Citizen Journalist: Siobhan Nestor


Nutrition and WaSH Integration, Research and Future Challenges

Integration of Nutrition and WaSH programmes was the key topic discussed at the multi sectorial panel seminar hosted by Irish Aid, the IFGH and the Development Studies Association of Ireland on the 19th May.

Jacinta Greene and Dr. Sean Farren of DSA Ireland introduced the panel of speakers, consisting of Professor Robert Chambers, Research Associate at the Institute of Development Studies; Niall Roche, WaSH / Environmental Health consultant; Mags Gaynor of Irish Aid; and Kate Golden, Senior Nutrition Advisor to Concern Worldwide. Attendees drew from anthropologists, health professionals, nutritionists, WaSH advisers, NGO programme managers, researchers and policy makers.


Shit stunts – long-term consequences of poor sanitation

The day’s unofficial catchphrase of “Shit Stunts” succinctly captured the dangers of poor sanitation and its impacts on nutrition and health outcomes in infants and children. Barriers to integration of both nutrition and WaSH programmes were duly tackled by the panel, and comprised an insufficient research base surrounding faecally transmitted infections (FTIs), social and cultural taboos enveloping basic hygiene practices such as handwashing, and the current emergency funding style of programmes, preventing long term intervention, or funding being directed towards singular aspects of WaSH such as provision of the safe quality of water.

Professor Robert Chambers gave the key opening address drawing our attention to the international progress of community led sanitation programmes and highlighted the need for sanitary conditions in preventing and thus tackling under nutrition. Prof. Chambers described a series of biases provided by misperceptions directed towards FTIs, such as the reductionism bias with a tendency to focus research and funding towards the “oral versus anal” such as the current standard approach of hunger programmes to focus on food and nutrient availability, agriculture, access, and ability to obtain food whereas the impact of the gut and microbiota, parasitic interactions on the nutritional status struggles to remain a priority for medical research in the developing context.

Another bias highlighted facing WaSH programmes and research into FTIs was that of social taboo and misperceptions surrounding the “attractiveness” of these infections. For example, the currently used measurable indicators such as the incidence of diarrhoeal episodes, and focus on the oral route, exclude consideration for other infections such as hookworm which enters the body via the skin.

The concept of Community-Led Total Sanitation (CLTS) programmes was described as being designed with intent to stimulate active involvement of the community through a series of practical hands-on workshops and inciting community responsibility for developing open defecation free areas and barriers to the same in high population density areas such as India. The five influencing factors surrounding the success of CLTS were described as antibodies in fighting infections, allopathogens and availability, the access route, nutrient availability and nutrient absorption.

Field knowledge and rapid learning

Niall Roche went further in discussing the issue of high population density, mentioning the need for urban planning in developing open defecation free areas as well as leveraging the private sector in developing novel initiatives such as biodegradable defecation bags that can be utilised as bioresources, drawing the audience’s attention to the potential commodity value of human waste. Roche stressed the “know-do gap” in our current practices citing historical examples of concurring decreases in infections with enactment of good hygiene and sanitary practices within the developed world and yet insufficient timely implementation of these simple interventions within the developing context. He discussed the known impacts of WaSH programmes on health benefits, however also ascertained a need to increase the smaller evidence base for direct impacts on nutrition outcomes.

Mags Gaynor described the common underlying determinants of under nutrition and poor sanitation practices as gender equity, poverty, and climate change with a direct need for integrated programmes to focus at grassroots level and take lessons from causal analysis, operational research and personal experiences.

“Baby WaSH” was proposed by Kate Golden as a revolutionary area for further development and implementation into nutrition and WaSH programmes. Simple strategic measures such as provision of protected area for children to play or rest away from contaminated areas with faeces, soil, washing practices, handwashing by the caregiver, and exclusive breastfeeding for six months and boiling drinking water were all cited as effective hygiene interventions.

Golden also advocated for overlap between both Nutrition and WaSH professionals and the potential efficacy of conducting joint assessment, survey analysis and outreach programmes steered by both disciplines. Upskilling of professionals was determined as a prerequisite to reaching this lateral sharing of knowledge between both sectors.

Shared experience and analysis

The facilitated discussion and questions posed to the panel surrounded future take home messages and areas for development to integrate both nutrition and WaSH programmes. Future developments proposed from the engaging discussion surrounding programme integration included lateral knowledge sharing through rapid adaptive learning, causal analysis and ensuring context specific, operational research primarily focuses on the experiences of individuals and communities.

Key messages from the day included development of outcome measures relevant to both disciplines such as stunting and child morbidity, providing for gender equality through empowerment and supply of micro finance, redefining and using rapid adaptive learning from previous experiences and creating positive deviance, drawing on ideas provided by the market sector to harness the power of simple, effective behaviour change communication messages and assuring future developments for context specific research.

The inaugural presentation of the Robert Chambers Award drew the stimulating discussion to a close. The award was presented to Professor Padraig Carmody of the TCD Geography Department, whose paper, “It is Easy to Rule a Poor Man: “Ecolonisation” and the politics of Land Grabbing in Uganda”, co-authored with Professor David Taylor, was the most innovative paper presented at the last DSA Ireland Annual Conference (2014).

Siobhan Nestor is a clinical nutritionist with a passion for advocating on nutrition and food  systems within the developing world. She is currently an active member of the Joint DSA Ireland / IFGH Child Health, and Nutrition Groups.

Siobhan can be contacted via email at: [email protected]


This article is just one of the many great pieces in our growing library of Global Health Writes articles. We have an ever-expanding team of IFGH Citizen Journalists, and have recently held a training workshop. If you would like to join this new programme, please click here!


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