2017年-世界发展银行全球_WASH_for_Human_Development___Can_Scaling_Up_Water_Supply_Sanitation_and_Hygiene_Interventions_Help_Children_Grow_in_Tanzania__8页_1mb

WASH for Human Development: Summary

Core Content

This document discusses the role of Water, Sanitation, and Hygiene (WASH) interventions in addressing chronic undernutrition among children under five in Tanzania. It highlights the challenges and opportunities for improving nutrition outcomes through WASH-sensitive programming.

Main Points

1. Undernutrition in Tanzania

• Approximately 2.7 million children under five suffer from chronic undernutrition.
• The prevalence of chronic undernutrition is 35% nationally, with 40% in the poorest quintile and 21% in the richest.
• Boys have a higher prevalence of undernutrition (37%) than girls (32%).
• Rural children are more likely to suffer from chronic undernutrition (37%) than urban children (26%).
• The southwestern region of Tanzania has the highest rates of chronic undernutrition, coinciding with areas of high poverty.

2. Undernutrition Framework

• Chronic undernutrition is caused by inadequate dietary intake and disease.
• Environmental Enteric Dysfunction (EED) is a new hypothesis that links poor WASH environments to chronic undernutrition.
• EED results from repeated exposure to fecal bacteria, impairing nutrient absorption and leading to stunting.

3. WASH-Related Drivers of Undernutrition

• Community-level sanitation is the most significant WASH-related factor affecting chronic undernutrition.
• A 24% threshold of improved sanitation coverage is needed to see a reduction in undernutrition.
• Handwashing with soap also has a significant effect, especially for infants aged 0–6 months.
• Improved water access does not have a strong correlation with chronic undernutrition, likely due to inadequate water quality.
• Indirect pathways of WASH include the time spent collecting water, which reduces opportunities for child care and education, and lack of toilets in schools, which increases school dropout rates among girls.

4. Policy and Operational Implications

• Multisectoral approaches are necessary to address chronic undernutrition, as it is influenced by multiple factors.
• WASH interventions should be nutrition-sensitive, focusing on fecal-oral transmission pathways and monitoring indicators related to enteric infections.
• Smart targeting of interventions in areas with high chronic undernutrition and low sanitation coverage is recommended.
• The WASH Poverty Diagnostic (TWPD) has identified key areas where WASH and nutrition programs can be converged for greater impact.

Key Information

• Data Source: Analysis based on the 2016 Demographic and Health Survey (DHS) data.
• Methodology: Econometric analysis using Shapley decomposition to identify the contribution of WASH variables to chronic undernutrition.
• Recommendations:
  • Prioritize community-level sanitation and handwashing with soap in WASH programming.
  • Monitor water quality and hygiene behaviors to ensure effective interventions.
  • Integrate WASH with nutrition and health programs to create synergies.
  • Focus on areas with high undernutrition and low sanitation coverage for targeted interventions.

Conclusion

Chronic undernutrition in Tanzania is a complex issue influenced by both economic and environmental factors, with WASH playing a critical role. While progress has been made, the lack of clean water and poor sanitation continues to be major barriers. By adopting nutrition-sensitive WASH interventions and multisectoral approaches, policy makers can better address this issue and improve child health and development outcomes.

References

• Chase, C., and F. Ngure. 2016. Multisectoral Approaches to Improving Nutrition: Water, Sanitation, and Hygiene.
• Dangour, A. D., et al. 2013. "Interventions to Improve Water Quality and Supply, Sanitation and Hygiene Practices, and Their Effects on the Nutritional Status of Children."
• Humphrey, J. H. 2009. "Child Undernutrition, Tropical Enteropathy, Toilets, and Handwashing."
• Ngure, F. M., et al. 2014. "Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development."
• Shekar, M., et al. 2017. "Reaching the Global Target to Reduce Stunting: An Investment Framework."
• Skoufias, E. 2016. "Synergies in Child Nutrition: Interactions of Food Security, Health and Environment, and Child Care."

Acknowledgments

• The brief was developed by the Tanzania WASH Poverty Diagnostic team, including George Joseph, Sabrina Sharmin Haque, and Sophie Ayling.
• Contributions were made by Katia Vinha, Peter Gething, John Newman, and Isabel Larenas.

About the WASH Poverty Diagnostic Initiative

• A global initiative led by the World Bank, aiming to improve WASH service delivery for the poor and vulnerable.
• It seeks to understand binding constraints in service delivery and identify technically and politically feasible solutions.
• Results are intended to inform country-level policy dialogue and programming.