Integration of water, sanitation, hygiene and nutrition programming is associated with lower prevalence of child stunting and fever in Oromia, Ethiopia

  • African Journal of Food, Agriculture, Nutrition and Development, Volume 19, No. 4, Year 2019

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Study Justification:
The study aimed to investigate the impact of integrating water, sanitation, hygiene (WASH) and nutrition programming on the prevalence of child stunting and fever in Oromia, Ethiopia. This research was conducted to address the knowledge gap regarding the effectiveness of integrated interventions in improving child health outcomes in areas with poor WASH conditions.
Highlights:
1. The study compared two intervention groups: a nutrition-only group and an integrated WASH and nutrition group.
2. Health care workers were trained in community management of acute malnutrition and infant and young child feeding practices in both groups.
3. The integrated group received additional interventions, including water tap construction and community-led total sanitation and hygiene.
4. A household and child anthropometric survey was conducted four years after the initiation of the interventions.
5. Children from the integrated group had a significantly lower prevalence of stunting and fever compared to children from the nutrition-only group.
6. Access to improved sanitation facilities was higher in the integrated group.
7. The integration of WASH and nutrition was associated with improved child growth and reduced disease prevalence.
Recommendations:
1. Policy makers should prioritize the integration of WASH and nutrition interventions to improve child health outcomes, particularly in areas with poor WASH conditions.
2. Health care workers should receive training in community management of acute malnutrition and infant and young child feeding practices.
3. Efforts should be made to increase access to improved sanitation facilities, as this was associated with improved child growth.
4. Community-led total sanitation and hygiene programs should be implemented to promote proper hygiene practices and reduce disease prevalence.
Key Role Players:
1. Health care workers: Trained in community management of acute malnutrition and infant and young child feeding practices.
2. Policy makers: Responsible for prioritizing and implementing integrated WASH and nutrition interventions.
3. Community leaders: Engaged in community-led total sanitation and hygiene programs.
4. Researchers: Conducting further studies to assess the long-term impact and sustainability of integrated interventions.
Cost Items for Planning Recommendations:
1. Training programs for health care workers.
2. Construction of water taps and sanitation facilities.
3. Community-led total sanitation and hygiene programs.
4. Monitoring and evaluation of interventions.
5. Research studies to assess the effectiveness and sustainability of integrated interventions.
Please note that the provided cost items are general categories and not actual cost estimates. The actual costs will depend on various factors such as the scale of implementation, local context, and specific interventions chosen.

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The difference in prevalence of undernutrition and two-week disease history in women and children in Oromia, Ethiopia was compared between two intervention groups: nutrition only (comparison group) and integrated water, sanitation, and hygiene (WASH) and nutrition (integrated group). In both groups, health care workers were trained in community management of acute malnutrition and infant and young child feeding practices. Health care workers in turn organized events and household visits to identify and treat acutely malnourished infants and children, convey messaging regarding proper infant and young child feeding, and provide vegetable seeds for household gardens. The integrated group additionally received water tap construction and community-led total sanitation and hygiene. Four years post initiation, a household and child anthropometric survey (n=1,007) of mothers of children 0-59 months was conducted in 12 villages (6 per group). Accounting for sample design, logistic regression was used to determine adjusted odds ratios for child nutritional outcomes and child and maternal two-weekdisease history by intervention group. At follow up, intervention groups were similar in demographics, diet and feeding practices, immunization, supplementation, and access to water and hygiene. Access to an improved sanitation facility was greater in the integrated group (48%) than in the comparison group (28%) (p=0.02). Children from the integrated group had a 16 percentage point (95% CI: 0-32 percentage points) and 14 percentage point (95% CI: 5-22 percentage points) lower prevalence of stunting and fever, respectively, than children from the comparison group. The adjusted odds of stunting and fever in children from the integrated group were 50% (OR: 0.50, 95% CI: 0.26, 0.97) and 49% (OR: 0.51, 95% CI: 0.36, 0.74) lower than the odds of stunting and fever in children from the comparison group. Stratifying by intervention group, mean height-forage Z-score increased with sanitation facility among children from the comparison group only. There was no difference in maternal history of disease between groups. Integration of WASH and nutrition was associated with less stunting and disease in children 0-59 months in a setting with poor WASH conditions. Differences in sanitation may contribute to the gains in growth seen among children in the integrated group.

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One potential innovation to improve access to maternal health based on the study mentioned is the integration of water, sanitation, hygiene (WASH), and nutrition programming. This approach involves combining efforts to address both nutritional needs and access to clean water, sanitation facilities, and hygiene practices. The study found that the integrated group, which received WASH and nutrition interventions, had a lower prevalence of child stunting and fever compared to the nutrition-only group. This suggests that integrating WASH and nutrition can have positive effects on child health outcomes.
AI Innovations Description
The recommendation from the study is to integrate water, sanitation, hygiene (WASH) programming with nutrition interventions to improve access to maternal health. The study conducted in Oromia, Ethiopia compared two intervention groups: a nutrition-only group and an integrated WASH and nutrition group. In both groups, health care workers were trained in community management of acute malnutrition and infant and young child feeding practices. They organized events and household visits to identify and treat malnourished children, provide messaging on proper feeding practices, and distribute vegetable seeds for household gardens.

The integrated group received additional interventions including water tap construction and community-led total sanitation and hygiene. Four years later, a survey was conducted on mothers of children aged 0-59 months. The results showed that children from the integrated group had a lower prevalence of stunting and fever compared to the comparison group. The adjusted odds of stunting and fever in children from the integrated group were also lower than in the comparison group.

The study suggests that integrating WASH and nutrition interventions can lead to improved maternal health outcomes, specifically reduced stunting and disease prevalence in children. The access to improved sanitation facilities was also found to be greater in the integrated group. This indicates that differences in sanitation may contribute to the positive effects seen in the integrated group. Therefore, integrating WASH and nutrition interventions can be a promising innovation to improve access to maternal health.
AI Innovations Methodology
Based on the provided description, the integration of water, sanitation, hygiene (WASH), and nutrition programming has shown positive impacts on improving access to maternal health in Oromia, Ethiopia. The methodology used to simulate the impact of these recommendations on improving access to maternal health involved the following steps:

1. Intervention groups: Two groups were formed – the comparison group (nutrition only) and the integrated group (WASH and nutrition). Both groups received training in community management of acute malnutrition and infant and young child feeding practices.

2. Implementation of interventions: Health care workers organized events and household visits to identify and treat acutely malnourished infants and children, provide messaging on proper infant and young child feeding, and distribute vegetable seeds for household gardens. The integrated group additionally received water tap construction and community-led total sanitation and hygiene.

3. Follow-up survey: Four years after the initiation of interventions, a household and child anthropometric survey was conducted in 12 villages (6 per group). The survey included mothers of children aged 0-59 months.

4. Data analysis: Logistic regression was used to determine adjusted odds ratios for child nutritional outcomes and child and maternal two-week disease history by intervention group. The analysis accounted for sample design and adjusted for potential confounding factors.

5. Comparison of outcomes: The prevalence of undernutrition and two-week disease history in women and children was compared between the two intervention groups. The integrated group showed lower prevalence of child stunting and fever compared to the comparison group.

6. Statistical analysis: Adjusted odds ratios were calculated to quantify the differences in child nutritional outcomes and disease history between the two groups. Stratification by intervention group was done to analyze the impact of sanitation facilities on child growth.

7. Interpretation of results: The integration of WASH and nutrition programming was associated with lower prevalence of stunting and fever in children aged 0-59 months. The presence of improved sanitation facilities in the integrated group may have contributed to the observed improvements in child growth.

In summary, the methodology involved comparing the outcomes of two intervention groups, analyzing the data using logistic regression, and interpreting the results to assess the impact of integrating WASH and nutrition programming on improving access to maternal health.


Statistics:
Citations: 3
Identifiers:
DOI: 10.18697/ajfand.87.17785
ISSN: 16845358
Research Areas:
Community Interventions, Environmental, Food Security, Health System and Policy, Maternal and Child Health
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Quasi Experimental Study, randomised-control-trial
Study Approach:
Quantitative
Participants Gender:
Female
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