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Improving health and sanitation for young children

Plan International Cambodia has significantly boosted early learning among young children in Trapang Steung village in Tbong Khum province by promoting a nutritional diet, along with effective hygiene and sanitation practices.

Preschool is an important part of early childhood care and development. Children who attend preschool are more likely to succeed in primary school. Children benefit most from preschools that provide children access and early orientation to effective hygiene and sanitation practices. Given the high grade repetition level in primary school and late start, the benefits of preschools become even more apparent. Many children in Cambodia do not have access to early childhood education, despite its inclusion in Cambodia’s constitution.

Our experience shows that preschool and sanitation promotion alone is not a complete solution to bringing about quality learning that prepares children for the primary education. In other words, children need to be well fed, too, to perform best at school. An estimated 32% of Cambodian children under the age of 5 are stunted as a result of chronic malnutrition and 10% suffer from acute malnutrition (Cambodia Demographic and Health Survey 2014).  A further 1 in 5 women is underweight, which impacts on maternal health. Children suffering from malnutrition are less likely to succeed in school and are more prone to dropping out (World Food Programme, 2014*).

To address this, we focus our work in Cambodia on child-centred community development and Cambodian ownership of projects that promote the integration of nutrition, hygiene and sanitation and early-learning among small children as a means of ending childhood poverty.

The project has so far benefiting 42,099  people (9,544 families), of whom 21,242 are female and 4,997 are younger than five, 2,504 of whom are girls.

Mon Mon feeding her youngest girl with porridge prepared communily by the mothers
Mon Mon feeding her youngest girl with porridge prepared communily by the mothers

Trapang Stoeung village recently worked together to build a new community preschool.  Mothers have been meeting to cook porridge, with support from CHADA NGO, a Plan International partner. The purpose is to improve the nutritional status of poor and vulnerable people. They also encourage mothers to breast feed their babies and not use formula to reduce stunting and malnutrition in children and to support pregnant women. 

A large group of women have gathered together to prepare the morning meal for their young children, from newborns to 6 year old children. Porridge, pumpkin and eggs are on the menu.

Chorm Che, 35, is cheerfully feeding her young baby.  She has 3 children. When asked to compare her baby’s development to that of her older children, she does not hesitate: “The older children are relatively smaller and they are thinner.  The baby is also more active than the older children were when they were babie." Her experience is not unique.

“I think that when I join with the other mothers here to cook porridge, my daughter is stronger,” says Mon Mom, 22, who has two old daughters. “I myself eat the porridge.  I am now less often sick than before. Compared to my older child who is 8 years old, my younger child is healthier.”

Women share in the porridge cooking, pooling resources and time at a home near the community preschool building. It’s a sociable event and takes place after preschool class from 7 to 9 am.  The building is decorated in educational child-friendly posters, detailing the nutrition in colourful local vegetables.

Sum Chaden, 32, is pregnant and has a 4-year-old child: “We cook for 5 days a week and contribute 4,000 riel [about US$ 1] each for the week. The contribution depends on the what the mother can afford. Before, we didn’t like to eat vegetables in our porridge, but we find it healthy now.”

Those who most benefit from the parent cooking group are those who have little or no land to grow food on. They are forced to sell their labour in rice fields, rubber tree plantations, and cassava farms or migrate to a neighbouring country to work. 

Duang Pha, 35, says: “My children are not often sick. My daughter is 2 years old and has never been seriously sick. If she has a fever, it is gone in 3 days. Here we have education. They teach us about sanitation, hygiene, and the use of purification tablets for water. That is why our children are now healthier. They teach us to clean our hands, cut finger nails and how to use a tooth brush. We get this education from the preschool teacher."

The preschool teacher, Sum, has 2 roles. She also works as the health volunteer leader for the Village Health Support Group (VHSG). Sum mobilises the village and teaches them about sanitation, using water, and how to build a latrine.

As a natural leader, and with the help of local authorities, she has helped inspire the use of latrines. “We used to have no latrines in my village but now there is one in nearly every house,” she said.

The combination of better nutrition, increasing latrine use and improved hygiene, has lead to significant health improvements. Meas Phearun, 42, the Ponley Health Centre chief explains: “Children were often sick before, with respiratory infections, diarrhoea and malnutrition and stunting. Working in the health centre, children's diseases have reduced dramatically. Only 20% have got sick; it used to be 70%. It is a big change for us.”