Improved Water, Sanitation, and Hygiene Practices in Childcare Centers in Rural Malawi

Diarrhea is the second highest cause of global mortality of children under five, responsible for nearly one in five childhood deaths. Outcomes are estimated to be worse for children with HIV. CRS, with WHO, USAID, and local partners, developed a pilot project in a rural high-prevalence region of Malawi to improve WSH practices at community-based childcare centres (CBCCs). The pilot collected pre and post-test data on WSH knowledge, attitudes and practices (KAP) of community caregivers at twelve purposively sampled CBCCs, each with four caregivers serving an average of 70 children, ages 2-5. WSH interventions were implemented within the communities, with an assessment conducted after one year to examine changes in KAP within CBCCs. There were significant improvements in WSH practices at the CBCCs over the one-year period including: 1.) 100% increase in caregivers who reported treating the water at the facility; 2.) 100% increase in caregivers who reported drawing water in a safe manner; 3.) Observed hand washing facilities increased by 60%; 4.) The number of facilities with latrines increased by 17%; 5.) The number of latrines with visible fecal matter declined by 34%; and 6.) In the communities surrounding the CBCCs, household members with reported diarrhea during the previous two weeks declined from 26.3% to 15%. Small, do-able actions, combined with complementary interventions to improve access to basic services resulted in substantial WSH improvements in HIV-affected communities' childcare centres. Replication of these actions may be an option to decrease diarrhea and morbidity in children from high HIV prevalence communities.