Q+A: Improving Water, Sanitation and Hygiene Practices in Tajikistan

Family with a donkey at their home in the mountain village of Margib, Sughd Province, Tajikistan. Image credit: iStock

Water, sanitation and hygiene practices are a challenge in many developing countries, including Tajikistan in Central Asia. According to the United Nations Children’s Fund (UNICEF), these practices, which share the public health designation “WASH,” are a top factor contributing to death and disability for households in the country.

Research led by Brandy-Joe Milliron, Phd, an associate professor in the Nutrition Science department in Drexel University’s College of Nursing and Health Professions, and Ann Klassen, PhD, a professor in the Community Health and Prevention department in Drexel’s Dornsife School of Public Health, described WASH and other food and cooking practices in Tajik households to determine possible interventions and improve health and nutrition.

Milliron and Klassen spoke with the Drexel News Blog about the study, published in the Journal of Hunger & Environmental Nutrition, the importance of WASH practices and how their findings suggest which Tajik households could benefit from WASH interventions.

What was the purpose of this work in Tajikistan?

Brandy-Joe Milliron (BJM): I’d first like to share a little information about Tajikistan because I’ve noticed many people that I speak with are not familiar with this small country. Tajikistan is a predominantly mountainous and land-locked country in Central Asia, located between the Altay and Pamir mountain ranges. The country shares borders with China, Kyrgyzstan, Uzbekistan and Afghanistan.

Despite recent improvements in poverty rates over the past two decades, Tajikistan persists among the poorest countries in Central Asia. Over three quarters of Tajikistan’s population live in rural areas where access to health care, safe water and sanitation is low. For example, only 36% of the rural population has access to safe drinking water.

To help inform future public health efforts to improve WASH-related factors and lower WASH-related illnesses, the purpose of this study was to describe household WASH practices in Tajikistan, especially behavioral factors related to cooking and food storage.

How did you come to do this work in Tajikistan?

Ann Klassen (ACK): Since 2013, Drexel has held a Long-Term Agreement for Services (LTAS) with UNICEF in the area of Communication for Development (C4D) through the Department of Community Health and Prevention (CHP) in the Dornsife School of Public Health. C4D is a key strategy for public health partnerships with local stakeholders and communities, to build health education campaigns at the community level, and through the LTAS, CHP faculty have provided C4D expertise across the globe. Dr. Milliron and I have worked closely as partners with UNICEF Tajikistan on two projects, in the areas of infant and young child feeding and childhood immunization.

Can you explain WASH practices and why they are important to health and nutrition?

BJM: Water, sanitation and hygiene (WASH) practices include things like the availability of clean water and soap, handwashing, proper storage and disposal of food and water, and the presence of latrines that are covered and kept clean, among other environmental characteristics and behavioral practices.

WASH practices are critically important to health and nutrition because conditions including diarrhea, cholera and intestinal parasites are often the result of poor hygiene, and result in chronic intestinal inflammation and subsequent poor gut nutrient absorption. This cycle often leads to stunting and micronutrient deficiencies, which can lead to further death and disability, as well as cognitive impairment and a loss in economic productivity.

These nutritional diseases among women and children in Tajikistan are a major concern; WASH-related factors remain among the top 10 factors contributing to death and disability in Tajikistan and diarrheal diseases account for nearly 20% of mortality among young Tajik children.

What does this study mean for Tajikistan?

ACK: Our findings highlight both positive aspects and areas for improvement in household WASH practices in Tajikistan. Overall, Tajik households practiced moderately healthy WASH behaviors, as suggested by a high average summary WASH score and positive scores in the personal and latrine domains. However, soap availability for handwashing was low and few households in our study had clean food preparation areas, including kitchen counters, utensils and dishcloths. These domains shed light on content areas for improvement through intervention.

Future WASH-related behavior change interventions in Tajikistan should focus on the importance of clean kitchen environments, including the storage of water and food. Our findings suggest that there are certain types of households that could particularly benefit from WASH education and support in Tajikistan, including those without a patriarchal head of household, households with lower education levels, and households with poor food security.

Read the full study here: https://doi.org/10.1080/19320248.2022.2150109

Media interested in talking to Klassen should contact Greg Richter, assistant director, News and Media Relations, at gdr33@drexel.edu or 215.895.2614.

Media interested in speaking with Milliron should contact Annie Korp, Assistant Director, News and Media Relations, at amk522@drexel.edu or 215-571-4244.