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Helping children survive and thrive: How toilets play a part

Claire Chase's picture



While child mortality rates have plummeted worldwide, nearly one-third of all children under 5 in developing countries are stunted. Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.  
 
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
 
Just last week estimates were released suggesting that poor sanitation is the second leading cause of child stunting worldwide (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).  
 
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:

Addressing the urban sanitation crisis: Time for a radical shift

Martin Gambrill's picture

Co-authors:

The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell

Children in Maputo, Mozambique 
Photo credit: 
Isabel Blackett/The World Bank

A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).

World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.

120 minutes: A story of a water master and transformative irrigation in Afghanistan

Bashir Ahmad's picture



As the local mirab - “water master” and I walked along the high-elevation canal, high winds blew sand in our mouths and eyes. The elevation canal in Herat province is famous for its “120 days of wind.” Located in the far west of Afghanistan, Herat is home to the Hari Rud River basin, giving the province the potential to be an agricultural heartland. But the area I walked was not green and lush, rather, it looked like desert.
 
Herati farmers cultivate wheat, barley, and vegetables, but also face severe water shortages and irrigation issues. “Poor people cultivate wheat as a major crop to have at least something to eat,” said a local villager. “Most years, the flood flushes away our soil bags and we cannot divert water into the canal.”
 
The water shortages are not due to the lack of water, but rather the lack of efficient water management. As Regional Manager of the On-Farm Water Management Project (OFWMP) in Herat, I was there to visit sites for potential irrigation projects in three villages: Kushk-e-Baad Saba village in Injil district, and Deh Surkh and Deh Pada villages in Zenda Jan district. Through these projects, we could work with local villagers to transform this dusty desert into fruitful farmland.

Looking ahead towards a water-secure world for all

Guangzhe CHEN's picture

To many people, it is a surprise to learn that in an age of such advanced technology, at least 663 million people still lack access to basic needs, like safe drinking water, or that 2.5 billion people lack access to sanitation, such as a toilet or latrine. And while much progress has been made, receiving safe drinking water 24 hours a day, seven days a week simply by turning a tap is still a dream for many in the developing world.
 
Even fewer realize this is not just a problem for families, but also for those on which families rely and that also need water: the farmers who grow the families’ food, the environment that protects and sustains their homes and communities, the businesses that employ them, the cities that house them, the schools that educate their children, the clinics and hospitals that treat them, and even the power plants that generate their electricity.
 
Why does this challenge persist? How can this challenge be met? And an increasingly urgent question: is there enough water to go around?

5 reasons why big data innovation is critical to address climate resilience

Haishan Fu's picture


In today’s world of mobile technology, social networks, pervasive satellite and sensor information and machine-to-machine transactions, data is becoming the lifeblood of many economies. Data-informed decision making is more important than ever before. However, the ability to use data in development and decision-making processes has not seen the same progress. Relying on data to inform decisions requires that the appropriate tools and analytical methodologies exist in order to use it effectively.

Through the Big Data Innovation Challenge, the World Bank is calling out to innovators globally for higher resolution, regional or sector-specific big data prototypes and solutions in support of watersheds, forests, food security and nutrition.

Here are five facts from our climate team about our water, forests and food security that remind us why your big data innovation is necessary.

Targeting urban sanitation: Looking behind aggregated city-level data

Peter Hawkins's picture
Also available in: Español

In our previous blogs: Fecal Sludge Management: the invisible elephant in urban sanitation,  5 lessons to manage fecal sludge better, and A tale of two cities: how cities can improve fecal sludge management, we outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing urban sanitation challenges and how they can be used. Today, on World Cities Day, we are looking more deeply into a city — Lima, Peru, to shed light on how cities around the world can meet opportunities and address challenges of urbanization including providing improved sanitation for a rapidly growing number of urban residents.

CCTs for Pees: Cash Transfers Halloween Edition

Berk Ozler's picture

Subsidies to increase utilization are used in all sorts of fields and I have read more than my fair share of CCT papers. However, until last week, I had not come across a scheme that paid people to purchase their urine. Given that I am traveling and the fact that I am missing Halloween, I thought I’d share (I hope it’s not TMI)…
Here is the abstract of an article by Tilley and Günther (2016), published in Sustainability:
In the developing world, having access to a toilet does not necessarily imply use: infrequent or non-use limits the desired health outcomes of improved sanitation. We examine the sanitation situation in a rural part of South Africa where recipients of novel, waterless “urine-diverting dry toilets” are not regularly using them. In order to determine if small, conditional cash transfers (CCT) could motivate families to use their toilets more, we paid for urine via different incentive-based interventions: two were based on volumetric pricing and the third was a flat-rate payment (irrespective of volume). A flat-rate payment (approx. €1) resulted in the highest rates of regular (weekly) participation at 59%. The low volumetric payment (approx. €0.05/L) led to regular participation rates of only 12% and no increase in toilet use. The high volumetric payment (approx. €0.1/L) resulted in lower rates of regular participation (35%), but increased the average urine production per household per day by 74%. As a first example of conditional cash transfers being used in the sanitation sector, we show that they are an accepted and effective tool for increasing toilet use, while putting small cash payments in the hands of poor, largely unemployed populations in rural South Africa.”
 

Korea: A model for development of the water and sanitation sector

Alexander Danilenko's picture
Cheonggyecheon Stream, Seoul, Korea 
Photo: Mark Pegrum

Can a sustainable water sector be developed simultaneously with a country’s growth? Can the water sector continue to expand and achieve comprehensive coverage and financial sustainability goals to become a recognized global model for water sector management and performance? Can a country without a single sewer line in 1958 have 90 percent of its wastewater treated by 2012?

The answer is yes! The example is Korea.

New directions in the economics of agricultural water conservation

Susanne M. Scheierling's picture

A challenging area in agricultural water management is the assessment of policy and investment options in irrigated agriculture for conserving water and adapting to increasing water scarcity, in particular when the linkages to groundwater resources and their management are to be considered and incorporated. 

However, this is an increasingly important area of research for a number of reasons.  First, irrigated agriculture accounts for about 70% of global freshwater withdrawals, and is a major contributing factor to the water scarcity situation in many countries.  Second, with almost a quarter of freshwater withdrawals for irrigated agriculture being made up of groundwater supplies—corresponding to 70% of total groundwater withdrawals—, agricultural water use is also a major contributing factor to aquifer overexploitation.  And, third, surface water and groundwater are closely linked in most parts of the world, with groundwater discharge contributing to the base flow of streams and surface water contributing to groundwater recharge, and these interactions are intensified by human action, in particular water withdrawals for irrigated agriculture.  Even in cases where irrigated agriculture depends mostly on surface water, groundwater impacts therefore need to be accounted for when assessing water conservation efforts (and vice versa).


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