Relationship between water, sanitation, hygiene, and nutrition: what do Link NCA nutrition causal analyses say?
Defined by UNICEF as ‘the outcome of insufficient food intake and repeated infectious diseases’, undernutrition is one of the world’s most serious problems, with long-lasting harmful impacts on health and devastating consequences for social and economic development. The three main underlying causes of undernutrition, namely unsuitable or insufficient food intake, poor care practices, and infectious diseases, are directly or indirectly related to inadequate access to water, sanitation facilities, and hygiene practices (WASH). There is a growing base of evidence showing the links between poor WASH conditions, especially exposure to poor sanitation, and stunting (low height for age ratio). However, the effects of WASH interventions on wasting (low weight for height ratio) and the impact of environmental enteric dysfunction (chronic infection of small intestine caused by extended exposure to faecal pathogens) on undernutrition should be explored further. Action Against Hunger (Action Contre la Faim) promotes a participatory nutrition causal analysis, the Link NCA methodology, which is used to analyse complex, dynamic, locally specific causes of undernutrition. This article aims to assess the main findings from 12 most recent Link NCA studies, conducted from the beginning of 2014 until the end of 2016. Results show that inadequate WASH conditions are often identified as major contributors to undernutrition in the study areas. The article also provides lessons learned and a set of practical recommendations for better alignment and integration of WASH and nutrition interventions.
Are ceramic water filters effective in preventing diarrhoea and acute malnutrition among under-five children in Sudan?
Access to safe drinking-water at home is essential during the outpatient treatment of children with acute malnutrition due to their increased vulnerability to infections and disease. The study aimed to evaluate the effectiveness of ceramic water filters with safe storage in preventing diarrhoea and acute malnutrition among under-five children in Kassala state, Sudan. It was designed as an open-label randomized controlled trial, comparing two study groups. Data was collected through face-to-face interviews and direct observations, then processed and analysed using Epi Info 126.96.36.199. Use of water filters is a potential predictor of number of diarrhoea episodes per child (P < 0.001). The intervention group had a lower diarrhoea occurrence (P < 0.001), better monthly average weight gain (P = 0.012) and average mid-upper arm circumference increase (P = 0.001), and lower prevalence of acute malnutrition at the end of the study (P = 0.001) compared with the control group. Ceramic water filters with safe storage can be effective in preventing diarrhoea and acute malnutrition, and beneficial to children admitted to Community Management of Acute Malnutrition programmes in Kassala state. More research is needed to understand the pathways to achieving these outcomes. Other WASH interventions may be needed to interrupt the primary vectors of diarrhoea disease transmission in this setting.