2021 Thematic Discussion Series

Hosted by CF&N, PRO-WASH, and WASHPaLS

March 24th, 30th April 7th, 14th

In response to strong interest for in-depth dialogue around specific guidance/ tools for implementation and monitoring of multi-sectoral programs focusing on infants and young child growth and development, CF&N, PRO-WASH and WASHPaLS held a series of discussions in Spring 2021. The main goal was to get an exchange of ideas between participants from multiple sectors, and to put together an informal list of recommendations that could be utilized in future programming and advocacy. The three main discussions were:

  1. Early Childhood Development – Ensuring integration and measurement of ECD within WASH programs and ensuring hygienic implementation of ECD programs (March 24th). Watch the Recording here.
  2. Behavior Change – Interventions along the behavior change spectrum to reduce infant exposure to animal and human fecal pathways (March 31st). Watch the Recording here.
  3. Agriculture and Animals – Rethinking the micro-environment – practical ways to rethink agriculture and animal husbandry (April 7th). Watch the Recording here.

View recommendations that came out of the discussions here (English) and here (French).

Webinar summary: The forgotten juncture? Handwashing and safe management of child feces

This post originally appeared on the Global Handwashing Partnership’s web site, here.

On August 22nd, 2018 at 6pm ET, the Global Handwashing Partnership, in conjunction with USAID, the International Water Center, the Water and Engineering Center for Development, and UNICEF hosted a discussion on the intersection of handwashing and the safe management of child feces.

Safe disposal of children’s feces is a critical practice, and programs often under-emphasize critical times for handwashing related to infant and child feces. This webinar aimed to:
• Discuss the present status and impact of child feces disposal practices and handwashing,
• Highlight case studies, interventions and evidence,
• Share experiences across regions; and
• Review key considerations for practitioners.

Nga Nguyen, Senior WASH and Social Behavior Change Adviser at USAID, introduced the status of child feces disposal practices and handwashing, and the role of this webinar in highlighting evidence and interventions and providing an open forum for implementers to review key considerations.

Emily Christensen Rand, UNICEF Vanuatu WASH Specialist, presented a global overview of the status of evidence on child feces management and handwashing. Evidence was captured from regional studies, with the earliest evidence from the 1980s. This review opened with the 2015 UNICEF and World Bank research into the child feces disposal practices in 24 countries in different regions. In most countries analyzed, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed. These findings were corroborated by studies in subsequent years, with some evidence suggesting a correlation between health impacts and safe disposal of child’s feces. Research also showed that caregivers don’t always include handwashing as a part of child feces management. A variety of factors which affect this behavior were explored in different regions, including economic status, beliefs, and culture.

In the next presentation, Edith Kamundi, Project Officer at the International Water Centre, described a behavior change campaign on infant feces management in East Sepik Province in Papua New Guinea (PNG). The campaign findings revealed that the key motivators for improved hand hygiene behavior at this key instance were nurture, community status and competing household priorities during the sequence of events in child feces handling. This led the innovation of the 5 Star Mama behavior change campaign, with a focus on the sequence of steps in safe infant feces management, and the collective community responsibility towards this behavior. The team found that culture and gender heavily influence this behavior in PNG. The campaign implementation further revealed it is critical that practitioners work through other sectors beyond WASH, such as nutrition, which address the same target audience. The need for integration was the strongest takeaway from this intervention.

Jake Pitts, a WEDC Water and Waste Engineering MSc student, presented recent formative research on child feces management in the Rhino Refugee Settlement in Uganda. This research highlighted that household child feces management strategies vary with children age groups and status of health. Caregivers adopted coping strategies for child feces management to overcome economic barriers, such as improvised diapers from bedding. Further, caretakers behaved differently when children had diarrhea; including increased washing and disposal. Understanding these differences, along with the process that households use for managing child feces, is very useful for targeted programming. Further, in low resource contexts, even with adequate knowledge and consistent child feces disposal, there are still other risks for fecal contamination.

Following these short presentations, all participants engaged in an active discussion focused on evidence and interventions across regions, motivators for hand hygiene behavior during child feces management and recommendations from participants. Some key points from this discussion included comparing child feces practices in other regions, such as community buy-ins into potty purchases, and creating child-focused latrine systems. The discussion was moderated by Nga Nguyen, and Carolyn Moore, Secretariat Director at the Global Handwashing Partnership.

A recording of the webinar is available here. If you have questions or feedback about the webinar; or if you have resources related to safe management of child feces as a critical time for handwashing, please email contact@globalhandwashing.org.

Learn more: If you are interested in learning more about child feces disposal practices, please see the list of resources below. This list is adapted from a list prepared by Dan Campbell of the Water CKM Project.

• WSP – Ensuring Safe Sanitation for Children – This series of country profiles provides an overview of the available data on child feces disposal.
• Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana. American Society of Tropical Medicine and Hygiene, May 2018.
• Unsafe disposal of feces of children under 3 years among households with latrine access in rural Bangladesh: Association with household characteristics, fly presence and child diarrhea. PLoS One, April 2018.
• Piloting a low-cost hardware intervention to reduce improper disposal of solid waste in communal toilets in low-income settlements in Dhaka, Bangladesh. BMC Public Health, August 2017.
• Identifying Potential Sources of Exposure Along the Child Feces Management Pathway: A Cross-Sectional Study Among Urban Slums in Odisha, India. Am. J. Trop. Med. Hyg., 97(3), 2017.
• The impact of a rural sanitation program on safe disposal of child feces: a cluster randomised trial in Odisha, India. Transactions of the Royal Society of Tropical Medicine and Hygiene, 110 (7), 2016.
• Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth. Journal of Pediatrics, September 2016.
• Management of Child Feces: Current Disposal Practices. WSP, June 2015.

 

Taking Action and Marching for Improved WASH and Nutrition this Month

Originally published on the Global Public-Private Partnership for Handwashing’s Website

The beginning of March here in Washington, DC is oftentimes accompanied by signs of an impending springtime. Slowly the days get a little bit longer and the cold winter winds begin to subside. For many, as trees and plants begin to bloom, springtime brings to mind new life. The first few days of spring are tenuous, and the same is true for the first months of a baby’s life. It is, thus, fitting that March kicks off two advocacy campaigns—Water Action Month and #March4Nutrition—that address significant issues of child survival.

Image from MCSPglobal

While to the casual observer, these two campaigns might seem very different, they in fact are incredibly intertwined. Water, sanitation, and hygiene (WASH) interventions are critical allies in the fight against undernutrition, particularly in the first 1,000 days of life. This is because undernutrition is not only caused by a lack of food, but also the body’s inability to absorb nutrients from food.

Undernutrition and diarrhea form a vicious cycle, where children with diarrhea both eat less and are less able to absorb essential nutrients. Likewise, undernourished children are more susceptible to diarrheal diseases. WASH interventions can significantly reduce the risk of diarrheal disease; handwashing with soap alone can do so by up to 50%.  As such, improved access to WASH can help interrupt this cycle.

Undernutrition is the underlying cause of 45% of child deaths each year, but its impact is also much broader with lasting consequences for growth and development.1 Undernutrition manifests itself through reduced growth rate—or stunting—in early childhood. And, while the physical effects of stunting (reduced stature) are most visible, the negative repercussions that stunting can have on the cognitive development of children are lasting. Ultimately, undernutrition can have life-long consequences.

This is why we must continue to explore collaboration across the WASH and nutrition sectors. Evidence continues to emerge indicating that WASH and nutrition integration makes good sense. In Ethiopia, for instance, one study found that WASH interventions reduced the prevalence of stunting by 12 percent.2

Given the positive synergies between sectors, we are working to drive forward thinking around integration. To this end, we are proud to partner with colleagues from both the nutrition and early childhood development sectors in the Clean, Fed & Nurtured community of practice. This month we will celebrate Water Action Month and #March4Nutrition by sharing information and resources around WASH and nutrition integration with weekly facts on Twitter and blog updates with links to some of our favorite WASH and nutrition publications.

An estimated 860,000 deaths per year due to undernutrition can be prevented through WASH. So, please join us this month. Follow #WaterActionMonth and #March4Nutrition online and learn more about these key public health interventions.

 

  1. Black R et al. 2013. Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries. The Lancet. 382 (9890): 427–451.
  2. Fenn, B., et al. (2012). An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia. Public Health Nutrition.17, 1-9.

Upcoming Event: Clean, Fed & Nurtured Global Health Mini-University Session

What Gets Measured Gets Done: Identifying Integrated Indicators that Count

11:00-12:00 • March 4, 2016
Marvin Center Room 308, George Washington University
Washington, DC

Join the Clean, Fed & Nurtured Community of Practice on Friday, March 4 at the Global Health Mini-University to learn about the “why” and the “how” of developing and using indicators for integrated global health programs.

This session will outline the importance of measurable indicators for integrated programming, explore challenges to effective cross-sector collaboration, specifically between those working on water, sanitation, and hygiene, nutrition, and early childhood development, and allow the opportunity for participants to contribute to the development of inter-sectoral indicators.

Attendance at the Mini-University is free, but you do have to register online. Don’t miss this great opportunity to join the Clean, Fed Nurtured Community of Practice as we work together to promote early childhood growth and development. Register today!

Rationale for a new community of practice exploring how we can help babies be Clean, Fed & Nurtured

By Hanna Woodburn

Originally published June 14, 2013 on the Gates Foundation Impatient Optimists blog.

In early May a gBangladesh woman and child GM (2)roup of experts gathered in a Washington, D.C. conference room. Such meetings are commonplace in this town, particularly within the international development community. But this meeting was different, not because it connected luminaries and experts, but because they represented three different sectors—water, sanitation, and hygiene (WASH); nutrition, including infant and young child feeding (IYCF); and early childhood development (ECD). Representatives of these sectors came together to explore ways to work toward a common goal: ensuring that babies around the world are Clean, Fed & Nurtured.

The participants largely determined the course of the meeting, organizing working groups on topics that most interested them. Before parting ways, delegates from academia, funding organizations, international NGOs, and the private/commercial sector made personal commitments for actions to kickstart integration of the three sectors within their spheres of influence.

The science is becoming clearer: for children to reach their full human potential both physically (including to prevent stunting) and cognitively, improving food intake alone is not enough. An estimated 165 million children under 5 years of age have significantly impaired physical growth and are unable to reach their full potential. Increasingly, we see that to tackle stunting at scale, we must work together.

Recently, governments, donors, and private sector organizations made a significant commitment to reaching the benchmarks established in the Global Nutrition for Growth Compact. To achieve these objectives, it will be essential that intersecting disciplines are no longer placed in separate silos. Certainly progress has been made in this regard.

As The Lancet asserted in the June 2013 series on maternal and child nutrition, integration among complementary program interventions—including WASH, nutrition, and ECD—has the potential to increase efficiency and enhance benefits. We could not agree more.

While adequate nutrition in the first two years is critical to prevent stunting, research also points to the important role of ECD, including early childhood stimulation, to support brain development and to strengthen the impact of nutrition interventions. And increasingly, evidence links WASH interventions to improved child growth.

The experts have previously worked on two-way integration. WASH + nutrition sectors have lately shown a lot of collaboration. Likewise, ECD + nutrition researchers are putting the finishing touches on a special issue of Annals of New York Academy of Sciences on integrated interventions in nutrition and child development (watch for this issue by end of 2013). But rarely do programs or studies put a focus on all three sectors.

How might this new focus on the Clean, Fed & Nurtured baby shift the ways we promote child growth and child development? Participants’ commitments were concrete. Members of one NGO, who represented all three sectors, pledged to work together to choose at least one country where they can “collectively put our heads together to influence programs.” A leader in WASH pledged to encourage that sector to add the indicator for child stunting (height for age) into the WASH evaluation plans. The author of an internationally sanctioned guide for child health, nutrition, and child care announced that there is still time to build in guidance on WASH – under-represented in earlier versions – and asked meeting participants for contributions. A small group stepped up to define a set of “essential hygiene actions,” offering programmers an add-on to the existing “essential nutrition actions.” Participants offered to make immediate modifications to build integration into programs they are designing, conference themes they are developing, or studies they are about to launch.

The Clean, Fed & Nurtured consultative meeting demonstrated nascent steps toward these integrated objectives, but we cannot go it alone.

Practitioners, keep an eye out for opportunities for integration. Prepare programs to train, equip, and evaluate frontline field agents in each of these areas.

Researchers, help us fill the gaps in the evidence. What indicators should an integrated program include? How can frontline workers and families integrate multiple household practices to promote child growth and development?

Finally, join in these evolving conversations by inquiring, sharing successes, and disseminating pertinent research. Right now, the primary vehicle for doing so is a new Clean, Fed & Nurtured LinkedIn Group, which we hope you will contribute to. We can also be found on Twitter, @thrivingbaby, and ask you to begin using #CleanFedNurtured.

Promote the idea, promote the brand, promote the practice!

At the May 2013 Clean, Fed & Nurtured meeting, we made small, accessible commitments to build upon. How can you do the same?

Co-sponsors of Clean, Fed & Nurtured Consultative Meeting: Alive & ThriveFHI 360, the Global Public-Private Partnership for HandwashingSave the ChildrenUSAID and WASHplus.