Author Archives: WASHplus

Editorial – The elusive effect of water and sanitation on the global burden of disease

Editorial – The elusive effect of water and sanitation on the global burden of disease. Tropical Medicine and  International Health, Feb 2014.

by  Wolf-Peter Schmidt, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK. Tel.: +44-20-7636 8636, E-mail: Wolf-Peter.Schmidt@lshtm.ac.uk

Introduction
About 2.5 billion people lack access to improved sanitation, and 1 billion have no access to any form of sanitation (UNICEF 2013). About 780 million people lack access to an improved water source, a figure that is based on a fairly generous definition incorporating little with respect to reliability, proximity and convenience of access (UNICEF 2013).

While the ancient Romans may already have been aware of it (Bradley 2012), water and sanitation came to be regarded as key to improve health in the growing cities of Europe and America in the late 19th and early 20th centuries. A number of notable observational studies were carried out that even with the limited epidemiological tools available at the time all but proved the direct link between water, sanitation and health (Snow 1860; Pringle 1910). By contrast, in the early days of development aid in the post-colonial era, water and sanitation were often not regarded as a health issue, but primarily provided with the aim of making people’s life easier and enable developmental activities. Whoever tried to argue for more investment on health grounds was faced by a lack of epidemiological studies conducted in low-income settings, which led to a renewed interest in research from the 1970s.

Simple before/after and case-control studies to evaluate water and sanitation programmes
The studies on water and sanitation conducted in low-income settings since the 1970s were usually simple in design (Rubenstein et al.1969; Aziz et al1990; Zhang et al20002005; Azurin & Alvero 2007). Typically, a programme to improve water access would be implemented in one or two villages, with latrine construction and some form of hygiene education being provided at the same time. Disease (for example diarrhoea, schistosomiasis or soil-transmitted helminths) would be measured at baseline and then again after the intervention. A couple of not too distant villages with ‘similar socio-economic conditions’ would have been followed up as a control group. Allocation of the intervention was unlikely to be random. Villages might have received the intervention because they had many diseases or were the poorest in the region. They might have been chosen for having been the least or the most accessible, the politically most influential or the most neglected. The commonly small number of allocated villages enabled a close supervision of the intervention, assuring that everything was carried out according to plan. However, the within-village (‘-cluster’) correlation of disease meant that statistically not much could be made of any difference between intervention and control arm if there were <5 or 6 villages on either side. Accounting for the baseline levels of disease allowed strengthening the causal inference (Norman & Schmidt 2011), but only to some extent. Larger, randomised studies were deemed unfeasible given the logistical and engineering complexities involved, and the low budgets available at the time.

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12 March – SuSanA​​–WASHtech webinar on Technology Applicability Framework (TAF)

SuSanA

12 March -16h00 : SuSanA​​–WASHtech webinar on Technology Applicability Framework (TAF)

SuSanA secretariat and WASHtech invites you to participate in a webinar that will present and discuss the Technology Applicability Framework (TAF) developed during the WASHtech project: www.washtechnologies.net

When: 16h00 CET on 12th March 2014 (Time converter: www.worldtimebuddy.com/)

Webinar outline:

15h30- Webinar room open
16h00- Welcome by Trevor Surridge (SuSanA secretariat)
16h05- Introduction to TAF by André Olschewski (Skat Foundation)
16h15- Questions on André’s presentation
16h20- Experiences using TAF in Ghana by Benedict Tuffuor (TREND)
16h30- Questions on Benedict’s presentation
16h35- WaterAid’s experience adapting and applying the TAF to a pour-flush toilet option in the Nicaraguan Caribbean by Joshua Briemberg (WaterAid)
16h45- Questions on Joshua presentation leading into an open Q&A session
16h59- Closing and wrap-up from Trevor
17h00- End of Webinar

Webinar Chair: Trevor Surridge (SuSanA secretariat)
Moderation Support: Sean Furey (Skat Foundation)

To participate you need to register:
To register send an email to ruralwater@skat.ch and clearly state “TAF webinar” in the subject and you will be sent an invitation link to the Webinar.

Technical requirements:
For the technical requirements for WebEx:

If you have any questions about the webinar post them in reply to this post or email them to info@susana.org.

Study Highlights Limited Progress in WASH Access Among Sub-Saharan African Cities

George Washington University Study Highlights Limited Progress in Water and Sanitation Access Among Major Sub-Saharan African Cities | Source: George Washington University, School of Public Health |

Sub-Saharan Africa’s urban population is predicted to nearly triple by 2050, increasing from 414 million to over 1.2 billion. This growth challenges municipalities attempting to provide basic access to water supply and sanitation (WS&S). A new analysis published in BMC Public Health by researchers at the George Washington University School of Public Health and Health Services (SPHHS) looks at how well cities in sub-Saharan Africa are doing when it comes to providing their urban residents with access to basic public health infrastructure.

Photo credit: Jay Graham

Photo credit: Jay Graham

Mike Hopewell, a recent graduate of the MPH program at SPHHS, and Jay Graham, an SPHHS assistant professor of environmental and occupational health, estimated changes in access to water supply and sanitation in the largest cities across sub-Saharan Africa between 2000 and 2012. They then explored the relationship of city-level and country-level factors to progress or regression in these cities.

The authors found that cities appeared to be making the most progress in gaining access to WS&S along metrics that reflect specified targets of the Millennium Development Goals (MDGs), global targets for improved wellbeing that countries aim to achieve by 2015. Nearly half of the cities, however, did not make progress in reducing open defecation or the time households spent collecting water. This may reflect a focus on “improved” services that are MDG targets while other measures, potentially more relevant to the extreme poor, are being neglected. This study highlights the need to better characterize access, beyond definitions of improved and unimproved, as well as the need to target resources to cities where changes in WS&S access have stalled, or in some cases regressed.

Cartoon contest – break the silence about toilets and sanitation in India!

With your creativity we want to break the silence about toilets and sanitation in India! SanitationTaboo

The Sustainable Sanitation Alliance (SuSanA) and GIZ together with Goethe Institute Max Müller, the Indian Institute for Cartoonists and EAWAG/Sandec invite creative minds to submit fun and striking ideas about toilets and sanitation in the form of Cartoons, Caricatures or Infographics that will create a humorous atmosphere around sanitation concerns. Because sanitation in India is still a taboo; the media doesn’t address the issue often enough and people feel uncomfortable talking about it, even though it’s an issue that concerns all of us – several times a day, every day. We are flexible with the entry’s format as long as it:

Surprises the silent majority and makes them laugh and talk about sanitation!

So what’s the cartoon competition all about?

  • The idea is to have a cartoon competition on the topic of sanitation and toilets.
  • The inspiration comes from the ‘Reinvented Toilets’ Programme by the Gates Foundation.
  • The approach taken by the Cartoon-Competition is, however, one both smaller in scale and more abstract in style.
  • The essence of the endeavour is to break the taboo that surrounds talking about sanitation and toilets in India with humor and laughter.

The deadline for submitting entries is Monday, 10 March, 2014 (midnight Indian Standard Time).

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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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Toilets, trash and social status: the top 10 emergency hygiene challenges

Toilets, trash and social status: the top 10 emergency hygiene challenges | Source/Complete article: Kathy Migiro, Thomson Reuters Foundation | Feb 17 2014

Excerpts:  NAIROBI (Thomson Reuters Foundation) – More than 900 beneficiaries, field practitioners and donors named their most pressing gaps in emergency water, sanitation and hygiene promotion (WASH) services in a 2013 survey.

Congolese refugees gather around dry water taps at Bukanga camp, Uganda, July 17, 2013. REUTERS/James Akena

Congolese refugees gather around dry water taps at Bukanga camp, Uganda, July 17, 2013. REUTERS/James Akena

The Humanitarian Innovation Fund (HIF), which carried out the survey, plans to solve them through open innovation, where grants of up to $20,000 are given to the best new ideas.

Here are the top 10 gaps HIF will tackle (in no particular order):

1)    Latrine lighting - In many refugee camps, latrines are not lit at night making them dangerous for women to use.

Challenge: To light communal latrines at night in a cheap and sustainable manner.

2)    Space saving jerrycan - In emergencies, agencies traditionally buy and distribute jerrycans, which can mean transporting 15 or 20 litres of air. Collapsible jerrycans only last a couple of months before they start leaking.

Challenge: To design a 15 litre jerrycan, costing less than $5, with limited volume when stored, lasting one year.

3)    Excreta disposal in urban emergencies - Earthquakes and floods often cut off urban water supplies and damage toilets. When large numbers of displaced people gather in safe places like schools, sanitation facilities get overwhelmed. Many agencies build raised latrines. But they need to be emptied frequently, with waste being dumped in purpose-built pits or rivers, creating health risks.

Challenges: To develop new products to provide safe excreta disposal in urban environments after disasters. Solutions should consider not only containment, but also emptying and disposal mechanisms.

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Child Feces Disposal Practices in Rural Orissa: A Cross Sectional Study

Child Feces Disposal Practices in Rural Orissa: A Cross Sectional Study. PLoS One, Feb 2014.

Fiona Majorin, et al

Background – An estimated 2.5 billion people worldwide lack access to improved sanitation facilities. While large-scale programs in some countries have increased latrine coverage, they sometimes fail to ensure optimal latrine use, including the safe disposal of child feces, a significant source of exposure to fecal pathogens. We undertook a cross-sectional study to explore fecal disposal practices among children in rural Orissa, India in villages where the Government of India’s Total Sanitation Campaign had been implemented at least three years prior to the study.

Methods and Findings – We conducted surveys with heads of 136 households with 145 children under 5 years of age in 20 villages. We describe defecation and feces disposal practices and explore associations between safe disposal and risk factors. Respondents reported that children commonly defecated on the ground, either inside the household (57.5%) for pre-ambulatory children or around the compound (55.2%) for ambulatory children. Twenty percent of pre-ambulatory children used potties and nappies; the same percentage of ambulatory children defecated in a latrine. While 78.6% of study children came from 106 households with a latrine, less than a quarter (22.8%) reported using them for disposal of child feces. Most child feces were deposited with other household waste, both for pre-ambulatory (67.5%) and ambulatory (58.1%) children. After restricting the analysis to households owning a latrine, the use of a nappy or potty was associated with safe disposal of feces (OR 6.72, 95%CI 1.02–44.38) though due to small sample size the regression could not adjust for confounders.

Conclusions – In the area surveyed, the Total Sanitation Campaign has not led to high levels of safe disposal of child feces. Further research is needed to identify the actual scope of this potential gap in programming, the health risk presented and interventions to minimize any adverse effect.

Benin – Behaviour change, a must for improved sanitation

Benin – Behaviour change, a must for improved sanitation | Source/complete article:  Edmund Smith-Asante | Graphic.com – 21 February 2014

Excerpts - Benin’s Minister of Health, Professor Dorothéme Kinde Gazard, has called on African nations to lay emphasis on behaviour change communication, as it is the surest way to achieve improved sanitation.

Disclosing that 87 per cent of Africans were still engaged in open defecation, while only three out of 10 people washed their hands with soap, she stated, “So the challenge is also on behaviour change.”

Some of the participants at the Benin workshop.

Some of the participants at the Benin workshop.

The Health Minister therefore urged African countries to strike a balance between change in behaviour and the provision of sanitation facilities.

Governments’ Commitments to WASH

Professor Dorothéme Gazard made the statements when she addressed the opening of a three-day regional workshop on “Advocacy, Communications and Monitoring of [water, sanitation and hygiene] WASH Commitments” for selected journalists, in Cotonou on Tuesday.

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WASHplus Weekly: Focus on WASH-related disesases

Issue 135 February 21, 2014 | Focus on WASH-Related Diseases

This issue contains recent studies and reports on several WASH-related diseases: neglected tropical diseases (NTDs), malnutrition, cholera, diarrhea, fluorosis, and malaria. Some of the resources include: a WASH and NTDs global manual and country reports from the Sightsavers Innovation Fund; an article on the origins of the cholera outbreak in Haiti; a review of evidence linking WASH, anemia, and child growth; Cochrane Reviews on the prevention and control of malaria; and additional studies and resources. weekly

We welcome your suggestions for future issues of the Weekly. Topics for upcoming issues include World Water Day 2014, WASH and nutrition, behavior change, community-led total sanitation, household water treatment, and menstrual hygiene management.

GENERAL/OVERVIEW

Human Health and the Water Environment: Using the DPSEEA Framework to Identify the Driving Forces of DiseaseScience of the Total Environment, 2014. J Gentry-Shields.(Link)

There is a growing awareness of global forces that threaten human health via the water environment. A better understanding of the dynamic between human health and the water environment would enable prediction of the significant driving forces and effective strategies for coping with or preventing them. This report details the use of the Driving Force–Pressure–State–Exposure–Effect–Action (DPSEEA) framework to explore the linkage between water-related diseases and their significant driving forces.

Seasonal Effects of Water Quality: The Hidden Costs of the Green Revolution to Infant and Child Health in India, 2013. E Brainerd. (Link)
This paper examines the impact of fertilizer agrichemicals in water on infant and child health using water quality data combined with data on child health outcomes from the Demographic and Health Surveys of India. The results indicate that children exposed to higher concentrations of agrichemicals during their first month experience worse health outcomes on a variety of measures; these effects are largest among the most vulnerable groups, particularly the children of uneducated poor women living in rural India.

Water, Sanitation and Hygiene: Evidence Paper, 2013. Department for International Development. (Link)
This paper aims to provide an accessible guide to existing evidence, including a conceptual framework for understanding how WASH impacts health and well-being and a description of methods used for ascertaining the health, economic, and social impacts of WASH. It also presents the available evidence on the benefits and cost-effectiveness of WASH interventions.

NEGLECTED TROPICAL DISEASES

WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers, 2014. Sightsavers, et al. (Link) | (Blog post)
These manuals are free to download and distribute. New users must create an account to download the manuals, which are divided into disease-specific chapters that describe the transmission cycle, symptoms, and disease burden of the WASH-related NTDs. Each chapter includes information about WASH activities that are most essential to the control of each disease. Maps of disease prevalence are provided to enable identification of disease-endemic communities most in need of sustainable WASH services. Country-specific versions of the manual are available so far for Brazil, Burkina Faso, Cameroon, Chad, Ethiopia, Indonesia, Kenya, Malawi, Mali, Mozambique, Nigeria, Sudan, Tanzania, and Uganda.

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Valerie Curtis – Don’t Look, Don’t Touch! Brains and behaviour from a disgust perspective

Don’t Look, Don’t Touch! Brains and behaviour from a disgust perspective, by Valerie Curtis, Ph.D. | Source/complete article: Psychology Today.

Valerie-Curtis

Valerie Curtis, Ph.D., is a Disgustologist and Director of the Hygiene Centre at London School of Hygiene and Tropical Medicine.

Disgust Has Us in Its Grip – Five things disgust tells us about ourselves 

Disgust is one of our most powerful emotions, it drives what we do in the privacy of our homes, as well as out in the world. It drives our most intimate habits, our social interactions and our moral judgement. Yet it’s still not very well understood. That’s a pity, because disgust can teach us a lot about ourselves. Here’s five things we can learn from disgust:

1. Brains are for behaviour.

You may think that your brain is for thinking, for cogitating, for solving problems. But thinking is only the icing on the cake. Brains evolved because they made the animals that were our ancestors behave in ways that got them what they needed. One fundamental need of all animals is to not get eaten. Hence all animals have behavioural strategies to keep safe from predators. The brain system that drives such behaviour is called FEAR. But it’s not just predators that want to eat you. Billions of microbes and parasites want a free meal and a free ride out of you too. The brain system that keeps us away from these micro-predators is called DISGUST. Our brains instinctively recognise yucky, smelly, sticky, contaminated stuff as potentially risky and the disgust system in the brain dictates the appropriate behaviour: ‘Don’t look, don’t touch, don’t eat!’ Brains evolved to make us do such tasks (others include nurturing, hoardingpair bonding and status seeking) without invoking conscious, rational calculation. Our brains are for behaviour.

2. You are disgusting.

Unpleasant as it may be to contemplate, you are a walking mass of infectious material. You are home to billions of microbes, millions of worms and plenty of other parasitic creatures. You are therefore a disease threat to other people and, hence, you are disgusting. (So am I!). But being disgusting is a bit of a problem for a social species like ourselves. How to get all the benefits of cooperating with friends and acquaintances, alike, without turning them off you? The answer is simple – good manners. You learnt from your Mom and your mates at an early age not to wear stinky clothes, to breathe in someone’s face, to wee in their front room or to offer them your dirty towel. If you did they’d be disgusted, and you’d lose an ally. Because you are disgusting you have good manners and that’s how you tip the balance between being disgusting and being accepted as a member of society.

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