lead to more worm infections and other diseases).

Another interesting aspect in this context of WASH and nutrition are helminth infections, which are caused by lack of sanitation and which can lead to malnutrition (and to anaemia) if the worm population inside the person gets so large that they take away the calories from the host. Do you have any information on how much malnutrition could be reduced by if we could eradicate helminth infections?
Guinea worm disease is close to being eradicated (en.wikipedia.org/wiki/Dracunculiasis) but all the other intestinal worms are far from being eradicated
(en.wikipedia.org/wiki/Helminthiasis#Epidemiology)...

Best regards,
milli]]>
Nutrition and WASH Mon, 09 Feb 2015 10:48:06 +0000
Image for flipchart WASH in Nut - by: exobarbiche http://forum.susana.org/forum/categories/92-nutrition-and-wash/11959-image-for-flipchart-wash-in-nut#11959 http://forum.susana.org/forum/categories/92-nutrition-and-wash/11959-image-for-flipchart-wash-in-nut#11959
I am looking for images for a flipchart about WASH and nutrition in Tchad, with the following messages:
1.Arrange a protected space for children play, so they do not put soil or animal feces in their mouths
2.Wash the child daily with soap ( hand, face, bottom ) or when it is outside the protected area
3.Quick burial of children's faeces and associated washwater, cleaning with soap the cloth or ustensil (potty) used
4.The person in charge of the child should wash hands with soap after any contact with fecal material, and before preparing / serving food
5.Proper transport and storage of drinking water in the home
6.Boil or disinfect drinking water, at least water consumed by children aged from 6 to 24 months
7.Before breastfeeding, nipples should be washed with soap
8.Once weaned , avoid giving children the leftover food from the day before , or only once warmed

If you have some suggestion or images, can you send it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it ? Thanks!]]>
Nutrition and WASH Mon, 09 Feb 2015 09:05:36 +0000
January 2015 posts to the WASHplus WASH Nutrition Library - by: campbelldb http://forum.susana.org/forum/categories/92-nutrition-and-wash/11814-january-2015-posts-to-the-washplus-wash-nutrition-library#11814 http://forum.susana.org/forum/categories/92-nutrition-and-wash/11814-january-2015-posts-to-the-washplus-wash-nutrition-library#11814 WASH Nutrition Library

Titles

- The Other Asian Enigma: Explaining the Rapid Reduction of Undernutrition in Bangladesh
- SPRING – Essential Nutrition Actions and Essential Hygiene Actions: A Training Guide for Peace Corps Health Volunteers and Peace Corps Staff
- World Bank – Promoting Handwashing and Sanitation Evidence from a Large-Scale Randomized Trial in Rural Tanzania
- Child malnutrition and the Millennium Development Goals: much haste but less speed?
- Pediatric small intestine bacterial overgrowth in low-income countries
- ACF – Greater investment in water, sanitation and hygiene is key to the fight against undernutrition]]>
Nutrition and WASH Thu, 29 Jan 2015 20:01:06 +0000
‘Stop Stunting’, which examined the linkages with child food/feeding, maternal nutrition and sanitation - by: hvannorden http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#11652 http://forum.susana.org/forum/categories/92-nutrition-and-wash/10947-improvements-to-wikipedia-page-on-stunting-and-environmental-enteropathy#11652
UNICEF ROSA held a regional conference in 2014 on ‘Stop Stunting’, which examined the linkages with child food/feeding, maternal nutrition and sanitation. The main presentations are available here: stopstunting.org/


Regarding the Wikipedia page on stunting, en.wikipedia.org/wiki/Stunted_growth, perhaps the section on ‘causes’ could better explain the ‘mix’ of causes: child food and feeding, maternal nutrition and water/sanitation/hygiene practices. Poor WASH practices result in diarhoea, intestinal worms and environmental enteric dysfunction (env enteropathy). While diarrhoea and helminths have been shown to contribute to child stunting, the evidence that env enteropathy stunts children is not inconclusively available yet, although the link is plausible. Several studies are underway on this topic.

To what extent improvements in drinking water safety, toilet use and good handwashing practices contribute to reduce stunting depends on the how bad these practices were prior to interventions.

Hope this helps!

Best regards

Henk


----------------------
Hendrik van Norden
Regional Adviser (Sanitation & Hygiene)
UNICEF Regional Office for South Asia (ROSA)
Kathmandu, Nepal
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Phone: +977-9851035244]]>
Nutrition and WASH Sun, 18 Jan 2015 05:09:57 +0000