Linking Sanitation and Nutrition Interventions for Children

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Client: UNICEF Kenya
Partners: Kitui County Ministry of Health and Sanitation
Location: Kenya (Kitui County)
Sector: Water, Sanitation and Hygiene (WASH), Nutrition
Dates of service: 2015 – 2017
IDinsight service: Embedded learning partnership with impact evaluation, process evaluation, capacity building and nimble data analysis
IDinsight contacts: Lilian Lehmann, Jeff McManus
Status: Complete
Additional resources:

The Problem

Child stunted growth and open defecation are common in many of UNICEF’s target geographies. Stunting, a reflection of chronic undernutrition, contributes to nearly half of all child deaths globally. [1] Open defecation further adds to this figure by causing diarrheal-related deaths in children.

Despite their shared connection to child undernutrition and stunting, Water, Hygiene & Sanitation (WASH) and nutrition interventions are often implemented separately. This was the case in one of UNICEF’s target counties, Kitui County, which has the second highest child stunting rates in Kenya.

 UNICEF Kenya sanitation and nutrition teams and the Kitui County Public Health Office jointly designed an integrated sanitation and nutrition intervention (SanNut) that extended an existing community-led total sanitation (CLTS) intervention with a set of behavior-change messages targeted at caregivers of young children [2].

As part of a two-year embedded engagement with UNICEF Kenya, IDinsight generated evidence on whether integration of child-focused sanitation and nutrition programming to existing CLTS interventions could improve caregiver childcare knowledge and practices.

Evidence Needs

IDinsight Service

IDinsight designed and conducted a randomized controlled trial to evaluate the impact of the SanNut program on caregiver knowledge and practices. A total of 604 villages were randomly assigned to either the CLTS intervention alone (control), or both the CLTS intervention and the SanNut intervention (treatment). IDinsight surveyed 4,322 caregivers on sanitation and nutrition practices. We also conducted a process evaluation to assess whether there were gaps between the program’s expected and actual implementation that could be improved during programmatic scale-up.

 The evaluation showed that SanNut led to modest improvements in sanitary knowledge and practices. Caregivers in treatment villages were more likely to mention lack of handwashing after handling child faeces as a potential cause of diarrhoea, report safe disposal of child faeces, and have a stocked handwashing station than caregivers in control villages. Treatment households were also less likely to report incidences of child diarrhoea. However, SanNut appears to have had no detectable impact on nutritional practices, such as breastfeeding, vitamin A supplementation or deworming. Non-child outcomes traditionally associated with CLTS, including latrine use and homestead sanitary conditions, were similar in treatment and control groups.


UNICEF is scaling the integrated sanitation and nutrition program to a second focal county in Kenya, West Pokot, which has an estimated 100,000+ children under 5 and the highest child stunting rates in the country. UNICEF has also leveraged findings from IDinsight’s process evaluation to improve programmatic delivery, especially for the nutrition component, in the scale-up.