WASHplus Weekly on WASH-Related Diseases

This issue contains recent studies and resources on several WASH-related diseases: cholera, dengue, diarrhea, leptospirosis, neglected tropical diseases, malnutrition, and typhoid. Included are a just-published UNICEF cholera toolkit, an updated review of WASH-related diseases from DfID, typhoid case studies from Bangladesh and Fiji, and other resources. 

The Centers for Disease Control and Prevention suggested the topic for this issue, and we welcome other suggestions for topics. Future issues will focus on menstrual hygiene management, innovation, water point mapping, mobile applications, and WASH in schools; more than 100 past issues of the Weekly are archived on the WASHplus website.

• Link to Weekly

WASH for Life grants for the HappyTap and six other innovations

WaterSHED’s Vietnamese HappyTap. Photo: WaterSHED

The HappyTap, a low-cost handwashing device for the Vietnamese market, is one of seven innovations to receive a grant from the WASH for Life Partnership. This US$ 17 million initiative is co-funded by the Bill & Melinda Gates Foundation and USAID’s Development Innovation Ventures (DIV).

In 2010, with USAID support, the WaterSHED program teamed with the Water and Sanitation Program (WSP) to develop and market a new handwashing device. The design came from IDEO.org, which itself has received a WASH for Life grant for Clean Kumasi, an digitally-supported approach to Community-Led Total Sanitation (CLTS). Together with Water and Sanitation for the Urban Poor (WSUP), IDEO.org is working to combat open defecation in Kumasi, Ghana using mobile phones and open-source mapping.

Examples of signs posted to prompt residents to flash Clean Kumasi. Photo: IDEO.org

New Global Study Pinpoints Main Causes of Childhood Diarrheal Diseases

New Global Study Pinpoints Main Causes of Childhood Diarrheal Diseases, Suggests Effective Solutions

A new international study published today in The Lancet provides the clearest picture yet of the impact and most common causes of diarrheal diseases, the second leading killer of young children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa.

GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, confirmed rotavirus – for which a vaccine already exists – as the leading cause of diarrheal diseases among infants and identified other top causes for which additional research is urgently needed. GEMS found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhea (MSD) each year, which increased children’s risk of death 8.5-fold and led to stunted growth over a two-month follow-up period.

Developing and Monitoring Protocol for the Elimination of Open Defecation

Developing and Monitoring Protocol for the Elimination of Open Defecation in Sub-Saharan Africa, 2013.  UNICEF.

• Link to full text, pdf

Eliminating open defecation is increasingly seen as a key health outcome, with links to reduced stunting, improved educational and positive health outcomes for children. In Sub Saharan Africa, over 35 countries are implementing some form of CLTS, ranging from TATS in Tanzania to CLTSH in Ethiopia. Since the introduction of CLTS in 2005 in the region, rapid scale-up has been achieved with suggested numbers of ODF communities in the range of 30,000 affecting over 15 million people in SubSaharan Africa. Several countries have set aggressive targets for elimination of Open Defecation in rural areas for the next five years which often include not only safe disposal of faeces but handwashing facilities, cleanliness and solid waste management.

Sustaining the progress made through the application of the CLTS process is emerging as a challenge with experience suggesting that sustainability is determined by the process followed to achieve ODF. Rapid scale up in SSA is arguably linked to the fact that CLTS is based on the concept of triggering community-wide behaviour change, requires no subsidies and integrates easily into existing health programming structures. Current focus is on ‘triggering’ communities into action; while considerably less resources and emphasis on following up and mentoring of communities ‘post-triggering’.

This paper reviews process and protocol for defining, reporting, declaring, certifying ODF and sustaining ODF, highlighting where the process varies between countries and potential determinants of sustainability within the process itself. Critical questions include what elements (should) constitute an ODF protocol, what are the determinants of sustainability and what impact does target-setting have on achievement of ODF goals in country?

WSA signs up with Malaysian firm for technical support on sanitation

Water and Sanitation for Africa (WSA) has signed a memorandum of understanding with Malaysian firm Indah Water Konsortium Sdn Bhd for technical know-how and consultancy services in sewerage management in African countries.

WSA selected Indah Water “to be in a technical committee formed by the Bill and Melinda Gates Foundation to propose immediate, medium- and long-term solutions for sanitation services in WSA member countries”. In 2011-2012 WSA received three Gates Foundation grants totalling US$ 7.2 million, one of which to develop sanitation financing models for urban poor and another to set an African Sanitation Think Tank.

Chief Executive Officer Datuk Abdul Kadir Mohd Din said that the Gates Foundation “had sent a team of wastewater experts from the United States to visit Indah Water after visiting the African continent and Asean countries”.

Indah Water is Malaysia’s national sewerage company. In 1994, the Federal Government awarded the company the concession for nationwide sewerage services which before were the responsibility of local authorities.

Water and Sanitation for Africa (WSA) is a Pan African Inter-governmental Agency based in Burkina Faso, previously known as the African Regional Centre for Water and Sanitation (CREPA). WSA has a presence in 32 African countries.

Source: Bernama, 16 May 2013

Kiribati’s North Tarawa declared first open defecation free island in the Pacific

Everyone on North Tarawa now has access to improved sanitation. Photo: ABC Radio Australia / UNICEF Pacific.

North Tarawa in Kiribati is the first island in the Pacific to be declared open defecation free, thanks to the “Kiriwatsan I Project”. The Ministry of Public Works is implementing this project with technical support from UNICEF and funding from the European Union.

North Tarawa is made up of a string of islets with a combined population of 6,102 (2010) and a land area of 15.26 sq.km.  Previously about 64 per cent of people used the beaches and mangroves for defecation and dumping their rubbish.

UNICEF spokeswoman Nuzhat Shahzadi says that diarrhoeal diseases cause 15 per cent of the deaths of children under five in Kiribati.

In March 2013, North Tarawa adopted the Community-Led Total Sanitation (CLTS) approach following a training of trainers course conducted by Dr Kamal Kar. The CLTS pioneer wrote that he had convinced Kiribati President Anote Tong to set December 2015 as the target date for the whole nation to become open defecation free.

The villagers of North Tarawa dig shallow pits and use local materials like brick and coconut leaves to build the toilet superstructure. They keep water and soap in one corner. After using the toilet, the villagers sprinkle ash to stop the smell and flies getting in, and then keep it covered.

Ms Shahzadi said that the women and girls were very happy that no longer have to go out on the beach in the middle of the night if they need to use the toilet.

Source: UNICEF, 11 May 2013 ; Radio New Zealand International, 13 May 2013 ; ABC Radio Australia, 14 May 2013

UNICEF launches groundbreaking cholera toolkit

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

• WHO – Cholera
• CDC – Cholera
• MSF Field Research – Cholera

Source: UNICEF, 15 May 2013

 

 

May #MENSTRAVAGANZA – WASH United’s menstrual hygiene campaign

“If women can have moustaches we can all talk about menstruation”. With this message WASH United kicked off May MENSTRAVAGANZA, a 28-day campaign to raise awareness and break the silence around menstruation and menstrual hygiene.

Messages are posted on the campaign website:
wash-united-may-menstravaganza.tumblr.com and
on Twitter using hashtag #MENSTRAVAGANZA

India, Bihar: rapes ’caused by lack of toilets’

Map showing frequency & severity of violence against
women in Bhalswa slum, Delhi. Shirley Lennon/SHARE.

The lack of safe toilets for women and girls is often linked to an increased risk of sexual harassment and rape. Earlier studies [1] from Kenya, Uganda and India, and now a recent BBC news item are some of the few sources to actually quantify this risk.

Senior police official Arvind Pandey from the Indian state of Bihar told the BBC that 400 women would have “escaped” rape in 2012 if they had toilets in their homes. The rapes take place when women go outside to defecate early in the morning and late evening. These “sanitation-related” rapes make up nearly half of the more than 870 cases of rape in Bihar in 2012.

The BBC news item lists three specific cases:

• On 5 May, an 11-year-old girl was raped in Mai village in Jehanabad district when she was going to the field at night
• On 28 April, a young girl was abducted and raped when she had gone out to defecate in an open field in Kalapur village in Naubatpur, 35km (21 miles) from the state capital, Patna
• On 24 April, another girl was raped in similar circumstances on a farm in Chaunniya village in Sheikhpura district. She told the police that two villagers had followed and raped her. One of them has been arrested

In Bihar , 75.8% of homes have no toilet facilities (Census 2011). Some 49% of the households without a toilet wanted one for “safety and security” for women and children, according to a study by Population Service International (PSI),   Monitor Deloitte and Water for People.

[1] Heise, L., 2013. Danger, disgust and indignity : women’s perception of sanitation in informal settlements. Powerpoint presented at “Making connections: Women, sanitation and health”, 29 April 2013, London School of Hygiene and Tropical Medicine (LSHTM). Video version available at:  http://www.youtube.com/watch?v=AS9ulpJqh7s

Related news:

• Request for Proposals: The effects of poor sanitation on women and girls in India, Sanitation Updates, 07 Mar 2013
• India, Delhi: how sexual violence against women is linked to water and sanitation, E-Source, 27 Mar 2012

Source: Amarnath Tewary, BBC, 09 May 2013

 

Sri Lanka: new partnership tackles fecal sludge management

Septage disposal. Sri Lanka/Nuwara Eliya sanitation project, 2008, Photo: Flickr/USAID.

An international research institute is helping the government of Sri Lanka to improve septage management in the country.

On 8 May 2013, the Colombo-based International Water Management Institute (IWMI) and the Ministry of Water Supply and Drainage signed a Memorandum of Understanding that provides a collaborative framework for sustainable septage management in Sri Lanka.

IWMI will contribute research data for the drafting of a septage management component of the national sanitation policy. The Ministry will lead implementation of the policy through an advisory committee headed by Minister Dinesh Gunawardena.

Only about 3% of Sri Lankans have a sewerage connection while the rest rely on latrines and septic tanks for sanitation. Safe disposal of septage (fecal sludge) is a problem because of a lack of treatment facilities in large parts of the country.

IWMI is studying a new approach in cities around the world, which treats the sludge so that it can be safely reused as agricultural fertiliser. With the rising costs of imported fertiliser, such an approach would not only benefit farmers but also allow better sanitation and environmental protection for all.

Related news:

• The business of the honey-suckers in Bengaluru (India), E-Source, 27 Sep 2012
• WASHplus Weekly: Focus on Fecal Sludge Management, Sanitation Updates, 30 Nov 2012

Related web sites:

• IWMI - Resource Recovery and Re-use
• Ministry of Water Supply and Drainage
• SuSanA - WG 5 – Food security and productive sanitation systems and Library – Fecal sludge management

 Source: IWMI, 8 May 2013