Category Archives: Resources

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study

The current issue of PLoS Medicine has an important review on sanitation and hygiene and also below is an analysis of the review by Jonny Crocker and Jamie Bartram.

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study. PLoS Med, May 2016. Authors: Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L., et al.

Full text: http://goo.gl/z0h9P0

Background – Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child’s risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.

Methods/Findings – The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1–2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India.

Conclusions – This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children’s Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea. PLoS Med, May 2016. Author: Jonny Crocker, Jamie Bartram

Full text: http://goo.gl/6SzZmr

The draft sanitation ladder for measuring SDG progress allows sharing of improved facilities by fewer than five households to count towards ending open defecation [19]. Higher rungs refer to private facilities and safe excreta management. The indicators also interpret access as including use, which was not included in GEMS. Future research should include indicators on use of facilities and excreta management.

Baker and colleagues provide valuable evidence that confirms that private sanitation often provides greater benefits than shared sanitation. Prior evidence suggests health benefits for use of any sanitation facility (including shared) when compared to open defecation [8–10]. This study will inform policy and programming, yet shared facilities may still have a role in addressing open defecation in challenging settings. For reasons beyond just health such as dignity and gender equity [20,21], we should advocate for private access whenever possible.

Baker and colleagues present the best dataset yet on diarrheal disease associated with sanitation and hygiene. They provide compelling evidence on sanitation and hygiene risk factors for MSD and variability in that risk. Importantly, they also demonstrate the feasibility and value of rigorous data collection on health outcomes, something that future studies should develop yet further.

WASH Futures Conference, May 2016

WASH Futures 2016 – Pathways to universal and sustained water, sanitation and hygiene WASH2016-banner

The future of action on WASH (water, sanitation and hygiene) looks positive – with the post-2015 Sustainable Development Goals global agenda maintaining attention on the need for water, sanitation and hygiene for everyone, all the time. But the path to achieving this global agenda requires new ways of thinking.

How can all WASH actors – governments, private sectors and civil society – work together to ensure WASH, whether at community-scales or larger institutional-scales, to achieve not only sustained access for everyone, but also health, well-being, environmental and economic outcomes for societies?

In May 2016 practitioners and professionals from civil society, governments, private sectors, donors, students and academic institutions, will come together to contribute to the broader international WASH dialogue and share knowledge with the Australian WASH community and partners.

Go to the conference website.

Recent studies on sanitation acess & violence,and others

Below are links to the abstracts or full text of recently published articles:

Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya. Int J Environ Health Res. 2016 June.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/26593879

This study analyzed 2008 Kenya Demographic Health Survey’s data and found women who primarily practice open defecation (OD), particularly in disorganized communities, had higher odds of experiencing recent non-partner violence

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought. Environ Sci Technol. 2016 Apr 25.
Abstract: http://pubs.acs.org/doi/abs/10.1021/acs.est.5b06186

Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern.

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali. Amer Jnl Trop Med Hyg, Current issue
Abstract – http://www.ajtmh.org/content/early/2016/04/21/ajtmh.15-0757.abstract

We found that a school-based WASH intervention can have a positive effect on reducing rates of illness, as well as absence due to diarrhea. However, we did not find evidence that these health impacts led to a reduction in overall absence. Higher absence rates are less likely attributable to the intervention than the result of an imbalance in unobserved confounders between study groups.

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SuSanA webinar monthly webinar 1: “Opportunities & challenges of achieving WASH behaviour change”

Published on Apr 28, 2016

The webinar brought together speakers who presented their perspectives on how we can improve WASH behavior change. First, we learnt about how we can do a better job of leveraging the influence of community leaders to change some of the social and cultural norms that prevent uptake of healthy WASH behaviors. The role of both formal and informal leaders was explored, as well as how to extend this collaboration beyond CLTS to incorporate it more into other WASH approaches.

Three things that make SaniPath special

Three things that make SaniPath special | Source: SaniPath blog, April 21 2016 |

The SaniPath team has created an exposure assessment tool to be used in urban low-resource areas with poor sanitation. It stands out as a resource for its accessibility, easy to understand results, and potential to influence policy making. sanipath

1. THE SANIPATH TOOL IS EASY TO USE AND UNDERSTAND
The tool was designed with the goal that it would be able to be used independently by a variety of organizations interested in improving sanitation. It comes with a detailed manual describing the steps of the data collection and the analyses process than can be understood by anyone with a basic scientific background. Minimum requirements for use of the tool include:

  • A funding source (ex: local government or international organization)
  • A lab with the ability to detect E. coli and technicians to carry out the procedures in a sterile environment
  • A team with experience conducting surveys
  • A local group to assist with data collection and distribution

Read the complete article.

Barbara Frost on the rise and rise of WaterAid

Barbara Frost on the rise and rise of WaterAid | Source: Third Sector, April 22 2016 |

The chief executive has led the charity for a decade of almost uninterrupted success and has escaped the fire directed at others. 

FeatureBarbaraFrost-20160421120321316

Barbara Frost

In 1972 Barbara Frost left Keele University after two years studying psychology and social sciences, and went on what was intended to be a gap year. She took the so-called magic bus to Istanbul, continued by public transport on the hippy trail to India and Nepal, and ended up living in a commune in Australia. She didn’t come back to England for 24 years.

During that time she made rapid progress in public service jobs, developed homecare services in New South Wales and worked for Oxfam, Save the Children and ActionAid in Mozambique and Malawi. And when she finally returned to England in the mid-1990s it was to head the charity Action on Development and Disability – based, by coincidence, where she grew up, near Frome in Somerset.

She’s now been chief executive for a decade of one of the UK’s most successful and highly regarded charities, which works to provide water, sanitation and hygiene in 31 developing countries. Since 2010 she has also led WaterAid International, the federation set up to coordinate the UK charity’s relations with WaterAids that have sprung up in the US, Canada, Australia, Sweden and India.

Read the complete article.

Links to recent sanitation research

Research Updates

Exploring the Potential of Antimicrobial Hand Hygiene Products in Reducing the Infectious Burden in Low-Income Countries: An Integrative ReviewAmerican Journal of Infection Control, April 2016. The study looks at whether adding antimicrobial agents to hand hygiene products increases the health benefits of handwashing with plain soap in low-income settings.

What is Sanitation Success? Improve International, April 2016. This desk review found there was not one widely accepted definition of sanitation success, even for broadly used approaches like community-led total sanitation.

Ruminants Contribute Fecal Contamination to the Urban Household Environment in Dhaka, BangladeshEnvironmental Science & Technology, April 2016. Results suggest that effective household fecal management should account not only for human sources of contamination, but also for animal sources.

Can Behavior Change Approaches Improve the Cleanliness and Functionality of Shared Toilets? Water and Sanitation for the Urban Poor, 2016. A research project in Dhaka looks at whether behavior change strategies help users keep their toilets clean and functional.

Urban Solutions: Metropolitan Approaches, Innovation in Urban Water and Sanitation, and Inclusive Smart Cities: A New Generation of Ideas. Wilson Center, March 2016. The Wilson Center’s Urban Sustainability Laboratory, Cities Alliance, Global Coalition for Inclusive Housing and Sustainable Cities, USAID, and the World Bank are cosponsoring the Reducing Urban Poverty Paper Competition for advanced graduate students. The competition seeks to encourage a new generation of urban policymakers and promote early career research.

Innovation in Scaling Up Access to Water and Sanitation Services in Kenya. Water and Sanitation Program (WSP), 2015. An analysis and summary of the World Bank WSP’s technical assistance to five cities in Kenya. The objective of this technical assistance was to increase access to water and sanitation services by the urban poor in peri-urban areas.

Innovation in the Sanitation Sector: e-Catalogue for Individual Household Toilets.Water for People, 2016. The e-Catalogue, developed in India, is a flash-based software application for desktops and laptops, and an Android application for tablets and smartphones. With the e-Catalogue, a family or customer can design their own toilet based on their individual budget. The e-Catelogue also helps generate demand among households to choose and construct their desired toilet models.