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Starting life strong in slums: the role of engaging vulnerable groups on sanitation and nutrition

Claire Chase's picture
This blog is co-authored with Lawrence Haddad, Executive Director, The Global Alliance for Improved Nutrition (GAIN)

Other co-authors: 
Beatrice Montesi, GAIN  
Martin P. Gambrill, The World Bank 
Rebecca Jean Gilsdorf, The World Bank

 
Children in a slum in Dhaka, Bangladesh.
Credit: UN Photo/Kibae Park

Crowded slums, poor sanitation and unhealthy diets.  It’s a potent cocktail and for too many families across the world, a daily reality.  Right now, an estimated one billion people live in slums and that number is expected to double by 2030. Slums are where the many deprivations facing the urban poor collide, including lack of access to clean drinking water, sanitation, safe and nutritious foods, sufficient living space, durable housing and secure tenure (UN Habitat).  They’re where human waste is routinely emptied into streets, canals, and garbage dumps. And where overcrowding and low rates of immunization and breastfeeding combine to exacerbate the already perilous problems children face.

Children growing up in these surroundings are at a higher risk of death and disease and are more likely to be chronically malnourished (Ezeh et al. 2017). For example, forthcoming World Bank research from Bangladesh shows that children living in slums are 50 percent more likely to be stunted than children living in other urban areas. This doesn’t just have implications for today - children who are stunted early in life go on to learn and earn less, and face a higher risk of chronic disease as they grow older. Tragically, these effects are often passed on to offspring, trapping families in poverty and malnutrition for generations, as per findings in a forthcoming World Bank report called Uncharted Waters.

Starting a marathon with a broken ankle: how poor water and sanitation sets children behind

Maximilian Leo Hirn's picture
Children in Koutoukalé, Niger

Have you ever wondered how your life chances are affected by where you were born? Odds of being born at all are already miraculously small, but only one in ten of us is born into the relative security of a high-income country. What if you are born in Niger or in the Democratic Republic of the Congo (DRC)? Before you could even walk or talk, your challenges would be daunting. That's because, despite progress, deaths of children under five years old are more than twenty times higher than in the EU and nearly ten times higher than in China.

Even if you survived, you would confront another major risk to your development: malnutrition. In Niger and DRC, almost one out of every two children is stunted. Stunting has significant and long-lasting negative effects on early childhood development, impeding physiological and mental development, and making small children more vulnerable to disease. Starting off in life stunted is akin to starting a marathon with a broken ankle.

World Population Day 2017: What can we learn from Bangladesh?

Maitreyi Bordia Das's picture
Mom and daughter at a community health center outside Dhaka,
Bangladesh. Photo: Rama George-Alleyne / World Bank

Today marks World Population Day and this year’s theme is “Family Planning: Empowering People, Developing Nations”. It is an opportune moment to reflect and continue the conversation on demographic trends that I started through my blog on fertility decline last month.

Self-Help Women’s Groups in India help change behavior around diets and toilet use to improve health

Vinay Kumar Vutukuru's picture



Sushila Devi, a mother of four in the rural Rohtas district of Bihar, India, has no significant assets and depends primarily on casual labor for income. She recently was able to take out a bank loan of INR 12,000 (US$180), which she used to construct a toilet in her family home

It was the Self-Help Group (SHG) in her village that persuaded Sushila of the importance of sanitation for her children’s health and nutrition, and helped her get the loan she needed. SHGs generally consist of 12 to 15 rural women, grouped into larger federations. They engage with formal financial institutions to help unbanked households access financial services, acting as platforms for standardized large-scale sensitization of community members on a variety of subjects.

Sushila’s actions are part of a larger change driven across Bihar by the recently launched Bihar Transformative Development Project (BTDP), commonly known as JEEViKA-II. This joint initiative of the Government of Bihar and the World Bank covers 300 (56 percent) of the blocks of rural Bihar. The project is working through SHGs to deliver awareness, training, finance, and monitoring on sanitation and nutrition in an integrated manner.

Toward water and sanitation for all: Featuring Matt Damon, co-founder of Water.org

Brittany Scalise's picture
Matt Damon urges ministers to move aggressively toward water and sanitation for all.
Watch his full remarks: http://live.worldbank.org/water-and-sanitation



Last week, on April 20th, Matt Damon, co-founder of Water.org, addressed ministers of finance, water, and sanitation from across the world at the Sanitation and Water for All (SWA) Finance Ministers’ High Level Meeting at the 2017 World Bank-IMF Spring Meetings. The meeting focused on finding ways to fill the enormous financing gap via innovative financial solutions. Mr. Damon urged ministers to consider the full breadth of financing options to achieve the goal of providing safe, affordable, and sustainable water and sanitation for all.

The “5Ds”: Changing attitudes to open defecation in India

Vandana Mehra's picture
In the village of Bharsauta in Uttar Pradesh, India, construction worker Vishwanath lives with his wife, four children and their elderly parents. Three years ago, the government paid to build a toilet in their house. But the job was not done well: the pit was too shallow, it overflows frequently, and the smell makes it suffocating to use.

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.

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?

How we help countries track and report on the Sustainable Development Goals on water, sanitation and hygiene

Ana María Oviedo's picture
Enumerators in Ecuador collecting water sample
for water quality test.
Credit: World Bank team in Ecuador

Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
 
From MDGs to SDGs: What’s New for Water and Sanitation?
 
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.

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