We investigate the impacts of access to piped water on drinking water quality, sanitation, hygiene and health outcomes in marginalized rural households of north-western Bangladesh, using a quasi-experimental setup. A government organization – the Barindra Multipurpose Development Authority (BMDA) – established a piped water network to connect rural households with the deep ground water resources and improve their access to potable water. Using propensity score matching, the study compares a treatment and a control group of households to identify gains in water-sanitation, hygiene and health outcomes. In terms of water safety, we find no improvement in the quality of drinking water, measured by E. coli count per 100 ml of water at the point of use (i.e. the pots and jars used to store it). Food utensils tested positive for E. coli in both the control and treatment group, thus showing no improvement through the BMDA intervention. Hygiene behavior such as handwashing with soap after defecation or before feeding children also does not improve. Finally, we do not find evidence of health benefits, such as decreased diarrhea incidence of under-five children or improved nutritional outcomes such as stunting, underweight and wasting. Although access to BMDA piped water in the premises is subject to a fee, it seems this incentive mechanism is not strong enough to improve water behavior or its outcomes: treated households are as poor as the non-treated in terms of maintaining hygiene and water quality, possibly because of lack of information.

Background: Inadequate food and water resources negatively affect child health and the efficiency of nutrition interventions. Methods: We used data from the SHINE trial to investigate the associations of food insecurity (FI) and water insecurity (WI) on mothers’ implementation and maintenance of minimum infant dietary diversity (MIDD). We conducted factor analysis to identify and score dimensions of FI (poor access, household shocks, low availability & quality), and WI (poor access, poor quality and low reliability). MIDD implementation (n = 636) was adequate if infants aged 12 months (M12) ate ≥ four food groups. MIDD maintenance (n = 624) was categorized into four mutually exclusive groups: A (unmet MIDD at both M12 and M18), B (unmet MIDD at M12 only), C (unmet MIDD at M18 only), and D (met MIDD at both M12 and M18). We used multivariable-adjusted binary logistic and multinomial regressions to determine likelihood of MIDD implementation, and of belonging to MIDD maintenance groups A-C (poor maintenance groups), compared to group D, respectively. Results: Low food availability & quality were negatively associated with implementation (OR = 0.81; 0.69, 0.97), and maintenance (ORB = 1.29; 1.07, 1.56). Poor water quality was positively associated with implementation (OR = 1.25; 1.08, 1.44), but inconsistently associated with maintenance, with higher odds of infants being in group C (OR = 1.39; 1.08, 1.79), and lower odds of being in group B (OR = 0.80; 0.66, 0.96). Conclusion: Food security should be prioritized for adequate implementation and maintenance of infant diets during complementary feeding. The inconsistent findings with water quality indicate the need for further research on WI and infant feeding. | Non-PR | IFPRI3; DCA; CRP4; 2 Promoting Healthy Diets and Nutrition for all | PHND; A4NH | CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

Background: Inadequate food and water resources negatively affect child health and the efficiency of nutrition interventions. Methods: We used data from the SHINE trial to investigate the associations of food insecurity (FI) and water insecurity (WI) on mothers’ implementation and maintenance of minimum infant dietary diversity (MIDD). We conducted factor analysis to identify and score dimensions of FI (poor access, household shocks, low availability & quality), and WI (poor access, poor quality and low reliability). MIDD implementation (n = 636) was adequate if infants aged 12 months (M12) ate ≥ four food groups. MIDD maintenance (n = 624) was categorized into four mutually exclusive groups: A (unmet MIDD at both M12 and M18), B (unmet MIDD at M12 only), C (unmet MIDD at M18 only), and D (met MIDD at both M12 and M18). We used multivariable-adjusted binary logistic and multinomial regressions to determine likelihood of MIDD implementation, and of belonging to MIDD maintenance groups A-C (poor maintenance groups), compared to group D, respectively. Results: Low food availability & quality were negatively associated with implementation (OR = 0.81; 0.69, 0.97), and maintenance (ORB = 1.29; 1.07, 1.56). Poor water quality was positively associated with implementation (OR = 1.25; 1.08, 1.44), but inconsistently associated with maintenance, with higher odds of infants being in group C (OR = 1.39; 1.08, 1.79), and lower odds of being in group B (OR = 0.80; 0.66, 0.96). Conclusion: Food security should be prioritized for adequate implementation and maintenance of infant diets during complementary feeding. The inconsistent findings with water quality indicate the need for further research on WI and infant feeding.