Category Archives: Sanitation and Health

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. International Journal of Hygiene and Environmental Health
Volume 220, Issue 6, August 2017, Pages 928-949.

Authors: Matthew Freeman, Joshua Garn, Gloria Sclar, et al.

Background – Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry.

Methods and findings – We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review’s end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review’s inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high.

Conclusions – This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions.

 

In Haiti, a Building Fights Cholera

In Haiti, a Building Fights Cholera. New York Times, September 12, 2017.

Next month marks the seventh anniversary of the cholera outbreak that ravaged Haiti. The disease, which can cause death within hours if left untreated, came less than a year after Haiti was rocked by an enormous earthquake that left hundreds of thousands dead and millions injured, displaced and destitute.

Haiti is prone to earthquakes and tropical storms — the island was spared the worst of Hurricane Irma last week — but the cholera outbreak was an anomaly; the disease had never before struck Haiti. It was brought in, it is widely believed, by United Nations peacekeepers from Nepal.

A child with cholera symptoms being examined in the Cholera Treatment Center in Port-au-Prince, Haiti. Credit Dieu Nalio Chery/Associated Press

A child with cholera symptoms being examined in the Cholera Treatment Center in Port-au-Prince, Haiti. Credit Dieu Nalio Chery/Associated Press

One of the world’s most infectious waterborne diseases, cholera spreads quickly and has proved extremely difficult to contain in Haiti. Over 10,000 have died and nearly a million have been stricken to date.

But one organization has managed to nearly eradicate it in a large slum in Port-au-Prince that lacks clean water and sanitation.

One of the game changers that would surprise most people, including global health experts, was actually a building.

It wasn’t just any building, but a very intelligently and beautifully designed one: the Cholera Treatment Center, operated by Les Centres Gheskio, an acronym that stands for the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections.

Read the complete article.

Guardian series on the first 1,000 days

Sept 7 – Surviving without thriving – but all is not lost for the world’s ‘stunted’ children

About 159 million under-fives suffer impaired growth and brain development, but now a study is challenging the view that nothing can be done to help them. Feeding interventions alone are not enough. Environmental factors have to be addressed too.

A quarter of all stunting is linked to chronic diarrhoea in the first two years and almost 90% of cases are the result of a lack of clean water, sanitation and hygiene. Air pollution and the use of biomass fuel play a part. Perhaps better gender parity will prove most significant. If stunting begins in the womb, then clearly maternal health is key: shorter mothers are more likely to have stunted children.

Sept 6 – The first 1,000 days: Jay Rayner explains their impact on a child’s future – video

Good nutrition, healthcare and sanitation are crucial to a child’s early development. Without these, a child’s brain won’t develop properly. They will have a lower IQ and they will grow up shorter than they should, a condition known as stunting. The Observer’s food critic, Jay Rayner, explains how a child’s future is determined by the first years of life.

WSSCC Releases New Global Sanitation Fund Equality and Non-Discrimination Study

How can WASH programmes leave no one behind, as called for in the Sustaionable Development Goals? WSSCC’s new study, Scoping and Diagnosis of the Global Sanitation Fund’s Approach to Equality and Non-Discrimination, helps answer this question.

The study reveals that many people who may be considered disadvantaged have benefited positively from WSSCC’s Global Sanitation Fund (GSF)-supported programmes, particularly in open defecation free verified areas. In addition, a range of positive outcomes and impacts related to empowerment, safety, convenience, ease of use, self-esteem, health, dignity, an improved environment and income generation were reported by people who may be considered disadvantaged.

EQND-Article-Slider
Photo Credit: WSSCC

However, the study finds that GSF has not yet systematically integrated EQND throughout the programme cycle. Across all countries, there are people who have either fallen through the net or whose lives have become more difficult after being unduly pressured, or after taking out loans and selling assets to build toilets. More proactive attention is needed throughout the programme cycle to build on current successes and ensure that people are not left behind or harmed through the actions or omissions of supported programmes.

GSF is in the process of putting the study’s recommendations into practice through revised guidelines, minimum standards, practical tools and other mechanisms.

Download the full study, plus a summarized version with GSF reflections, and annexes

‘It’s a Slow Death’: The World’s Worst Humanitarian Crisis

‘It’s a Slow Death’: The World’s Worst Humanitarian Crisis. New York Times, August 23, 2017.

SANA, Yemen – After two and a half years of war, little is functioning in Yemen.

Repeated bombings have crippled bridges, hospitals and factories. Many doctors and civil servants have gone unpaid for more than a year. map_cholera_top-1050

Malnutrition and poor sanitation have made the Middle Eastern country vulnerable to diseases that most of the world has confined to the history books.

In just three months, cholera has killed nearly 2,000 people and infected more than a half million, one of the world’s largest outbreaks in the past 50 years.

Read the complete article.

Nearly a Billion People Still Defecate Outdoors. Here’s Why

Nearly a Billion People Still Defecate Outdoors. Here’s Why. Nat Geo Magazine, August 2017.

The problem isn’t just a lack of toilets—it’s a lack of toilets that people want to use. The result: millions of deaths and disease-stunted lives.

At 65, Moolchand, bandy-legged and white-haired, has no problem rising for his predawn hunts. In fact he revels in them.

“I hide along the lane with my flashlight,” he says in a low, excited voice, gesturing down the main road of Gaji Khedi village, in India’s Madhya Pradesh state. “And I look for people walking with a lota.”

At a community toilet complex in Safeda Basti, one of Delhi’s many slums, women wait their turn for the single functioning latrine—while covering their noses against the smell of feces left by someone who couldn’t wait. Many people skip the hassle of city-run facilities altogether and do their business in rubble-strewn lots.

At a community toilet complex in Safeda Basti, one of Delhi’s many slums, women wait their turn for the single functioning latrine—while covering their noses against the smell of feces left by someone who couldn’t wait. Many people skip the hassle of city-run facilities altogether and do their business in rubble-strewn lots.

A lota is a water container, traditionally made of brass but these days more often of plastic. Spied outdoors in the early morning, it all but screams that its owner is headed for a field or roadside to move his or her bowels—the water is for rinsing.

“I give chase,” Moolchand continues. “I blow my whistle, and I dump out their lota. Sometimes I take it away and burn it.” Moolchand sees himself as defending a hard-won honor: The district has declared his village “open defecation free.”

“People get angry and shout at me when I stop them,” he says. “But the government has given villagers lots of help to construct a toilet, so there is no excuse.”

Read the complete article.

Handwashing research – Water Currents

Handwashing research – Water Currents, August 8, 2017.

Highlighting the most recent handwashing research, this issue of Currents includes literature reviews by the Global Handwashing Partnership, the International Initiative for Impact Evaluation, and an interesting report on handwashing and rational addiction. Articles discuss handwashing research in Bangladesh, Tanzania, and Zimbabwe as well as studies on handwashing and infectious diseases, among other topics. Handwashing as an important role in preventing infection

Reports 
The State of Handwashing in 2016: Annual ReviewGlobal Handwashing Partnership (GHP), March 2017. This GHP review summarizes key themes and findings from 59 peer-reviewed handwashing-related research papers published in 2016.

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic ReviewInternational Initiative for Impact Evaluation, June 2017. The purpose of this review was to learn which factors might change handwashing and sanitation behavior, finding that a combination of different promotional elements may be the most effective strategy.

Habit Formation and Rational Addiction: A Field Experiment in HandwashingYale University, Economic Growth Center, December 2016. The researchers in this study designed and implemented an experiment to test predictions of the rational addiction model in the context of handwashing. The findings are presented in a video from a 2016 conference.

Read the complete issue.