Tag Archives: hygiene

Links to WASHplus Weeklies on Sanitation

Below are links to WASHplus Weeklies on sanitation-related topics:

Behavioral Determinants of Handwashing with Soap in Senegal and Peru: Emergent Learning

A new Water and Sanitation Program (WSP) Learning Note found that beliefs and ease of access to soap and water were correlated with handwashing with soap behaviors for given proxy measures among mothers and caretakers in Peru and Senegal.

“Behavioral Determinants of Handwashing with Soap Among Mothers and Caretakers: Emergent Learning from Senegal and Peru,” is based on survey data from nearly 3,500 households in Peru and 1,500 households in Senegal. This data was analyzed using FOAM, a conceptual framework developed by WSP to help identify factors that might facilitate or impeded handwashing with soap practices at critical times.

The analysis revealed that the impact of different determinants varies depending on the chosen proxy measure, such as the presence of a handwashing station or its distance from kitchen or latrine facilities. Given this variability, the Learning Note found that program managers must clearly define the exact behavior they seek to improve before choosing which determinant to focus on in their formative research.

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The effect of cord cleansing on neonatal mortality in rural Bangladesh

The Lancet, Early Online Publication, 8 February 2012

The effect of cord cleansing with chlorhexidine on neonatal mortality in rural Bangladesh: a community-based, cluster-randomised trial

Shams El Arifeen DrPH, et al.

Background – Up to half of neonatal deaths in high mortality settings are due to infections, many of which can originate through the freshly cut umbilical cord stump. We aimed to assess the effectiveness of two cord-cleansing regimens with the promotion of dry cord care in the prevention of neonatal mortality.

Design – We did a community-based, parallel cluster-randomised trial in Sylhet, Bangladesh. We divided the study area into 133 clusters, which were randomly assigned to one of the two chlorhexidine cleansing regimens (single cleansing as soon as possible after birth; daily cleansing for 7 days after birth) or promotion of dry cord care. Randomisation was done by use of a computer-generated sequence, stratified by cluster-specific participation in a previous trial. All livebirths were eligible; those visited within 7 days by a local female village health worker trained to deliver the cord care intervention were enrolled. We did not mask study workers and participants to the study interventions. Our primary outcome was neonatal mortality (within 28 days of birth) per 1000 livebirths, which we analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT00434408.

Results – Between June, 2007, and September, 2009, we enrolled 29 760 newborn babies (10 329, 9423, and 10 008 in the multiple-cleansing, single-cleansing, and dry cord care groups, respectively). Neonatal mortality was lower in the single-cleansing group (22·5 per 1000 livebirths) than it was in the dry cord care group (28·3 per 1000 livebirths; relative risk [RR] 0·80 [95% CI] 0·65—0·98). Neonatal mortality in the multiple-cleansing group (26·6 per 1000 livebirths) was not statistically significantly lower than it was in the dry cord care group (RR 0·94 [0·78—1·14]). Compared with the dry cord care group, we recorded a statistically significant reduction in the occurrence of severe cord infection (redness with pus) in the multiple-cleansing group (risk per 1000 livebirths=4·2 vs risk per 1000 livebirths=1·2; RR 0·35 [0·15—0·81]) but not in the single-cleansing group (risk per 1000 livebirths=3·3; RR 0·77 [0·40—1·48]).

Interpretation – Chlorhexidine cleansing of a neonate’s umbilical cord can save lives, but further studies are needed to establish the best frequency with which to deliver the intervention.

Research-Based Campaign Messaging is Critical for Sustaining Handwashing Behavior Change

Using data from formative research to focus messaging on mothers’ aspirations for their children and fine-tuning activities based on feedback from the field and household survey data have been key to developing and implementing a handwashing with soap behavior change program in Vietnam.

A new Learning Note, Vietnam: A Handwashing Behavior Change Journey for the Caretakers’ Program published by the Water and Sanitation Program (WSP), describes the steps that were taken to design, implement, and monitor the program to aid program managers in developing other handwashing and hygiene promotion efforts.

Working closely with the Woman’s Union, the program’s activities in Vietnam reached 540 communes in 10 provinces. The project also trained more than 15,000 community motivators who reached more than 1.76 million women through interpersonal communications activities. As the Learning Note reports, these activities evolved over time based on information from the monitoring systems.

“As the target audiences move beyond knowledge to intention to handwash with soap, behavior change messages must also be modified,” the report found, adding that as the project progressed, opportunities arose to “fine-tune the interpersonal communications activities based on feedback from the field and from the household monitoring data.”

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Ethiopia – Ministry to count water, sanitation, hygiene facilities

Jan 29, 2011 – The Ministry of Water and Energy said that it has finalized preparations to begin counting the number of potable water, sanitation and hygiene facilities available in the country.

Ministry Public Relations and Communication Directorate Director, Bizuneh Tolcha, told WIC today that the counting process will be carried out from February-June, 2011.

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Katine winner sets standards in national hygiene drive

Katine ‘ideal home’ winner sets standards in national hygiene drive

In a campaign to promote household and personal hygiene in Uganda, a Katine family has won an “ideal homestead” competition. How did they do it?

Almost everything about Charles Adengu’s home tempts you to look again. None more so than the five large, terrace-thatched huts with smooth walls painted with motorcycles, footballs, cattle or juicy-looking pineapples. A sixth, smaller hut, just outside the main compound, looks like a teenager’s fancy dwelling until you are told that it is actually the pit latrine, with a yellow jerry-can for hand-washing suspended from a stick in the ground nearby.

Pit latrine with hand-washing facility in foreground at Charles Adengu's compound. Photograph: Richard M Kavuma

Riding in on a sunny Thursday afternoon, I am struck by the cool, fresh air thanks to numerous trees that cast swaying shadows on the brown earth of an impeccably clean, well-swept compound in Katine, north eastern Uganda. I had not heard of Adengu until I was given his name a few hours earlier by the African Medical Research Foundation (Amref), which with the Guardian is supporting the Katine community development project. Adengu, with his family, is the proud winner of an “ideal home” competition in Katine, and sitting on the brick-bordered veranda of one of the huts, with its smooth, cow dung-plastered floor, I can see why.

“I was happy that my home was selected as the cleanest because I have always tried to have a spacious, clean homestead; even [our] previous homestead was nearly as good as this one,” Adengu tells me later under bright moonlight, after he has returned from grazing cattle.

Besides the cleanliness of the homestead, which is surrounded by hedges, Adengu says the water and sanitation inspectors from both Katine and Soroti district were impressed because they found “everything” that a home should have – pit latrine, bath shelter, rubbish pit, granary, chicken house, rack for utensils, etc.

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Burundi – Poor hygiene causes 80% of deaths

Aug 24, 2010 – The Burundian Minister of Health, Dr. Emmanuel Gikoro, Monday lamented that the absence of a national hygiene and sanitation policy was responsible for 80 percent of deaths in the country.

Gikoro, speaking at the opening of a three-day national forum on a new and more coherent hygiene and sanitation policy, noted that the evolution of killer diseases such as malaria, diarrhoea and respiratory complications came about through the absence of national hygiene and sanitation policy.

‘At the socio-economic level, diseases related to poor basic hygiene still cause huge financial looses to households and the state, which needs to pay or subsidize healthcare,’ he said.


Bibliography on household water treatment and safe storage

Environmental Health at USAID has compiled an annotated bibliography of 21 journal articles on household water treatment and safe storage that were published from January-July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf (pdf, 70KB)

Below are 3 of the 21 studies from the bibliography:

1 – Am J Trop Med Hyg. 2009 May; 80(5):819-23.
Laboratory assessment of a gravity-fed ultra-filtration water treatment device designed for household use in low-income settings.

Clasen T, Naranjo J, Frauchiger D, Gerba C.

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrheal disease, a leading cause of mortality and morbidity in the developing world. We assessed the microbiologic performance of a novel water treatment device designed for household use in low-income settings. The device employs a backwashable hollow fiber ultrafiltration cartridge and is designed to mechanically remove enteric pathogenic bacteria, viruses, and protozoan cysts from drinking water without water pressure or electric power. In laboratory testing through 20,000 L (approximately 110% of design life) at moderate turbidity (15 nephelometric turbidity unit [NTU]), the device achieved log(10) reduction values of 6.9 for Escherichia coli, 4.7 for MS2 coliphage (proxy for enteric pathogenic viruses), and 3.6 for Cryptosporidium oocysts, thus exceeding levels established for microbiological water purifiers. With periodic cleaning and backwashing, the device produced treated water at an average rate of 143 mL/min (8.6 L/hour) (range 293 to 80 mL/min) over the course of the evaluation. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.

4 – Environ Sci Technol. 2009 Feb 15; 43(4):986-92.
Household water treatment in poor populations: is there enough evidence for scaling up now?

Schmidt WP, Cairncross S.
Point-of-use water treatment (household water treatment, HWT) has been advocated as a means to substantially decrease the global burden of diarrhea and to contribute to the Millennium Development Goals. To determine whether HWT should be scaled up now, we reviewed the evidence on acceptability, scalability, adverse effects, and nonhealth benefits as the main criteria to establish how much evidence is needed before scaling up. These aspects are contrasted with the evidence on the effect of HWT on diarrhea. We found that the acceptability and scalability of HWT is still unclear, and that there are substantial barriers making it difficult to identify populations that would benefit most from a potential effect. The nonhealth benefits of HWT are negligible. Health outcome trials suggest that HWT may reduce diarrhea by 30-40%. The problem of bias is discussed. There is evidence that the estimates may be strongly biased. Current evidence does not exclude that the observed diarrhea reductions are largely or entirely due to bias. We conclude that widespread promotion of HWT is premature given the available evidence. Further acceptability studies and large blinded trials or trials with an objective health outcome are needed before HWT can be recommended to policy makers and implementers.

7 – Int J Epidemiol. 2009 Jul 2.

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala.

Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr.

BACKGROUND: The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities.

METHODS: We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age.

RESULTS: The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth.

CONCLUSIONS: To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials.

Annotated bibliography on handwashing/hygiene

This bibliography contains citations and abstracts to 17 journal articles published from January – July 2009. The bibliography will be updated on a periodic basis and posted to the Environmental Health at USAID website.

Link – http://www.ehproject.org/PDF/ehkm/handwashing-bibliography_july2009.pdf (pdf, 60KB)

World Toilet Day: The Royal Society For Public Health Asks ‘How Healthy Are Our Loos’?

Poor hygiene is threatening public health and The Royal Society for Public Health believes that, on World Toilet Day – Monday November 17, the developed world has no reason to be complacent about its loo routines.

Toilet germs are spreading fast, with almost 50% of adults in the UK failing to dry their hands after using a public toilet, and one in six adults admitting that they don’t wash their hands every time(1). (…)

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