Category Archives: Sanitation and Health

The snails spreading fever across Africa

The snails spreading fever across Africa | Source: CNN Health, Feb 9, 2016 |

According to WHO, 90% of those requiring treatment for schistosomiasis live in Africa, but most of them live around lake and river regions. The factor helping the disease persist, is poor sanitation. snails

“The problem that sub Saharan Africa has is a lack of fresh water, safe water, and adequate sanitation,” says Fenwick. “People who need to urinate and defecate tend to do so on the open ground, and their excreta can be washed into water where the eggs will then infect snails.”

Infections primarily affect young children, but symptoms can take years to appear, making finding and treating those infected a challenge.

Read the complete article.

Feb 18 Webinar – WASHing away diseases: two hands at a time

February 18, 2016 Webinar, 9:00 a.m EST- WASHing away diseases: two hands at a time

Please join the Global Public-Private Partnership for Handwashing and the USAID/WASHplus project for a webinar discussing why water, sanitation, and hygiene (WASH) matter to neglected tropical diseases (NTDs), and addressing the need for new approaches for multi-sector initiatives to promote equity, poverty alleviation, health, and well-being. webinar

Featuring speakers from WaterAid, Sightsavers, the FHI 360-led USAID/WASHplus project, and USAID, this webinar is an excellent opportunity for those working in both WASH and NTDs to learn about the global landscape of WASH/NTD strategy and glean practical insights from projects that are operating in this context.

This webinar will include brief presentations on:

  • The link between WASH and NTDs
  • How we can work together to achieve common goals through the World Health Organization’s Joint WASH-NTD strategy; and
  • Integration in practice.About the speakers:
  • Renuka Bery, MPH, Senior Program Manager for the USAID/WASHplus project, has an extensive background in WASH integration.
  • Sophie Boisson, PhD, Technical Officer for Water, Sanitation, Hygiene and Health at the World Health Organization.
  • Edouard Tianhoun, RN, MSc, WASH-NTD Coordinator for the USAID/WASHplus Burkina Faso pilot project, has been in involved in WASH programs in his native Burkina Faso since 2011.
  • Yael Velleman, MSc, Senior Policy Analyst on Health and Sanitation, leads WaterAid’s strategy, advocacy, and research agenda on health.
  • Merri Weinger, MPH, Senior Environmental Health Advisor at USAID’s Bureau for Global Health, has over 30 years of experience in health programs at USAID, WHO, and PAHO.
  • Geordie Woods, MPH, Technical Adviser-NTDs at Sightsavers, specializes in health behavior and strategic communication with a technical focus that includes NTDs and WASH.

Infant and Young Child Feces Management and Enabling Products for Their Hygienic Collection, Transport, and Disposal in Cambodia

Below are links to the abstracts of 3 interesting WASH studies that can be downloaded free of charge from the American Journal of Tropical Medicine and Hygiene.

Infant and Young Child Feces Management and Enabling Products for Their Hygienic Collection, Transport, and Disposal in Cambodia
Authors: Molly K. Miller-Petrie*, Lindsay Voigt, Lyn McLennan, Sandy Cairncross and Marion W. Jenkins

Abstract/order info: http://goo.gl/o252V9

In Cambodia, children’s feces are rarely disposed of in an improved sanitation facility. This study examines current practices and the role that enabling products may play in increasing hygienic management of infant and young child (IYC) feces in households with access to improved sanitation.

A survey was conducted with the primary caregiver of a child under 5 years of age in 130 homes with an improved latrine in 21 villages across two provinces in Cambodia. Two focus group discussions per province were conducted after the survey to obtain caregiver feedback on new enabling products for hygienic management. Among caregivers, 63% reported child feces disposal in an improved latrine but only 36% reported doing so consistently.

Besides child age, years of latrine ownership, caregiver age, consistency of adult latrine use, and presence of child feces management tools in the latrine were associated with hygienic disposal. The youngest caretakers with the newest latrines and youngest children were least likely to dispose of IYC feces hygienically, representing a key target group for interventions to improve hygienic disposal in Cambodia. Reusable diapers, child-friendly potties, and possibly latrine seats, that offer child safety, time and cost savings, and easy disposal and cleaning could potentially facilitate hygienic disposal for these ages.

A Cluster Randomized Controlled Evaluation of the Health Impact of a Novel Antimicrobial Hand Towel on the Health of Children Under 2 Years Old in Rural Communities in Nyanza Province, Kenya
Authors: Rachel B. Slayton*, Jennifer L. Murphy, Jamae Morris, Sitnah Hamidah Faith, Jared Oremo, Aloyce Odhiambo, Tracy Ayers, Shawna J. Feinman, Allison C. Brown and Robert E. Quick

Abstract/order info: http://goo.gl/L76AEH

To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster randomized, yearlong field trial. At baseline, we surveyed mothers, and gave four towels plus hygiene education to intervention households and education alone to controls. At biweekly home visits, we asked about infections in children < 2 years old and tested post-handwashing hand rinse samples of 20% of mothers for Escherichia coli.

At study’s conclusion, we tested 50% of towels for E. coli. Baseline characteristics between 188 intervention and 181 control households were similar. Intervention and control children had similar rates of diarrhea (1.47 versus 1.48, P = 0.99), respiratory infections (1.38 versus 1.48, P = 0.92), skin infections (1.76 versus 1.79, P = 0.81), and subjective fever (2.62 versus 3.40, P = 0.04) per 100 person-visits.

Post-handwashing hand contamination was similar; 67% of towels exhibited E. coli contamination. Antimicrobial hand towels became contaminated over time, did not improve hand hygiene, or prevent diarrhea, respiratory infections, or skin infections.

Consistency of Use and Effectiveness of Household Water Treatment Practices Among Urban and Rural Populations Claiming to Treat Their Drinking Water at Home: A Case Study in Zambia
Authors: Ghislaine Rosa*, Paul Kelly and Thomas Clasen

Abstract/order info: http://goo.gl/ocN3bH

Household water treatment (HWT) can improve drinking water quality and prevent disease, if used correctly and consistently. While international monitoring suggests that 1.8 billion people practice HWT, these estimates are based on household surveys that may overstate the level of consistent use and do not address microbiological effectiveness.

We sought to examine how HWT is practiced among households identified as HWT users according to international monitoring standards. Case studies were conducted in urban and rural Zambia. After a baseline survey (urban: 203 households, rural: 276 households) to identify HWT users, 95 urban and 82 rural households were followed up for 6 weeks.

Consistency of HWT reporting was low; only 72.6% of urban and 50.0% of rural households reported to be HWT users in the subsequent visit. Similarly, availability of treated water was low, only 23.3% and 4.2% of urban and rural households, respectively, had treated water on all visits. Drinking water was significantly worse than source water in both settings.

Only 19.6% of urban and 2.4% of rural households had drinking water free of thermotolerant coliforms on all visits. Our findings raise questions about the value of the data gathered through the international monitoring of HWT practices as predictors of water quality in the home.

Topic of the Week – January 2016 Handwashing Studies

Emerging infectious diseases. 2016 Feb; 22(2):233-41. doi: 10.3201/eid2202.151175.

Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera. Authors: George CM, et al.

The risk for cholera infection is >100 times higher for household contacts of cholera patients during the week after the index patient seeks hospital care than it is for the general population. To initiate a standard of care for this high-risk population, we developed Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which promotes hand washing with soap and treatment of water. To test CHoBI7, we conducted a randomized controlled trial among 219 intervention household contacts of 82 cholera patients and 220 control contacts of 83 cholera patients in Dhaka, Bangladesh, during 2013-2014. Intervention contacts had significantly fewer symptomatic Vibrio cholerae infections than did control contacts and 47% fewer overall V. cholerae infections. Intervention households had no stored drinking water with V. cholerae and 14 times higher odds ofhand washing with soap at key events during structured observation on surveillance days 5, 6, or 7. CHoBI7 presents a promising approach for controlling cholera among highly susceptible household contacts of cholera patients.

Am J Trop Med Hyg. 2016 Jan 19. pii: 15-0335.

Beliefs, Behaviors, and Perceptions of Community-Led Total Sanitation and Their Relation to Improved Sanitation in Rural Zambia. Authors: Lawrence JJ, et al.

Inadequate hygiene and sanitation remain leading global contributors to morbidity and mortality in children and adults. One strategy for improving sanitation access is community-led total sanitation (CLTS), in which participants are guided into self-realization of the importance of sanitation through activities called “triggering.” This qualitative study explored community members’ and stakeholders’ sanitation, knowledge, perceptions, and behaviors during early CLTS implementation in Zambia. We conducted 67 in-depth interviews and 24 focus group discussions in six districts in Zambia 12-18 months after CLTS implementation. Triggering activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and handwashing stations. New sanitation behaviors were also encouraged by the hierarchical influences of traditional leaders and sanitation action groups and by children’s opinions. Poor soil conditions were identified as barriers to latrine construction. Taboos, including prohibition of family members, in-laws, and opposite genders from using the same toilet, were barriers for using sanitation facilities. CLTS, through community empowerment and ownership, produced powerful responses that encouraged construction and use of latrines and handwashing practices. These qualitative data suggest that CLTS is effective for improving sanitation beliefs and behaviors in Zambia.

Int J Environ Res Public Health. 2016 Jan 14;13(1). pii: E129. doi: 10.3390/ijerph13010129.

Behavior Change without Behavior Change Communication: NudgingHandwashing among Primary School Students in Bangladesh. Authors: Dreibelbis R, et al.

Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed.

Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.

Arch Dis Child. 2016 Jan;101(1):42-50. doi: 10.1136/archdischild-2015-308875.

Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis. Authors: Willmott M, et al.

OBJECTIVE: To undertake a systematic review and meta-analysis to establish the effectiveness ofhandwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings.

RESULTS: Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children’s absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal.

CONCLUSIONS: Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required.

J Pediatr Gastroenterol Nutr. 2016 Jan;62(1):150-6. doi: 10.1097/MPG.0000000000000901.

Predictors of Stunting Among Children Ages 0 to 59 Months in a Rural Region of Armenia. Authors: Demirchyan A, et al.

OBJECTIVES: The prevalence of stunting in Armenia more than doubled since the 1990s. This study aimed to investigate the prevalence and the predictors of stunting among children younger than 5 years in a rural region of Armenia, Talin, targeted by the World Vision (WV) nutrition interventions.

CONCLUSIONS: The study findings suggest that although WV nutrition interventions have shown impact, there is also a nonnutritional pathway of child stunting in rural Armenia. Thus, antistunting interventions should include sanitation and hygienic measures along with adequate perinatal care and maternal and child nutrition to further reduce childhood stunting, ensuring long-term health benefits for children not only in rural Armenia but also in rural communities in other low/middle-income countries.

Angela Kearney on Sanitation and Stunting

In a recent interview in the Pakistan Television programme ‘Diplomatic Enclave’, conducted by Omar Khalid Butt, UNICEF Representative in Pakistan Ms. Angela Kearney sheds light on the priorities of UNICEF and the targets and achievements of the UN Children’s Fund in Pakistan.

In this clip she speaks about access to sanitation and stunting in Pakistan, and the relation between the two problems. She also sheds light on the progress Pakistan has made in the recent years in achieving the Millennium Development Goal (MDG) on sanitation.

Are studies underestimating the effects of sanitation on child nutrition?

Are studies underestimating the effects of sanitation on child nutrition? – Authors’ reply. Lancet Global Health, Feb 1, 2016. Authors: Amy J Pickering, Maria Laura Alzua.

Should child growth replace diarrhoea as the primary child health outcome for sanitation trials? We appreciate Derek Headey’s comment in relation to our trial that the window of opportunity to plausibly affect growth faltering is from in utero up to 24 months, and therefore that sanitation trials should focus growth assessments in children with exposure to the intervention who are younger than 24 months.

Ongoing sanitation trials in rural Kenya (NCT01704105), Bangladesh (NCT01590095), and Zimbabwe (NCT01824940) have chosen to enrol target children in utero precisely because of the recognition that child stunting and environmental enteric dysfunction can begin before birth.

However, the effect of enteric pathogen exposure—either through reduced acute diarrhoea or asymptomatic infections—is likely to be one of many causes of linear growth faltering. In some settings, competing risks such as poor nutrition and non-enteric infections (eg, malaria) could overshadow improved sanitation’s contribution to growth.

Child growth is also unable to capture potential health benefits of sanitation interventions for children older than 2 years. For these reasons, it could be premature to rely exclusively on anthropometry measurement before additional sanitation intervention trials successfully show an effect on child growth.

Although we agree with Headey that caregiver-reported diarrhoea can be a biased outcome, we see value in measuring the effect of sanitation interventions on more objective indicators of enteric infections. Notably, recently developed molecular techniques allow for the simultaneous detection of many relevant diarrhoeal pathogens in stool samples, including bacteria, viruses, protozoans, and soil-transmitted helminths.

Antibody measures of infection in saliva, blood, and stools provide additional multiplex opportunities to objectively measure enteric pathogens. Continued advancements in molecular techniques are reducing costs and increasing the feasibility of their use in low-income settings.

Although the high incidence of asymptomatic infections precludes the use of pathogen presence as a direct indicator for clinical diarrhoea, enteric pathogen infection status would be a valuable outcome to understand the ability of sanitation interventions to interrupt transmission of diarrhoeal pathogens.

We propose that enteric pathogen detection be deemed a complementary outcome to child growth for a more comprehensive understanding of the potential benefits of sanitation trials.

The anatomy of a campaign: ‘If men had periods’ by WaterAid

The anatomy of a campaign: ‘If men had periods’ by WaterAid | Source: The Guardian, Jan 25, 2016.

WaterAid’s campaign to raise awareness about the importance of menstrual hygiene playfully imagines a world where men have periods.

Back story

At WaterAid, we asked why menstruation provokes such a response? And I asked myself why, as a woman in my early 30s, do I still hide my tampon up my sleeve when I go to the office toilet?

wateraid

If Men had Periods – manpon campaign by Wateraid Photograph: WaterAid

More than one billion women don’t have access to somewhere safe to go to the toilet when they’re on their period. Often forced to find somewhere after dark, this is both undignified and dangerous. A lack of toilets in schools means that young girls often drop out of education when they reach puberty, limiting their life chances.

Without access to proper sanitary products, many women and girls use rags, newspaper and even mud, which can lead to infections. In rural Nepal and northern India the outlawed practice of chhaupadi – being ostracised from your family during your monthly cycle – still prevails.

In the UK, we use extraordinarily inventive euphemisms for menstruation – phrases like “I’m on”, “It’s that time of the month”, “the painters and decorators are in” are common, but starting your period should be a celebrated rite of passage, not an invisible act.

Development issues can be tough to translate to a UK audience, but periods are a relatable experience and we decided to use that to our advantage.

Read the complete article.