The USAID Neglected Tropical Disases (NTD) program has programs to eliminate and/or control NTDs in 24 countries. Even as NTDs are eliminated through mass drug administration, the reinfection of these diseases will remain a problem if behaviors and the environment remain unchanged. STH, schistosomiasis, and trachoma are all clearly linked to inadequate sanitation, contaminated food and water, and poor hygiene, providing an opportunity for water, sanitation, and hygiene (WASH) related approaches to help change behavior and the environment.

For decades, implementers have applied water, sanitation, and hygiene (WASH) and nutrition-based interventions—alone and in a variety of combinations—to address diarrheal disease and stunting among infants and young children (IYC) in low- and middle-income countries. Given the extensive and intensive efforts, why aren’t we seeing more progress?

The USAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project conducted a review of the scientific and grey literature, complemented by dozens of key informant interviews with researchers and field implementers, to synthesize the latest understanding of key pathways of fecal microbe ingestion by infants and young children (IYC) and their links to diarrhea, EED, and poor nutrition and development outcomes.

Specifically, the review sought to: