Evaluating the Effectiveness of Safe Drinking Water in SAM Treatment

Grant awarded: £300,000

Lead organisation: Action Against Hunger USA

Partnering organisations: Johns Hopkins Bloomberg School of Public Health

Project length: 2015-2017

Study locations: Pakistan

Principal Investigator: Dr Silke Pietzsch

  • Zameer,1 year, Dadu

  • Dadu nutrition

  • Hygiene Promotion Supervisor Kousar Jahan, 38, delivering hygiene session to a study participant Noor Jahan, 35, at her home in Dadu on 18th May 2016. Noor Jahan’s son Adnan, 6 months old, is a SAM patient.

  • An example of the IEC material used during hygiene promotion sessions.

  • Marvi and Waheed, Hyigene Promoter - Data Gatherers, carry out an indepth interview for qualitative data collection with Ameena and her daughter Aneela, 8 months.

  • Benazir, Hyigene Promoter - Data Gatherer, conducts a session on personal hyigene for Abrab, 35, who has brought her son, Ajeeb, 12 months old, for follow-up at the CMAM site.


Malnutrition contributes to more than half of child deaths in less-developed settings. Severe acute malnutrition (SAM) affects an estimated 20 million children under five worldwide, and contributes to more than 1 million child deaths annually. The development of Ready to Use Therapeutic Foods (RUTFs) has resulted in a huge shift in the treatment of SAM through Community Management of Acute Malnutrition. Waterborne diseases are a major cause of malnutrition and use of unsafe water reduces the efficacy of RUTF. The proposed research will evaluate the effectiveness of introducing water, sanitation and hygiene (WASH) interventions such as safe drinking water into SAM treatment. Point-of-Use water treatments have the potential to decrease exposure to disease and therefore increase speed of recovery of children in SAM treatment.

Expected outcomes:

Anticipated short term outcomes of the research include:
- At the individual level, reduced length of stay (LoS) in SAM treatment programmes and shorter recovery times for children with SAM that participate in the research.
- At the community level, communities to adopt and modify sustainable water treatment procedures to positively support health and the prevention of malnutrition.
- At the programme level, use findings to devise more effective WASH programmings strategies
- At the provincial level, findings can serve as a basis for the government and other stakeholders to integrate WASH components into national SAM treatment protocol and community nutrition programmes.
The study will help to determine the importance of using safe drinking water and hygiene promotion during the treatment of SAM in children under five in areas with difficult or no access to safe drinking water. The study has the potential to increase SAM treatment effectiveness, provide concrete recommendations for improvement of SAM treatment protocols, and reduce the cost of SAM treatment per beneficiary.


Elrha is hosted by Save the Children, a registered charity in England and Wales (213890) and Scotland (SC039570).

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