1. Linkages between Water, Sanitation and Hygiene with Food Safety and Nutrition Prof. Indira Chakravarty, PhD, DSC Chief Advisor Public Health Engineering Department, Govt. of West Bengal Member National Drinking Water and Sanitation Council, MDWS, Govt. of India Board Member United Nations University - IIGH Ex-Member Food Safety and Standards Authority of India, Ministry of Health and Family Welfare, Govt. of India Former Regional Director, South Asia MI, IDRC, Canada Former Addl. DGHS, Director and Dean All India Institute of Hygiene and Public Health, Ministry of Health and Family Welfare, Govt. of India Former Director Chittaranjan National Cancer Institute, Ministry of Health and Family Welfare, Govt. of India Former Regional Advisor Nutrition(Act) WHO, SEARO

2. Water and Sanitation Coverage – Indian Scenario (NFHS – 3 Survey of 2005- 2006) 2 SANITATIONPERCENTAGE OF SANITATION COVERAGE RURAL26% URBAN83.2% All India Average44.6% (only 8.9% increase from 1998-99 NFHS-2) WATERPERCENTAGE ACCESS TO SAFE DRINKING WATER RURAL (2007)74.39% URBAN91% Projected by 2012100% Indira Chakravarty

3. Water and Sanitation Coverage (Census - 2011) TOILET CONNECTIVITY DRINKING WATER SUPPLY WITHIN PREMISES TOTAL WITHIN PREMISES NEAR PREMISES ELSEWHERE INDIA (MEAN) 46.946.635.817.6 GUJARAT (MEAN)57.464.023.512.4 Source: Census 2011 Sanitation Coverage – Mean state Drinking Water Coverage – Mean state 3Indira Chakravarty

4. Data on wasting (Children) Stunting (Children) and Anemia (Children and Woman) UNDER WEIGHT WASTEDSTUNTEDANEMIA IndiaGujaratIndiaGujaratIndiaGujarat WOMENCHILDREN MARRIED WOMEN PREGNANT WOMEN IndiaGujarat IndiaGujaratIndiaGujarat NFHS-151.142.717.523.952.050.1na NFHS-242.741.619.720.351.052.051.846.349.747.474.274.5 NFHS-340.441.122.919.744.949.256.255.557.960.878.979.8 Source- NFHS Survey Indira Chakravarty 4

5. STATE DRINKING WATER (TOTAL) SANITATION (TOTAL) WATER BORNE DISEASES % WOMENS LITERACY % UNDER WEIGHT WASTEDSTUNTEDANEMIA INDIA (MEAN) 87.944.610.065.4640.422.944.9 PREGNANT WOMEN CHILDREN 58.769.5 GUJARAT 89.854.612.666.7741.419.749.260.869.7 Source: Census 2011, NFHS-3 Comparative Assessment of WES, Water borne disease, Women Literacy and Nutrition 5Indira Chakravarty

6. National Pilot Programme In Control Of Micronutrient Malnutrition States –Assam –Bihar –Jharkhand –Orissa –West Bengal –Tripura –Gujarat 6 STUDY CONDUCTED IN FOLLOWING STATES Indira Chakravarty

7. Prevalence of Anemia in women over life – Compiled data from 7 states Prevalence of Anemia in women over life – Compiled data from 7 states (The National Pilot Programme on Control of Micronutrient Malnutrition, AIIH&PH, 1995-2008) 7 AGE GROUP ANEMIA IN FEMALES MILD & MODERATESEVERE RANGE (%)MEAN (%)RANGE (%)MEAN (%) 6 m – 6 y49.2 - 86.568.21.2 - 4.52.8 6 – 12 y61.9 - 87.181.30.6 - 11.06.0 12 – 19 y79.5 - 89.382.73.2 - 9.16.4 19 – 45 y70.8 - 90.482.73.6 - 9.36.4 45 – 60 y68.0 - 88.079.13.0 - 9.45.9 60 y AND ABOVE64.8 - 88.278.02.2 - 4.53.3 PREGNANT WOMAN 68.0 - 89.079.73.3 - 15.011.2 Indira Chakravarty

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15. Impact of Water, Sanitation and Hygiene on Nutritional status. 15Indira Chakravarty

16. 16 Indira Chakravarty

17. 1.Unsafe water as well as unsafe food results in infections like diarrhea which causes loss of valuable nutrients from the body. This eventually leads to under-nutrition. 2.Reduced sanitary facilities and open defecation results in worm infestation which leads to micronutrient deficiencies (Hidden Hunger) viz anemia and under-nutrition. Impact of Unsafe Water and Lack Of Hygiene & Sanitation On Nutrition– 1/2 17 Indira Chakravarty

18. 3.Unavailability of water near habitats results in long walks (particularly for women) carrying heavy loads of water. This leads to expenditure of valuable nutritional energy (calories) from the body and loss of time. Hence, inaccessibility to water leads to loss of both calorific energy as well as time. Leads to overall malnutrition and ill health. 4.Pollutants in water like Arsenic, Fluoride etc. lead to a direct toxic impact on health and nutrition. Arsenic in particular also enter the food chain at several points. Impact of Unsafe Water and Lack Of Hygiene & Sanitation On Nutrition– 2/2 18 Indira Chakravarty

19. 1.Under-nutrition in the entire community, especially in children. 2.Anemia, especially in children and women. This may lead to Low Birth Weight (LBW) Babies, higher Maternal Mortality Rate (MMR), low work capacity, tiredness etc. 3.Disability – Both under-nutrition as well as unsafe environment are the causes of disability in many cases, specially in children. The most significant impact of poor WES On Nutrition 19 Indira Chakravarty

20. Impact of Water, Sanitation and Hygiene on Anemia 20 Economic Loss Poor Health Infectious and other Diseases  Loss of Nutrients from body  Poor absorbing capacity etc  Loss of Nutrients from body  Poor absorbing capacity etc Under Nutrition Worm Infestation Toxic effects Under Nutrition Arsenicosis Fluorosis Pesticide toxicity etc. Arsenicosis Fluorosis Pesticide toxicity etc. Poor Health ? Indira Chakravarty

21. 21 CASESTUDIES Indira Chakravarty

22. IMPACT OF SANITATION & CLEAN WATER SUPPLY AND HEALTH EDUCATION ON NUTRITIONAL STATUS (A WHO supported study) 22 Indira Chakravarty

23. 23 STUDY AREA Village:Daharpur District :Midnapore State:West Bengal Period : 3 years Indira Chakravarty

24. INCIDENCE OF DIARRHOEAL DISEASES AND WORM INFESTATION IN CHILDREN (INCIDENCE RATE %) 24 Incidence rate reduced PARAMETERSBASE-LINEPOST INTERVENTION Diarrhoeal Diseases27.2721.06 Worm Infestation85.0075.35 Indira Chakravarty

25. 25 CHANGE IN NUTRITIONAL STATUS OF CHILDREN AFTER PROVISION OF WES [Weight for Age ] Significant improvement NUTRITIONAL STATUSBASE LINEPOST INTERVENTION (%) NORMAL 5.2713.46 GRADE – I 26.3138.46 GRADE – II 57.8938.46 GRADE – III 10.839.62 Indira Chakravarty

26. 26 Significant Reduction in diarrheal and and worm infestation rate. Significant improvement in weight for age (nutritional status). After provision of WES for 3 years CONCLUSION *-Based on values of Normal. Indira Chakravarty

27. Easy Access To Water Saves Time And Energy (An UNICEF supported study) 27 Indira Chakravarty

28. 28 Districts covered in Nepal ZonesDistricts Central Kavre Mid West Surkhet Far West Dadeldura Indira Chakravarty

29. 29 THE STUDY COVERED FOLLOWING ASPECTS Epidemiological information. Nutritional status. Dietary intake. Health parameters. Water collection, usage, quality, etc. Time spent for water collection. Energy spent for water collection. Adverse effects of carrying water in hilly and mountainous zones. Housing / sanitation, etc. Socio-economic status. Utilization of saved time - Social, Economic, Child Care, etc. Indira Chakravarty

30. 30 AVERAGE TIME AND ENERGY SAVED Cross Sectional : Water already provided (compared with other villages without provision of water supply) Longitudinal : After provision of water to control villages. DESCRIPTION SAVED CROSS- SECTIONAL LONGITUDINALMEAN Energy (K. Cal) 588 (20.50%) 510 (18.08%) 549 (19.29%) Time (Hrs.)4.503.003.75 Indira Chakravarty

31. 31 IMPROVEMENT IN NUTRITIONAL STATUS OF CHILDREN* (WEIGHT FOR AGE) * 0-5 YEARS Pooled = Central, Mid-west, Far-west. Significant improvement of nutritional status SlZONESTATUSNUTRITIONAL STATUS OF CHILDREN (%) NORMALGRADE-IGRADE-IIGRADE-III 1.POOLEDCONTROL20.432.726.620.4 EXPERIMENTAL26.334.226.313.2 Indira Chakravarty

32. Increased access to water leads to a significant Amount of time being saved for fruitful activities. Improvement in nutritional status of children. 32Indira Chakravarty

33. Coverage of Safe water, Sanitation and Hygiene along with balanced nutrition is essential for proper Growth and Development of Children 33Indira Chakravarty

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