Prevalence and factors associated with nutritional outcomes in under-five children: the WASH-Nutrition Correlation Study

The WASH-Nutrition Correlation Study is a UNICEF-funded project conducted in three districts across Bangladesh – Rangpur, Comilla and Bandarban. The study commenced in September 2015 and is expected to be completed by March 2016. The objective of this descriptive cross-sectional study is to investigate associations between water, sanitation and hygiene (WASH) and nutrition-related factors with the nutrition status of children under five years of age. Specifically, the study aims to do the following:
• Measure associations between socio-demographic factors and household WASH knowledge and practices
• Measure water coverage, collection, treatment and storage practices and their association with growth outcomes among under-five children
• Measure knowledge and practice regarding hygiene and their association with growth outcomes among under-five children
• Measure sanitation coverage and practices and their association with growth outcomes among under-five children
• Measure nutritional knowledge and practices and their association with growth outcomes among under-five children
A key outcome of this study is to provide an evidence base for more coordinated programming across WASH and nutrition sectors. The first phase involved a household assessment conducted between September - October 2015 using a structured questionnaire and a spot checklist. Based on the findings of this initial assessment, UNICEF are to provide an intervention to these households, following which a process monitoring phase will continue until March 2016.

For the initial assessment, the research team at the James P Grant School of Public Health, BRAC University (JPGSPH) developed a structured questionnaire to assess WASH and nutrition-related knowledge and practices, as well as a spot checklist to verify the findings from the questionnaire. Local data collectors from each of the three study sites were recruited and trained over five days on the tools, WASH and nutrition topics, GPS data collection, and anthropometric measurement. Data collection was conducted from 14 September - 31 October 2015. The preliminary findings from this data were disseminated at the WASH-Nutrition Joint Programming Workshop on 15 December 2015.

Our development partners include the following:
• United Nations Children’s Fund (UNICEF) (donor/partner)
• Department of Public Health Engineering (DPHE) (partner)
• Integrated Community Development Project (ICDP) (partner)

The preliminary findings of the study were disseminated at the WASH-Nutrition Joint Programming Workshop organised by UNICEF on 15 December 2015. Participants from a number of development organisations, including the World Bank, icddr,b, UNICEF, Food and Agriculture Organization (FAO), DPHE and JPGSPH attended the workshop. The day-long workshop included discussions on challenges, possible interventions, and the scope for joint programming in this area. Importantly, the findings of concurrent research from the World Bank, icddr,b and JPGSPH were presented at the forum to help guide the discussion sessions.

Monitoring and evaluation of selected child wellbeing practices through Knowledge Management Outreach Sites (KMOS)

The Communication for Development (C4D) section of UNICEF and seven partner non-government organisations (NGOs) are implementing the “Engaging Communities for Social & Behavioral Change” project in seven hard-to-reach districts of Bangladesh. The aim of this project is to make a positive difference in the lives of children, their families and communities. The James P Grant School of Public Health, BRAC University (JPGSPH) has been assigned with the task to act as an external party to monitor the project and to assess the effectiveness of C4D approaches.

The objectives of the study are to capture the progress of overall programme activities, assess the implementation processes, and explain the reasons for any deviation in selected sentinel sites, as well as control sites. In addition, the project will also track the intended and unintended effects of C4D approaches in terms of trends in individual and community characteristics around selected behavioural themes. The knowledge gained and lessons learned from the study will be used to modify strategies and to strengthen the capacity of the C4D programme.

JPGSPH has successfully completed Phase I of the project. In Phase I, JPGSPH developed two separate but interconnected monitoring frameworks and necessary monitoring and evaluation tools for assessing the progress of the programme. In Phase II, JPGSPH has been implementing the tools developed during the previous phase to assess the programme’s effectiveness. Three quantitative surveys followed by qualitative studies will be conducted for results-based monitoring, followed by qualitative studies after each wave of quantitative data collection.

A baseline study (quantitative survey followed by qualitative study)has already been completed by JPGSPH. In addition, a formal training was provided to staffs from partner NGOs for the continuous collection of performance and process monitoring data.Data collection for the midline study is currently ongoing.

Phase I:
• From January-April 2014two separate but interconnected monitoring frameworks were developed:
1) Monitoring of the performance and process of the programme activities
2) Monitoring and evaluation of the results of the programme
Phase II:
• From the seven districts where C4D is implemented, seven sentinel sites and seven control sites were selected to conduct monitoring survey based on their geographical locations, similarity between sentinel and control sites, and accessibility.
• From February-March 2015, a total of 2,880 quantitative data were collected for baseline study using structured questionnaires from six sentinel and control sites.
• A total of 156 qualitative data were collected for the baseline study through focus group discussions and face-to-face, in-depth interviews with different target groups using semi-structured guidelines.
• After analysing both the quantitative and qualitative data, the final report was submitted to UNICEF.
• A unique software has been developed for monitoring performance and processes and proper documentation of project activities.
• From 30 November 2015, a second wave of data collection has commenced as part of the midline study.

• UNICEF (Donor)

• Two national level dissemination workshops have been organised to share the findings of the baseline study with UNICEF
• A training session on performance and process monitoring software was organised by JPGSPH for staffs from partner NGOs and district level C4D section heads of UNICEF.