Children watch as a woman and child practice hand washing in Mali. / WASHplus

Children watch as a woman and child practice hand washing in Mali. / WASHplus

In Yarou Plateau, a village in Mali, people used to use any open space for bathroom needs. You can imagine the consequences.

Flies could easily find fecal matter lying around, and from there land on food, spreading diseases like diarrhea and intestinal worms. Fecal matter in open areas also contaminated the groundwater, which villagers use for drinking and preparing food. In Yarou Plateau, frequent diarrhea was much too common among mothers and children.

This created a vicious cycle. Diarrhea can worsen malnutrition, and the undernourished already have weakened immune systems — making them more susceptible to intestinal infections and more severe episodes of diarrhea.

The situation in Yarou Plateau changed two years ago when the village’s chief, Hamidou Samakan, visited the neighboring village of Gouna. Gouna had transformed since Hamidou had last visited; it looked clean, with no noticeable feces and fewer flies. But it wasn’t just the pristine environment that impressed him. Hamidou noticed the villagers there appeared much healthier.

How did this happen? The people of Gouna had started sweeping their public spaces and building affordable latrines, and as a result fewer villagers were getting diarrhea and fewer children were malnourished. It was then that Hamidou decided to bring better sanitation to Yarou Plateau, too.

Men show onlookers an open toilet in Mali. / WASHplus

Men show onlookers an open toilet in Mali. / WASHplus

Holding up the village of Gouna as an example, Hamidou motivated the people of Yarou Plateau to improve the sanitation in their village. Now, after almost a year, the village has built over 60 latrines, and rehabilitated ones that had never been used.

Yarou Plateau is one of 180 villages supported by USAID’s WASHplus project in Mali, and more than 70 percent of them have been certified as free of open defecation. With access to a covered latrine and soap and water for handwashing in every household, villagers are noticing a drop in cases of diarrhea and fewer malnourished children.

To achieve this, WASHplus took a multi-sectoral approach. The project set out to work with communities in Mali not only to improve water, sanitation and hygiene (WASH) but also to reduce diarrheal diseases and malnutrition. Beyond building latrines, WASHplus works to change behaviors. In villages like Yarou Plateau, people are now using latrines, washing their hands, treating their drinking water, and preparing and storing food safely.

What is WASH? WASH is everything from handwashing with soap, to safely disposing of adult and child feces, to preparing and storing food safely.

Today, on World Toilet Day, WHO, UNICEF and USAID are releasing a jointly-produced document with guidelines on integrating WASH into nutrition programs in order to achieve positive gains in the fight against undernutrition.

The document, called Improving Nutrition Outcomes With Better Water, Sanitation and Hygiene: Practical Solutions for Policies and Programmes, details WASH practices that help improve nutrition and how they can be incorporated into programs focused solely on nutrition. This will springboard global efforts to integrate WASH intro nutrition programming, helping implementing partners and USAID achieve greater results.

By using WASH in programs that work across sectors to address malnutrition in all its forms, we can help reach the 2025 Global Nutrition Targets and the Sustainable Development Goals and work to end preventable child and maternal deaths.

Undernutrition is an underlying factor in almost half of all child deaths. Malnourishment significantly increases the risk of a child dying from diseases like pneumonia and diarrhea. When an unhealthy and unsanitary environment leads to frequent diarrhea or other diseases associated with unclean water, this can lead to loss of appetite, nutrients not being absorbed properly, and anemia.

Villagers like those in Yarou Plateau know first-hand how poor WASH practices can lead to undernutrition. USAID will continue to scale up nutrition and WASH  programs to reduce maternal and child deaths in places like Mali and around the world. This document shares best practices to integrate water, sanitation and hygiene practices into nutrition programs to ultimately create a healthier future and bring a higher quality of life to the developing world.


Merri Weinger is the Environmental Health Team Leader in USAID’s Bureau for Global Health.