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Office of Global Health and HIV (OGHH)
Office of Overseas Programming & Training Support (OPATS)
Integrating WASH and NutritionWater, Sanitation, and Hygiene Training Package
WASH
UNICEF Framework for Child Malnutrition
Key Nutrition Terminology
Matching Quiz– Working with a partner, match the nutrition term
to its definition. – You have three minutes to complete the activity. – Stand up when you are finished.
Biological Linkages Between WASH and Nutrition
Overview of Topics:1. Diarrheal Disease2. Environmental Enteric Dysfunction (also
known as Environmental Enteropathy)
1. The Role of Diarrheal Disease
After exclusive breastfeeding in the early months of life, children 6–17 months of age show an increase in the incidence of diarrhea that correlates with the introduction of complementary feeding.1
In developing countries, children under age 2 experience an average of three episodes of diarrhea, most between 6–11 months of age. 2
Unsafe water was considered the primary cause of diarrhea in children transitioning from an exclusive breastfeeding diet, but recent evidence also points to unsafe food. 3
Vicious Cycle between Diarrhea and Undernutrition
Diarrhea Undernutrition
Children with diarrhea eat less and absorb fewer
nutrients from their food
Undernourished children are more susceptible to diarrhea
when exposed to fecal material from their
environment
More than Just Diarrhea: Environmental Enteric Dysfunction (EED) Inflammation of the gut,
caused by chronic childhood exposure to fecal microbes and poor sanitation that results in nutrients being diverted from growth and toward immune stimulation.1
Not symptomatic, but appears to be associated with stunting.
Healthy lining of the gut
Inflamed lining of the gut
Environmental Enteric Dysfunction (EED)
Evidence suggests an effect of WASH interventions on linear growth (stunting) that is independent of its effect on diarrhea.
Also called Environmental Enteropathy or Tropical Enteropathy
Poor Sanitation
and Hygiene
Child Undernutrition
Diarrhea
Environmental Enteric Dysfunction
SHINE Study in Zimbabwe Observed babies to
measure what they put in their mouths, then conducted microbiological analysis of samples
Material Average number of E Coli bacterium consumed by baby per day
Infant Food 0
Drinking Water 800
Soil in laundry area 1,400
Chicken feces 10,000,000
The Fecal-Oral Transmission Cycle for Babies
Feces
Fields/Floors
Fluids
Fingers
Flies
Food
Diaper/ Laundry Water
Animal Feces
Dirty Hands
The Fecal-Oral Transmission Cycle and Protective Barriers for Babies
Feces
Fields/Floors
Fluids
Fingers
Flies
Food
Diaper/ Laundry Water
Animal Feces
Dirty Hands
Sanitation Safe Water Hygiene
Protective Play Space
Breaking the Cycle
What are some WASH actions that could break the fecal/oral contamination cycle for nutrition?– Feces management– Water treatment and storage– Handwashing with soap– Food hygiene– Animal management/Protective play space
Barriers to Change in our Country
What are possible barriers to behavior change around WASH related to nutrition outcomes?– Availability of water, soap, basins for washing food, dish drying
racks– Water treatment options and safe storage and handling of
water and water serving implements.– Food hygiene– Cultural norms around child rearing, food preparation and
eating practices, complementary feeding practices, and defecation
– Livestock management practices, availability of space or resources to separate livestock
Small Group Task
As a group, prepare a response to each of the following questions and nominate a group member to report out:
1. Does this activity already have elements of WASH/nutrition integration? If so, please identify them.
2. Do you think this activity could incorporate additional WASH/nutrition considerations?
3. What are the barriers or challenges for the community to address WASH/nutrition in the context of this activity?
4. What are the challenges for the service provider (health worker, Volunteer, etc.) in integrating WASH/nutrition for this activity?
5. How would you incorporate WASH/nutrition into this activity?