Why WASH, Nutrition and ECD Matter for health, thriving infants and children

Julia Rosenbaum, FHI360USAID WASHplus Project

Building the Case for Integration:

The 3 Legged Stool

Source: State of the World’s Children, UNICEF 2008

What Kills More Children Each Year?

Pneumonia18%

Malaria 7%

Diarrhea 11%Other Neonatal

40%

All Other 24%

Causes of Mortality for Children Under 5

Diarrhea: 11% of all child deaths

Diarrhea leading cause of malnutrition

Undernutrition contributed 1/3 to ½ of all mortality

A Viscious Cycle

Undernutrition

Diarrhea

• Children with diarrhea tend to eat less• With diarrhea, nutrients from food are not well-

absorbed• Undernourished children are more susceptible to

diarrhea

Scope of Undernutrition & Stunting

Prevalence of stunting (height/age) >-2SD (HAZ)Source: Black et al, 2008

Not just about child survival… and not just about more / better food

• Adequate nutrition for pregnant women and infants is necessary for ‘normal’ brain development

• Key period for formation of the brain, laying the foundation for development of cognitive, motor and socio-emotional skills

• Lack of micronutrients especially critical to optimal infant cognitive and motor development

• Children with restricted development in early life are at risk – later neuropsychological problems, – poor school achievement, – early school drop out, – low-skilled employment and lower wage earnings, – poor care of their own children

• Some of damage is irreparable if not addressed before age 2**• Contributes to the intergenerational transmission of poverty

What supports child nutrition, growth and development?

Access to

water/sanitatio

n/hygiene

and basic health

services

Improved

maternal and child-care

practices

Access to food

– quantity

and quality

1. What percentage of child deaths caused by diarrhea are

preventable through WASH related interventions?

a. 0%-30%b. 31%-60%c. 61%-80%d. over 80%

POP QUIZ!!!!!!!!

Safe Storage & Treatment of Water

Handwashing

Safe Feces DisposalFocus on WASH

behaviors for Diarrhea Disease Reduction….

Food hygiene

Safe Storage & Treatment of Water

Handwashing

Safe Feces DisposalFocus on WASH

behaviors for Diarrhea Disease Reduction….

21%

30% ++

43%

30-50%

The Case for the 3 Legged StoolIntegrating WASH, Nutrition & ECD

• Recognition of the synchronicity of the dyads– WASH and nutrition– Nutrition and ECD

• Abundant research has demonstrated that nurturing and responsive interactions between caregivers and infants promote optimal growth and development

• Maybe a handful of efficacy trials for even the ‘pairs’, none??/few?? for the triad

• Limited intervention experience• Little though promising programming guidance

A few program examples• Integrated nutrition and child development efficacy trial in

Andhra Pradesh, India • SPRING** 5-year effectiveness trial in India and Pakistan• Alive & Thrive (FHI360/Gates)/ Bangladesh• MAMA reaches over 25 million moms in 22 markets around

the globe through text messages -- with a unique blend of stage-based advice and mom-to-mom wisdom.

• The Essential Package Frameworks: Holistically Addressing the Needs of Young Vulnerable Children (Save, CARE, more)

Mobile Alliance for Maternal Action

Reaches over 25 million moms in 22 markets

•stage-based advice •mom-to-mom wisdom

When they need it: timed for each week

Where they need it: on their mobile phone

How they need it: as SMS (text) messages

A few program examples• Integrated nutrition and child development efficacy trial in

Andhra Pradesh, India • Alive & Thrive (FHI360/Gates)/ Bangladesh• SPRING** 5-year effectiveness trial in India and Pakistan• MAMA reaches over 25 million moms in 22 markets around

the globe through text messages -- with a unique blend of stage-based advice and mom-to-mom wisdom.

• The Essential Package Frameworks: Holistically Addressing the Needs of Young Vulnerable Children (Save, CARE, more)

Alive and Thrive BangladeshBehavioral Objectives

• Handwashing with soap & water before food preparation and feeding the child– Maintaining handwashing station- Soap & water near to food

preparation & child feeding area

• Complementary feeding : Correct quantity & frequency• Complementary feeding: Four varieties including one

animal food daily

WASH Behavior Reduces Neonatal Deaths

• Study in Nepal – Maternal and birth attendant handwashing

leads to a 41% reduction in neonatal deaths

• Programming implications – Handwashing training for birth attendants– Including soap in clean birthing kits– Including handwashing messages and

practice in birth counseling– Promoting fixed handwashing stations or

“tippy taps”

Integrating WASH is an incentive for earlier and more frequent prenatal care

Distributing a “safe water kit” that includes a water treatment product, water storage container and soap

• Earlier enrollment• Increased ANC visits• More HIV testing of women and partners• More attended/facility delivery

Adding Handwashing and Responsive Feeding as Essential Nutrition Actions

Contact Information

Julia Rosenbaumjrosenbaum@fhi360.org

Contact Information

Julia Rosenbaumjrosenbaum@fhi360.org