WASH’ Nutrition

1.10. monitoring of HOUSEHOLD WASH CONDITIONS IN CASE OF SAM relapse
A certain proportion of children discharged as cured from nutrition programmes have a new event of acute undernutrition
soon after the successful discharge - a relapse. Many factors could contribute to SAM relapse including lack of access to
nutritious foods, inadequate care practices, illness of caretaker, high infections disease burden in the community, etc. WASHrelated
diseases, such as repeated bouts of diarrhea, are known to be a risk factor for wasting relapse. That being the case,
in the settings where prevalence of severe acute undernutrition is high, regular visits to the households of the relapse SAM
cases could be organized. The purpose of these visits is to investigate household WASH conditions i.e. access to water and
sanitation, water treatment and storage practices, use and maintenance of toilets by adults and children, general hygiene in the
household, hand-washing practices of mother/caretakers, etc. and investigate if there is an association between poor WASH
conditions at the household level and the SAM relapse. This information can help the project team to better shape WASH
interventions and focus on specific issues in the households that are contributing to worsening of children’s nutritional status
and put them in risk of relapsing.
Similarly to SAM relapse, the GEMS study 137 recommends specific monitoring and follow-up care of diarrhea episodes.
Changing the way diarrheal disease care is delivered to include longer-term monitoring and nutritional rehabilitation could
improve child health and survival. In particular, instituting a follow-up visit after the initial treatment, either in a healthcare
setting or at home, could dramatically improve health outcomes. 138
Key messages on WASH and nutrition at the individual and household level:
KEY
MESSAGES
Household WASH interventions that address caregiver hygiene behaviours and keep children
from consuming contaminated food and water are essential for preventing diarrhea, nematodes
and EED and ensuring good nutritional outcomes.
Standard WASH interventions do not address the important vectors of soil, poultry feces, and
infant foods, such as providing a clean play and infant feeding environment. The essential goal of
Baby WASH is to interrupt the key fecal-oral vectors of babies’ hands and hand-to-mouth activity,
paying attention to animal feces as well as human feces. This is a more specific, age-targeted
approach, which does not replace general household WASH interventions but complements
them with more targeted interventions for very young children.
Interventions aimed at preventing and reducing EED, particularly through baby-targeted
WASH interventions may be crucial to global stunting-reduction efforts.
Different approaches can be used to encourage households to adopt better WASH practices, with
a minimum need for additional resources. WASH and nutrition interventions can be harmonized
and integrated by using approaches such as “Small Doable Actions” or “The Clean Household”.
Key WASH behaviours needed at the household level to block fecal-oral transmission and prevent
disease are: correct hand washing with soap at key times; using hygienic latrines and safely
disposing child feces; treating, storing and drinking water safely as well as practicing safe food
hygiene. Improving these key behaviours can help prevent undernutrition.
Follow-up and monitoring of diarrhea episodes and SAM relapse cases can help WASH teams
to better address specific issues at the household level contributing to worsening of children’s
nutritional status.
137 - Global Enteric Multi-Centre Study (2014) http://medschool.umaryland.edu/GEMS/
138 - Ibid
WASH’Nutrition
A practical guidebook
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