WASHplus – WASH/Nutrition Literature Update – March 2014

WASH/Nutrition Literature Update – March 2014

The March 2014 literature update includes details on an upcoming USAID-sponsored WASH nutrition presentation on April 1, 2014, and the March 2014 issue of USAID’s Global Waters magazine with descriptions of USAID WASH and nutrition efforts in Liberia and other countries. Other resources include a 2014 WHO report on childhood stunting, an award winning poster on food hygiene, an enteropathy study in Zimbabwe, and other resources.


April 1, 2014 – Integrating WASH and Nutrition: Current Approaches, Lessons Learned, and Considerations for Future Programming, a presentation by Francis Ngure, Water and Sanitation Program.  Date: Tuesday, April 1, 2014 | Time:  3-4:30 pm | Place: USAID, Room 4.08 E/F, Ronald Reagan Bldg. (RSVP/additional info)
You are invited to a presentation on current strategic and operational approaches linking WASH and nutrition programming based on an investigation conducted by the World Bank Water and Sanitation Program. The session will include preliminary findings and lessons learned from field examples that will inform future programming.


WASH Benefits Study/Bangladesh & Kenya – (Website)
The WASH Benefits Study will provide rigorous evidence on the health and developmental benefits of water quality, sanitation, hand washing, and nutritional interventions during the first years of life. The study includes two cluster-randomized controlled trials to measure the impact of intervention among newborn infants in rural Bangladesh and Kenya. Both will be large in scope and measure primary outcomes after two years of intervention.

Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.  PLoS One, Feb 2014. A Prendergas. (Link)
Stunting began in utero and was associated with low maternal IGF-1 levels at birth. Inflammatory markers were higher in cases than controls from 6 weeks of age and were associated with lower levels of IGF-1 throughout infancy. Higher levels of CRP and AGP during infancy were associated with stunting. These findings suggest that an extensive enteropathy occurs during infancy and that low-grade chronic inflammation may impair infant growth.

Could Poor Sanitation Begin Stunting Children in Utero? 2014. D Spears. (Blog post)
Evidence is building up that enteropathy may matter a great deal.  Andrew Prendergast and nine coauthors published a new paper in PLoS One: “Stunting Is Characterized by Chronic Inflammation in Zimbabwean Infants.”  They collected data on about 14,000 infants at periodic intervals in their first 18 months of life. They ended up with a sample of 101 stunted infants—meaning too short—and 101 non-stunted infants in order to have a healthy comparison group. The paper is important because it speaks to the hypothesis of enteropathy as a determinant of stunting among poor children who grow up exposed to intestinal disease.

Water, Sanitation, and the Prevention of Stunting:  An Holistic View of Why Food Isn’t Enough, 2014. J Griffiths. (Presentation)
Poor populations will likely eat aflatoxins in foods; many will have environmental  enteropathy and live without good water or sanitation. Lacking WASH and barriers to fecal contamination, they will have a different spectrum of gut bacteria than people with good WASH.

Water, Energy and Food. USAID Global Waters, March 2014. USAID. (Link)
This issues contains descriptions of USAID WASH and nutrition efforts in Liberia and other countries.

Design and Test of an Intervention to Change 5 Food Hygiene Behaviours in Nepal, 2014. O Gautam. (Link to poster)
This campaign used modern behavior change science, moving away from standard educational approaches. Campaign activities such as changing kitchen settings, use of emotional drivers, eye danglers, and engaging in events such as games or competitions (i.e., clean kitchen, ideal mother, safe food hygiene zone) encouraged mothers to adopt and practice five key food hygiene behaviors. Significant improvements in targeted behaviors indicate that it is possible to change multiple food hygiene behaviors employing emotional motivators.

Effects of Malnutrition on Children’s Immunity to Bacterial Antigens in Northern SenegalAmer Jnl Trop Med Hyg, Mar 2014. L Gaayeb. (Abstract/order info)
The relationship among village, time of visits, and levels of antibodies to tetanus showed that environmental factors played a role in modulating humoral immunity to tetanus vaccine over time. Therefore, these results show that nutritional status can specifically alter the efficacy of long-lasting immunity to tetanus.

The Effect of Malnutrition on Norovirus InfectionmBio, Mar 2014. D Hickman. (Link)
To probe the effects of malnutrition on an enteric infection in a well-controlled system devoid of other environmental and genetic variability, we studied norovirus infection in a mouse model. We have revealed that malnourished mice develop more severe norovirus infections and they fail to mount effective memory immunity to a secondary challenge. This is of particular importance because malnourished children generally mount less effective immune responses to oral vaccines, and we can now use our new model system to probe the immunological basis of this impairment.

Effect of a Behaviour-Change Intervention on Handwashing with Soap in India (SuperAmma): A Cluster-Randomised TrialLancet Global Health, Feb 2014. A Biran.(Link)
This study shows that substantial increases in hand washing with soap can be achieved using a scalable intervention based on emotional drivers.

Prevalence of Anemia and Its Risk Factors Among Lactating Mothers in MyanmarAm Jnl Trop Med Hyg, Mar 2014. A Zhao. (Abstract/order info)
In Myanmar, 60 percent of the population consists of mothers and children, and they are the groups most vulnerable to anemia. The objectives of this study are to determine (1) the anemia prevalence among lactating women and (2) the risk factors associated with anemia. Factors of malnutrition, self-reported symptoms of night blindness or poor dark adaptation, lack of primary education experience, low family annual capita income, drinking spring or river water, and drinking unboiled water were associated with anemia. To promote health in lactating women, a comprehensive intervention is needed in these regions.

Can an Integrated Approach Reduce Child Vulnerability to Anaemia? Evidence from Three African Countries. PLoS One, Mar 2014. K Siekmans. (Link)
Addressing the complex, multi-factorial causes of childhood anemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a “buffering” of risk associated with known causes of anemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention.

Systematic Review and Meta-Analysis: Association Between Water and Sanitation Environment and Maternal Mortality, 2014. SHARE Project. (Link)
There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders.

Review Paper: The Uneven Progress of Sanitation in IndiaJournal of Water, Sanitation and Hygiene for Development , 4(1) 2014. A Ghosh. (Link)
The 2001 and 2011 Census of India returns are used to document the proportion of households with access to a latrine on their premises, in the different regions, states, and districts of India and track their progress toward meeting Millennium Development Goals. This analysis found wide regional differences and explored the causes for these variations. One possible cause is the close association between district sanitation coverage and female literacy, suggesting an important role for education.

2014: The Year We Defeat Child Hunger? The Guardian, Mar 2014. S Gillespie. (Link)
Building on last year’s momentum, nutrition projects have the potential to improve the lives of vast numbers of children, as long as we learn from past successes and failures.

Practical Toolkit for Integrated Programming for Improved Nutrition, 2014. P Schmied. (Link)
People in Need’s approach to nutrition—Integrated Programming for Improved Nutrition— is based on the recognition that undernutrition is caused by multiple factors that cannot be addressed by a single-sector intervention.

Childhood Stunting: Challenges and Opportunities Report, 2014. WHO. (Link)
This report summarizes a roundtable session that sought to reflect on how countries could operationalize their commitment to reduce stunting and other forms of child malnutrition. Three “models” originating at national, subnational, and grassroots levels, respectively, were considered as entry points for agenda setting in stunting reduction. Far from being mutually exclusive, coherence among the three models is central to the success of stunting reduction efforts.

2013 Global Food Policy Report, 2014. International Food Policy Research Institute.(Link)
IFPRI’s flagship report examines the major food policy issues, developments, and decisions of 2013. It puts into perspective the year’s food policy successes and setbacks, and suggests how to advance policies that will improve the food situation for poor people in developing countries.

This literature review is prepared on behalf of the the USAID Community of Practice on WASH, Nutrition, and Food Security was established to facilitate a dialog between and among the staff at USAID and partner organizations. The goals are to encourage discussion around unanswered questions for integrated programming and to provide a clearinghouse for informative articles, events, and recent studies and datasets.

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