Water access and management play central roles in determining nutritional outcomes. Water-for-nutrition is most often approached from a WASH (water, sanitation and hygiene) perspective, where the aim is to improve water quality and practices for domestic water supply, thus reducing the burden of water-related diseases in a population. A WASH focus for improving nutritional outcomes is especially pertinent, given recent evidence highlighting the role of diarrhoeal disease and environmental enteropathy in determining child stunting. However, there are a number of water-nutrition pathways in addition to WASH that would benefit from greater attention in research and discussion. A session aimed at expanding our understanding of water-nutrition linkages was organised during the 2016 Stockholm World Water Week (26 August to 5 September, 2016). The session was organised by the International Food Policy Research Institute (IFPRI) in collaboration with the Center for Development Research (ZEF) at the University of Bonn, USAID, and Texas A&M University

Mekonnen, D. K.

English

Texas A&amp;M Repository

菀菀. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Beyond the drinking glass:expanding our understandingof water-nutrition linkagesDawit Mekonnen is a Research Fellow atthe International Food Policy ResearchInstitute (IFPRI) in the Environment andProduction Technology Division. Hiscurrent research in sub-Saharan Africafocuses on understanding the impact ofBy Dawit Mekonnen, International Food Policy Research Institute Outline of the sessione session was organised to strengthen insightson the interaction between sectors not oenlinked: nutrition, gender, irrigation, WASH andagriculture. It started off with an interactive ac-tivity where participants wrote down componentsof the water-nutrition “system” on note cards.is provided the more than 75 participantsfrom universities, government agencies, researchinstitutes, intergovernmental organisations, non-governmental organisations (NGOs), civil soci-eties and the private sector the opportunity toidentify potential pathways from water to nu-trition from their respective vantage points. e information gathered is expected toenrich the conceptual framework that IFPRIuses on water-for-nutrition linkages. e inter-active session was followed by four oral presen-tations and discussions on irrigation-nutritionlinkages: Insights from the Innovation Lab forSmall Scale Irrigation (ILSSI) Project and Beyondby Dawit Mekonnen of IFPRI; Agriculture,Water Quality, Nutrition and Health byMuhammed Abdella Usman of ZEF; Multiple-Use Water Services and Improved Dietary Di-versity in Rural Tanzania and Burkina Faso bySara Marks of Eawag (the Swiss Federal Instituteof Aquatic Science and Technology); and Im-proving Community-Led Total Sanitationthrough Experimental Games by Yaniv Stopnitzkyof University of San Francisco. Key findingse presentation on irrigation-nutrition linkagesby researchers from IFPRI explored the majorpotential pathways through which irrigation caninfluence nutritional status. ese potential path-ways include: the production pathway, where ir-rigation provides the opportunity to grow in thelean season to increase production of animalfoods through irrigated fodder and improve cropyields (especially with improved varieties andcomplementary inputs); the income pathway,since irrigation usually leads to higher grossrevenue per hectare for small scale irrigators asit is used mainly for cash crops; the water-supplypathway, as irrigation water may be used forother purposes such as drinking, washing, bathingor other productive purposes (such as livestockwatering and aquaculture); the health-risks path-way, where negative relationship between irrigationand nutrition may arise from increased risk ofvector-borne diseases (such as malaria anddengue), depending on the source of water forirrigation and method of water application; andthe gender pathway, where irrigation projectstargeted at women may have differential impacton nutrition and health outcomes. is is becausewomen may allocate resources gained from thesale of irrigated crops to food and health expen-ditures or use irrigation to grow more nutritiousfoods for home consumption, or because irrigationmay directly contribute to women’s empowerment(for instance, by increasing assets owned orincome controlled by women), but have a potentialnegative effect due to time burden (dependingon the type of irrigation technology or source ofirrigation water).e preliminary findings from an econometricanalysis of irrigation-nutrition linkages by theteam from IFPRI using data from the ILSSIproject in Ethiopia and Tanzania showed thataccess to irrigation significantly improves bothhousehold income and the diversity of cropsthat farmers produce. Increasing household in-come led in turn to higher dietary diversity,suggesting that the income pathway betweenirrigation and nutrition is at play; whereas therelationship between production diversity anddietary diversity is not statistically significantaer controlling for the income effect of irrigation.Although further research is needed on whyproduction diversity from irrigation does notdirectly translate into higher dietary diversity,the researchers hypothesize that this is possiblydue to forgone income benefits from specialisationas farmers in the sample are, on average, pro-ducing up to seven different crops on cultivatedland of less than two hectares. e research from Eawag explores the impactof multiple-use water services (MUS) on thehealth and diet of rural households based oncontrolled-impact evaluation of two MUS pro-grammes in rural Africa. e WA-WASH pro-gramme in Burkina Faso and the iWASH pro-gramme in Tanzania both delivered integratedwater services to improve access to drinkingwater, support vegetable gardens, animal hus-bandry and many other activities. Results showthat whereas food insecurity existed to someextent in all communities, the number of house-holds self-identifying as food insecure was sig-nificantly lower in communities receiving MUS.In addition, a slight improvement in overall di-etary diversity was observed in Tanzania as airrigation on agricultural productivity,nutrition, health and women’sempowerment under the Feed the FutureInnovation Lab for Small-Scale Irrigation, abilateral activity under the CGIAR ResearchProgramme on Water, Land and Ecosystems.Water access and management play central roles in determining nutritional outcomes. Water-for-nutrition ismost oen approached from a WASH (water, sanitation and hygiene) perspective, where the aim is to improvewater quality and practices for domestic water supply, thus reducing the burden of water-related diseases in apopulation. A WASH focus for improving nutritional outcomes is especially pertinent, given recent evidencehighlighting the role of diarrhoeal disease and environmental enteropathy in determining child stunting.However, there are a number of water-nutrition pathways in addition to WASH that would benefit from greaterattention in research and discussion. A session aimed at expanding our understanding of water-nutritionlinkages was organised during the 2016 Stockholm World Water Week (26 August to 5 September, 2016). esession was organised by the International Food Policy Research Institute (IFPRI) in collaboration with theCenter for Development Research (ZEF) at the University of Bonn, USAID, and Texas A&M University. WFP/Rein Skullerud, Liberia, 2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Research菀菀. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .result of MUS. e research also found that an-imal-product consumption improved significantlyas a result of MUS. Data for this study weresourced from USAID and the GLOWS pro-gramme, with support from Winrock, FloridaInternational University and Eawag.e research from ZEF brings another im-portant dimension to the overall discussion asit explores the linkages between agriculture,water quality, nutrition and health using datafrom two districts in Ethiopia. e data fromthe two districts show that although householdswith access to irrigation have slightly betteraccess to drinking water, spend less time collectingwater and have higher per capita water con-sumption compared to non-irrigating households,the level of E. Coli per 100 ml of drinking waterand exposure to malaria was higher among ir-rigators than non-irrigators. Irrigators in thesample had a higher overall morbidity thannon-irrigators and children of irrigating house-holds are more likely to be undernourishedthan children of non-irrigators. A significantnumber of households reported that they directlydraw water from irrigation sources for householdconsumption. Similarly, household membersworking on an irrigated field may contaminatedomestic water sources if proper personal hygieneand handwashing are lacking. e research from University of San Franciscoaimed to explore whether experience of playinga short experimental game, which was designedto mimic strategic interdependencies in sanitationand hygiene behaviour, might alter related pref-erences and behaviour. Looking at a cross-section of data, the authors were unable to as-certain whether playing the experimental gamealters real-world behaviour, although they intendto pursue this question with follow-up surveys.However analysis of the game shows strong ev-idence that even a short, structured game cansignificantly alter a large set of preferencesaround sanitation and hygiene, and importantlyat a very low cost compared to other types ofinterventions. See also: www.ifpri.org/publica-tion/changing-preferences-through-experimen-tal-games-evidence-sanitation-and-hygiene-tamilDiscussion and conclusionse session has brought to light different di-mensions of water-nutrition linkages. e maintheme underlying all the presentations and dis-cussion in the session is that agriculture-water-sanitation-nutrition linkages form a complexsystem that requires a mix of multiple instrumentsfor success. Given the complexity of these linkages,analysing a single pathway may lead to misleadingpolicy recommendations. Analysis thereforecalls for a cautionary approach that exploitssynergies and reduces trade-offs among potentialcausal linkages. For instance, small-scale irrigationcan lead to higher nutritional status (measuredas dietary diversity and food security), but thenutrition and food security dividend from small-scale irrigation requires that health, sanitation,nutrition and gender considerations are activelypromoted during the design and implementationof irrigation development. On the other hand,widespread household water contamination inrural areas can undermine the progress madein increasing access to improved water supplyin many developing countries. e presentations and discussions in the ses-sion showed that the numerous pathways linkingwater, nutrition and gender are still insufficientlyunderstood and call for the water, gender andnutrition sectors to work together to developrigorous research exploring efficient approachesand to collaborate in developing effective pro-grammes and policies to better ensure that therelated Sustainable Development Goals (SDG)of zero hunger, gender equality and clean waterand sanitation are achieved. For more information, contact: Dawit Mekonnen,email: d.mekonnen@cgiar.orgDeterioration of children withMAM who have no access tosupplementary feedingprogrammes Location: EthiopiaWhat we know: ere is no consensus on how best to treat moderate acute malnutrition(MAM) in children; Supplementary Feeding Programmes (SFPs) are commonly used. InEthiopia, SFPs are only implemented in selected woredas defined as chronically foodinsecure.What this article adds: A recent study in two woredas of Ethiopia where no SFPs were inplace investigated outcomes among moderately malnourished children. At baseline, themajority of households were food insecure (one third severely); over two thirds of enrolledchildren (median age 12 months) were stunted (47.3% severe, 20% moderate); 25.1% weremoderately wasted; and 12.7% severely wasted. At endline (28 weeks), one third (32.5%)remained moderately malnourished; 9.3% had experienced at least one episode of severeacute malnutrition (SAM); and 0.9% had died. Only 54.2% of the children recovered fromMAM with no episode of SAM by the end of the study. Children with the lowest MUAC atbaseline had the highest risk of developing SAM or failing to recover from MAM.Independent predictors of relapse aer recovery were MUAC, age, and weight-for-height zscore (WHZ) at admission. Independent predictors of remaining MAM included MUAC andWHZ at baseline, wealth and maternal work indexes, feeding practice scores, WASH intakesand self-reported vitamin A intake. Further preventive and curative approaches should1 James P, Sadler K, Wondafrash M, Argaw A, Luo H, Geleta B, et al. (2016) Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia. PLoS ONE 11(4): e0153530. doi:10.1371/ journal.pone.0153530Summary of researchiChildren with moderate acute malnu-trition (MAM) have an increasedrisk of mortality, infections and im-paired physical and cognitive devel-opment compared to well-nourished children.Consensus on how to manage MAM most effec-tively has still not been reached internationally,although targeted supplementary feeding pro-grammes (TSFPs) are the most common ap-proach, using a variety of supplements such asfortified blended flour and ready-to-use sup-plementary food (RUSF). Other approaches in-clude nutrition counselling and increasing dietarydiversity from existing natural food sources. In Ethiopia, acute malnutrition remains anextensive and seemingly embedded problem. In2011, 10% of children under five years old wereacutely malnourished, 70% of whom had MAM(DHS, 2011). e current strategy in Ethiopia isto restrict SFPs for treatment of MAM to selectedworedas (districts) of the country defined aschronically food insecure. In remaining woredas,there are no food supplementation programmes.e short-term outcomes of children who haveMAM in such areas are not currently described;an urgent need for evidence-based policy rec-ommendations remains.Research

Beyond the drinking glass: expanding our understanding of water-nutrition linkages

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Beyond the drinking glass: expanding our understanding of water-nutrition linkages

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Beyond the drinking glass: expanding our understanding of water-nutrition linkages

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