Transcript ASIAN TSUNAMI DISASTER

Food Security and Nutrition Network
Regional Knowledge Sharing Meeting
Washington, DC
November 15, 2012
WASH and Health
and Nutrition
Chris Seremet, PE
Technical Advisor – Water Supply and Sanitation
Catholic Relief Services
Baltimore, MD
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Food For Peace Goal
• To minimize hunger in the world so that people
everywhere can enjoy active and productive lives
and, ultimately, to ensure that one day no one
needs food aid
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However, there are barriers to realizing healthy,
productive lives…….
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Diarrhea
• 2.2 million deaths each year
– 1.6 million preventable child deaths per year
• 73 million DALYs lost per year
• 80% of cases of diarrhea worldwide are attributable
to the ingestion of pathogens, especially in unsafe
drinking water, in contaminated food or from
unclean hands.
• Cholera, typhoid and dysentery
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Neglected Tropical Diseases
• Soil-transmitted Helminths (Ascariasis,
Trichuriasis and Hookworm)
– 2 billion infections—affecting one third of the
world’s population—that could be prevented
– 4 million DALYs lost per year
– Affects 400 million school-aged children per year
– Transmission of intestinal parasitic worm
infections occurs through soil contaminated with
feces.
– Entirely preventable by adequate sanitation, and
intervention outcomes are reinforced by good
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hygiene.
Neglected Tropical Diseases
• Schistosomiasis
– 200 million people with preventable infections
– 1.7 million DALYs lost per year
– Caused by contact with water bodies
contaminated with the excreta of infected people
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Malnutrition
• 860,000 preventable child deaths per year
• 17 million DALYs lost per year
• Childhood underweight causes about 35% of all
deaths of children <5 years worldwide.
• An estimated 50% of this underweight or
malnutrition is associated with repeated diarrhea or
intestinal parasite infections
– a result of unsafe water, inadequate sanitation or
insufficient hygiene.
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Tropical Enteropathy
• Changing the structure and function of the small
intestine leads to undernutrition
• Reduced surface area of small intestine - decreased
villous height - ‘flat architecture’
– Lowers nutrient absorption
• ‘Leaky gut’ (increased permeability of the intestinal
tract) and impaired ability to prevent pathogens from
breaching the intestinal barrier
– Elevated immune response
– Nutrients diverted from growth to defense
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Tropical Enteropathy
• Thought to be caused by chronic ingestion of
pathogenic microorganisms.
• Linked to living conditions with poor sanitation and
hygiene practices.
• Likely to be prevalent in developing countries.
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Fecal – Child Undernutrition
Pathway
Source: Humphrey (2009)
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Evidence is Lacking
• Many studies, many methodological issues
• Limited evidence
– Suggests that nutrition interventions can
substantially reduce or even eliminate the
negative effect of diarrheal disease on child
growth.
– Can’t conclude that high rates of infection make
nutrition interventions ineffective for improving
child growth.
• Likely a combination of improved nutrition and
infection prevention and control efforts
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Evidence is Lacking
• Most studies agree with WASH interventions
• Randomized controlled trials of toilet provision and
handwashing promotion that include tropical
enteropathy and child growth as outcomes
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The F-Diagram
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Source: UNICEF
Nutrition and infection prevention
and control interventions
• Hygiene Behavior Change
– Handwashing with soap at key times
– PHAST / CLTS
• Sanitation
– Latrines – household and at the fields
– Improve drainage around muddy areas
• Water
– Drinking Water Supply from a protected source
• Drinking water system at same time as irrigation system
• The potential health gains are reduced sharply with even
occasional consumption of untreated drinking water
– POU Treatment and Storage
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FFP Standard WASH Indicators
• Percentage of households using an improved
drinking water source
• Percentage of households with access to an
improved sanitation facility
• Percentage of households with children aged 0–
23 months that have water and soap or locally
available cleansing agent at a hand washing place
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Improved Drinking Water Source
• An improved water source is an infrastructure improvement to
a water source, a distribution system, or a delivery point. By
nature of its design and construction, the improvement is
likely to protect the water source from external contamination,
in particular fecal matter.
• Improved drinking water sources are:
–
–
–
–
–
–
Piped water into dwelling, plot, or yard
Public tap/standpipe
Tube well/borehole
Protected dug well
Protected spring
Rainwater collection
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Improved Sanitation Facility
• A sanitary facility in the household and whether that sanitary
facility meets the improved sanitation standards defined in
the Millennium Development Goals (MDGs).
• Improved sanitation is defined as:
– Flush or pour/flush facilities connected to a:
• Piped sewer system
• Septic system
• Pit latrine
– Pit latrines with a slab
– Composting toilets
– Ventilated improved pit latrines
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Improved hygiene practices
• At households with children aged 0–23 months:
– Presence of a hand washing station
– Presence of water in hand washing station
– Presence of soap or other cleansing agent at hand
washing station
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Thank You
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Chris Seremet
Technical Advisor – Water Supply and Sanitation
Catholic Relief Services
E-mail: [email protected]
Website for CRS publications:
www.crsprogramquality.org
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Fecal – Child Undernutrition
Pathway
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