Food is nothing without hygiene

Water sanitation and hygiene are key for good nutrition outcomes

By James Chavula
Annie Lihoma washes her dishes at Chimiko Village in Thyolo
UNICEF Malawi/2021/Chikondi
21 June 2021

In Chimiko village in the southwestern part of the tea-growing district of Thyolo, children in Anne Lihoma's home get any food they yearn for.

In the homestead, the signs flash past: maize ready for harvest, a vegetable garden in the backyard, different fruit trees, two pigs, five chickens and three guinea pigs.

Every day, the farmer reaps a handful of vegetables from the backyard and washes hands with soap before chopping the leaves for the day's meal.

Sanitation and hygiene help everyone in the homestead get the full benefits of the diversified diets, which contain locally available legumes, meat and fruits.

"Some children eat food from all six groups but still suffer from malnutrition due to poor hygiene," she explains.

The household of seven boasts a clean pit toilet with a hole cover, a foot-operated handwashing facility called mpondagiya, a spotless kitchen fitted with a less smoky cookstove that uses less fuelwood than open fireplaces marked by three stones, a rubbish pit and a wooden rack for kitchen utensils.

The sanitation and hygiene facilities reduce the risk of preventable infections, especially diarrhoea.

"Gone are the days a single latrine served 10 households. Now every household is required to own one because unsanitary homes are hotspots of diarrhoea which fuel malnutrition in children," she says.

To Anne, "nutritious food is nothing without sanitation and hygiene". She strives to keep her household and everything in it clean.

Annie Lihoma and her daughter Ivy Wayile feed their Guinea Pigs at their home
UNICEF Malawi/2021/Chikondi
Annie Lihoma and her daughter Ivy Wayile feed their Guinea Pigs at their home

"If you give children all food groups, they will rarely get bedridden by preventable diseases. However, infections and parasites can wipe away the gains a balanced diet brings to children," she states.

In 2015, her five-year-old daughter was diagnosed with tapeworms. Tapeworms cause anaemia, which leads to child malnutrition which affects children’s physical and mental growth.

"I spent a lot of money buying medicine because the boy was weak and sickly despite eating three different meals a day. When he saw worms in his stools, I paid K1 000 to hire a bicycle that took him to Khonjeni health centre where a clinician confirmed that he had tapeworms that were getting fatter while he was losing weight," she says.

The hospital trip drained money that Anne's household could have used to buy nutritious foods such as fish and beans, she explains.

Anne rarely buys vegetables because there are plenty in her grass-fenced garden. She shares some with her neighbours.

Her clean and food-secure household mirrors the benefit of Afikepo, a nutrition programme supported by UNICEF and FAO with funding from the European Union.

Anne narrates:  "Sanitation and hygiene has reduced house flies that once contaminated foodstuffs and utensils as they flew from stools and other unclean places," she says.

Anne's village has realised that no one is safe unless everyone has adequate sanitation and hygiene.

In response to the project, Group Village Head Chimiko has ordered every house on the edge of the sprawling tea fields to own a clean toilet instead of depending on neighbours’.

Anne attributes this to the influence of community-based volunteers trained by Afikepo to promote nutrition, sanitation and hygiene. They target households with pregnant women, breastfeeding mothers and children aged below five, but the whole community benefits.

"Since we embraced sanitation and hygiene, cholera has become history and children are not frequently haunted by diarrhoea and sanitation-related diseases transmitted through contaminated water and food," says Anne.

Five-year-old Ivy Wayile washes her hands at home using a bucket provided by the Afikepo programme
UNICEF Malawi/2021/Chikondi
Five-year-old Ivy Wayile washes her hands at home using a bucket provided by the Afikepo programme

She is steadfast on washing dishes using clean water and soap. Water has become a trusted weapon against the COVID-19 pandemic prevented by repeatedly washing hands with soap, social distancing and wearing a mask.

The coronavirus outbreak has illustrated how hand hygiene reduces deadly infections.

According to the Ministry of Health, 52 per cent of outpatients in the country's hospital seek treatment for waterborne and sanitation-related illnesses.

To reduce the disease burden, Anne requires everyone in her household to wash hands during critical junctures such as before eating and feeding a baby, prior to cooking as well as after using the latrine and changing the baby.

"Improved sanitation and hygiene pay. For a year, my five-year-old daughter Ivy, who is in Standard One, has never fallen sick. She never misses classes to seek medical treatment," she states.

"When Ivy was hospitalised at Khonjeni, I was stuck by her bedside instead of taking care of my household, doing income-generating activities or participating in community development works," she states.

Afikepo care group promoter Patricia Moses watering her own vegetable garden
UNICEF Malawi/2021/Thoko Chikondi
Afikepo care group promoter Patricia Moses watering her own vegetable garden

Anne’s husband sells secondhand clothes in the rural trading centres. The couple thanks a promoter who constantly gives them nutrition, sanitation and hygiene tips.

"The promoter visits me twice a month to discuss how we can take care of our children and the rest of the household without compromising their health," she says.

Nutritional promoter Patricia Moses, 36, visits 16 households a fortnight. The single mother of five has all sanitation facilities seen in the homesteads she serves. With K7 000 from piecework in neighbouring crop fields, she engaged young men to dig a pit and construct a latrine. 

"I have to live by example. I should be number one by doing what I promote because action speaks louder than words," Patricia says.

She has made handwashing a habit to beat COVID, which disrupted her work in January when Malawi was overwhelmed by the second wave.  Patricia urges Malawians to keep washing hands with soap because it reduces numerous infections that fuel malnutrition and deaths among children.

"COVID-19 has shown the benefit of basic hygiene. I hope we will continue to wash hands with soap when the outbreak is over," she says.

The promoter works with the village head to dial-up sanitation and hygiene.

Says Group Village Head Chimiko, born Esther Makina: "When Afikepo arrived in my territory, I was happy because healthy people are productive. Dirty hands and homes without latrines fuel disease outbreaks that make our nation poor. We are paying a huge price for this negligence”.