Integrated WASH and Community Based Nutrition Programs: - PowerPoint Presentation

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Integrated WASH and Community Based Nutrition Programs:

insights from a five-year UNICEF program in Ethiopia

Authors: Samuel Godfrey, Jane Bevan, Katherine F. Shields, Argaw Ambelu, Ronna Chan, Georgia Kayser, Jamie Bartram

Sanitation in Ethiopia

FMoH/UNICEF/EU Situation Analysis of the Nutrition Sector in Ethiopia: 2000-2015. Ethiopian Federal Ministry of Health, UNICEF and European Commission Delegation. Addis Ababa, Ethiopia 2016

Ethiopia

Sanitation

National*

Rural

Urban*Safely managed-4-Basic service7118Limited service7130Unimproved596244No service27327  *No safely managed estimate available 

Malnutrition in Ethiopia

Data from 2016 DHS

Rural Water Supply

Rural

water supplies in

30 Districts

benefiting 1,800 communities

Sanitation & Hygiene

Community Led Total Sanitation and Hygiene resulting in home built toilets, benefiting 280,000 familiesWASH in Schools150 rural primary schools (97,500 school children) with a complete WASH packageWASH in Health Centers150 rural health facilities with complete WASH packageDemonstration of MUSEstablishment of 60 school-managed market gardens to demonstrate the benefits of MUSEnhancing Capacity and KnowledgeStrengthened capacity for communication for behavior and social change in schools and communitiesKnowledge generation and dissemination through networks and fora to inform policy and practiceCBN PackageScaling-up of CBN package in 15 Districts targeting 134,000 children under-two years with GMP, counseling on infant and young child feeding best practicesComplementary FoodsSupporting local production of complementary foods targeting 60 per cent of children under-two years and promote household garden to improve dietary diversityCommunity Health DaysBiannual provision of vitamin A and deworming capsules and quarterly screening of children under 5 and pregnant and lactating mothers for malnutrition and referral to HFCapacity of health workersStrengthening the capacity of health workers on nutrition and data managementNutrition EducationEstablishing nutrition education in 60 per cent of the schools through nutrition clubs and BCC activitiesMicronutrient SupplementationProviding micronutrient supplementation to pregnant and lactating mothers and adolescent girls in and out of school with strong BCC

WASH & MUS

CBN

Integrated WASH, MUS and CBN

UNICEF Ethiopia WASH/CBN

Program components 2012 to 2017

UNICEF Ethiopia WASH/CBN Implementation regions

SNNPR

Oromia

Amhara

Tigray

Outcomes of Interest

StuntingHeight for age z-score 2 standard deviations or more below normal.Baseline: children under the age of fiveMidline: children measured at baseline, new children under the age of five

DiarrheaSelf-reported by head of householdAsked for each member of the householdAnalyzed for children under the age of five

Program groups

Intervention

30

woredas

576

kebeles

319 CBN & CLTSH

kebeles33-50 householdsdepending on region33% houses withoutchildrenControl92 woredas2,158 kebeles4 Regions27 CBN & MUSkebeles230 CBN & CWSkebeles

22 CBN & CH&S

kebeles

2 CBN & MUS

kebeles

16 CBN & CWS

kebeles

67% houses with children

< 5

40-44 households

depending on region

33% houses

without

children

67% houses with children

< 5

36-39 households

depending on region

33% houses

without

children

67% houses with children

< 5

Intervention

30

woredas

576

kebeles

319 CBN & CLTSH

kebelesControl92 woredas2,158 kebeles4 Regions27 CBN & MUSkebeles230 CBN & CWSkebeles40 controlkebeles38-42 householdsdepending on region33% houses

without

children

67% houses with children

< 5

Data collection

Baseline conducted June – Aug 2013Midline: January-March 2017

30 Woredas (Districts)80 kebeles (sub-districts)4 surveysHouseholdCommunityWaSH committeeSchool

Key Results

Stunting reduction across the study is in range of 7-9%, about 2.2% per year

This compares with the national rate of reduction (DHS) of 1.2% per yearNo evidence of difference

between

CBN and

WaSH+CBN

groups from baseline to midlineafter controlling for child age, child gender and region.Diarrheal disease prevalence uncommon (2-4%)

Diarrheal prevalence by Age Group

Mean height-for-age Z-score (HAZ) Stunting

Mean weight-for-age Z-score (WAZ)Underweight

Mean weight-for-height Z-score (WHZ) - Wasting

Stunting: Sanitation Vs Water

Predicted probabilities for likelihood of stunting based on a difference-in-difference analysis of stunting controlling for child age, access to drinking water and sanitation type

Shows differential

effect of improved versus unimproved

drinking water source

by age

group, not for sanitation Sanitation  Drinking water  Child age

Practices to reduce diarrhea

Conclusions and Way Forward

Conclusions

Way ForwardStunting reduction across the board higher than national rate despite El Nino drought (2015-2016)

CBN is being scaled up across the country to support the continued decline of stunting

Convergence of programmes will continue

No statistically significant change in the primary outcomes (stunting and diarrhea) between the two study groups from baseline to midline

Sanitation marketing is being rolled out to increase and improve existing sanitation coverage Baby WASH added to programme to focus specifically on child faeces disposal, infant hygiene and safe play areasDiarrheal prevalence lower than expected based on 2011 DHS results and recent AWD outbreaksChallenges with access, reduced sample size, seasonal variations to be addressed for endline, planned for 2020Data analysis suggests higher impact of water quality on stunting than sanitationSupporting GoE on regulating water safety plans and water quality managementMinimum dietary diversity was found to be very low at baseline and midline, but in-line with the findings from the DHSCBN is being scaled up across the country to support the continued decline of stunting

Acknowledgements and Thanks

With support from:

Government of Ethiopia

And National Partners Plan, SNV, IDE, Ripple

Thank you!