Does Village Water Supply Affect Children's Length of Stay in a Therapeutic Feeding Program in Niger? Lessons from a Médecins Sans Frontières Program

Objective: With an increasing move towards outpatient therapeutic feeding for moderately and severely malnourished children, the home environment has become an increasingly important factor in achieving good program outcomes. Infections, including those water-borne, may significantly delay weight gain in a therapeutic feeding program. This study examined the relationship between adequacy of water supply and children's length of stay in a therapeutic feeding program in Niger. Methods: The length of stay in a therapeutic feeding program of Médecins Sans Frontières in Niger was registered for 1518 children from 20 villages in the region. In parallel, the quality and quantity of the water source in each village were documented, and the association between adequacy of the water supply and length of stay in the program was assessed through Generalized Estimating Equation analysis. Results: 36% of the children presented with a secondary infection, 69% of which were water-related. When stratified by the adequacy of the quantity and/or quality of the water supply in their village of origin, non-adequacy of the water supply was clearly associated with a higher prevalence of secondary water-related infections and with much longer lengths of stay of malnourished children in the therapeutic feeding program. Conclusion: This study suggests that therapeutic feeding programs using an outpatient model should routinely evaluate the water supply in their target children's villages if they are to provide optimal care.