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?