WASH’ Nutrition

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LIST OF FIGURES Figure 1: Different types of undernutrition 17 Figure 2: Conceptual Framework of undernutrition 19 Figure 3: Undernutrition throughout the life cycle 21 Figure 4: Nutrition-specific and Nutrition-sensitive interventions 22 Figure 5: Nutrition security approach 23 FIGURE 6: Global trends in child stunting and wasting 27 Figure 7: Relationship between poor WASH and child undernutrition 33 Figure 8: Median age-specific incidences for diarrheal episodes per child per year from three reviews of prospective studies in developing areas 35 Figure 9: Vicious CYCLE BETWEEN intestinal infections AND UNDERnutrition 35 Figure 10: Difference between healthy (left) and EED-infected intestine (right) 36 Figure 11: REDUCTION IN DIARRHEAL MORBIDITY 38 Figure 12: The F-diagram - Fecal-oral route of disease transmission and how WASH provision can prevent it 39 Figure 13: Effect of improvements in drinking water and sanitation on diarrhea disease risk 40 Figure 14: Increasing levels of multi-sectoral integration 46 FIGURE 15: Relevant stakeholders for WASH and nutrition integration 60 FIGURE 16: Humanitarian clusters and their coordination 61 Figure 17: Allocate a protected space for children to play, limiting the likelihood of them ingesting soil or animal feces 75 Figure 18: The Clean Household Approach 75 Figure 19: A counselling card highlights when to wash hands with soap 77 Figure 20: Poster used to discuss key food hygiene practices BY ACF CHAD 81 Figure 21: Global coverage of WASH in health care facilitates 95 FIGURE 22: The Fit for School Action Framework 101 Figure 23: Holistic approach to WASH and nutrition integration 105 Figure 24: DRM cycle, continuum and contiguum 109 LIST OF TABLES Table 1: Cut-off values and anthropometric indicators of undernutrition 18 Table 2: Mortality risks for wasting and/or stunting 20 Table 3: Non-exhaustive example of WASH interventions 26 Table 4: Incorporating WASH elements into nutrition assessments and vice versa 50 Table 5: Common barriers and challenges in WASH and nutrition integration 53 Table 6: Illustrative criteria for population targeting 54 TABLE 7: Ten step model for Assisting behaviour Change (ABC) 58 Table 8: WASH minimum package for households 63 Table 9: WASH Minimum package for health and nutrition centres 65 Table 10: WASH Minimum package for mobile clinics 67 Table 11: Integrating WASH into nutrition counselling and health promotion 86 Table 12: WHO definition of environmental management 91 Table 13: WHO standards on water, sanitation and hygiene in health care 96 Table 14: Excreta disposal options for young children in emergencies 112 Table 15: Evaluation of an integrated project 122 Table 16: Advocacy tools for promoting WASH and nutrition integration 133 10 WASH’Nutrition A practical guidebook
LIST OF BOXES BOX 1: Design characteristics of nutrition-sensitive interventions 23 BOX 2: Community Management of Acute Malnutrition (CMAM) approach 24 BOX 3: WASH’Nutrition TARGETING 45 BOX 4: Seasonal calendar 49 BOX 5: Different age stages and WASH programming 55 BOX 6: Improving children’s participation in WASH behaviour change programmes 57 BOX 7: Assisting Behaviour Change (ABC) model 58 BOX 8: BABY WASH messages 74 BOX 9: 5 CRITICALS times for hand washing with soap 77 BOX 10: 5 Keys to Safer Food by the WHO 80 BOX 11: Breastfeeding – the ultimate hygiene intervention 81 BOX 12: Linking WASH and nutrition when delivering overall community services 84 BOX 13: Reducing animal waste contamination 93 BOX 14: Main hygiene promotion messages used in the ACF mission in Chad during the weekly hygiene promotion sessions in health centres 98 BOX 15: Public health approach to nutrition 105 BOX 16: Overcoming the humanitarian-development divide when addressing undernutrition 108 BOX 17: Child-to-Child Approach overview 113 BOX 18: Monitoring indicators suggested by WASH’Nutrition strategy 120 BOX 19: Effectiveness of adding a Household WASH component to a routine outpatient programme OF Severe Acute Malnutrition 127 BOX 20: International days of shared interest for WASH and nutrition sectors 130 BOX 21: Missing Ingredients Report – WaterAid and SHARE Consortium 135 BOX 22: Germany’s Special Initiative “ONE WORLD NO HUNGER” 137 LIST OF MAPS Map 1: DiarrHea deaths UNDER 5 28 Map 2: WASTING CHILDREN BY REGION 28 Map 3: percentage of children under 5 who are stunted 28 Map 4: Overlying GAM rates with access to drinking water in Chad 48 Map 5: NIGER, 2000: STUNTING, DIARRHEA AND WASH 142 WASH’Nutrition A practical guidebook 11
Page 1 and 2: WASH’ Nutrition A practical guide
Page 3 and 4: WASH’Nutrition A practical guideb
Page 5 and 6: Table of Contents STATEMENT ON COPY
Page 7 and 8: ACKNOWLEDGEMENTS This guidebook has
Page 9: FOREWORD Undernutrition remains a s
Page 13 and 14: NCD NGO NTD NTU ORS PEFSA V PHAST P
Page 15 and 16: The basics of undernutrition and WA
Page 17 and 18: 1. DEFINING undernutrition Defined
Page 19 and 20: 2. the main causes of undernutritio
Page 21 and 22: Chronic undernutrition impairs chil
Page 23 and 24: of undernutrition, the global probl
Page 25 and 26: The CMAM approach has four componen
Page 27 and 28: 6. Global trends in undernutrition
Page 29 and 30: Today, the world’s attention is t
Page 31 and 32: Linking nutritional outcomes with t
Page 33 and 34: 1. nutritional status and the WASH
Page 35 and 36: Figure 8: Median age-specific incid
Page 37 and 38: 3. CONTRIBUTING WASH-related diseas
Page 39 and 40: Figure 12: The F-diagram - Fecal-or
Page 41 and 42: KEY MESSAGES Chapter 2 Despite not
Page 43 and 44: WASH’Nutrition strategy WASH’Nu
Page 45 and 46: 1. Aligning WASH and Nutrition prog
Page 47 and 48: assessment, programme design and/or
Page 49 and 50: pile sorting 89 or focus group disc
Page 51 and 52: 2.3. Formulation and financing of i
Page 53 and 54: Table 5: Common barriers and challe
Page 55 and 56: 3.1. Why targetiNG children, pregna
Page 57 and 58: 4. emphasis on behaviour change PIL
Page 59 and 60: 4.2. Barrier analysis Barrier Analy
Page 61 and 62:
4 Signing memorandum of understandi
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Table 8: WASH minimum package for h
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In remote regions, where infrastruc
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Table 10: WASH Minimum package for
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Better alignment and integration al
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integratING activities at different
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1. at the individual and household
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Figure 17: Allocate a protected spa
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BOX 9: Five CRITICAL times for hand
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1.7. Household water treatment and
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Food hygiene implies maintaining pr
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1.10. monitoring of HOUSEHOLD WASH
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2.1. Community access to WASH for i
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2.3. Community engagement in safe e
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Sanitation marketing (SM) uses comm
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Table 12: WHO definition of environ
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BOX 13: Reducing animal waste conta
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3. AT INSTITUTIONAL LEVEL (HEALTH C
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EXAMPLE FROM THE FIELD 14 Improvin
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EXAMPLE FROM THE FIELD 15 Improvin
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3.4. WASH and nutrition in schools
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enefit when the main vectors for di
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Figure 23: Holistic approach to WAS
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5. Integrating interventions in eme
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Figure 24: DRM cycle, continuum and
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Promoting breastfeeding (and other
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3) Hygiene promotion Hygiene promot
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Key messages on aligning WASH and N
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Monitoring and evaluation of integr
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1. Monitoring integrated activities
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WASH Key indicators 1 Diarrhea prev
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© ACF Chad, 2016 Picture 11: Monit
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MOVING TOWARDS UPTAKE WASH’Nutrit
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1. OPERATIONAL RESEARCH Beyond the
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Southampton University The Universi
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WASHplus Since 2010, the USAID-fund
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Table 16: Advocacy tools for promot
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LEARN MORE A follow-up document to
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Canada, the European Union, France,
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PROGRAMMATIC resources WASH’NUT A
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1. PROGRAMMING EXAMPLE OF AN INTEGR
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2. IDENTIFICATION MIRA (Multi-secto
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3. FORMULATION EXAMPLE OF A WASH’
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EXAMPLE OF A WASH’Nutrition PROJE
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4. FINANCING EXAMPLE OF A WASH’Nu
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5. IMPLEMENTATION AND MONITORING ho
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6. EVALUATION Examples of WASH’Nu
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WASH’Nutrition A practical guideb
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WASH’ Nutrition

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