Category Archives: Sanitation and Health

Rose George – What is life like when your period means you are shunned by society?

What is life like when your period means you are shunned by society? by Rose George, WaterAid Blog, July 2014 |

Journalist Rose George reports on her visit to WaterAid Nepal, where she saw the impact of menstrual taboos on women and girls.

Excerpts – For Radha dinner is served at 7. She crouches down behind a shed, a good distance from her house, then waits.

She knows what the menu will be: boiled rice, the same as yesterday and the day before. She knows that it will be her little sister who serves it, throwing the rice onto her plate from a height, the way you would feed a dog.

Radha Bishwa Karma serving food behind the toilet. Credit: WaterAid/Poulomi Basu

Radha Bishwa Karma serving food behind the toilet.
Credit: WaterAid/Poulomi Basu

In Jamu, Radha’s village in western Nepal, her status is lower than a dog’s, because she is menstruating.

She is only 16, yet, for the length of her period, Radha can’t enter her house or eat anything but boiled rice. She can’t touch other women – not even her grandmother or sister – because her touch will pollute them. If she touches a man or a boy, he will start shivering and sicken.

If she eats butter or buffalo milk, the buffalo will sicken too and stop milking. If she enters a temple or worships at all, her gods will be furious and take their revenge, by sending snakes or some other calamity.

Here, menstruation is dirty, and a menstruating girl is a powerful, polluting thing. A thing to be feared and shunned.

 

Deprived of water and sanitation in Gaza

We don’t want another catastrophe besides the one we already have. Fatma (43) mother of 9 children

Since the start of the Israeli assault on Gaza on 7 July 2014, codenamed “Protective Edge”, the water and wastewater infrastructure in Gaza has been heavily affected by Israeli airstrikes and shelling.

Main water supply and wastewater as well as electricity infrastructure has been hit. As a result services have been cut or severely disrupted, affecting the entire population in Gaza.

Up to 25 per cent of Gaza’s population were displaced. The 1.8 million people in Gaza, living in homes and shelters have extremely restricted access to water and sanitation.

Fatma, 45, was displaced with her family and sought shelter at a school in Ash Shuja’iyeh. She speaks in a Thirsting for Justice campaign video about the problems with water, sanitation and hygiene that her family faces amongst the many other displaced.

Photo: EWASH

Thirsting for Justice is an initiative of EWASH, the Emergency Water Sanitation and Hygiene group in the Occupied Palestinian Territory.

WASHplus Weekly: Focus on Cholera and Ebola Outbreaks

Issue 157 | August 8, 2014 | Focus on Disease Outbreaks

This issue highlights recent alerts, news and publications on cholera and Ebola outbreaks. On August 1, 2014, WHO published its latest statistics on the number of cholera cases and cholera-related deaths in 2013. In 2013, there was a 47% decrease in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined. Resources on the Ebola outbreaks include WHO alerts, a WHO fact sheet, recent newspaper articles and reports on the One Health approach, which investigates human, animal, and environmental interconnectedness and its impact on health.

CHOLERA NEWS/OUTBREAK ALERTS

Recent Newspaper Articles on Outbreaks – Cameroon – Aug 6, 2014 | Ghana – Aug 4, 2014 | South Sudan – July 30, 2014 | Vietnam – Aug 6 2014 |

CHOLERA STATISTICS/FACT SHEETS

Cholera Fact Sheet, 2014. World Health Organization. (Link)
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera. The short incubation period of two hours to five days enhances the potentially explosive pattern of outbreaks.

USAID-IWASH Ebola Preparedness Response

USAID-IWASH Ebola Preparedness Response

Cholera in 2013. Weekly Epidem Rec, Aug 2014. WHO. (Link)
In 2013, 47 countries reported a total of 129,064 cases of cholera including 2102 deaths, giving a case-fatality rate of 1.63%. This represents a decrease of 47% in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined.

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The Bangladesh Paradox: exceptional health and sanitation advances despite poverty

Dr. Mushtaque Chowdhury from BRAC on the Bangladesh public health miracle, aid or trade, arsenic, floating latrines and the post-2015 development agenda.

Dr. Mushtaque Chowdhury from BRAC presents the "Bangladesh Paradox", International Water House, The Hague, Yje Netherlaands, 30 July 2014

Dr. Mushtaque Chowdhury from BRAC presents the “Bangladesh Paradox”, International Water House, The Hague, The Netherlands, 30 July 2014

By Cor Dietvorst and Vera van der Grift, IRC
Originally posted on the IRC web site, 01 August 2014

Bangladesh has made tremendous progress in the fields of health and sanitation. With a population of 149 million, it now has the highest life expectancy; the lowest fertility rate and the lowest mortality rate of children under five in South Asia (excepting Sri Lanka), although it spends less on health care than most neighbouring countries. Only 10% of the population in Bangladesh practices Open Defecation (OD) compared to 50% in India.

It is one of only six countries that are on track to achieve Millennium Development Goals 4 and 5 on reducing child mortality and improving maternal health.

Emerging from the war of liberation in 1971, Bangladesh embraced a new more liberal identity, which manifested itself in a change in societal attitudes towards women, and girls’ education in particular.

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WaterAid – Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea

Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea, 2014. WaterAid.

The research revealed that people living with HIV in PNG have increased needs for WASH, and that these needs are not being adequately met. Stigma and discrimination were found to be barriers to access to WASH for respondents and their families. In addition, this study identified priority areas for service providers to direct future activities and best integrate WASH into programming for people living with HIV. Priority areas include hygiene education, safe treatment and storage of water, self-treatment for diarrhoea, latrine construction, and education around the transmission of HIV.

Compendium of Sanitation Systems and Technologies, 2nd Edition

Compendium of Sanitation Systems and Technologies 2nd Edition, 2014. IWA; EAWAG.

Authors: E. Tilley, et al. eawag

This second, revised edition of the Compendium presents a huge range of information on sanitation systems and technologies in one volume. By ordering and structuring tried and tested technologies into one concise document, the reader is provided with a useful planning tool for making more informed decisions.

  • Part 1 describes different system configurations for a variety of contexts.
  • Part 2 consists of 57 different technology information sheets, which describe the main advantages, disadvantages, applications and the appropriateness of the technologies required to build a comprehensive sanitation system. Each technology information sheet is complemented by a descriptive illustration.
Download the English 2nd Edition
Download the 1st Edition

 

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration. Int J Public Health, 2014 Jul 11.

Authors: Teague J, Johnston EA, P Graham J.
Author email: jteague@washadvocates.org

OBJECTIVES: This study explores the integration of water, sanitation, and hygiene (WASH) and nutrition programming for improved child health outcomes and aims to identify barriers to and necessary steps for successful integration.

METHODS: Sixteen semi-structured in-depth interviews were conducted with key stakeholders from both the WASH and nutrition sectors, exploring barriers to integration and potential steps to more effectively integrate programs.

RESULTS: Key barriers included insufficient and siloed funding, staff capacity and interest, knowledge of the two sectors, coordination, and limited evidence on the impact of integrated programs. To achieve more effective integration, respondents highlighted the need for more holistic strategies that consider both sectors, improved coordination, donor support and funding, a stronger evidence base for integration, and leadership at all levels.

CONCLUSIONS: Organizations desiring to integrate programs can use these results to prepare for challenges and to know what conditions are necessary for successfully integrated programs. Donors should encourage integration and fund operational research to improve the efficiency of integration efforts. Knowledge among sectors should be shared and incentives should be designed to facilitate better coordination, especially where both sectors are working toward common goals.

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition | Source: by Gardiner Harris, New York Times, July 13, 2014.

Excerpts: A long economic boom in India has done little to reduce the vast number of children who are malnourished and stunted, leaving them with mental and physical deficits that will haunt them their entire lives. Now, an emerging body of scientific studies suggest that many of the 162 million children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation. sanitation-nytimes

Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problem.

“Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

This research has quietly swept through many of the world’s nutrition and donor organizations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?

WASHplus Weekly: Focus on Fecal Sludge Management

Issue 153 | July 11, 2014 | Focus on Fecal Sludge Management

This issue focuses on studies, reports, and other materials that have been published so far in 2014 on fecal sludge management (FSM). Included is a just-published and comprehensive guide on planning and organizing the entire fecal sludge management service chain. A WASTE report evaluates FSM methods in emergency situations, and a Water and Sanitation Program  report examines FSM in 12 cities. washplus

EVENTS

3rd International Faecal Sludge Management Conference, Jan 18-22, 2015, Hanoi, Vietnam(3rd Conference Link) | (2nd Conference Presentations)
Building on the success of the two previous International FSM Conferences in Durban (2011 and 2012), FSM3 will bring together world-class research and science and donors, cities, utilities, investors, consultants, governments, service providers, and industries with the aim of fostering an effective dialogue on solving the problem of dealing with human waste.

GUIDES

Faecal Sludge Management (FSM): Systems Approach for Implementation and Operation, 2014. L Strande, ed., EAWAG. (Link)
This guide compiles the current state of knowledge of this rapidly evolving field and presents an integrated approach that includes technology, management, and planning. It addresses the planning and organization of the entire FSM service chain, from the collection and transport of sludge and treatment options, to the final end use or disposal of treated sludge.

Emergency Sanitation: Faecal Sludge Treatment, 2014. J Spit, WASTE. (Link)
This research aims to expand the knowledge of possible simple fecal sludge treatment technologies that could be rapidly deployed in the event of an emergency and are effective under challenging physical conditions such as unstable soils, high water tables, and flood-prone areas. Three fecal sludge sanitization methods—lactic acid fermentation, urea treatment, and hydrated lime treatment—were investigated by undertaking small scale field trials with pit latrine sludge in Blantyre, Malawi.

Facilitation Manual: Sanitation Entrepreneur Training, 2014. Water and Sanitation Program (WSP). (Link)
A WSP team felt there was a growing need for a standard reference for implementing sanitation entrepreneur training and developed a training program and guide that could be replicated and carried out independently by interested stakeholders.

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Estimates on the WASH-related Global Burden of Disease

Below are abstracts and links to the full-text of articles in the August 2014 issue of  Tropical Medicine and International Healthtmih

Focus on the Global Burden of Disease from Water
While the methods of Global Burden of Disease (GBD) study continue to evolve, recent changes raise questions about the basis of new estimates of the risk associated with water, sanitation and hygiene and warrant consideration of alternative approaches.

  • ​Inadequate water, sanitation and hygiene are estimated to have caused 842,000 deaths from diarrhoea in 2012, i.e., 1.5% of deaths worldwide. These include 361,000 deaths of children under five years.
  • ​A systematic review of the global prevalence of handwashing with soap and its effect on diarrhoeal diseases estimates that only 19% of the world’s population washes hands with soap after contact with excreta and that handwashing reduces the risk of diarrhoeal disease by 23%–40%.
  • ​Based on over 300 studies from a systematic review, an estimated 1.1 billion people are exposed to a drinking water source of moderate to high risk.
  • ​A meta-regression shows that risks of diarrhoea from inadequate drinking water and sanitation could be reduced considerably through targeted interventions. Risk differences depend on type of intervention.

1 – Authors:  Clasen, Thomas, Pruss-Ustun, Annette, Mathers, Colin D., et al.

TI  - Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods
Abstract – http://onlinelibrary.wiley.com/doi/10.1111/tmi.12330/abstract
AB  – The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted.

2 – Authors: Prüss-Ustün, Annette, Bartram, Jamie, Clasen, Thomas,  et al.

TI  – Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

Objective – To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases.

Methods – For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.

Results – In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group.
Conclusions – This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.

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