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nutrition

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.

Why nutrition is a smart development investment

Julia Dayton Eberwein's picture



“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.” - World Bank Vice President of Human Development, Keith Hansen


This is a sentiment long-shared by many of us in the nutrition community and as the global movement in nutrition grows, so does our body of evidence supporting how powerful nutrition interventions are for individuals and for societies.

How protein deficiencies impact the health of communities in India

Parvati Singh's picture
Soybean farmers discuss best practices that can leverage improvement of food and nutrition security in Madhya Pradesh.

The state of Madhya Pradesh in India is largely vegetarian with limited consumption of eggs and meat. 

While these dietary preferences are commonplace in other Indian states, Madhya Pradesh is facing a protein deficiency epidemic which threatens the long term health of its population.

How did it get there?

In 2015 I spent five weeks in rural and tribal areas of Madhya Pradesh evaluating the World Bank’s Madhya Pradesh District Poverty Intervention Project (MPDPIP II), with the support of the South Asia Food and Nutrition Security Initiative (SAFANSI)

Across the 8 districts I visited, families shared how they had improved their agricultural productivity, started backyard kitchen gardening, and supplemented their income through dairy and poultry farming, collective procurement and small scale enterprises.

As I examined local village level health records, Anganwadi Center (AWC) registers, Auxiliary Nurse and Midwife (ANM) registers and Primary Health Center (PHC) documents, I noticed a reduction in severe malnutrition and severe anemia among pregnant women and under 5-year-old children.

However, this decrease did not extend to moderate or mild malnutrition and anemia.

Chickens don't use toilets: Why managing animal feces helps children grow taller

Derek Headey's picture
Those who have tried toilet training a pet dog or cat know that it is a difficult proposition. How about toilet training a flock of 30 chickens?

“Why would I want to?” Because in poor countries, chickens are everywhere, they are pooping wherever they want, and chicken feces is dangerous for young children.

#8 from 2016: Globalization of Food Has a Long History

Maya Brahmam's picture

Our Top Ten blog posts by readership in 2016. This post was originally published on June 17, 2016.  

Our Green Competitiveness Launchpad team is looking at agriculture supply chains in Bangladesh and how they’re affected by climate change – as farmers change the crops they plant owing to drought or flooding. As a result, we’ve been exploring the supply chains of a number of crops from guavas to sunflower and mung beans.

There’s a fascinating infographic from CIAT (International Center for Tropical Agriculture) that illustrates the geographical diversity of the common foods we eat every day. It shows that the globalization of food began centuries ago. Many cultures incorporate foods that originated thousands of miles away. For example, sunflower originated in North America and is now widely produced in Eastern Europe, and guava originated in Central America and is now mainly produced in South Asia.

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:

Why cities matter for the global food system

Francisco Obreque's picture
La Paz, Bolivia. Photo by Andy Shuai Liu / World Bank

I was with the World Bank delegation at the Habitat III Conference in Quito last week, reflecting on the future of cities and speaking at a panel on food security. While there, I could not help but remember the story of Wara, an indigenous Aymara woman, one of eight children from a poor rural family living in the Bolivian Altiplano. Poverty forced her to migrate to the city when she was young.

Now living in La Paz, Wara has been working as a nanny in households for decades. She has three teenagers. Her oldest son is overweight and has already had several health problems. He occasionally works with his father building houses. The other kids are still in school and Wara hopes that armed with an education, they will be able to find a good job.

According to statistics, Wara is no longer poor. Indeed, Wara and her family are better off when compared to her modest origins. The truth is, however, that she is vulnerable and can easily fall back into poverty and hunger.

As in most Aymara families, Wara’s husband administers the money, including her own earnings, but she is the food-provider for the family. Each Saturday he gives Wara some money to get food for the week. She wakes up early to go to one of the four big markets in La Paz to buy basic staples such as potatoes, fresh vegetables, rice, sugar and oil, among others.

At the market, Wara doesn’t always find everything she needs. Climatic or logistic factors often hamper food deliveries to the city. When this occurs, perishable food arrives in bad condition or with lesser quality, and many products are just thrown away.

The story of Wara illustrates some of the current and future challenges for the food system. 

What we learned about the Global Burden of Disease?

Patricio V. Marquez's picture

Kofi Annan, the former Secretary-General of the United Nations, observed that knowledge is power and information is liberating. Indeed, the collection, analysis and dissemination of data and information should not be seen only as an instrument of scientific inquiry but more importantly, as a critical tool for guiding the formulation and implementation of policies to address complex problems in society. 

Tips for reporting on early development: Find the children behind the data

Jerri Eddings's picture
This post originally appeared on International Journalist's Network on September 19, 2016
 
ICFJ Webinar: Reporting on Early Childhood Development
 

Global experts report that a child’s early years are critical to the rest of life. Proper nutrition and brain stimulation improve physical growth and learning ability, while the absence of proper care and feeding in the first 1,000 days can lead to stunting, poor school performance and lower earnings as an adult.

Combating poverty and building resilience through social protection

Michal Rutkowski's picture
Beneficiaries from a safety net program in Madagascar, most of them women, receive regular cash grants and training on nutrition, early childhood development and leadership skills. Photo by: Mohamad Al-Arief / World Bank

In the last few decades, we have seen an increase in the number of countries investing in social protection programs. These programs help individuals and families especially the poor and vulnerable cope with crises and shocks, invest in the health and education of their children, supporting young people by developing their skills and finding jobs, and protecting the aging population.


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