Safe Drinking Water and CMAM: Experiences from Dadu‚ Pakistan

This study involves collecting bothquantitative and qualitative data to compare the effectiveness of three different water treatment methods in the contextof a CMAM program that ACF operates in Dadu District of Sindh Province. Data collection began in February and will beongoing through August. In these final months of the data collection, the team has been reflecting on the challenges metover the course of the project, as well as on progress that we have made as ateam.This study involvescollecting both quantitative and qualitative data to compare the effectiveness of three different water treatmentmethods in the context of a CMAM program that ACF operates in Dadu District of Sindh Province. Data collection began inFebruary and will be ongoing through August. In these final months of the data collection, the team has been reflectingon the challenges met over the course of the project, as well as on progress that we have made as ateam.

Challenges in Study Implementation:

The team has faced numerous challenges in study implementation, due to bothfactors in the local context and the complexity of the study. The study involves enrolling participants as they bringtheir children to SAM treatment sites, providing them with hygiene promotion and/or a water treatment device accordingto the study arm, and then following up with collection of child anthropometric measurements during the participants’weekly visits to their treatment site. In addition, each participant receives a household follow-up visit after havingbeen in the program for approximately one month, to assess their utilization of the water treatment product and to testtheir household drinking water quality.

One major challenge faced by team members who were working withparticipants at the SAM treatment sites is that of conducting the hygiene sessions and demonstrations in conditions thatvary significantly from site to site. Some sites are well-equipped and have plenty of space for participants tocomfortably receive hygiene messaging, while others have severe space limitations. Moreover, enrollment varies from siteto site, so crowding is an issue in some locations as many people come to attend their follow-up visits at the sametime.

These challenges were compounded as the summer season arrived, with temperatures reaching over 50 degreesCelsius regularly and impacting research team members and participants alike. The team responded to these challengeswith dedication, working hard to maintain a high level of quality in the hygiene sessions and the data collectiondespite these difficulties.
Teams who were visiting participants at the household level likewise have faced a numberof challenges. Some participants are difficult to trace to their homes, so team members have responded with increasedcoordination with the CMAM program nurses and village volunteers to locate participants. Household entry can also bechallenging in the local context; our female team members are particularly essential for gaining access to interviewswith female participants in theirhomes.

Progress and Accomplishments:
Despite these challenges, with a committed team we completed the enrollment targetat the end of May, according to the schedule. Enrollment data has shown good quality; moreover, it indicates a highlevel of consistency of baseline characteristics across study arms. Household monitoring visits will complete withinthis month as well.

Another major marker of progress comes with the increased capacity of the field team itself.The team entered the project with a variety of experiences ranging from nutrition to WASH to data collection. Because ofthe integrated nature of the study, team members had the opportunity to learn from each other’s skill sets over thecourse of the project. Through the experience, every team member has significantly developed professionally, which maybe considered an accomplishment as it has built the capacity of these individuals for futureprojects.

Moving Forward and Implications

Data collection is continuing at this time; once complete, we hope that theanalyzed data will offer insight into integrating a WASH component into SAM treatment programs. The interlinkagesbetween nutrition and WASH are well-established; however, this study explores this relationship in the context of CMAM.We feel that the data will offer evidence on how CMAM programs could incorporate a WASH element and, more specifically,on whether introduction of point-of-use water treatment devices for families entering a CMAM program may have an impacton the child’s recovery from SAM. If ensuring clean drinking water can speed children’s recovery, this component canimprove the children’s health and also render CMAM programs more effective, enabling these programs to reach morechildren in need of treatment for undernutrition.