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Integration of Water, Sanitation, Hygiene, and Nutrition Programming Associated with Lower Prevalence of Child Stunting and Fever in Oromia, Ethipoia

The difference in prevalence of undernutrition and two-week disease history in women and children in Oromia, Ethiopia was compared between two intervention groups: nutrition only (comparison group) and integrated water, sanitation, and hygiene (WASH) and nutrition (integrated group). In both groups, health care workers were trained in community management of acute malnutrition and infant and young child feeding practices. Health care workers in turn organized events and household visits to identify and treat acutely malnourished infants and children, convey messaging regarding proper infant and young child feeding, and provide vegetable seeds for household gardens. The integrated group additionally received water tap construction and community-led total sanitation and hygiene. Four years post initiation, a household and child anthropometric survey (n=1,007) of mothers of children 0-59 months was conducted in 12 villages (6 per group). Accounting for sample design, logistic regression was used to determine adjusted odds ratios for child nutritional outcomes and child and maternal two-week disease history by intervention group. At follow up, intervention groups were similar in demographics, diet and feeding practices, immunization, supplementation, and access to water and hygiene. Access to an improved sanitation facility was greater in the integrated group (48%) than in the comparison group (28%) (p=0.02). Children from the integrated group had a 16 percentage point (95% CI: 0-32 percentage points) and 14 percentage point (95% CI: 5-22 percentage points) lower prevalence of stunting and fever, respectively, than children from the comparison group. The adjusted odds of stunting and fever in children from the integrated group were 50% (OR: 0.50, 95% CI: 0.26, 0.97) and 49% (OR: 0.51, 95% CI: 0.36, 0.74) lower than the odds of stunting and fever in children from the comparison group. Stratifying by intervention group, mean height-forage Z-score increased with sanitation facility among children from the comparison group only. There was no difference in maternal history of disease between groups. Integration of WASH and nutrition was associated with less stunting and disease in children 0-59 months in a setting with poor WASH conditions. Differences in sanitation may contribute to the gains in growth seen among children in the integrated group.