Testing community interventions to reduce infant fecal exposure in rural Zambia Dadirai Fundira Cornell University Kelly Alexander CARE USA Background The Problem Stunting Short ID: 733248
Download Presentation The PPT/PDF document "Environmental Enteropathy and Baby Wash" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Environmental Enteropathy and Baby Wash
Testing community interventions to reduce infant fecal exposure in rural Zambia:Dadirai Fundira – Cornell UniversityKelly Alexander – CARE USA Slide2
Background:
The Problem Stunting
Short stature for age
Affects a quarter of children in developing countries
Develops between conception and the first 2 years of
life
LAZ Z score -2Slide3
Background: Why we care
165 million
Consequences:
Poor cognitive development
Poor educational outcomes
Lower adult wages
Nutrition-related chronic diseasesSlide4
What is causing all of this stunting?
Cause 1: poor diet
The best studies caused a 0.7 Z score improvement. BUT:
the average growth deficit of African and Asian children is
-2.0 Z
At best, diet solved
33% of the problem.Cause 2: Diarrhea The Lancet Nutrition Series (2008) concluded that by implementing sanitation and hygiene interventions with
99%
coverage, child malnutrition would be reduced by only
2.4%
Cause 3: Environmental
Enteropathy
In 2009 Jean Humphrey put forward the hypothesis that
EE primary causal pathway from poor sanitation and hygiene to stunting Slide5
Source: World Bank, accessed 6.23.11
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTWAT/EXTTOPSANHYG/Slide6
6
Babies are fed on *Ground in the yard (60-80% E coli+) or
*Kitchen floor
(81% E coli+)Slide7
% HH with E coli + sample
E coil/
Per gram
Average E Coli
Per Day
Infant Food
0%
0
0
Drinking Water
54%
2
800
Soil in
laundry area
60-80%
70
1,400
Chicken
feces
100%
10,000,000
10,000,000
Ngure
et al,2013Slide8
% HH with E coli + sample
E coil/
Per gram
Average E Coli
Per Day
Infant Food
0%
0
0
Drinking Water
54%
2
800
Soil in
laundry area
60-80%
70
1,400
Chicken
feces
100%
10,000,000
10,000,000
Clearly, kids must stop eating dirt and chicken poop!
Ngure
et al,2013Slide9
Geophagia
, dirty hands
Laundry
Water
Nappy Handling
Protective Play Space
for babies!
Baby WASH: a new paradigm
Ngure
et al,2013Slide10
Methods: The
Baby WASH interventions
Commercial
Community-builtSlide11
Methods: Context
Zambia
Lundazi
district
(Eastern
province)
6 intervention
villages
30 households
Nutrition at the
Center
Integrated
project of CARE
Zambia (
WASH
, nutrition, food security and
gender)
One Health Study
Nested within
Nutrition at the Center intervention areas Slide12
One Health Phases
Participatory w
orkshops to build, prepare, and
explore solutions to babies eating feces
Select & sensitize
6 villages
Recruit Mothers & Babies
(30 HH)
Conduct Baseline Survey & Observation (30 HH)
Introduce
Baby WASH
Module
6 villages
3 Villages
Commercial Play Yard
3 Villages
Community Design
Data Analysis
Consent & interview family; introduce community solution
Interview mother, 24 hour recall, counseling
Interview, 24 hour recall, counseling, Baby & HH observation
Interview, 24 hour recall, counseling
Interview, 24 hour recall, counseling, Baby & HH observation
Consent & interview family re: reactions to EE module, Introduce commercial play yardTrials of Improved Practices (TIPs)Trials of Improved Practices (TIPs)Visit 1, +0wkVisit 2, +2wkVisit 3, +4wkVisit 1, +0wkVisit 2, +2wkVisit 3, +4wkPLANNING & PROTOCOLPHASE 12PHASE 34Slide13
Results: study participants
30 HH baseline observation
Received Intervention and not lost to follow-up
11 HH commercial
playard
10 HH community-built
playardSlide14
Results: Baseline n
=30
Water sources
47% unprotected
Latrine ownership
37% own latrine
Handwashing
231HW events/455 opportunities (50%)
6
% HWWS
Median 1 HW event for babies
Geophagy
98% caregiver reported
100% observedSlide15
Feces in the household yardSlide16
Feces in the household yard
Even
households with latrines had observable human fecesSlide17
What infants mouthed
Mouthing episodes
observed occurred
while infant was on the ground and inside the house or inside the household yardSlide18
In-depth interviews
Most caregivers reported seeing their infant eat soilFive caregivers reported having seen their infant eat chicken feces
Two caregivers reported seeing their infant eat other animal feces
Some mothers believed that eating soil can help close the
fontanel
An increasing number of mothers believed in the harm of
eating: soil < chicken feces < other animal feces
Results: Baseline n
=30Slide19
Methods: The interventions
Commercial
Community-builtSlide20
Results: Describing use
“when he is outside he eats dirty, he even eat chicken droppings but when he is inside he does not eat all
those, he plays very well”“when he is playing from outside he can pick anything even animal waste because he is without reason but when he is inside there, he is safe, there is nothing dirty there”
“…
when he
is inside
they stay together with his friends but when they are outside the friends go away and run away from him.”“When he is in the play yard he sits down to play. When he is outside he moves a lot.”
Commercial
Community-built
How did
playard
affect child’s
exposure to soil and feces, regular movement, and interaction with other
children?Slide21
Results: Describing use
Moved several times a day
Soap used to wash
Used as a play area
Frees
caregiver time
“…once [the mother] puts the baby in the play yard, she can do a lot of chores while the child is playing…” [HH 21: Father]
B
uilt
in area
close to house
Swept several times a day
Play areas and can protect child
May hinder work
"The only problem is that
I always
have to look into [the
play yard
] so much so that when I want
to go
to the field sometimes I am
late… [
HH 54]
Commercial
Community builtSlide22
Summary and conclusion
Both community-built and commercial protective play area acceptable and feasible to mothers
It is clear we need to re-think how we do WASH for the babies
Remaining
questions
Are interventions
effective at reducing fecal exposure?How do we scale up and adapt to different contexts?Safety – leaving babies unattended
Balancing potential benefits of play space and child developmentSlide23
Baby WASH
Funding:
David Atkinson Fou
ndation
Acknowledgements
Rebecca Stoltzfus (Cornell
)
Brie
Reid (Cornell
)
Gretel
Pelto
(Cornell)
Rie
Seu
(Cornell)
Jenny Orgle (CARE USA
)
SHINE trial (Zimbabwe)
Modesta
Chileshe
and the rest of the CARE Zambia team
All the mothers who let us observe them and visit them numerous times!