Category Archives: Sanitation and Health

My toilet: global stories from women and girls

You are invited to view an exciting new exhibition by WSUP, launched to mark World Toilet Day.

My Toilet documents women and girls and their toilets to build a visual representation of the day to day reality and the effect this has on their lives, both positive and negative.

Keyla, 4, by her toilet in Bolivar, Ecuador. Photography Karla Gachet. Panos Pictures for WSUP.

Keyla, 4, by her toilet in Bolivar, Ecuador. Photo: Karla Gachet, Panos Pictures for WSUP.

The images and stories show that, although the type of toilet changes from country to country, the impacts have recurring themes. Having can mean a better chance of education, employment, dignity, safety, status and more. Wherever you are in the world, a toilet equals far more than just a toilet.

Get involved on social media!
Help spread this message by sharing a picture of yourself holding up a sign with the hashtag #ToiletEquals followed by a word, or a few words, to describe what having a toilet equals for you and for millions of others around the world. All the tweets and pictures will be shown on the My Toilet website.

Visit the exhibition!
Images from 20 countries, spanning every continent, will be exhibited at The Royal Opera Arcade Gallery, London SW1Y 4UY. The gallery is open to the public from 17 – 22 November 2014, 10am – 5pm daily. Entry is free. We hope to see you there!

Beyond Malnutrition: The Role of Sanitation in Stunted Growth

Below are the 3 latest posts to the WASH Nutrition Library, http://blogs.washplus.org/washnutrition that is maintained by the USAID Community of Practice on WASH and Nutrition. If your organization has recent studies that we can add to the library, please let us know.

  • ​Beyond Malnutrition: The Role of Sanitation in Stunted Growth
  • Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As
  • Understanding the Rapid Reduction of Undernutrition in Nepal, 2001–2011:​

Beyond Malnutrition: The Role of Sanitation in Stunted GrowthEnv Health Perspect, Nov 2014

Author: Charles W. Schmidt

An excerpt from the article: Beyond Nutrition – Nutritionists have tried dozens of approaches to prevent stunting, such as micronutrient supplements for pregnant women and children (especially growth promoters including iron, zinc, calcium, and folate); increased availability of fat-fortified commercial products such Nutributter and Plumpy’nut; a concerted push to encourage breastfeeding during the first six months of life; and efforts to improve the nutritional quality of the complementary foods babies eat while weaning.6

But Jean Humphrey, a professor of human nutrition at the Johns Hopkins Bloomberg School of Public Health, says none of these interventions has been able to eliminate stunting completely. At best, she says, they improve growth by about a third of the typical height deficit in stunted Asian and African children. “This tells us that dietary improvements are important but not sufficient,” she says. “If we really want to eliminate stunting, we need to do more.”

Meanwhile, mounting evidence has shown that poor hygiene and sanitation also constrain linear growth in children. One study found that Bangladeshi children who had access to clean drinking water, improved toilets, and facilities for handwashing with soap, for instance, had a roughly 50% improvement in HAZ scores compared with control children who didn’t.18 Similar results emerged from studies in Sudan19 and Mexico,20 yet it was unclear exactly why poor WASH would contribute to stunting and WASH improvements would help to ameliorate it.

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Reframing Undernutrition: Faecally-Transmitted Infections and the 5 As, October 2014.

Robert Chambers and Gregor von Medeazza, Institute of Development Studies.

The dominant nutrition discourse concerns access to adequate food and its quality. It now includes food security, food rights and justice, governance and agriculture. Despite many initiatives to assure food access, and growing economies, high levels of undernutrition persist in much of Asia. It is increasingly suggested that much of this ‘Asian enigma’ can now be explained by open defecation (OD) combined with population density. However, the insight that ‘shit stunts’ remains a widespread blind spot. The persistence of this blind spot can in part be explained by factors which are institutional, psychological and professional.

Reductionist focus on the diarrhoeas, which are serious, dramatic, visible and measurable, has led to the relative neglect of many other often subclinical and continuously debilitating faecally-transmitted infections (FTIs) including environmental enteropathy (EE), other intestinal infections, and parasites. These are harder to measure but together affect nutrition much more: the diarrhoeas are only the tip of the much larger sub-clinical iceberg. How OD and FTIs, poverty and undernutrition reinforce each other is illustrated in this paper by looking at the case of India, which has about 60 per cent of the OD in the world, around a third of the undernourished children, and approximately a third of the people living in poverty. Through OD, FTIs and in other ways, lack of sanitation leads to losses, which may be estimated, in the range of 1 to 7 per cent of GDP in various countries.

To reframe undernutrition for a better balance of understanding and interventions, we propose two inclusive concepts: the FTIs and the 5 As. The first two As – availability and access – are oral, about food intake, while the last three As – absorption, antibodies and allopathogens – are novel categories, anal and internal, about FTIs and what happens inside the body. These concepts have implications for research, professional teaching and training, and policy and practice. While other countries make rapid progress towards becoming open-defecation free, India remains obstinately stuck, making undernutrition in India one of the great human challenges of the twenty first century. The concepts of FTIs and the 5 As reframe more inclusively how undernutrition is perceived, described and analysed. Our hope is that this reframing will contribute however modestly to a cleaner, healthier and happier world in which all children and adults are well-nourished and can grow and live to their full potential.

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Understanding the Rapid Reduction of Undernutrition in Nepal, 2001–2011: IFPRI Discussion Paper 01384, 
October 2014.

AUTHORS: Derek D. Headey (d.headey@cgiar.org) is a senior research fellow in the Poverty, Health, and Nutrition
Division of the International Food Policy Research Institute (IFPRI), Washington, DC.

John Hoddinott is a senior research fellow in the Poverty, Health, and Nutrition Division of IFPRI,  Washington, DC.

Abstract: South Asia has long been synonymous with unusually high rates of undernutrition. In the past decade, however, Nepal has arguably achieved the fastest recorded decline in child stunting in the world and has done so in the midst of civil war and postconflict political instability. Given recent interest in reducing undernutrition–particularly the role of nutrition-sensitive policies–this paper aims to quantitatively understand this surprising success story by analyzing the 2001, 2006, and 2011 rounds of Nepal’s Demographic Health Surveys.

To do so, the authors first construct and test basic models of the intermediate determinants of child and maternal nutritional change and then decompose predicted changes in nutrition outcomes over time. They identify four broad drivers of change: asset accumulation, health and nutrition interventions, maternal educational gains, and improvements in sanitation.

Many of these changes were clearly influenced by policy decisions, including increased public investments in health and education and community-led health and sanitation campaigns. Other factors, such as rapid growth in migration-based remittances, are more a reflection of household responses to changing political and economic circumstances.

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Oliver Cumming – Does Improving Sanitation Benefit Health? (podcast)

PODCAST: Does Improving Sanitation Benefit Health?

Description In this podcast, Oliver Cumming, Policy & Research Manager at SHARE, discusses whether improving sanitation benefits health and explains how a sanitation campaign in rural India has led to a rethink about future interventions. This podcast was first published on 23/10/14 by LSHTM.

WASHplus Weekly: Focus on WASH & Ebola

Issue 167| Oct  31, 2014 | Focus on WASH and Ebola

This issue contains updates on Ebola outbreaks and other recent journal and newspaper articles as well as links to World Health Organization (WHO), UNICEF, and Centers for Disease Control and Prevention (CDC) websites on Ebola. Included are WHO/UNICEF factsheets, guidance on making chlorine solution from Tufts University, articles from the Global Public-Private Partnership on Handwashing, a summary of water and Ebola issues from the Pacific Institute, Ebola-related anthropological studies from the Institute of Development Studies, and other resources. WASHPlus_HTMLbanner_weekly_600x159

OVERVIEWS

Ebola Virus Disease (EVD): Key Questions and Answers Concerning Water, Sanitation and Hygiene, 2014. WHO. Link
The key to controlling the hazard associated with the presence of the virus in the body fluids of infected individuals lies in the rigorous enforcement of protocols to separate and contain ALL body fluids (including feces and urine). Feces from suspected or confirmed Ebola cases must be treated as a biohazard and handled at a minimum.

An Open Memo on Ebola and Water. Science Blogs, Oct 2014. P Gleick, Pacific Institute.Link
As input to the ongoing discussions about how to meet and overcome the spreading risks of Ebola, this blog post provides thoughts on the water-related components of U.S. efforts. The author urges manufacturers of water treatment technologies to confirm that they are designed and can be operated to specifically remove or inactivate Ebola-type viruses with high reliability and for medical experts to determine the quality and quantity of water needed in a field hospital setting.

Ebola Virus Disease Factsheet, 2014. WHO. Link
Good outbreak control relies on applying a package of interventions, namely case management, surveillance, and contact tracing; a good laboratory service; safe burials; and social mobilization. Community engagement is key to successfully control outbreaks.

WASH-RELATED RESOURCES

Methods to Make Chlorine Solution in Ebola Emergencies, 2014. D Lantagne, Tufts University. Link
The methods for onsite manufacturing of chlorine include: diluting HTH or NaDCC powder in water; diluting concentrated liquid solution in water; and generating sodium hypochlorite using salt, water, and electricity.

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Robert Chambers – So Much to Keep Up With, So Much to Learn

This was the first time I have been to the annual four and a half day conference of the Water Institute at the University of North Carolina.  Like the annual WEDC conference, there was a huge, almost overwhelming, harvest of information and learning. Here are some bullets of things that struck me:

Inequality is big, big now, with the post-2015 agenda.  It will be picked up and reported in the JMP.  We are entering a new space.  Good. Robert_chambers

Ash. Soap or ash for handwashing.  A JMP committee was unwilling to mention ash because there has been no study of the health effects, only those of soap, although there is no question that microbiologically it is nearly as good as soap.  Let us hope that research will be funded – there are people willing to carry it out.  But the big money for HW research comes, I suppose, from Unilever and Proctor and Gamble.  There is scope here for funding from others.  Ash is poor-friendly – widely available, costless, can be left outside without being stolen or taken by teachers, and is not eaten by goats.  But the deeply rooted refrain is ‘handwashing with soap’.  Again and again one has to argue for including ash – ‘handwashing with soap or ash’ or for that matter, soil, depending on the soil.

Behaviour change.  This came up repeatedly. Far too much to absorb or report but some snippets:

  • Signing a pledge can be effective
  • When someone has invested (e.g in building their own toilet) they may feel they have to keep up appearances and justify it by using it
  • Frequent rewards can reinforce behaviour
  • Special times can be picked as opportunities for change – e.g. a marriage or funeral
  • New behaviours can piggy-back on one another through linking
  • ‘Choice is the enemy of behaviour change’.
  • People infer motives from observing their own behaviour (linked with dissonance reduction)

Read the complete post

WASHplus Weekly – World Habitat Day: Focus on Slums

Issue 164 | Oct 3, 2014 | World Habitat Day: Focus on Slums

The first Monday in each October is World Habitat Day. This year the theme is Voices from Slums. This issue of the weekly contains news of upcoming urban events, urban innovation awards, recent urban WASH studies, and other reports and resources on issues faced by the urban poor.

EVENTS

World Habitat Day: Voices from Slums, October 6, 2014Link
Each year World Habitat Day takes on a new theme chosen by the United Nations based on current issues relevant to the habitat agenda. The themes are selected to bring attention to UN-Habitat’s mandate to promote sustainable development policies that ensure adequate shelter for all. This year’s theme, Voices from Slums, is intended to give voice to slum dwellers for improving quality of living conditions in existing slums. This is the UN’s official website for the event. washplusweekly

International Conference on Urban Health, March 9-12, 2015, BangladeshLink
The International Society for Urban Health is an association of researchers, scholars, professionals, community members, and workers and activists from various disciplines, roles, and areas of the world whose work is directly related to the health effects of urban environments and urbanization. The International Conference on Urban Health provides an international forum for information exchange among urban health stakeholders. The theme for the 2015 conference is Urban Health for a Sustainable Future: The Post 2015 Agenda.

URBAN HEALTH STUDIES

USAID/WASHplus Urban Health UpdatesLink
Urban Health Updates contains more than 800 peer-review articles and “gray” literature reports on health issues faced by the urban poor.

Urban Health: It’s Time to Get Moving! Global Health Science & Practice, May 2014. V Barbiero. Link
Policy makers must commit to a long-term action plan that addresses the triple burden of health issues faced by growing urban populations. A comprehensive global urban health strategy is in order; one similar to the global approach to HIV/AIDS, polio eradication, and malaria. The strategy should build on the urban experience, both positive and negative, from all regions of the globe and provide a clear vision and programmatic guidance.

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Sanitation in Malawi – SHARE project and CCODE work

Published on Sep 2, 2014

The video features the work of CCODE and the Federation of the Rural and Urban Poor in Blantyre, framed on the SHARE (Sanitation and Hygiene Applied for Equity) research project, as well as the challenges that the country faces in terms of sanitation, water and hygiene.

SHARE’s work to date in Malawi has focused on Ecological Sanitation (Ecosan), which has been heavily promoted in urban areas. Blantyre in Malawi is also one of the cities included in the City-Wide Sanitation Project.

For more information about the work of CCODE and the Federation of the Rural and Urban Poor visit http://www.ccodemw.org/.

For further info about SHARE visit http://www.shareresearch.org