wash, nutrition and ecd matter_julia rosenbaum_4.25.13
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Why WASH, Nutrition and ECD Matter for health, thriving infants and children
Julia Rosenbaum, FHI360USAID WASHplus Project
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Building the Case for Integration:
The 3 Legged Stool
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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
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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
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Scope of Undernutrition & Stunting
Prevalence of stunting (height/age) >-2SD (HAZ)Source: Black et al, 2008
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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
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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
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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!!!!!!!!
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Safe Storage & Treatment of Water
Handwashing
Safe Feces DisposalFocus on WASH
behaviors for Diarrhea Disease Reduction….
Food hygiene
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Safe Storage & Treatment of Water
Handwashing
Safe Feces DisposalFocus on WASH
behaviors for Diarrhea Disease Reduction….
21%
30% ++
43%
30-50%
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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
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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)
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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
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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)
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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
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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”
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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
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Adding Handwashing and Responsive Feeding as Essential Nutrition Actions