Safe water, sanitation and hygiene:
An important condition for improved
maternal and child nutrition
Ministry of Rural Development
Dr. Mao Saray, Director of Rural Water Supply
May 21, 2012
1. Introduction/Background
• Poor sanitation and water quality cause chronic
diarrhea and intestinal tract infections;
• Diarrhea and intestinal tract infections cause
nutritional deficiencies, reduced immunity, and
impaired mental and physical growth of children
• Adequate sanitation and water quality and
quantity are important factors in the body’s
ability to absorb/retain nutrients (i.e., Nutrition).
From the global literature on nutrition
and water, sanitation & hygiene:
• 50% of under-nutrition cases are linked to poor
environmental health conditions
• Consequences of poor water, sanitation & hygiene are
diarrhea, intestinal tract infections,worm infestation, and
other water borne diseases
• A Study of 2-year-old children found:
– 25% of all stunting was attributed to having 5 or more
diarrhea episodes;
– Stunting can increase by 2.5% per diarrhea episode;
• Children under 2 who are malnourished will not achieve
the full cognitive physical development potential 
poor education performance
More consequences of poor sanitation
and unsafe water. . .
• Globally, unsafe water and poor
sanitation and hygiene cause 860,000
malnutrition-related deaths of under-5
children per year
• Young children living in poor sanitation
and hygiene environments ingesting large
amounts of fecal bacteria through food
and water which causes irreversible
intestinal damage.
What can be done? Simple and effective
solutions:
• Using a latrine reduces diarrheal cases by
36%,
• Washing hands with soap at critical times
reduces diarrheal cases by 45%
• Hygiene promotion is the most cost-effective
public health intervention ($3 per DALY
averted)
• Sanitation promotion is also cost-effective (at
$11 per DALY averted)
Rural water & sanitation in Cambodia:
NSDP Midterm Review (2011)
Unit
Rural access to
improved drinking
water
Rural access to
sanitation
2008
2009
2010
2011
%
40.49
42.18
43.51
43.89
%
23.24
24.24
25.00
26.00
Rural sanitation coverage in Cambodia
by wealth quintiles:
Open Defecation
Unimproved
Improved
100%
90%
80%
45.2%
70%
60%
60.8%
71.7%
84.3%
80.2%
4.7%
50%
40%
5.4%
30%
4.4%
20%
10%
4.3%
4.7%
11.0%
50.1%
33.8%
23.9%
15.5%
0%
Poorest
Source: CSES 2009
2
3
4
Richest
2. Problems/Challenges
• The CMDG for sanitation (30%) is low by global
standards. Even if it is met, more than two-thirds of
the rural population will not have a toilet by 2015.
• Cost-effective and simple household treatment
methods for improved water quality receive limited
attention
• Limited nation-wide investment in hygiene and
sanitation promotion in rural areas
• Current model of sanitation and hygiene promotion is
fragmented by projects, with insufficient investment
and very little private sector involvement
• Nutrition programs are often linked with health but
disconnected from water supply, sanitation and
hygiene
3. Solutions for better maternal and child
nutrition
• Develop national scale promotion of water,
sanitation and hygiene linked with nutrition
initiatives
- Simple interventions can have high economic and
social returns
- Scale-up household water treatment
programs
– Partnerships with private sector, NGOs, and other
government ministries are key
– MRD is working on national drinking water quality
standards, national guidelines for household
water treatment, and water safety plans
4. Conclusions and way forward
• Fighting diarrhea with improved water, sanitation &
hygiene should be a central strategy for improved
maternal and child nutrition
• Absorption of micronutrients is as crucial as food
security itself
• Promoting safe drinking water, sanitation and hygiene
practices is a cost-effective public health intervention
that should be included in all national nutrition
programs
• We need a major national and sub-national advocacy
and behavior change campaign for improved rural
water supply, sanitation & hygiene
References :
1.
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7.
8.
Int J Epidemiol 2008, Checkley W, Buckley G, Gilman RH, et al, The Childhood
Malnutrition and Infection Network. Multi-country analysis of the effects of
diarrhea on childhood stunting.;
Juan Costain, Water and Sanitation Program, WB (2012) http://www.hungerundernutrition.org/blog/2012/03/malnutrition-and -health-the-sht-factor.html
Lancet (2009); Humphrey JH. Child undernutrition, tropical enteropathy, toilets,
and handwashing.
Scott, (2006): Well Fact Sheet- Health Influences of Improved Household
Sanitation
UNICEF/WHO (2009): Diarrhoea: Why children are still dying and what can be
done;
WHO (2008), Safer Water, Better Health – Costs, benefits and sustainability of
interventions to protect and promote health
MRD (2011) National Strategy for Rural Water Supply, Sanitation & Hygiene
RGC (2011) National Strategic Development Plan Mid-Term Review
THANK YOU