1. 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

2. 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).

3. 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

4. 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.

5. 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)

6. Rural water & sanitation in Cambodia: NSDP Midterm Review (2011) Unit2008200920102011 Rural access to improved drinking water %40.4942.1843.5143.89 Rural access to sanitation %23.2424.2425.0026.00

7. Rural sanitation coverage in Cambodia by wealth quintiles: Source: CSES 2009

8. 8 Investing in sanitation a cost effective way to improve health and quality of life DALY (Disability-Adjusted Life Year) = one year of healthy life lost

9. 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

10. 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

11. 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

12. References : 1.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.; 2.Juan Costain, Water and Sanitation Program, WB (2012) http://www.hunger- undernutrition.org/blog/2012/03/malnutrition-and -health-the-sht-factor.htmlhttp://www.hunger- undernutrition.org/blog/2012/03/malnutrition-and -health-the-sht-factor.html 3.Lancet (2009); Humphrey JH. Child undernutrition, tropical enteropathy, toilets, and handwashing.Humphrey JH 4.Scott, (2006): Well Fact Sheet- Health Influences of Improved Household Sanitation 5.UNICEF/WHO (2009): Diarrhoea: Why children are still dying and what can be done; 6.WHO (2008), Safer Water, Better Health – Costs, benefits and sustainability of interventions to protect and promote health 7.MRD (2011) National Strategy for Rural Water Supply, Sanitation & Hygiene 8.RGC (2011) National Strategic Development Plan Mid-Term Review

13. THANK YOU