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DIGHR (Dahdaleh Institute for Global Health Research) and MSF have partnered to investigate and develop operational guidance for mitigating potentially adverse effects in the treatment and recovery of children with severe acute malnutrition due to chemical water quality in intensive therapeutic feeding centres.

What is the humanitarian need?

Recent experiences in the Horn of Africa famine response have raised concerns that chemical water quality in inpatient therapeutic feeding centres (ITFCs). The water quality may be linked to medical complications in the treatment and recovery of children and infants with severe acute malnutrition (SAM) even when concentrations are within established international limits — as the physiological and metabolic function of SAM children may be compromised.

There is an urgent need to develop operational guidance on allowable chemical water quality in ITFCs as well as technical management strategies, especially in a context of advancing climate change and widespread over-exploitation of water resources.

What is the innovative solution?

This project will synthesize medical and engineering knowledge from multiple domains including pediatrics, nutrition, nephrology, hydrogeology, aqueous chemistry, and water treatment. The project will convene an expert panel process with leading nutrition, medical, and WASH experts globally to produce operationally relevant guidance for chemical water quality management in ITFCs during humanitarian emergencies. The guidance outputs of this project will help address an urgent operational knowledge gap on an emergent climate change-related health challenge and will help improve patient care and outcomes for the most vulnerable groups during famine and food insecurity crises.

What are the expected outcomes?

The project will generate two key knowledge synthesis reports (medical and engineering), including knowledge gap analysis, on the core challenge.

From this, we will develop draft operational guidance on chemical water quality in ITFCs, which will subsequently be refined and vetted by an international expert panel.

By systematically reviewing the literature and engaging world-leading experts, we will identify priorities for further research and development on this emergent climate change-related health challenge.

The project will produce:

  • one peer-reviewed journal article,
  • multiple presentations at key international practitioner and academic meetings, and
  • disseminate operational guidance to the key humanitarian agencies operating ITFCs in humanitarian emergencies.

Latest Updates

Evidence-based chlorination targets for household water safety in humanitarian settings

1 Feb 2021

Dahdaleh, MSF and Development Impact Labs share the recommendations from their 2013-15 multi-site study in refugee camps in South Sudan, Jordan, and Rwanda to achieve safe levels of chlorine in household drinking water.


What if the water we use at nutrition clinics has the potential to harm?

24 May 2019

The project team reflect on the steps taken to creating Intensive Therapeutic Feeding Centres water quality guidance.


Stepping towards water quality guidance for intensive therapeutic feeding centers

24 May 2019

As aid workers in nutritional crises, we try to support affected populations through ambulatory feeding programmes, or through therapeutic feeding in clinical settings for the most critically ill. But what if the water we use in these clinics could be presenting a potential harm?


Related Resources

Report Water, sanitation & hygiene

Final Report: Chemical water quality and impacts on the treatment of severely malnourished infants and children

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