64th World Health Assembly approves three WASH resolutions

The 64th World Health Assembly (WHA) has adopted a resolution on drinking-water, sanitation and health, and two other related resolutions on cholera and Guinea worm (dracunculiasis).

Yael Velleman at the WHA in Geneva with a copy of the WaterAid report "The sanitation problem - What can and should the health sector do". Photo: WaterAid

WaterAid had issued a call to leaders participating in the WHA in Geneva to prioritise sanitation and water in the fight against diseases including cholera and dracunculiasis. In support of their campaign, WaterAid published a new report
The sanitation problem: What can and should the health sector do?. WaterAid’s Senior Health Policy Analyst Yael Velleman wrote an opinion piece in the Guardian and posted daily updates from the WHA.

Water, Sanitation Could Erase Cholera and Guinea Worm

GENEVA, May 19, 2011 (IPS) – The World Health Assembly could adopt landmark resolutions asking governments to improve water and sanitation to eradicate cholera and guinea worm, the latter of which exists in just four countries in Africa. While safe drinking water and toilets are the most cost-effective public health measures, they have not been a priority for most developing countries.

“In 1989, when we started our programme, 180,000 people were affected by guinea worm,” Dr. Andrew Seidu Korkor, national coordinator for guinea worm at the Ghana Health Service, told IPS in a phone interview. “In 2010 we had only eight cases and today there are none. But it takes three years to get the certification that the disease is not endemic in your country any more.”

The guinea worm causes Dracunculiasis, a waterborne parasitic disease that exists in only four countries – Ghana, Mali, Ethiopia and Sudan. It lives in stagnant water. When people drink contaminated water, the parasite grows up to three feet and lives just below the skin, often crippling its human host.

There are no medicines to treat the disease or vaccines to prevent it. The only cure is to slowly, painfully extract it over days. While the disease is not lethal, its disabling effect prevents those affected from working or attending school, putting already vulnerable individuals and communities at further risk of chronic poverty.

“If potable water was provided, then guinea worm could be definitely eradicated,” Seidu Korkor continued. “But you cannot get 100 percent water supply immediately, because it is expensive and it takes time. Therefore, we also educate people on prevention measures, we look for cases and treat them, we use filters to improve the water supply and apply chemicals to kill the intermediate host.”

If completely eradicated, guinea worm would become the second disease wiped out by humankind – the first since smallpox was eradicated in the 1970s.

Haiti: UN panel reports on source of cholera outbreak

The cholera outbreak that has so far killed 4,888 people in Haiti was caused by a strain “very similar but not identical” to current South Asian strains, a UN independent panel of experts said. The source of the outbreak was due to contamination of the Meye Tributary of the Artibonite River, used by tens of thousands of people for washing, bathing, and drinking.

Anti-UN protests in Haiti

Many people in Haiti blamed the epidemic on UN peacekeepers from Nepal, who had been accused of poor sanitation at their base near Mirebalais, the town where the epidemic first began. In November 2010, this led to violent protests against the UN peacekeeping forces. Others believed that the outbreak was linked to voodoo. More than 50 voodoo followers have been killed since the outbreak of cholera following accusations that they spread the disease with occult power. However, the U.N. panel declined to point the finger at any single group for the outbreak, saying it was the result of a “confluence of circumstances”.

“The introduction of this cholera strain as a result of environmental contamination with faeces could not have been the source of such an outbreak without simultaneous water and sanitation and health-care system deficiencies,” the report concludes.

Haiti: disease model predicts more cholera and potential impact of clean water

The number of Haitians infected with cholera may reach 779,000 by the end of November 2011, nearly twice as many as UN estimates, according to a new study [1].

The UN estimate is “essentially a guess, based on no data, and ignoring the dynamics of cholera epidemics” co-author Dr. Jason Andrews told SciDev.Net.

Using a mathematical model of the epidemic, the study projects 779 000 cases of cholera and 11,100 deaths between March 1 and November 30, 2011, if there are no new interventions to curb transmission and treat victims.

The researchers estimate that 170,000 cases of cholera and 3,400 deaths could be averted by a combination of clean water, vaccination and greater distribution of antibiotics.

A 1% per week reduction in consumption of contaminated water would the greatest effect by averting 105,000 cholera cases and 1,500 deaths. Vaccination of 10% of the population would avert 63,000 cases and 900 deaths. The extension of the use of antibiotics to all patients with severe dehydration and half of patients with moderate dehydration would avert 9,000 cases and 1,300 deaths.

Andrews told SciDev.Net that the interventions could be achieved if the international community was willing to invest in them.

But Marcos Espinal, head of health surveillance, disease prevention and control at the Pan American Health Organization (PAHO), defended the UN’s approach. He told SciDev.Net that “the model used up to now is consistent with reality. We have seen just over 250,000 people with cholera in six months”.

A cholera epidemic broke out in Haiti in late October 2010, in the wake of the earthquake in January of the same year. The latest UN figures for the epidemic, published on 31 March 2011, are 267,224 cases, 4,749 deaths and a mortality rate of 1,8%.

[1] Andrews, J.R. and Basu, S. (2011). Transmission dynamics and control of cholera in Haiti : an epidemic model. The Lancet, 16 March 2011 (Article in Press). DOI: (free registration is required to view this article)

Source: María Elena Hurtado, SciDev.Net, 28 March 2011

Battling cholera with NFC RFID-tracked drinking water in Haiti

Deep Springs International (DSI), a non-profit organization based in Pennsylvania, USA, and Nokia Research Center (NRC), Palo Alto, California, are teaming up to ensure the supply of clean drinking water in Haiti with NFC (near field communication) technology.

DSI has been delivering water treatment systems (which essentially consist of a covered 19-liter bucket with a spigot at the bottom) and a locally manufactured chlorine solution it has labeled Gadyen Dlo (Creole for "water guardian") since 2007.. Photo: Michael Ritter, DSI

Water treatment kits are being provided to track chlorine levels in household drinking water using NFC-enabled cell phones. NRC provided the health workers with approximately 50 Nokia 6212 NFC-enabled phones while UPM RFID supplied UPM BullsEye™ NFC tags with NXP Mifare Ultralight chip. Joseph “Jofish” Kaye, Senior Research Scientist, NRC, initiated the project together with David Holstius, a student and Ph.D. candidate at the University of California, Berkeley’s School of Public Health, who developed the software application for mobile phones.

Families in the most rural areas in Haiti will have one water treatment kit consisting of a five-gallon (19 litre) plastic bucket with a lid and spigot. The RFID (radio-frequency identification) tags are attached to buckets for storing the treated drinking water and delivered to families together with a chlorine solution and written instructions for using the kit. When DSI’s water technicians visit their homes, they check whether they are using the kits properly and provide additional chlorine solutions. The technicians will read the tags using NFC cell phones loaded with software guiding them to ask relevant questions about the water being tested. They then send the data to DSI’s headquarters via SMS. The software application uses the Frontline SMS platform.

Cholera epidemic kills 60 in Ghana

WHO says prevention must be stepped up;  Four regions hit, Accra the worst affected

ACCRA, March 18 (Reuters) – A cholera epidemic in Ghana has killed 60 people and infected almost 4,000 since the first cases emerged last September, with 482 new cases reported this week alone, health authorities said on Friday.
The outbreak, which started in centre of the West African country and spread to four regions, has hit the capital Accra the worst, said Joseph Amankwah of the Ghana Health Service.

“This is a major outbreak. It’s a major concern,” he told Reuters by telephone. “Cases are on the increase. … We need to address the risk factors aggressively.”
Ghana has seen outbreaks of the disease roughly every five years since the 1970s, Amankwah said, adding that he believed the origin of the outbreak may be contaminated water sources following flooding last year.

Cholera is a bacterial disease spread by contaminated water and food. If caught early can be easily treated by oral rehydration fluids. If not treated, it can kill in hours.
“I wouldn’t say it’s out of control but it’s alarming so we need to step up preventive efforts,” said Sally Ohene from the World Health Organisation.
The disease has been reported in the Greater Accra, Central, Eastern and Upper Eastern regions.

Source

Côte d’Ivoire, Abidjan: cholera claims eight lives

Poor hygiene exacerbated by growing piles of rubbish and the current political crisis are all factors that haelth experts and residents say contributed to a dry-season cholera outbreak in Abidjan, the capital of Côte d’Ivoire. So far eight people out of 61 infected have died.

The first case – in Abidjan’s Adjamé District (a poor neighbourhood that has seen severe post-election violence in recent weeks) – was registered in mid-January [2011]; the major rains ended in November [2010]. Cholera has also affected the district of Williamsville.

“Across this region [West Africa] there are pockets of poverty where hygiene is poor and we see occasional outbreaks,” Mamadou D. Ball, WHO representative in Côte d’Ivoire, told IRIN. “The cholera bacterium is always present.”

Sandrine Touré, a health assistant in Williamsville, said she often sees children eating just after playing in rubbish. She added that many people, even in Abidjan, have no access to safe drinking water.

Since the political deadlock, household garbage is no longer being collected.

Even if families know that poor sanitation is linked to infectious disease, cholera was not much on people’s minds this time of year, said Soumaïla Traoré. “There is negligence in some communities. With the piles of rubbish people knew the threat of illness was real. But no one talked of cholera in this period.”

UNICEF and WHO are working with local health authorities to treat patients and promote better hygiene. advise communities on prevention. They are providing soap, cholera treatment kits and posters with prevention messages.

Source: IRIN, 31 Jan 2011

Haiti: US$ 10 million World Bank grant to bolster efforts against cholera, WHO warns that 400,00 could be affected

In response to the cholera outbreak in Haiti, the World Bank is preparing a US$ 10 million Cholera Emergency Grant as part its US$ 479 million reconstruction support. As of 22 November 2010 the outbreak has caused 1,523 deaths and could kill up to 10,000 people and affect 40,000 if the outbreak is not contained, according to the Pan American Health Organization (PAHO). The UN has appealed for US$ 164 million for additional treatment centres, scaled-up public information campaigns, supplies of medical equipment, rehydration salts, water purification tablets and bars of soap to respond to the outbreak.

The US$ 10 million grant will bolster the surveillance and monitoring capacity of the Ministry of Public Health and Population (MSPP) and the Haitian National Directorate of Water Supply and Sanitation (DINEPA). The initiative is aligned with the Cholera Inter-Sector Response Strategic Plan for Haiti, under the leadership of MSPP and DINEPA.

Haiti: hygiene promotion is key to preventing nationwide cholera epidemic, says Save the Children as death toll passes 900

As the death toll from Haiti’s cholera epidemic reached 917 on 12 November 2010, Save the Children says the best way to reduce the disease’s spread is to arm people with information and supplies to improve hygienic practices.

Cholera has reached the capital Port-au-Prince, where 27 deaths have been recorded and over 1.3 million earthquake survivors living in tent camps are at risk. Throughout the country 14,600 cholera victims have been hospitalised.

The United Nations forecasts up to 200,000 Haitians could contract cholera as the outbreak extends across the country of nearly 10 million, and says $163.9 million in aid is needed over the next year to combat the epidemic.

Haiti: unarmed in the fight against cholera, death toll passes 500

Cholera prevention poster in Haiti. In reality clean water, sanitation and nearby health clinics are absent in most rural communities. Photo: PAHO

Safe water and sanitation, vital tools to combat the current cholera epidemic, are absent in most communities  in Haiti, reports IRIN. The death toll rose to 501 on 6 November 2010, up from 442 on 3 November, and hospitalisations for cholera totaled 7,359, up from 6,742.

Haiti is one of the few countries in the world where both urban and rural sanitation coverage has steadily decreased between 1990 and 2008, according to the WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation (WHO/UNICEF, March 2010).

Historical legacies of inequality, corruption, and extreme poverty all contribute to the Haitian government’s systemic inability to deliver safe water and sanitation.