In 2013, World Vision Vanuatu and World Vision New Zealand implemented a three-year water, sanitation, hygiene (WASH), and nutrition project (the Project) in south west Tanna, Vanuatu. The overall goal of the Project was to reduce child undernutrition, with short- and medium-term objectives to increase WASH infrastructure, and improve caregiver WASH and nutrition knowledge and practices. In January 2015, after two completed years of the Project, we designed and undertook an evaluation.
For households with children aged under five years of age in the Project villages we conducted: WASH and child health surveys; WASH infrastructure observations; anthropometric measurements of children under five years of age and their mothers; and microbiological drinking water testing. We compared our data with those gathered at baseline and at the end of year one of the Project. We undertook logistic regressions to investigate associations between: child health outcomes and WASH and nutrition factors; and household microbiologic water safety and WASH factors.
Complete enumeration of households with children under five years of age was attempted. Overall, 220 households and 320 children participated in the evaluation. There was a significant increase over time in the proportion of households with access to improved latrines, from 39 (26.4%) of 148 households in 2013, to 202 (97.1%) of 208 in 2015 (p<0.001); and in the proportion of handwashing facilities from 31 (21.0%) of 148 in 2013, to 172 (82.7%) of 208 in 2015 (p<0.001). Caregiver WASH knowledge improved over the course of the project. A total of 12 (4.0%) of 303 children were wasted (<-2 Z-score weight-for-height), 145 (48.8%) of 297 children were stunted (<-2 Z-score height-for-age), and 59 (19.1%) were underweight (<-2 Z-score weight-for-age). In the two weeks prior to the survey 35 (11.6%) of 303 children had diarrhoea. Factors associated with a lower prevalence of stunting included using improved water sources (PR: 0.69, 95% CI:0.56–0.85, p=0.001) and a greater maternal height (PR: 0.95, 95% CI: 0.91–0.99, p=0.006). Using an improved water source was associated with a lower prevalence of being underweight (PR: 0.45, 95% CI: 0.27–0.74, p=0.002). Of the 201 households with microbiological water testing, 10 (5.0%) had E. coli levels safe for drinking at <1/100 mL, whereas 145 (72.1%) had E. coli levels indicating very high health risk at >100/100 mL. Factors associated with lower odds of very high risk drinking water included the source being rainwater (OR: 0.10, 95% CI: 0.02–0.59, p=0.009), and having a water container with a spigot (OR: 0.34, 95% CI: 0.13–0.77, p=0.010). Additionally, households with severely stunted children or underweight children had higher odds of having very high risk drinking water (OR: 3.02, 95% CI: 1.13–8.03, p=0.027 and OR: 2.51, 95% CI:1.02–6.19, p=0.045).
We found that the Project achieved most of its short- and medium-term objectives to improve WASH and nutrition infrastructure, knowledge, and practices. Microbiologic testing indicated that most drinking water in the Project households was unsafe. Undernutrition remained high in the Project population and was associated with having very high risk drinking water. Providing the Project population with improved drinking water as planned in the third Project year, is likely to contribute to achieving the Project’s overall goal to reduce child undernutrition.||