Safe Drinking Water and CMAM: Experiences from Dadu, Pakistan

This study involves collecting both quantitative and qualitative data to compare the effectiveness of three different water treatment methods in the context of a CMAM program that ACF operates in Dadu District of Sindh Province. Data collection began in February and will be ongoing through August. In these final months of the data collection, the team has been reflecting on the challenges met over the course of the project, as well as on progress that we have made as a team.

Challenges in Study Implementation:

The team has faced numerous challenges in study implementation, due to both factors in the local context and the complexity of the study. The study involves enrolling participants as they bring their children to SAM treatment sites, providing them with hygiene promotion and/or a water treatment device according to the study arm, and then following up with collection of child anthropometric measurements during the participants’ weekly visits to their treatment site. In addition, each participant receives a household follow-up visit after having been in the program for approximately one month, to assess their utilization of the water treatment product and to test their household drinking water quality.

One major challenge faced by team members who were working with participants at the SAM treatment sites is that of conducting the hygiene sessions and demonstrations in conditions that vary significantly from site to site. Some sites are well-equipped and have plenty of space for participants to comfortably receive hygiene messaging, while others have severe space limitations. Moreover, enrollment varies from site to site, so crowding is an issue in some locations as many people come to attend their follow-up visits at the same time.

These challenges were compounded as the summer season arrived, with temperatures reaching over 50 degrees Celsius regularly and impacting research team members and participants alike. The team responded to these challenges with dedication, working hard to maintain a high level of quality in the hygiene sessions and the data collection despite these difficulties.
Teams who were visiting participants at the household level likewise have faced a number of challenges. Some participants are difficult to trace to their homes, so team members have responded with increased coordination with the CMAM program nurses and village volunteers to locate participants. Household entry can also be challenging in the local context; our female team members are particularly essential for gaining access to interviews with female participants in their homes.

Progress and Accomplishments:
Despite these challenges, with a committed team we completed the enrollment target at the end of May, according to the schedule. Enrollment data has shown good quality; moreover, it indicates a high level of consistency of baseline characteristics across study arms. Household monitoring visits will complete within this month as well.

Another major marker of progress comes with the increased capacity of the field team itself. The team entered the project with a variety of experiences ranging from nutrition to WASH to data collection. Because of the integrated nature of the study, team members had the opportunity to learn from each other’s skill sets over the course of the project. Through the experience, every team member has significantly developed professionally, which may be considered an accomplishment as it has built the capacity of these individuals for future projects.

Moving Forward and Implications

Data collection is continuing at this time; once complete, we hope that the analyzed data will offer insight into integrating a WASH component into SAM treatment programs. The interlinkages between nutrition and WASH are well-established; however, this study explores this relationship in the context of CMAM. We feel that the data will offer evidence on how CMAM programs could incorporate a WASH element and, more specifically, on whether introduction of point-of-use water treatment devices for families entering a CMAM program may have an impact on the child’s recovery from SAM. If ensuring clean drinking water can speed children’s recovery, this component can improve the children’s health and also render CMAM programs more effective, enabling these programs to reach more children in need of treatment for undernutrition.