==== 1. Summary ====[[File:Under 5 y-o child mortality.png|thumb|right|200px|Under 5 year-old child mortality.]]
This article is based on a [http://www.susana.org/en/resources/library/details/2163 factsheet] that provides an overview on existing evidence and remaining research gaps regarding the link between inadequate sanitary conditions and its underestimated impact on undernutrition and stunting, particularly for children under five years of age. It is a clear plea for more rigorous research, policy coherence and cooperation between Health and Nutrition, WASH, Mental Health, Care Practices and Food Security sectors, and the need to adequately address and consider WASH as an integral part of nutrition interventions. It particularly highlights the impact of WASH interventions on mothers and children’s (under five years of age) nutritional and health status. An estimated 30% of all children in low-income countries suffer from undernourishment and WASH services can help to alleviate this:<br/>
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The aim of this fact sheet is to offer a compilation of relevant studies showing evidence on the link between sectors and to lobby for more cooperation between them.<br/>
==== 2. Key Facts about WASH and nutrition ====
*Globally, there are 1.7 billion cases of diarrheal disease annually, resulting in 628,500 (9.5%) of children deaths.<br/>
*99 million (15%) by underweight (low weight for age).<br/>
==== 3. Interventions ====[[File:Impact of WASH activities.png|thumb|right|200px|Impact of WASH activities]]
*WASH interventions can impact positively on stunting incidence rates (Cochrane, 2013).<br/>
*WASH intervention effect is an equivalent to a reduction of 15% in global prevalence of stunting (Cochrane, 2013).<br/>
*Children younger than 5 years old in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than in control groups (Luby, 2005).
==== 4. Main WASH routines ====[[File:5 A's framework.png|thumb|right|200px|5-A's framework]]
The 5 A’s is a new framework of analysis for undernutrition :
The last three “A’s” can be impacted positively by improved WASH facilities and services. Nutrition interventions typically focus on quantity and quality of food, feeding programs, and issues of governance and rights. This new framework of 5 A’s presents a more comprehensive analysis of undernutrition with attention to the role of fecal-transmitted infections (FTI) represented in the last 3 A’s. Among FTIs, diarrhea incidences received the most attention, but environmental enteropathy (damage of small intestine wall due to ingestion of fecal bacteria) is also nutritionally very significant. Recent research establishes the direct link with undernutrition and open defecation (OD) as well as its associated unhygienic conditions and practices.
==== 5. Links between sanitation and child height ====[[File:Link between sanitation and child height.png|thumb|right|200px|Link between sanitation and child height]]
“A child’s height is one of the most important indicators of her well-being. Height reflects the accumulated total of early-life health, net nutrition, and disease. Because problems that prevent children from growing tall also prevent them from growing into healthy, productive, and smart adults. Child height is strongly associated with the average number of people per square kilometer in a country who practice open defecation. The density of open defecation per square kilometer, in this simple linear graph, can account for 64% of international variation in child height.”
==== 6. Five main axes ====
#Ensure geographical / programatic integration of WASH and Nutrition projects by focusing WASH projects in high undernutrition prevalence areas
#Ensure that both coordination bodies (WASH and Nutrition) include representation from the other sector
==== 7. Remaining key questions ====
*Does a safe WASH environment at household- or community-level have an impact upon the prevalence of Global Acute Undernutrition?
