Tag Archives: handwashing

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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Lifebuoy premieres heart-breaking new film about the importance of handwashing

lifebuoy5 June 2014, London – In a follow up to its award-winning film, Gondappa, Unilever’s health soap, Lifebuoy has released a compelling new film, Tree of Life. The aim is to support Lifebuoy’s Help a Child Reach Five campaign and spread the word about the importance of handwashing with soap. The film is the story of a mother’s love, loss and longing after losing her child to a preventable disease such as diarrhoea.

unileverThe film follows a mother’s journey of love, loss and longing through her unique relationship with a tree, that highlights the importance of handwashing with soap. Tree of Life is inspired by folklore and this moving story is used to dramatise Lifebuoy’s Help a Child Reach 5 campaign.

A year ago Lifebuoy adopted Thesgora, a village in India and through its handwashing programmes dramatically improved children’s hand washing habits so that they now washed their hands 2 additional times per day. This year Lifebuoy takes its life saving mission to Bitobe in Indonesia and has created Tree of Life to raise awareness of their important mission.

Every 15 seconds, one child dies from diarrhoea or pneumonia, diseases that are preventable through the simple act of handwashing with soap.  That is 1.7 million children every year. Lifebuoy has taken its handwashing behaviour change programmes to 183 million people across the world, and now it is committed to change the handwashing behaviour of a billion people by 2015. This is part of Unilever’s commitment to help more than one billion people to improve their health and hygiene by 2020 under the Unilever Sustainable Living Plan.

Samir Singh, Global Brand VP, Lifebuoy, “It is unacceptable that 1.7 million children die every year from infectious diseases when we have cost effective lifesaving solutions, such as handwashing with soap, readily available. We wanted to tell the world the Lifebuoy story in a deeply emotional way and turn the Help A Child Reach 5 campaign into something personal and powerful.”

A Handwashing Song by OneRepublics

#Cricket4WASH: sanitation & hygiene promoted at major global sports event

Photo: WASH United

Photo: WASH United

Handwashing and menstrual hygiene were promoted at a major global sports event, thanks to a partnership between WASH United and the International Cricket Council (ICC).

WASH United raked in Indian cricket superstar Suresh Raina to become their brand ambassador at the ICC World Twenty20 Cricket World Cup, which was held from 16 March to 6 April, 2014, in Bangladesh.

 Suresh Raina and tournament mascot Happy the Hand-washing Tige

Suresh Raina and tournament mascot Happy the Hand-washing Tiger vow to “bowl ou diarrhoea”. Photo: WASH United

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THE URBAN PROGRAMMING GUIDE: How to design and implement a pro-poor urban WASH programme

Improving water, sanitation and hygiene services to low-income urban areas is a highly challenging and complex task. Traditional approaches have often failed to work. We need new approaches and fresh thinking. We need governments, donors and sector professionals genuinely committed to improving services in slum settlements. It’s challenging but it can be done! This guide offers some solutions based around WSUP’s experience: all you have to do is put them into practice!

The guide provides an introduction to urban WASH programming: how to design and implement a pro-poor urban water, sanitation and hygiene programme.

Urban Programming Guide
Who is this guide for?
This guide is primarily designed for WASH professionals working in governments, development agencies, funding agencies or civil society organisations. It will also be useful for professionals working for service providers including water utilities, local authorities and in the private sector.

How to use this guide
The guide provides an overview of some key strategies and service delivery models. It’s not intended to be encyclopaedic: it’s a rapid-reference document with the following intended uses:

  • To aid the planning, design and implementation of urban WASH programmes.
  • To assist with investment planning by service providers.
  • To point the reader towards further sources of information and guidance.

The guide is free to download from WSUP’s website: http://www.wsup.com/resource/the-urban-programming-guide

Unilever Lifebuoy Handwashing Campaign Reduces Diarrhea

Unilever Lifebuoy Handwashing Campaign Reduces Diarrhea from 36& to 5% in Indian Village unilever-logo

March 2014 – Unilever’s health soap Lifebuoy has this month announced the results of its Help A Child Reach 5 handwashing programmes launched in Thesgora, India, noting an overwhelming drop in incidence of diarrhoea from 36% to 5%.

The decrease in diarrhoea in this village – known for having one of the highest rates in India of this deadly yet preventable disease – was observed over the period of Lifebuoy’s intervention in an independent evaluation of 1485 households with children aged below 12 years, conducted by Nielsen in September 2013.

Lifebuoy’s Help A Child Reach 5 campaign aims to eradicate preventable deaths from diseases like diarrhoea one village at a time through teaching lifesaving handwashing habits. The campaign was launched with an award winning film http://www.youtube.com/helpachildreach5 and handwashing initiatives in Thesgora, a village in Madhya Pradesh.

These new results show that handwashing programmes have significant positive impact on both the handwashing behaviours and health of a community. Lifebuoy’s handwashing programmes are now being rolled out to villages across a further eight countries and scaled up in India to reach 45 million people.

Study examines sustainability of CLTS programmes in Africa

Plan-ODF-sustainability-coverDespite the widespread implementation of Community Led Total Sanitation (CLTS) programs and many claims of success, there has been very little systematic investigation into their sustainability.  A new study, which aims to change that, is creating a stir in the WASH sector.

A study commissioned by Plan International on the sustainability of CLTS programs in Africa revealed that 87% of the households still had a functioning latrine. This would indicate a remarkably low rate of reversion (13%) to open defecation (OD) or “slippage”.

However, if the criteria used to originally award open defecation free (ODF) status to villages are used, then the overall slippage rate increased dramatically to  92%. These criteria are:

  • A functioning latrine with a superstructure
  • A means of keeping flies from the pit (either water seal or lid)
  • Absence of excreta in the vicinity of the house
  • Hand washing facilities with water and soap or soap-substitute such as ash
  • Evidence that the latrine and hand washing facilities were being used

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“SuperAmma” campaign results in significant improvements in people’s handwashing behaviour

“SuperAmma” campaign results in significant improvements in people’s handwashing behaviour | Source: SHARE, Feb 27 2014 |

A unique handwashing campaign jointly funded by SHARE and the Wellcome Trust has shown for the first time that using emotional motivators – such as feelings of disgust and nurture – rather than health messages, can result in significant, long-lasting improvements in people’s handwashing behaviour, and could in turn help to reduce the risk of infectious diseases. SuperAmma

“Every year, diarrhoea kills around 800,000 children under 5 years old. Handwashing with soap could prevent perhaps a third of these deaths”, explains study author Dr Val Curtis, from the London School of Hygiene & Tropical Medicine (LSHTM).

“Handwashing campaigns usually try to educate people with health messages about germs and diseases, but so far efforts to change handwashing behaviour on a large scale have had little success. Understanding the motivating factors for routine hand washing is essential to any initiative likely to achieve lasting behaviour change.”

An evaluation of the behaviour-change intervention, published by the Lancet Global Health journal today, shows that 6 months after the campaign was rolled out in 14 villages in rural India, rates of handwashing with soap increased by 31%, compared to communities without the programme, and were sustained for 12 months.

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Tropical plant Moringa provides alternative to soap for handwashing

Moringa oleofera leaves and powde

Moringa oleofera leaves and powder. Photo: New Flavor House Inc.

SHARE-funded research [1] has found that Moringa oleifera, a common plant in many tropical and subtropical countries, can be an effective handwashing product if used in the correct concentration. Laboratory tests show that the plant has antibacterial activity against different pathogen, but its potential effect as a hand washing product had not been studied before.

By testing the effect of Moringa oleifera leaf powder on hands artificially contaminated with E. coli and comparing this to the effect of non-medicated liquid soap, the researchers from the London School of Hygiene and Tropical Medicine and SBI Consulting Ltd in Mozambique found that four grams of Moringa oleifera powder had the same effect as non-medicated soap when used for hand washing.

The next step will be to try this product in real conditions and study its acceptability and convenience for potential users.

To take part in a discussion on the use of Moringa as soap visit the SuSanA  Forum.

SHARE stands for Sanitation and Hygiene Applied Research for Equity, and is a five year initiative (2010-2015) funded by the UK Department for International Development

[1] Torondel, B., Opare, D., Brandberg, B., Cobb, E. and Cairncross, S., 2014. Efficacy of Moringa oleifera leaf powder as a hand- washing product : a crossover controlled study among healthy volunteers. BMC complementary and alternative medicine, 14 (57), pp. 1-7.   doi:10.1186/1472-6882-14-57

Source: SHARE, 21 Feb 2014

UNICEF – Handwashing Promotion: Monitoring and Evaluation Module

Handwashing Promotion: Monitoring and Evaluation Module, 2013. UNICEF.

Prepared by Jelena Vujcic, MPH and Pavani K. Ram, MD, University at Buffalo. UNICEF-M&E-Toolkit-Final-11-24-Low-Res-10

This guide will walk you through planning and implementing monitoring and evaluation (M&E) for your handwashing promotion programme. Programmes that promote handwashing are diverse and vary in scope. The content of this module is designed to be adapted to a variety of programmes. In this guide, you will be introduced to:

  • The 7 major steps of monitoring and evaluating handwashing promotion.
  • Choosing indicators appropriate to the programme’s objectives.
  • Collecting the necessary data, and sample questions for indicators relevant to handwashing advocacy, education and behaviour change.
  • Health impact measurement and caveats for the inclusion of health impact assessment as part of an M&E plan.