Category Archives: Sanitation and Health

Now available on WSUP-website for free download: masters-level professional training module “Water and Sanitation for Urban Low-Income Communities”

WSUP/WEDC have developed a teaching resource on urban WASH that is now available online for free, It aims at helping the urban WASH sector to professionalize. We hope it will be helpful for academics and practitioners to use or adapt if they feel it can be of value to them.

In short: this is a masters-level professional training module called “Water and Sanitation for Urban Low-Income Communities”. It was primarily designed to give engineering masters students in low-income countries an overview of things they need to know in order to apply their technical skills in low-income communities, and that’s how WSUP and WEDC are currently using it, in partnership with universities in Africa and Asia. But of course it may be adaptable to other teaching contexts.

It’s designed for classroom delivery, over about 45 hours of contact time. It’s made up of 16 thematic units, and within each unit the materials essentially comprise a Powerpoint presentation plus Lecturer Notes outlining the unit’s aims and content, and providing guidance on how to deliver the class. Some units are flexible in content, to enable adaptation to local contexts.

It can be delivered as an off-the shelf package; or you might want to cut-and-paste parts of it into your own materials; or you might simply use it as guidance in developing other materials.

It’s absolutely free to download, but we do ask that you fill in a brief Use Request Form explaining who you are and how you might use it: evidently, it’s useful for us to be able to communicate this to the funder of the work (DFID).

See www.wsup.com/programme/resources/

For information, we expect to have a French-language version available within the next few months.

The module was developed by (alphabetical order): Louise Medland, Guy Norman, Brian Reed, Pippa Scott, Regine Skarubowiz, and Ian Smout; inputs also came from Richard Franceys and Valentina Zuin.

WASHplus Weekly: Focus on Community-Led Total Sanitation (CLTS)

Issue 202 | August 14, 2015 | Focus on Community-Led Total Sanitation (CLTS)

This issue updates the March 6, 2015 Weekly on CLTS. Studies and resources in this issue include a webinar series on what constitutes success for CLTS, new reports from the UNC Water Institute and the Institute of Development Studies, a presentation by Kamal Kar on CLTS and scaling up, and a UNICEF report on CLTS in fragile and insecure contexts. Also included are recent studies on the health impacts of open defecation in India and Nepal and a Waterlines review on the safety of burial or disposal with garbage as forms of child feces disposal.

EVENTS

What Constitutes Success for CLTS? Measuring Community Outcomes and Behavior Changes, 2015.
The webinar had a chat show format where, following a panel interview, the audience will have the chance to interact with the panelists. This webinar was organized under the Knowledge Management initiative of the Building Demand for Sanitation (BDS) program of the Bill & Melinda Gates Foundation. Organizers included Euforic Services, the SuSanA secretariat and the Stockholm Environment Institute.

  • Introduction by Pippa Scott, Link to recording on YouTube
  • Chat show. Speakers: Ada Oko Williams, Technical Support Manager, Sanitation and Hygiene, WaterAid UK; Darren Saywell, Senior Director, Water, Sanitation and Health, Plan International USA and others, Link
  • Feedback from breakout rooms, Link
  • Closing panel, Link
  • More information and links to audio files are available on the SuSanA discussion forum

Seminar: CLTS at Stockholm World Water Week, August 23rd, 9:00 – 10:30, FH 202. Link
In this 90-minute event, speakers from Plan International and the Water Institute at UNC will discuss with the audience the results of an operational research program on the role and potential of local actors to sustain CLTS outcomes. Highlights will be shared from activities in 10 countries across Africa, Asia, and the Caribbean.

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Are burial or disposal with garbage safe forms of child faeces disposal?

Are burial or disposal with garbage safe forms of child faeces disposal? An expert consultation. Waterlines, July 2015.

Authors: Rob Bain, Rolf Luyendijk, et al. waterlines

The importance of safe handling and disposal of child faeces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries.

The safety of these two approaches is difficult to assess given the limited evidence available and we therefore sought the opinion of experts in the field of sanitation to support advocacy around the topic. We report the findings of an anonymous expert (Delphi) consultation on the safety of these two child faeces disposal methods. There was almost unanimous agreement these should be considered neither safe nor improved.

A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults. The consultation also highlighted gaps in the current evidence base that should be addressed to gain a fuller insight into the risks involved in these two forms of sanitation with a view to providing both programmatic and normative guidance.

In particular further work is needed to assess the potential for exposure to faecal matter in solid waste in low- and middle-income countries and to elucidate the predominant practices of child faeces burial including proximity to the home or infant play areas as well as depth of burial.

WASHplus Weekly: Focus on Animal Waste Management

Issue 201 | August 7, 2015 | Focus on Animal Waste Management

This issue focuses on the management of animal waste and includes recent studies and resources on the environmental and health impacts of waste from domestic animals such as cattle, pigs, and chickens. Specifically, reviews of animal waste management by the International Livestock Research Institute, and diarrheal infections associated with animal husbandry are included, as well as aWHO fact sheet on Taeniasis/Cysticercosis, and country studies from Bangladesh, Egypt, Ghana, and more.

WASTE MANAGEMENT

Global Assessment of Manure Management Policies and Practices, 2014. E Teenstra. Link
The study assessed livestock manure policies in 34 countries in Asia, Africa, and Latin America, then looked in depth at manure management practices in Bangladesh, Vietnam, Ethiopia, Malawi, Argentina and Costa Rica. The authors found wide variations in practice, with particular challenges in the handling of liquid manure; they also found government policies and lack of coordination often hindered the implementation of improved practices.

Manure Management Practices in Urban and Peri-urban areas of Tanzania pose a Public Health Threat, n.d. University of Copenhagen. Link
Livestock are increasingly kept in urban and peri-urban areas as a consequence of the growing urban demand for fresh meat and livestock products. Manure is a valuable byproduct of livestock production, but if it is not treated according to good manure handling practices, it may cause a public health treat due to the presence of pathogenic bacteria in the dung. A recent international research project working with cattle farmers in urban areas of Tanzania has documented that good manure handling practices are not always followed, and that this lead to direct human contact and environmental contamination with cattle manure.

A One Health Perspective for Integrated Human and Animal Sanitation and Nutrient Recycling, 2015. H Nguyen-Viet. | Order from CABI | Free View/Download
This chapter discusses a conceptual framework for integrated health and environmental assessment that combines health status, and the physical, socioeconomic and cultural environments in order to improve human health and minimize environmental impact. This concept’s application in the management of human and animal excreta in Vietnam is then described.

Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries, 2015. D Grace, International Livestock Research Institute. Link
This short paper identifies key evidence gaps in our knowledge of livestock- and fisheries-linked antimicrobial resistance in the developing world, and to document on-going or planned research initiatives on this topic by key stakeholders. The antimicrobial resistant (AMR) infections in animals that are of most potential risk to human health are likely to be zoonotic pathogens transmitted through food, especially Salmonella and Campylobacter. In addition, livestock associated methicillin resistant Staphylococcus aureus (LA MRSA) and extended spectrum beta lactamase E. coli (ESBL E. coli) are emerging problems throughout the world.

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Breaking the Next Taboo: Menstrual Hygiene within CLTS

Breaking the Next Taboo: Menstrual Hygiene within CLTSFrontiers of CLTS: Innovations and Insights, July 2015.

Authors: Sharon Roose and Tom Rankin, Plan International and Sue Cavill, Independent Consultant

Most adolescent girls and women menstruate. This means that for five to seven days each month they bleed through their vagina. This monthly bleeding is often accompanied by abdominal cramps, headaches, mood changes and general lethargy all of which can be exacerbated by social stigma, myths and a lack of requisite infrastructure to manage menstruation safely, privately and hygienically. Frontiers_Issue-6_MHM

The accumulated impact of these issues have significant implications for women and girls and the potential to limit their opportunity for education, equality, income generation and societal participation, all of which hamper self-worth and confidence.

This edition of Frontiers of CLTS illustrates how CLTS programmes can be expanded to address menstrual hygiene management (MHM) in schools
and communities to alleviate these stresses on women and girls.

Its specific objectives are to:

  • Increase the awareness of policy-makers and practitioners on MHM.
  • Engender change by highlighting the synergies between MHM and
    CLTS programmes.
  • Share examples of how MHM interventions have been incorporated
    into CLTS and School-Led Total Sanitation (SLTS) programmes,
    drawing on the innovations and experiences of several organisations.
  • Summarise what can be done to improve MHM through CLTS
    programmes.

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PloS Medicine, July 2015.

Authors: Bijaya K. Padhi, Kelly K. Baker, et al.

Background The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.

Methods and Findings A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72–3.71), preterm birth (OR: 2.36; 95% CI: 1.54–3.62), and low birth weight (OR: 2.00; 95% CI: 1.24–3.23) were found to be significantly associated with open defecation practices. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility of residual confounding should not be ruled out. We did not identify specific exposure pathways that led to the outcomes.

Conclusions This study provides the first evidence, to our knowledge, that poor sanitation is associated with a higher risk of APOs. Additional studies are required to elucidate the socio-behavioural and/or biological basis of this association so that appropriate targeted interventions might be designed to support improved birth outcomes in vulnerable populations. While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs

WASHplus Weekly: Focus on WASH & Nutrition

Issue 197| July 2, 2015 | Focus on WASH Nutrition

This issue on WASH and nutrition integration features a recent USAID webinar and briefs from USAID and WASHplus. Also featured is an upcoming conference organized by Catholic Relief Services and links to a May 2015 seminar by Irish Aid. A chapter from a 2015 report by the International Food Policy Research Institute discusses evidence of the link between sanitation, child height, and well-being. Other reports/articles discuss environmental enteropathy findings and explore water, food security, and nutrition linkages.

USAID AND WASHPLUS RESOURCES

USAID WASH and Nutrition Webinar, 2015. Link
Elizabeth Jordan and Katherine Dennison of USAID discuss the connection between undernutrition and lack of access to water, sanitation, and hygiene (WASH) services and highlight opportunities for integrated programming to achieve better health outcomes. Other recent USAID WASH webinars include: | Sanitation | Agricultural Water Management |Sustainability of WASH Services | Drinking Water Quality |

WASH and Nutrition Implementation Brief, 2015. USAID. Link
Positive nutritional outcomes are dependent upon WASH interventions and nutrition actions. Poor WASH conditions create an additional burden of undernutrition. Opportunities for co-programming WASH in nutrition programs exist and are discussed in this brief.

Integrating WASH and Nutrition Learning Brief, 2015. WASHplus. Link
Since 2010, the USAID-funded WASHplus project has been engaged both at the global and country levels in stimulating the discussion and improving the evidence base around integrating WASH into nutrition programming, sharing experiences and approaches to integrating the two sectors. This learning brief describes WASHplus country activities in Bangladesh, Mali, and Uganda; global knowledge sharing efforts; and other WASHplus activities.

EVENTS

September 14–16, 2015 – Catholic Relief Services (CRS) Integrated Nutrition Conference, Nairobi, Kenya. Link
CRS and members of the NGO, research, and donor community will host a two-day conference focusing on integrated solutions relevant to East Africa. Global leaders in the areas of nutrition, water and sanitation, agriculture, health, and early childhood development will come together to: bring knowledge, evidence, and experience on implementing integrated nutrition-sensitive programming; identify best practices in integrated nutrition-sensitive programs; and identify gaps that will lead to the development of a learning agenda for East Africa.

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