title: The Relationship Between Acute Malnutrition, Hygiene Practices, Water and Livestock, and Their Program Implications in Eastern Chad.
abstract: BACKGROUND
  The causes of acute malnutrition are complex and time and geography variant and need to be better understood in order to both design more effective nutrition programs and evaluate them. The findings reported here are part of an evaluation of a 4-year multisectoral nutrition program led by Concern Worldwide in the Sila Region of eastern Chad.
  
  
  OBJECTIVE
  To present evidence and learning about the relationships between acute malnutrition and potential drivers in Sila, Chad.
  
  
  METHODS
  Quantitative household-level data from a clustered randomized control trial were collected in November/December 2014. The survey was complemented with water quality testing and qualitative data collected in February and March 2013 and 2014.
  
  
  RESULTS
  Households who reported not regularly cleaning the container used for transporting water for household consumption were almost twice as likely to have a malnourished child. Households living in villages with larger concentrations of cattle and having more livestock sharing the same water source as for human consumption were significantly more likely to have a malnourished child. However, cleaning the water container mediated the negative impact of living in a village with a large cattle concentration on wasting.
  
  
  CONCLUSIONS
  These results demonstrate that hygiene practices and livestock water management are correlated with acute malnutrition in Sila, Chad. These findings provide a hypothesis for a possible pathogen driving acute malnutrition rates- Cryptosporidium-as part of a complex water chain, whereby the source of infection may be mitigated by hygiene behaviors with important implications for humanitarian programs.
authors.affiliation: 1 Feinstein International Center, Tufts University, Somerville, MA, USA.|2 Friedman School of Nutrition, Tufts University, Boston, MA, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Marshak
authors.affiliation: 1 Feinstein International Center, Tufts University, Somerville, MA, USA.|2 Friedman School of Nutrition, Tufts University, Boston, MA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Young
authors.affiliation: 3 United States Agency for International Development, Washington, DC, USA.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Bontrager
authors.affiliation: 2 Friedman School of Nutrition, Tufts University, Boston, MA, USA.|3 United States Agency for International Development, Washington, DC, USA.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Boyd
keywords: Chad; acute malnutrition; hygiene behaviors; livestock; wasting; water