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Food Security and Nutrition NetworkRegional Knowledge Sharing Meeting

Washington, DCNovember 15, 2012

WASH and Health and Nutrition

Chris Seremet, PE

Technical Advisor – Water Supply and Sanitation

Catholic Relief Services

Baltimore, MD

Food For Peace Goal

• To minimize hunger in the world so that people everywhere can enjoy active and productive lives and, ultimately, to ensure that one day no one needs food aid

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However, there are barriers to realizing healthy, productive lives…….

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Diarrhea

• 2.2 million deaths each year– 1.6 million preventable child deaths per year

• 73 million DALYs lost per year• 80% of cases of diarrhea worldwide are attributable

to the ingestion of pathogens, especially in unsafe drinking water, in contaminated food or from unclean hands.

• Cholera, typhoid and dysentery

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Neglected Tropical Diseases

• Soil-transmitted Helminths (Ascariasis, Trichuriasis and Hookworm)

– 2 billion infections—affecting one third of the world’s population—that could be prevented

– 4 million DALYs lost per year– Affects 400 million school-aged children per year– Transmission of intestinal parasitic worm infections

occurs through soil contaminated with feces. – Entirely preventable by adequate sanitation, and

intervention outcomes are reinforced by good hygiene.

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Neglected Tropical Diseases

• Schistosomiasis– 200 million people with preventable infections– 1.7 million DALYs lost per year – Caused by contact with water bodies

contaminated with the excreta of infected people

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Malnutrition

• 860,000 preventable child deaths per year• 17 million DALYs lost per year• Childhood underweight causes about 35% of all

deaths of children <5 years worldwide. • An estimated 50% of this underweight or

malnutrition is associated with repeated diarrhea or intestinal parasite infections – a result of unsafe water, inadequate sanitation or

insufficient hygiene.

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Tropical Enteropathy

• Changing the structure and function of the small intestine leads to undernutrition

• Reduced surface area of small intestine - decreased villous height - ‘flat architecture’

– Lowers nutrient absorption• ‘Leaky gut’ (increased permeability of the intestinal

tract) and impaired ability to prevent pathogens from breaching the intestinal barrier

– Elevated immune response– Nutrients diverted from growth to defense

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Tropical Enteropathy

• Thought to be caused by chronic ingestion of pathogenic microorganisms.

• Linked to living conditions with poor sanitation and hygiene practices.

• Likely to be prevalent in developing countries.

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Fecal – Child Undernutrition Pathway

10Source: Humphrey (2009)

Evidence is Lacking

• Many studies, many methodological issues• Limited evidence

– Suggests that nutrition interventions can substantially reduce or even eliminate the negative effect of diarrheal disease on child growth.

– Can’t conclude that high rates of infection make nutrition interventions ineffective for improving child growth.

• Likely a combination of improved nutrition and infection prevention and control efforts

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Evidence is Lacking

• Most studies agree with WASH interventions

• Randomized controlled trials of toilet provision and handwashing promotion that include tropical enteropathy and child growth as outcomes

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The F-Diagram

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Source: UNICEF

Nutrition and infection prevention and control interventions

• Hygiene Behavior Change– Handwashing with soap at key times– PHAST / CLTS

• Sanitation– Latrines – household and at the fields– Improve drainage around muddy areas

• Water– Drinking Water Supply from a protected source

• Drinking water system at same time as irrigation system• The potential health gains are reduced sharply with even

occasional consumption of untreated drinking water

– POU Treatment and Storage14

FFP Standard WASH Indicators

• Percentage of households using an improved drinking water source

• Percentage of households with access to an improved sanitation facility

• Percentage of households with children aged 0–23 months that have water and soap or locally available cleansing agent at a hand washing place

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Improved Drinking Water Source

• An improved water source is an infrastructure improvement to a water source, a distribution system, or a delivery point. By nature of its design and construction, the improvement is likely to protect the water source from external contamination, in particular fecal matter.

• Improved drinking water sources are: – Piped water into dwelling, plot, or yard – Public tap/standpipe – Tube well/borehole – Protected dug well – Protected spring – Rainwater collection

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Improved Sanitation Facility

• A sanitary facility in the household and whether that sanitary facility meets the improved sanitation standards defined in the Millennium Development Goals (MDGs).

• Improved sanitation is defined as: – Flush or pour/flush facilities connected to a:

• Piped sewer system • Septic system • Pit latrine

– Pit latrines with a slab – Composting toilets – Ventilated improved pit latrines

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Improved hygiene practices

• At households with children aged 0–23 months:– Presence of a hand washing station– Presence of water in hand washing station– Presence of soap or other cleansing agent at hand

washing station

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Thank You

• Chris Seremet

• Technical Advisor – Water Supply and Sanitation

• Catholic Relief Services

• E-mail: christopher.seremet@crs.org

• Website for CRS publications: www.crsprogramquality.org

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Fecal – Child Undernutrition Pathway

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