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FTIs and Undernutrition: burning questions for the WASH and Nutrition Forum in Bonn

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On the 11th and 12th November 2015, the German WASH-Network, an alliance of 19 German NGOs, is hosting an international conference on the nexus between WASH and nutrition security in Bonn.
The main aim of the forum is to bring together the relevant experts from both sectors. The objective is to come up with a concrete set of recommendations, next steps and commitments in terms of viable operational approaches, research, policy and advocacy issues to lead to a more integrated approach for tackling undernutrition and stunting.

Here, Robert Chambers poses some of his own burning questions of what we need to know:

Environmental enteropathy. What is the latest state of knowledge?  

  1. Prevalence especially among children (and in the first 1,000 days).  Stephen Luby has been quoted as asking  ‘Is it fifty per cent? Ninety per cent? That’s a question worth answering’ quoted in G. Harris New York Times 13 July 2014.  Has anything come to light?
  2. Causality.  To what extent is it FTIs (faecally transmitted infections) from humans, and to what extent general environmental dirt, and/or FTIs from animals?
  3. Assessing its presence, intensity and scale?. What progress has there been finding cheaper, quicker, easier ways of assessing its presence, intensity and scale?  I have heard there is progress with biomarkers used on faeces.  What about the C-Sucrose breath test described in Pediatrics vol 124 no 2 pp 620-626, August 1, 2009 (published on line)?   What work is here in hand by SHARE, ICDDR(B), others?

Prevalence of other FTIs (faecally transmitted infections): What is the state of knowledge?  Do WHO and Unicef have on-going programmes to keep data up to date?   For diarrhoeas, there is intermittent data (but usually two or more years out of date). But for other FTIs?  If so, what are the latest estimates globally and nationally (especially in India) at least for for ascaris, trichuris and hookworm?   And other FTIs? Should such data be collected and published regularly?  

Cow dung in India? Cow dung is widely believed to have ayurvedic properties.  Without taking a position on that, the question has to be asked how -  much human infection is there from cow dung? Like other dung, it carries a load of bacteria.  Hands, usually women’s, are used to collect it and make it into pats for fuel.  I have done this with my lady host in an immersion in Gujarat.  Wash as I did I could not get the smell off my hands.  Is this a significant route of gut infection, for EE, e.g. through preparing food after handling cow dung?   Has this topic been explored?  If so, what are the findings?  If not why not? 

Antibodies.  How much nutritional energy is consumed in immune responses to FTIs?  I have not been able to get anything beyond that it is all very complicated.  Is it not possible to make a guess within orders of magnitude? Can someone press immunologists on this?

Severe acute malnutrition (SAM): With SAM, are there studies of the relative causal significance of FTIs, lack of food, and lack of micronutrients?

FTIs and food losses: In child feeding programmes what proportion of the food is lost to FTIs (stolen by intestinal parasites, used up in immune response etc)? At national levels, and globally, how many millions of tonnes of foodgrain equivalents are lost annually through FTIs?

If you have answers or know of research relevant to any of these questions, please leave a comment below or get in touch with us.

Robert Chambers is a member of the CLTS Knowledge Hub and Research Associate at IDS.

(Photo: Abhijit Bhatlekar)

Date: 3 November 2015