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WASH, NUTRITION AND COMMUNITY-LED TOTAL SANITATION REVOLUTIONS IN INSIGHT AND ACTION
DSAI and Irish Aid Seminar on Nutrition and WaSH: integration, research and future challenges
held atPrinting House, Trinity College Dublin, 19 May 2015
Robert ChambersInstitute of Development Studies, University of Sussex
Opening up the black box of undernutrition
FOOD - ORAL AVAILABILITYACCESS
SHIT - ANALABSORPTIONANTIBODIES
ALLOPATHOGENS
The 5 As of NutritionORAL -FOOD
AVAILABILITY
ACCESS
ANAL - FTIs
ABSORPTIONEvacuation – diarrhoeasTheft - nematodes – ascaris, hookworm (sucking blood), trichuris,
tapeworms, giardia? Diminished, damaged and leaky gut-
ENVIRONMENTAL ENTEROPATHYthrough bacterial infections etc
ANTIBODIES to fight infections, using nutritional energy and proteins (immunologists please clarify)
ALLOPATHOGENS other pathogens - liverfluke, hepatitis A, B and E, typhoid fever, polio, trachoma, various zoonoses etc
ENVIRONMENTAL ENTEROPATHY (EE)
• EE has been epidemiologically linked to living in an unsanitary environment
• People living in contaminated environments have leaky, chronically inflamed intestines
• Gut: short blunted villi, tissue infiltrated with inflammatory cells. Associated with ↑ energy, protein, carbohydrate needs
• Diverts nutrients from growth to infection fighting
Korpe & Petri, Trends in Molecular Medicine June 2012, Vol. 18, No. 6
What is stunting
Early PEM in childhood. Growth failure. The children in this picture were aged 2, 4 1/2 and 5 1/2 years from left to right. The first two are normal but the last is grossly retarded in growth although the weight/height ratio is normal and there is no evidence of clinical malnutrition. Stunting is the commonest evidence of chronic, mild PEM.
Effects of stunting on brain development
Normal Stunting
Typical brain cells Extensive branching
Impaired brain cellsLimited branching
Abnormal, shorter branchesSource: Cordero E et al, 1993
The Double Threat of OD and Population Density
Spears, Dean (2012) ‘How Much International Variation in Child Height can Sanitation Explain?’ Rice Working Paper, 10 December 2012
Each circle represents a single Demographic and Health Survey round, reflecting one country in one year. The linear trend shows that children are shorter, on average, in countries where they are exposed to more OD. The circle sizes are proportional to population. The three largest circles represent surveys at different times in India
Change in number of
persons per square kilometerwho defecate in
the open
source: Gupta & Spears, 2014
0 10 0
100 99
0
20
40
60
80
100
1995 20081 30 2
99 95
0
20
40
60
80
100
1995 20083 60 2
97 92
0
20
40
60
80
100
1995 20084 90 3
9688
0
20
40
60
80
100
1995 2008
61214
9384
0
20
40
60
80
100
1995 2008
1322
04
8774
0
20
40
60
80
100
1995 2008
10170
4
9079
0
20
40
60
80
100
1995 2008
17
360
3
83
61
0
20
40
60
80
100
1995 2008
30
600
370
37
0
20
40
60
80
100
1995 2008
69
90
0
131
9
0
20
40
60
80
100
1995 2008
Poorest 10% 2nd 3rd 4th 5th 6th 7th 8th
9th Richest 10%
India: Rural areas
A RAPID RUN THROUGH CLTS
MappingBangladesh
Transect walk: looking for signs of ODMadagascar
Shit calculationKenya
Ignition: shock and disgustKenya
Disgust and IgnitionBolivia
Who wants to stop open defecation?Zambia
Verification and MonitoringEthiopia and Bangladesh
ODF DeclarationIndia
Pride, convenience, safety and self-respectIndonesia
Handwashing
For all the amazing achievements of CLTS, there are, to put it mildly, many third generation challenges
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