The first 1,000 days, the period from pregnancy to two years of age, are critical for early childhood development. During this time, children are especially vulnerable to stunting, an irreversible condition that can result in lifelong cognitive and physical deficits. In 2011, stunting, or low height-for-age, affected more than 165 million children worldwide (Black et al. 2013). Mounting evidence indicates that poor water, sanitation, and hygiene (WASH) practices contribute significantly to stunting. Improving WASH practices reduces diarrheal disease, environmental enteric
dysfunction, and soil-transmitted helminth (parasitic worm) infections. Combined, these reductions contribute to decreases in stunting.
In Ghana, stunting is a particularly serious challenge. According to the 2014 Ghana Demographic and Health Survey (GDHS), 19 percent of Ghanaian children under the age of 5 are stunted. Among the regions with the highest rates of stunting is the Northern Region, where the prevalence is 33 percent (GDHS 2014). WASH practices in many parts of the country contribute to this problem. The majority of households (93 percent) do not treat their drinking water by any method (GDHS 2014), while only 14 percent use an improved toilet facility that is not shared with other
households (GDHS 2014). In the two weeks preceding the 2014 GDHS survey, the overall rate of diarrhea reported among children under five was 12 percent, a figure which tends to vary seasonally.
The SPRING project is a seven-year USAID-funded cooperative agreement to strengthen global and country efforts to scale up high-impact nutrition practices and policies and improve maternal and child nutrition outcomes. SPRING has worked for three years in Ghana, where USAID has tasked it with helping to prevent stunting and reduce anemia in the Feed the Future Zone of Influence in 15 districts in the Upper East and Northern Regions.
SPRING’s “WASH 1,000” strategy promotes focused, evidence-based WASH behaviors to eliminate common fecal-oral contamination pathways in children during the first 1,000 days. The strategy takes an integrated, multi-sectoral approach, simultaneously delivering products, services, and information to households with pregnant and lactating women and those with children under two (i.e., 1,000-day households).
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Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010–2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementation has been continued and scaled up by national partners with support from other donors and with modifications such as added focus on maternal nutrition and reduced program intensity.