Category Archives: Hygiene Promotion

Recent sanitation/WASH research

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Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study. BMC Public Health, May 2017. We argue that handwashing with soap is influenced by broader range of antecedents, many unrelated to fecal contamination, that indicate to people when and where to wash their hands. This exploratory study aimed to identify and characterize this broader range of handwashing antecedents for use in future handwashing promotion efforts.

Provision versus promotion to develop a handwashing station: the effect on desired handwashing behavior. BMC Public Health, May 2017. We conducted a three-month pilot intervention to evaluate two options for setting up handwashing stations: i) provide a handwashing station, or ii) help the family to make their own from available materials. Additionally, we assessed the feasibility of this intervention to be integrated with a child feeding program.

ABSTRACT

Impact of Community Health Clubs on Diarrhea and Anthropometry in Western Rwanda: Cluster-Randomized Controlled Trial. FASEB Jnl, May 2017. (Abstract/order) – The CHC approach, as implemented in this setting in western Rwanda, had no impact on any main outcomes, but it had a positive impact on household water treatment and type and structure of sanitation facility. Our results raise questions about the value of implementing this intervention at scale.

Diet Quality, Water and Toilets Remain a Lingering Challenge for Undernutrition in India. FASEB Jnl, May 2017. (Abstract/order) – Using data from 2005–06, our regression analyses demonstrate a positive synergistic effect of better complementary feeding and better toilets for all anthropometric indicators, but not for improved drinking water or better ways of disposing child stools.

Evaluation of Student Handwashing Practices During a School-Based Hygiene Program in Rural Western Kenya, 2007. International Quarterly of Community Health Education, May 2017. (Abstract/order) – Teacher training and installation of water stations resulted in observed improvements in pupils’ hygiene, particularly when water stations were located

Consistency of Use and Effectiveness of Household Water Treatment Among Indian Households Claiming to Treat Their Water. Am Jnl Trop Med Hyg, online first. (Abstract/order) – Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Adding a Water, Sanitation and Hygiene Intervention and a Lipid-Based Nutrient Supplement to an Integrated Agriculture and Nutrition Program Improved the Nutritional Status of Young Burkinabé Children. FASEB Jnl, May 2017. (Abstract/order) – Adding WASH to the program in 2014 led to a significantly greater reduction in anemia, and including both WASH and LNS in communities with prior EHFP program exposure led to the largest and most diverse nutritional impacts including significant reductions in anemia, IDA and VAD. These results highlight the importance of addressing the multiple causes of undernutrition simultaneously, through multisectoral programs.

#InDeepShit

By Ingeborg Krukkert, Lead Asia Programmes | Sanitation and hygiene specialist, IRC

Human beings are being used to plug the gaps in failing sanitation systems – Bezwada Wilson.

#InDeepShit is the title of an event I attended on Saturday 22 April 2017. Talking about toilets and who is able to use one – or not; talking about who cleans them and how – sometimes literally with their hands deep in shit. I know this does not sound like an event a sane person would like to join on their day off. But you are mistaken! And I was not the only one. Around 80 young and critical people in the room showed that this was an event important enough to spend their free Saturday morning on.

I was triggered by the quote on the invitation saying: “Any human cannot clean somebody’s shit for the sake of roti. This is Independent India?”. The quote is from Bezwada Wilson, an Indian activist against manual scavenging. He was one of eight very interesting speakers invited to address the meeting. They covered a wide range of challenges: from barriers disabled people face when wanting to use a toilet (“we can’t hire you because we do not have a toilet for you”), to safety issues for transgender people (“we have progressive laws on paper, but this is not what I encounter in real life”), to accountability and manual scavenging.

Nine years

Almost nine years ago Bezwada Wilson was an inspiring and eloquent speaker at the IRC Symposium on Urban Sanitation for the Poor. Nine years and the same problems still need to be addressed. At that time he said: “sanitation is much broader than simply toilets. Effective sanitation also requires hygiene education – people have to change their practice as well as get access to toilets. It is inevitable that the main focus is on the early part of the chain (building toilets), but there is increasing awareness that the most difficult problems relate to the removal of faecal sludge […]. In many cities, treatment, disposal or reuse is not managed” and – as Bezwada Wilson put it so eloquently in his presentation during the symposium: “human beings are being used to plug the gaps in failing sanitation systems”.

Bezwada Wilson

Bezwada Wilson

Nine years later, this is exactly what is happening with the Swachh Bharat Mission. With the hard deadline of 2019 to reach the target of a toilet for every household, state and districts seem to have no choice but to focus on constructing toilets and on doing it fast. More than 700 million toilets to go…. There is no time to focus on use, no time to focus on what is happening with all that human waste after using the toilet, no focus on what happens when the pit is full, and no focus on who is emptying the toilet or how it is done.

Nine years of activism and there is still manual scavenging. Bezwada Wilson has not changed; he seems more motivated than ever. And with reason! It’s not only about dignity, safety is a huge issue too. Workers are dying, even in 2017, he points out referring to the recent sewage plant accident in Noida.

Chief Executive VK Madhavan from WaterAid India, however, also sees positive developments. He acknowledges that we cannot change where we are born, or in which family or caste. So true and yet so easy to forget: that privilege – or not – is no contribution of us as individuals, no contribution at all. What we can do is provide a space to those who are denied to speak up or to interact with the government. That is why WaterAid India together with Youth Ki Awaaz organised this event. Youth Ki Awaaz is India’s largest platform where young people can publish their stories to drive impact.

And this is what Bezwada Wilson has also done. He is founder and National Convenor of the Safai Karmachari Andolan (SKA), a national movement committed to the total eradication of manual scavenging and the rehabilitation of all scavengers for dignified occupations. SKA was instrumental in eradicating manual scavenging in as many as 139 districts in India since 2009. He created a change of perspective. And he is not alone. Mrs Lali Bai, a former manual scavenger, also shared her experiences with us. She is now an activist and founder of Rashtriya Garima Abhiyan, a national campaign for dignity and eradication of manual scavenging. For a long time many of us, including government officials, ignored or even denied the existence of manual scavenging. But there are many examples that manual scavenging is still going on as this picture from Cambodia shows.

Manual scavenger in Cambodia (photo by Danny Dourng)

Manual scavenger in Cambodia (photo by Danny Dourng)

Any shortcuts to change?

In India more and more authorities start to acknowledge the problem. Our role is to provide space to make this happen. It all goes terribly slowly though and I asked the panel if there is no shortcut to change. Nobody could answer that question. Can you?

The blog was originally posted on 24 April 2017 on the IRC website.

World Bank targets smarter sanitation communication for rural Ethiopia

By Peter McIntyre, IRC Associate

The World Bank in Ethiopia has commissioned a rapid survey of what motivates people to upgrade their latrines, with the aim of delivering behaviour change communication materials with greater impact.

Ethiopia Worldbank_bcc_launch_2_addis_230317

Sanitation rapid survey launch meeting Addis Abeba, 23 March 2017 (Photo: Sirak Wondimu)

The survey is being conducted in four regions, with the main target audiences being adult women, male heads of households, opinion leaders and existing sanitation businesses.

The aim is to pilot and produce materials that emphasise the dignity, prestige and status of having improved sanitation, rather than focusing only on health messages.

The WB decided a new approach was needed after Demographic and Health Survey (DHS) figures for 2016 suggested that only 4% of rural households in Ethiopia have improved toilets facilities while a further 2% have facilities that would be considered improved if they were not shared. This is well below the Joint Monitoring Program figure of 28% for improved latrines (although we understand this may be revised down to around 14%). Indeed, according to DHS, although access to some form of sanitation has risen, access to an improved latrine has declined in percentage terms over the past ten years. Most latrines in rural areas (55%) do not have an effective slab or lid while more than a third of rural households (39%) practise open defecation.

The Government of Ethiopia has a flagship programme to increase use of improved latrines to 82% by 2020.

At a launch meeting in Addis on 23 March 2017, social market consultant, Addis Meleskachew, said that this initiative will develop a memorable brand for marketing materials that will encourage the private sector to provide materials and will attract rural families to buy them.

Dagnew Tadesse,Hygiene and Environmental Health Case Team Leader for Ministry of Health, welcomed the initiative to attract business but emphasised that the GoE approach is based on a comprehensive health education strategy with multiple messages including hygiene awareness, handwashing and safe food, and said that these important messages should not be abandoned.

Jane Bevan, rural WASH Manager at UNICEF Ethiopia offered to share extensive data that UNICEF has collected for its country programme on attitudes to sanitation, which has identified the high cost of concrete slabs as a significant obstacle. She presented examples of low cost options for upgrading sanitation in a pilot project in Tigray region. It was agreed to collate all existing KAP studies and relevant data including research by SNV.

Monte Achenbach from PSI and John Butterworth from IRC spoke about the work being started by USAID Transform WASH to market innovative sanitation models. John Butterworth said there is a need to make people aware of what is available and to get materials to where they are needed.

The World Bank research is being conducted by 251 Communications.

This blog was originally posted on 5 April 2017 on the IRC website.

Swachh Bharat Mission Hygiene Index

Swachh Bharat Mission Hygiene Index

Since the announcement of the Swachh Bharat Abhiyan two-and-a-half years ago, individuals, communities and government bodies have busied themselves in a flurry of activity to realise the dream of a clean and sanitary India. swach2

While someone is trying to bring toilets to a remote village, someone else is trying to clean a river, while others are simply trying to build toilets for their own households.

This is the true story of the ambitious Swachh India campaign—a recognition that the country will never be truly ‘swachh’ until all stakeholders, from the government to corporates to each and every citizen, participate and do their bit.

To maintain the momentum and keep these efforts on track, constant evaluation is needed. And this is where the Hygiene Index comes in.

Read More: Swachh Hygiene Index: How Close Are We To The Dream Of A Swachh Bharat?

The Hygiene Index has been developed in support of the Swachh Bharat Mission, and evaluates various parameters that can help nudge cities in the direction of better sanitation and hygiene.

Read more.

WHO Trachoma Fact sheet, April 2017

WHO Trachoma Fact sheet, April 2017.

Key facts

  • Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis.
  • It is known to be a public health problem in 42 countries, and is responsible for the blindness or visual impairment of about 1.9 million people. Nearly 182 million people live in trachoma endemic areas and are at risk of trachoma blindness.
  • Blindness from trachoma is irreversible.
  • Infection spreads through personal contact (via hands, clothes or bedding) and by flies that have been in contact with discharge from the eyes or nose of an infected person. With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea.
  • The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem.
  • The elimination strategy is encapsulated by the acronym “SAFE”: Surgery for advanced disease, Antibiotics to clear C. trachomatis infection, Facial cleanliness and Environmental improvement to reduce transmission.
  • In 2016, more than 260 000 people received surgical treatment for advanced trachoma, and 86 million people were treated with antibiotics. Global-level antibiotic coverage was 47%, a considerable increase compared to the 29% coverage achieved in 2015.

12th SuSanA Thematic Discussion: “Menstrual Hygiene Management (MHM) in Schools – A neglected issue”

While nowadays the topic of MHM is gaining more and more attention, it has widely been neglected in the past. SDG4 (education), SDG5 (gender equality) and SDG6 (water and sanitation) require female friendly sanitation facilities and available informational materials at schools around the globe.

Taking into account the magnitude of the population affected by issues around MHM, schools provide an ideal environment to reach girls as well as young women and to address taboos and misconceptions in a culturally sensitive manner.

The question, however, is how to approach the topic in a culturally sensitive manner?

Running for two weeks from today (March 27 until April 09) the discussion on the SuSanA forum will look at two areas:

Week 1: Breaking the taboo around MHM                                           Thematic Lead: Dr. Marni Sommer (Associate Professor, Columbia University Mailman School of Public Health)

 Week 2: Infrastructural barriers and how to monitor MHM            Thematic Lead: Thérèse Mahon (Regional Programme Manager South Asia, WaterAid)

During the discussion, regular summaries of forum entries will be posted to keep you updated on our conversation.

Coordination on behalf of the SuSanA secretariat for this thematic discussion will be carried out by Dr. Bella Monse, Jan Schlenk and Mintje Büürma. For any questions, you can post on the forum or contact us directly at info@susana.org.

To join the discussion, follow: http://bit.ly/2nZn4n6

And to read the first contribution by Marni Sommer, click on: http://bit.ly/2n9JLkv

Recently published handwashing studies

1 – Trop Med Int Health. 2017 Feb 28. doi: 10.1111/tmi.12861. [Epub ahead of print]

Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low and middle income country settings.

RESULTS: Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective.

CONCLUSION: Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children’s handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area however does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC. This article is protected by copyright. All rights reserved.

2 – Am J Infect Control. 2017 Feb 24. pii: S0196-6553(17)30041-X. doi: 10.1016/j.ajic.2017.01.018. [Epub ahead of print]

The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.

BACKGROUND: Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known.

RESULTS: Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism.

CONCLUSIONS: The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism.

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