WASHplus Weekly: Focus on Global Handwashing Day 2015

Issue 209 | Oct. 9, 2015 | Focus on Global Handwashing Day 2015

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Global Handwashing Day occurs each year on October 15. It is a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives. This issue contains links to handwashing resources from WASHplus, the Global-Public-Private Partnership for Handwashing, recent studies, reports, and videos.  

RESOURCES

Global Public-Private Partnership for Handwashing (PPPHW)
This coalition of international stakeholders works explicitly to promote handwashing with soap and recognize hygiene as a pillar of international development and public health. Just a few of the partnership’s resources include the PPPHW website with links to webinars, fact sheets, andmember organizations. Also the Global Handwashing Day Social Media Toolkit features sample messages, blog ideas, and resources to help celebrants and handwashing champions spread the word about Global Handwashing Day.

WASHplus RESOURCES

Small Doable Actions: A Feasible Approach to Behavior Change Learning Brief, 2015. Link
A small doable action is a behavior that, when practiced consistently and correctly, will lead to personal and public health improvement. It is considered feasible by the householder, from HIS/HER point of view, considering the current practice, the available resources, and the particular social context. This brief takes a look at how WASHplus has applied this approach to a range of activities—handwashing, water treatment, improved sanitation, menstrual hygiene management, and food hygiene.

Handwashing and the Science of Habit, 2014. Webinar
This webinar features panelists David Neal, Catalyst Behavioral Sciences; The University of Miami; Jelena Vujcic, Catalyst Behavioral Sciences; The University of Buffalo; Orlando Hernandez, WASHplus, FHI360 and Wendy Wood, The University of Southern California.

Can we shift waste to value through 3D printing in Tanzania?

Can we shift waste to value through 3D printing in Tanzania? World Bank Blog, Sept 2015. Author: C. Paradi-Guilford.

• Full text

Plastic waste, in particular PET, which is typically found in soda bottles, is becoming abundant in African cities. In Dar es Salaam, one of the most rapidly urbanizing cities in Africa, BORDA found that about 400 tons of plastic waste per day remains uncollected or unrecycled.  Although about 98 percent of the solid waste generated per day can be recycled or composted, 90 percent is disposed in dumpsites.

A waste collection site in Dar es Salaam, Tanzania. Photo: Cecilia Paradi-Guilford

At the same time, the recycling industry has started to grow because of new initiatives, community organizations and private companies. There are a few organizations that repurpose waste into arts and crafts, tools or apply it as a source of energy – such as WasteDar. However, the majority collect or purchase plastic waste from collectors, primarily with a view to export, rather than recycle or reuse locally.

Socially and environmentally, waste management is one of the biggest challenges for an increasingly urbanized world. Waste pickers can earn as little as US$1-2 a day in dangerous conditions with little opportunity for advancement. They make up some of the most disadvantaged communities living in deep poverty.

Through a new market for sorted waste materials, these communities may access higher income generation opportunities in a sustainable manner. This presents an opportunity to explore turning this waste into value more close to home.

At the same time, 3D Printing is expanding
3D printing is an additive manufacturing process that applies layers of materials (typically plastic) to develop an object that is made up of thinly sliced horizontal layers. The design of the object is made in a Computer-Aided Design program using a 3D modeling, then is inputted into the 3D printer. Gaining popularity, 3D scanners are also used to make a digital copy of ab object. 3D printers take an input of filament consisting of varying types of plastic to create the object.

Oct 2015 WASH studies on toilets and health and other topics

Effect of Poor Access to Water and Sanitation as Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route. PLoS NTDs, Sept 30, 2015. Authors: Adriana Echazú , Daniela Bonanno, Marisa Juarez, Silvana P. Cajal, Viviana Heredia, Silvia Caropresi, Ruben O. Cimino, Nicolas Caro, Paola A. Vargas, Gladys Paredes, Alejandro J. Krolewiecki

Full text – http://goo.gl/DgAVMm

The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6–5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3–3.7). The present study reports an association between poor sanitation and water access and STH infections selective to the parasite route of entry. This finding could contribute to the design of specific and rational recommendations to reduce soil-transmitted helminths transmission.

MIT-USAID program releases evaluation of water filters: Study of water filters used in Indian homes assesses suitability, scalability, and sustainability, Oct 2015. | Complete report | Summary |

CITE’s household water filter evaluation allowed us to study innovations with the potential to better the lives of India’s “water poor”—the 76 million people in the country who lack improved drinking water. CITE teams studied over 100 models of householder water filters from nine major brands available on the market in Ahmedabad, India. These models fell into three main categories: conventional particle filtration (cloth/jali mesh), gravity non-electric filters, and reverse osmosis filters.

Toilets Can Work: Short and Medium Run Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation, 2015. Authors: ESTHER DUFLO, MICHAEL GREENSTONE, RAYMOND GUITERAS, AND THOMAS CLASEN

Full text: http://goo.gl/gafi0n

This paper estimates the impact of an integrated water and sanitation improvement program in rural India that provided household-level water connections, latrines, and bathing facilities to all households in approximately 100 villages. The estimates suggest that the intervention was effective, reducing treated diarrhea episodes by 30-50%. These results are evident in the short term and persist for 5 years or more. The annual cost is approximately US$60 per household.

Stunting is associated with poor outcomes in childhood pneumonia. Trop Med Intl Health, Oct 2015. Authors: Peter P. Moschovis, et al.

Abstract: http://goo.gl/4qAXXY

Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials.  Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.

 

Innovative WASH interventions to prevent cholera

Innovative WASH interventions to prevent cholera. Source: WHO Wkly Epid Rec, Oct 2, 2015

Authors: Daniele Lantagne, Andy Bastable, Jeroen H. J. Ensink, and Eric Mintz.

In the late 19th and early 20th centuries, epidemic cholera was virtually eliminated in industrialized countries through municipal water supply with treatment and sanitation infrastructure.1 A century later, in 2014, only 58% of the global population had access to piped-on premises water,2 and an estimated 1.8 billion people (28% of the global population) drank microbiologically contaminated water.3 Within this inadequate water and sanitation context, cholera transmission continues. 

In 2014, 32 countries – many of which are struggling with poverty, rapid population growth, and instability – reported cholera transmission.4

A recent model found that national improved water access of 71%, and improved sanitation access of 39%, predicted whether a country would have endemic cholera with 62%–65% sensitivity and specificity.5

As progress is made towards universal access to reliable piped-on-premises water, reducing the remaining cholera burden requires a comprehensive strategy. Community- and household level water, sanitation, and hygiene (WASH) interventions are one part of that strategy.

Common cholera-prevention WASH interventions include: water supply, water treatment (well, pot, or bucket chlorination and household treatment); sanitation options (latrines); and, promotion of hand washing and environmental hygiene.6

The effectiveness of these interventions varies7 : water supply and chlorine-based, filtration, and solar disinfection household options have been shown to reduce cholera transmission among users;8, 9, 10, 11, 12 well/pot chlorination effectively treats water only for a few hours,13, 14, 15 unless chlorine is regularly added;16 there is little research on bucket chlorination, sanitation, and hygiene interventions.

Recent innovations in chlorine-prevention WASH include identification of factors leading to programmatic success, and new product design (such as sourcebased water treatment and personal use sanitation options).

An investigation of 14 household treatment programmes implemented in 4 emergencies (including 3 cholera emergencies) found that reported use ranged from 1% to 93% and effective use (the percentage of recipients who improved their drinking water microbiological quality to international standards) ranged from 0 to 68%.17

The most successful programme provided an effective method (chlorine tablets), with the necessary supplies to use it (bucket and tap), and ongoing training by local community health workers to people using contaminated water who were familiar with chlorination before the emergency. Conversely, the least successful programme distributed only chlorine tablets in a relief kit labeled in English to populations without previous chlorination experience.

Similar results were found in an evaluation of dispensers, an innovative source-based intervention that includes a chlorine dispenser and dosing valve installed at water sources, community education, and chlorine refills. Across seven evaluations in four emergencies (including 3 cholera emergencies), reported dispenser use ranged from 9-97% and effective use from 0 to 81%.18

More effective programmes installed dispensers at point-sources, maintained a high-quality chlorine solution manufacturing and distribution chain, maintained hardware, integrated dispenser projects within larger water programmes, compensated promoters, had experienced staff, worked with local partners to implement the project, conducted ongoing monitoring, and had a sustainability plan.

The Peepoo is a personal, single-use, biodegradable selfsanitizing double-plastic bag toilet. Peepoos contain sufficient powdered urea to inactivate harmful pathogens in urine and feces after 4 weeks, at which time the waste can be used as fertilizer. Peepoos have been used where latrines are not feasible due to population density, and to bridge the gap between emergency onset and latrine construction.19

One emergency programme concluded that products should be pre-positioned before the emergency, all products necessary for use (including a sitting/squatting stool) should be provided to recipients, training for community health workers should occur before distribution, compensation for collection activities should be provided, and that the disposal mechanism and exit strategy should be predefined before distribution.

As can be seen, lessons learned from the programmes described above are similar: WASH interventions can successfully improve water quality, isolate feces from the environment, and reduce the potential for cholera transmission if they are wisely implemented and distributed with appropriate supplies and training to at-risk populations.

USAID/West Africa Sanitation Service Delivery – Making Kumasi a Cleaner City

Making Kumasi a Cleaner City, Sept 2015. Source: PSI Impact |

Sanitation Service Delivery (SSD) is a USAID/West Africa regional urban sanitation project that is implemented by PSI in collaboration with PATH and Water and Sanitation for the Urban Poor (WSUP). The project aims to improve sanitation outcomes by developing and testing scalable business models that engage private sector service providers and by contributing to the creation of a strong enabling environment for sanitation in West Africa. WSUP plays a vital role in supporting government partnership efforts to strengthen public support for improved sanitation and fecal sludge management (FSM) services in Ghana — an important aspect of the SSD. 

Photo Credit: Dana Ward

Highlighting the important role governments will play in this endeavor, Dana Ward, PSI country representative in Ghana and chief of party for Sanitation Service Delivery (SSD) Project in Ghana, Benin, and Cote d’Ivore caught up with Anthony Mensah, director, Waste Management Department Kumasi Metropolitan Authority (KMA), about the city’s strategy to make Kumasi among the five cleanest cities in Africa.

In this Q&A, Anthony Mensah responds to questions on successes and challenges of the Kumasi program. Read the complete article.

WASHplus Survey on Private Sector Support for WASH in Schools

Dear Colleagues:

In preparation for a targeted activity, WASHplus is conducting a survey on private sector support for WASH in Schools to determine what organizations are involved, where they are working, and what their programs entail.

We would appreciate your responses to this brief survey 7 question survey if you have or know of WASH in Schools programs where the private sector is involved, or if you are part of a company that supports WASH in Schools.

Survey link: www.surveymonkey.com/r/T6WJKTV

Many thanks,
Dan Campbell
Email: dacampbell@fhi360.org

Plan International – Testing CLTS Approaches for Scalability: Lao PDR Learning Brief

Community-led Total Sanitation in Lao PDR: Findings from an Implementation Case Study, 2015.

• Full text, pdf

Plan International supports Community-led Total Sanitation (CLTS) implementation in a number of districts in the Lao People’s Democratic Republic (PDR). In this learning brief, we review Plan International Laos’ CLTS activities.

We found that they have formed a strong working relationship with the national government and directly involved district government and community leaders in CLTS implementation.

“Open Defecation Signage” credit to Plan International/Alf Berg

Plan International Laos and other sanitation practitioners can support further progress by strengthening community selection for CLTS, expanding the cadre of CLTS trainers, and advocating for formal recognition and accountability of district government in the CLTS process.

Link to project website: http://waterinstitute.unc.edu/clts/

Handwashing practices added as new risk factor in latest Global Burden of Disease study

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, Sept 11, 2015.

• Full text

GBD 2013 Risk Factors Collaborators

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantifi cation, particularly of modifi able risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs.

Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing.

Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Open dumps a global health emergency

ISWA CALLS OPEN DUMPS A ‘GLOBAL HEALTH EMERGENCY  | | Source:  by Thomas Dimech | Resource, 8 September 2015 |

A new report by the International Solid Waste Association (ISWA) is highlighting the ‘global health emergency’ affecting tens of millions of people in developing countries who lack good sanitation infrastructure. 

The report, ‘Wasted Health: The Tragic Case of Dumpsites’, illustrates how the issues surrounding open dumpsites in the developed world 40 years ago are still prevalent in developing countries, but are also being compounded by unprecedented issues such as the unregulated accumulation of discarded electronics, mobile phones, and medical waste.

Some of the main problems identified in the report include:

• open dumpsites receive roughly 40 per cent of the world’s waste and serve about 3.5 to 4 billion people;
• there has been a substantial rise in unregulated dumping of mobile devices, electronic appliances, medical and municipal waste, accelerating the scale of the threat and health risks;
• uncontrolled burning of waste releases gases and toxins into the atmosphere;
• open waste sites in India, Indonesia and the Philippines are more detrimental to life expectancy than malaria;
• 64 million people’s lives (equal to the population of France) are affected by world’s 50 largest dumpsites;
• in addition to the human and environmental impacts, the financial cost of open dumpsites runs into the tens of billions of US dollars.

Small Doable Actions: A Feasible Approach to Behavior Change

Small Doable Actions: A Feasible Approach to Behavior Change, 2015. WASHplus.

• Full text

A small doable action is a behavior that, when practiced consistently and correctly, will lead to personal and public health improvement. 

It is considered feasible by the householder, from HIS/HER point of view, considering the current practice, the available resources, and the particular social context.

Although the behavior may not be an “ideal practice,” more households likely will adopt it because it is considered feasible within the local context