Category Archives: Sanitation and Health

To End Neglected Tropical Diseases, Start With The Basics Of Clean Water And Sanitation For The World’s Poorest

To End Neglected Tropical Diseases, Start With The Basics Of Clean Water And Sanitation For The World’s Poorest. Huffington Post, April 26, 2017.

Despite ‘unprecedented progress’ further gains depend on water and sanitation, says the World Health Organization 

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Itai Nakoru, 87, from Adengei village, Nakapiripirit District, Karamoja region, Uganda is examined to see if she is fit for eye surgery to treat her trachoma

87-year-old Itai Nakoru, opens her eyes slowly so the doctor can examine them. She’s in excruciating pain because every time she blinks, her eyelashes scratch her corneas.

For the last six years, my eyes have been itching so much, this year, my left eye totally lost sight,” she explains.Itai lives in Uganda’s northeastern Karamoja region. She’s being examined by a doctor to determine if she can have surgery to treat her trichiasis, which is a result of repeated trachoma infection.

This eye disease is caused by the bacterium Chlamydia trachomatis and leads to inflammation, scarring the inside of the eyelid. The eyelids eventually turn inwards causing the eyelashes to scratch the cornea.

Trachoma is the leading cause of preventable blindness in the world, affecting almost two million people globally. In this region of Uganda, trachoma rates are the highest in the country, largely because the area is hot and dusty and sanitation is poor, making it a perfect breeding ground for bacteria.

Read the complete article.

A big-picture look at the world’s worst Ebola epidemic

A big-picture look at the world’s worst Ebola epidemic. Hutch News, April 12, 2017.

International team of scientists show how real-time sequencing and data-sharing can help stop the next outbreak

An international effort to analyze the entire database of Ebola virus genomes from the 2013–2016 West African epidemic reveals insights into factors that sped or slowed the rampage and calls for using real-time sequencing and data-sharing to contain future viral disease outbreaks.

Published online today in the journal Nature, the analysis found that the epidemic unfolded in small, overlapping outbreaks with surprisingly few infected travelers sparking new outbreaks elsewhere, each case representing a missed opportunity to break the transmission chain and end the epidemic sooner.

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Dr. Gytis Dudas, a Mahan Postdoctoral Fellow at Fred Hutchinson Cancer Research Center, is the paper’s lead author. Photo by Bo Jungmayer / Fred Hutch News Service

“We calculated that 3.6 percent of cases traveled, basically meaning that if you were able to focus on those mobile cases and reduce their mobility, you might have had a disproportionate effect on the epidemic,” said computational biologist Dr. Gytis Dudas, a Mahan Postdoctoral Fellow at Fred Hutchinson Cancer Research Center and the paper’s lead author.

The West African Ebola epidemic dwarfed all previous central African outbreaks of the virus, sickening more than 28,000 people and killing more than 11,000 of them.

The 1,610 Ebola virus genomes analyzed by the researchers represented more than 5 percent of the known cases, the largest sample analyzed for a single human epidemic. The analysis is the first to look at how Ebola spread, proliferated and declined across all three countries most affected: Guinea, Sierra Leone and Liberia. Previous analyses focused primarily on either a single country, a limited time frame or used fewer sequences.

Read the complete article.

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.

Discovering sanitation realities through rural immersions

Discovering sanitation realities through rural immersions. by Jamie Myers, CLTS, March 2017.

At the end of last year the CLTS Knowledge Hub heard that the Indian Institute of Management (IIM), Indore, in collaboration with UNICEF and the Government of Madhya Pradesh, were sending 630 of their first year management students to spend a week living in 157 open defecation free (ODF) villages. clts

The villages cut across 13 districts in the central Indian State of Madhya Pradesh. Students were asked to verify ODF status of villages through a household survey and early morning and evening inspections of open defecation sites. They were also tasked with collecting data on school and Anganwadi (child and mother care) centres sanitation and handwashing facilities.

The sheer number of people involved was impressive in itself as was the level of detail that could be collected in the length of time they were able to spend there. Furthermore, the fact that they would be staying overnight meant that they would be in the villages at the times when open defecation was most common, early in the morning and later in the evening. Needless to say we were excited to hear not only about their findings but also the process and methodology.

Read the complete article.

Active trachoma and community use of sanitation, Ethiopia

Active trachoma and community use of sanitation, Ethiopia. WHO Bulletin, April 2017.

Objective – To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1–9 years and community sanitation usage.

Methods – Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys.

Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. blt-logo

All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma.

Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access.

Findings – In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28–30) and mean community sanitation usage was 47% (95% CI: 45–48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected.

Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57–1.03 and OR: 0.67; 95% CI: 0.48–0.95, respectively).

Conclusion – In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.

Duncan Mara – The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals

The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionalsJournal of Water, Sanitation and Hygiene for Development, February 2017. 1.cover-source

In 2015 there were 965 million people in the world forced to practise open defecation (OD). The adverse health effects of OD are many: acute effects include infectious intestinal diseases, including diarrheal diseases which are exacerbated by poor water supplies, sanitation and hygiene; adverse pregnancy outcomes; and life-threatening violence against women and girls.

Chronic effects include soil-transmitted helminthiases, increased anaemia, giardiasis, environmental enteropathy and small intestine bacterial overgrowth, and stunting and long-term impaired cognition. If OD elimination by 2030 is to be accelerated, then a clear understanding is needed of what prevents and what drives the transition from OD to using a latrine.

Sanitation marketing, behaviour change communication, and ‘enhanced’ community-led total sanitation (‘CLTSþ ’), supplemented by ‘nudging’, are the three most likely joint strategies to enable communities, both rural and periurban, to become completely OD-free and remain so.

It will be a major Sanitation Challenge to achieve the elimination of OD by 2030, but helping the poorest currently plagued by OD and its serious adverse health effects should be our principal task as we seek to achieve the sanitation target of the Sustainable Development Goals – indeed it is a moral imperative for all governments and development professionals.

WASH is a Key Ingredient in Tackling Poverty in Kenya – Global Waters

WASH is a Key Ingredient in Tackling Poverty in Kenya. Global Waters, March 2017.

Picture a rural household in Kisumu, Kenya. Kale, cowpeas, tomatoes, and butternut grow in a kitchen garden fed by a drip irrigation system. Children help harvest these vegetables for the stew that complements their family’s diet, formally reliant on maize and sorghum. A handwashing station adjacent to the cooking hut and the improved latrine remind family members to wash with soap at critical times.

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A farmer works in a greenhouse at a KIWASH-supported agriculture and nutrition demonstration farm in the largest health facility in Kisumu county. Photo Credit: Eric Onyiego, USAID KIWASH

Thanks to a new community solar-powered borehole, the family is no longer solely dependent on what the rain provides for drinking water. The family garden produces more food than is needed, and the remainder is sold to provide additional income.

Unlike millions of Kenyans, this family is overcoming the cycle of food insecurity, diarrheal disease, malnutrition, and poverty with the support of USAID’s Kenya Integrated Water, Sanitation, and Hygiene (KIWASH) Project.

Working to improve the lives and health of one million Kenyans in nine counties, the five-year project (2015–2020) focuses on the development and management of sustainable water, sanitation, and hygiene (WASH) services and increased access to irrigation and nutrition services.

Read the complete article.