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Stunting is a global burden affecting nearly 160 million children younger than five years of age. Whilst the linkages between nutrition and stunting are well recognized, there is a need to explore environmental factors such as water and sanitation, which may influence feeding practices and result in potential infection pathways. This paper explores the linkages between stunting and water, sanitation and hygiene (WASH) factors in Ethiopia, which is a relatively understudied context. The research draws upon baseline data for children under the age of five from 3200 households across four regions in Ethiopia as part of a wider study and integrated program led by the United Nations Children’s Fund (UNICEF). Using World Health Organization (WHO) z-scoring, the average stunting rate in the sample is 47.5%. This paper also takes into account demographic and social behavioural factors such as the age, gender of children, and gender of the primary caregiver, in addition to handwashing behaviour and drinking water facilities. The evidence recommends efforts to improve handwashing behaviour for mothers and children with a focus on access to clean water. Higher stunting rates with an increase in the age of children highlight the need for continued interventions, as efforts to improve nutrition and WASH behaviours are most effective early on in promoting long-term health outcomes for children.

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Abstractobjectives To review and synthesise the available evidence on the effectiveness of interventions targeting unsafe child faeces disposal in reducing this behaviour and improving child health in lowand middle-income countries.methods PubMed and EMBASE were systematically searched. Studies meeting the inclusion criteria were reviewed and key information on study methodologies and outcomes were extracted.results A total of 1048 articles were screened, and eight studies representing five countries were included for the review. Three were randomised controlled trials, and five were prospective cohort studies. There was wide variability across studies in the definition of 'safe disposal' of child faeces. Six studies reported the change in child faeces disposal practices associated with safe child faeces disposal interventions. However, only one study found a significant improvement in this behaviour. Two of the six studies that evaluated the health impact of delivered interventions found significant reductions in childhood diarrhoea associated with safe faeces disposal practices, and one study reported a positive effect on child growth and ascariasis. Only one study was identified that delivered a single intervention solely focused on safe child faeces disposal. Unfortunately, this study did not investigate the impact of this intervention on child health.conclusions There are major methodological limitations in studies that assessed the impact of safe child faeces disposal interventions. The health impact of these interventions is inconclusive because the quality of the current evidence is poor. Randomised controlled trials are urgently needed to assess the impact of safe faeces disposal interventions on child health.

This study examines the patterns, trends, and factors associated with functional community water points in rural Ethiopia and identifies potential areas of improvement in terms of practitioner response to functionality and functionality monitoring. It was part of an integrated WaSH and nutrition program implemented by UNICEF Ethiopia and the Government of Ethiopia. Cross-sectional surveys were conducted to collect WaSH-related data in communities and WaSH committees from four community-based nutrition (CBN) program groupings in Ethiopia. In all areas, CBN was implemented, but only in less than half of the areas, a WaSH intervention was implemented. Seventy-three representative kebeles, comprising 30 intervention and 43 control communities, were surveyed. Two structured surveys were conducted. The ‘community survey’ addressed community water points and their functionality and the main areas for improvement needed. The ‘WaSH committee survey’ investigated technical and management aspects of water points and their functionality. Data were analyzed using bivariate regression to identify community characteristics and management practices associated with functionality of water points and explore opportunities to improve water point functionality and monitoring. In the communities, 65% of water points were functional. Eighty percent of communities had a WaSH committee. The WaSH committee members reported that the most used water point types were protected dug wells and boreholes, and that 80% of their water points were functional. India Mark II pumps were more likely to be functional and communities with longer established WaSH committees had higher water point functionality. Communities suggested that the key factors for water point sustainability were improving water quality and water pressure, reducing water collection time, and speeding up repair times. Taking community leaders’ ‘priority lists’ into consideration offers sustainable opportunities for demand-driven, adaptive and targeted design and implementation of rural water supply programs, which, if they include the grassroots level as key informants and actors of change, can succeed. Interventions should integrate the ‘voice’ of the community, the WaSH committees, and other stakeholders and thereby facilitate transdisciplinary approaches at different stages of program management (planning, monitoring, and evaluation). This would help closing the knowledge to action gap and improve policy, programming, practice, and service delivery.