Tag Archives: handwashing

Handwashing practices added as new risk factor in latest Global Burden of Disease study

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, Sept 11, 2015.

GBD 2013 Risk Factors Collaborators

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantifi cation, particularly of modifi able risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs.

Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing.

Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Sept 23, 2015 – Creativity in Behavior Change Symposium

Whether it be washing hands with soap, driving sanitation demand, or purifying water, almost every area of public health requires behaviour change. The field of behaviour change is transforming.

There is a growing evidence base to suggest that traditional health education messages are insufficient to achieve sustained change and that more might be achieved by being more creative, for example by learning from product marketing, psychology and behavioural economics. logo

The ‘Creativity in Behaviour Change Symposium‘ will bring together behaviour change practitioners from academia, government and the private sector with the ambition of sparking an ongoing network of collaborators.

In addition to creative case studies and provocative discussions the event will feature interactive activities throughout the day, a ‘behaviour change cinema’ which will screen materials from creative projects from around the globe and there will be a ‘soap box’ where anyone can share their big ideas for the future of behaviour change.

For those who are not in the UK, all the sessions will also be filmed and available on our website at ehg.lshtm.ac.uk

The disgust box: a novel approach to illustrate water contamination with feces

Below are links to 5 Aug 2015 studies on digust, handwashing and maternal mortality, handwashing and NTDs, water quality awareness and breastfeeding and household characteristics and diarrhea.

The disgust box: a novel approach to illustrate water contamination with feces. Health & Science Bulletin, June 2015.

Link: http://goo.gl/3xDeen

Inadequate drinking water, sanitation and hand hygiene are responsible for approximately 800,000 deaths per year in low and middle-income countries. We evaluated the benefits of a behaviour change communication method to motivate water treatment practices in urban low income communities in Dhaka. We used a device called the ‘Disgust Box’ to provide a vivid demonstration of how piped water is contaminated with faeces to motivate people to chlorinate water. Most of the respondents were able to recall the demonstration at both four-month and one year qualitative assessments. At four months, the majority of participants stated that they still felt disgusted by the demonstration and mentioned it as a motivator for water chlorination. However, after one year, despite being able to recall the demonstration, disgust was no longer mentioned as a motivator to chlorinate water. The Disgust Box has the potential to be an effective communication method to motivate water treatment but additional research is necessary to establish a more sustainable approach to reinforce behaviour change.

Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal. PLoS One, Aug 2015. Authors: Nadine Seward, et al.

Link: http://goo.gl/02uiRi

Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

Assessment of water, sanitation, and hygiene practices and associated factors in a Buruli ulcer endemic district in Benin (West Africa). BMC Public Health, Aug 2015.

Link: http://goo.gl/CZvJPJ

BU is an important conditions in the district of Lalo with 917 new cases detected from 2006 to 2012. More than 49 % of the household surveyed used unimproved water sources for their daily needs. Only 8.7 % of the investigated household had improved sanitation facilities at home and 9.7 % had improved hygiene behavior. The type of housing as an indicator of the socioeconomic status, the permanent availability of soap and improved hygiene practices were identified as the main factors positively associated with improved sanitation status.

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Aug 10 – Weekly Update of Selected WASH Studies

Effectiveness of emergency water treatment practices in refugee camps in South Sudan. WHO Bulletin, Aug 2015. Authors: Syed Imran Ali, Syed Saad Ali & Jean-Francois Fesselet.
Link: http://goo.gl/BtnQVh

Current guidelines for free residual chlorine in emergency water supplies are not based on field evidence and offer inadequate protection after distribution in refugee camps in South Sudan. We recommend that the free residual chlorine guideline be increased to 1.0 mg/L in all situations, irrespective of disease outbreak, pH, or turbidity conditions. This is a tentative recommendation because the degree to which these findings can be generalized to other camps in different settings is unknown.

Nutrition in Ethiopia: An emerging success story? Author: Headey, Derek D.
Link: https://goo.gl/tmMCqX

Research does not always provide the results that we expect. At the recent conference on improving nutrition in Ethiopia, Together for Nutrition 2015, we learnt about the rapid progress in Ethiopia in child nutritional outcomes that are linked to improved birth size and, hence, improved maternal health. However, most of the improvement in maternal health seems related to better sanitation, rather than to diet, care, or health factors.

Diet and specific microbial exposure trigger features of environmental enteropathy in a novel murine model. Nature Communications, Aug 2015. Authors: Eric M. Brown, et al.
Link: http://goo.gl/Sgx6XP

Here we demonstrate that early-life consumption of a moderately malnourished diet, in combination with iterative oral exposure to commensal Bacteroidales species and Escherichia coli, remodels the murine small intestine to resemble features of EE observed in humans. We further report the profound changes that malnutrition imparts on the small intestinal microbiota, metabolite and intraepithelial lymphocyte composition, along with the susceptibility to enteric infection. Our findings provide evidence indicating that both diet and microbes combine to contribute to the aetiology of EE, and describe a novel murine model that can be used to elucidate the mechanisms behind this understudied disease.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. The Lancet, Aug 2015. Authors: Paul Little, Beth Stuart, et al.
Link: http://goo.gl/hHLnLI

Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors. 2015 Aug. Authors: Freeman MC, Chard AN, et al.
Link: http://goo.gl/HkdIyS

Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.

Modelling Optimal Control of Cholera in Communities Linked by Migration. Comput Math MethodsMed. 2015. Authors: Njagarah JB, Nyabadza F
Link: http://goo.gl/VU6I5G

A mathematical model for the dynamics of cholera transmission with permissible controls between two connected communities is developed and analysed. The dynamics of the disease in the adjacent communities are assumed to be similar, with the main differences only reflected in the transmission and disease related parameters. This assumption is based on the fact that adjacent communities often have different living conditions and movement is inclined toward the community with better living conditions. Our results indicate that implementation of controls such as proper hygiene, sanitation, and vaccination across both affected communities is likely to annihilate the infection within half the time it would take through self-limitation. In addition, although an infection may still break out in the presence of controls, it may be up to 8 times less devastating when compared with the case when no controls are in place.

Funky Sink Gets Kids In Cambodia To Wash Up, Could Save Thousands Of Young Lives

Funky Sink Gets Kids In Cambodia To Wash Up, Could Save Thousands Of Young Lives | Source: Huffington Post, July 8 2015 |

Cambodia has the lowest access to sanitation in all of Southeast Asia, and as a result more than 10,000 children die every year due to diarrheal diseases, according to WaterAid. watershed

To help curb those figures, nonprofit WaterSHED recently released the LaBobo, a portable and inexpensive sink whose colorful design encourages kids to improve their hygiene habits.

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Raise your hand for hygiene: Sign on to call for a global hygiene indicator in the SDGs!

Join the call for a global-level hygiene indicator in the Sustainable Development Goals! Source: Global Public-Private Partnership for Handwashing

The issue: The Post-2015 Sustainable Development Goals are the successors to the Millennium Development Goals; a draft was published, and the details of the SDGs are being negotiated now. Hygiene is essential for achieving global development, and is therefore included as a target as part of Goal 6. Countries will commit to demonstrating progress on achieving the targets by reporting on indicators. However, in the recent list of global-level indicators being considered by the UN Statistical Commission, hygiene has been deleted. This is likely because the decision makers want a shorter list of indicators. However, demoting hygiene to a huge, secondary list of ‘optional’ indicators will not give hygiene the priority needed for the SDGs to have real impact on both hygiene and the areas that it influences—such as health, education, and equity.

home-learn-photoObjective: The JMP Communications and Advocacy Group is coordinating delivery of a persuasive message about the importance of hygiene to encourage decision makers and stakeholders to act and recommend the reinstatement of a hygiene indicator in the list of global-level indicators for the SDGs.

Audience: This letter will be sent to members of the UN Statistical Commission and others who may have the opportunity to influence discussions and decisions around the SDG Indicators process.

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Global Sanitation Fund reports large-scale advances in sanitation and hygiene in 13 countries

Lucie Obiokang with the toilet she built after being triggered.

Lucie Obiokang with the toilet she built after being triggered.

A new report shows that the Global Sanitation Fund (GSF) has supported governments and hundreds of their national partners in 13 countries, stretching from Cambodia to Senegal, to enable 7 million people in more than 20,500 communities to end open defecation.   

These results are published in the GSF’s latest Progress Report (link to report; link to photos), which highlights cumulative results from the start of the fund until the end of 2014. Nationally-led programmes supported by the GSF have enabled:

  • 4.2 million people with improved toilets
  • 7 million people and more than 20,500 communities to be open-defecation free
  • 8 million people with handwashing facilities

Currently, 2.5 billion people, or 40% of the global population, lack access to decent sanitation. Of those, more than a billion defecate in the open. Diarrheal disease, largely caused by poor sanitation and hygiene, is a leading cause of malnutrition, stunting and child mortality, claiming nearly 600,000 under-5 lives every year. Inadequate facilities also affect education and economic productivity and impact the dignity and personal safety of women and girls.

Established by the Water Supply and Sanitation Collaborative Council (WSSCC), the GSF funds behaviour change activities to help large numbers of poor people in the hardest-to-reach areas attain safe sanitation and adopt good hygiene practices. These activities are community-led, support national efforts, and bring together a diverse group of stakeholders in order to address, at a large scale, the severe deficiencies in access to sanitation and hygiene.

The GSF is a pooled financing mechanism with the potential to further accelerate access to sanitation for hundreds of millions of people over the next 15 years. Between 2013 and 2014 alone, the GSF reported an almost 90 percent increase in the number of people living open-defecation free in target regions of 13 countries[1] across Africa and Asia. During this same period, the GSF has also supported a 55 percent increase in the number of people with access to improved toilets in those same areas. The United Nations system has identified global funds as an important tool to enable member countries to achieve their national development targets, including those for sanitation and hygiene.[2]

“These results prove that we are moving closer to our vision of a world where everybody has sustained sanitation and hygiene, supported by safe water,” said Chris Williams, Executive Director of WSSCC.  “This is a crucial step towards achieving better health, reducing poverty and ensuring environmental sustainability for the most marginalized people in the world.”

These GSF results have been achieved due to the work of more than 200 partners, including executing agencies and sub-grantees composed of representatives from governments, international organizations, academic institutions, the United Nations and civil society. One of the strongest success factors in the GSF approach is that it allows flexibility for countries to develop their programmes within the context of their own institutional framework and according to their own specific sanitation and hygiene needs, sector capacity and stakeholders. This implementation methodology is used to reach large numbers of households in a relatively short period of time and is vital for scaling up safe sanitation and hygiene practices.

“GSF is one of the few funds for government-led, donor-funded sanitation and hygiene programmes,” said Williams. “It can uniquely serve as a catalyst to the wider sector as a model that is replicable for others interested in large-scale behaviour change.”

Reaching scale has required that sub-grantees can identify influential, strategic communities, and make effective use of natural leaders, religious and local leaders, or hundreds of others who serve as individual sanitation and hygiene champions. GSF supported programmes apply a local delivery mechanism that engages households in thousands of villages, which enables people to make informed decisions about their sanitation and hygiene behaviour that can improve their health, education and productivity.

The report also highlights the GSF’s impact on national programmes. In Uganda, there are now more than 1.4 million people living in open-defecation free (ODF) environments, thanks to GSF-funded activities, and close to three million people have been reached by hygiene messages as a result of decentralized local government intervention. In Madagascar, over 1.3 million people are now living in ODF environments – in all 22 of the countries regions – and India’s GSF-supported programme has over 782,000 people with handwashing facilities.

“Access to improved sanitation has to be a sustainable reality for every person in the community, regardless of age, gender or disability, in order for the health and other benefits to be enjoyed by all,” said David Shimkus, Programme Director of the GSF. “This report shows that GSF-supported programmes are making major strides in achieving improved sanitation and hygiene for the most vulnerable, and all stakeholders will continue to work together to ensure such progress continues.”

The Governments of Australia, Finland, the Netherlands, Sweden, Switzerland and the United Kingdom have contributed to the GSF since its establishment in 2008. Close to $105 million has been committed for 13 country programmes, which aim to reach 36 million people.

[1] Benin, Cambodia, Ethiopia, India, Kenya, Madagascar, Malawi, Nepal, Nigeria, Senegal, Tanzania, Togo and Uganda.

[2] See draft outcome document for the forthcoming Addis Ababa Accord of the Third International Conference on Financing for Development, and the UN Sustainable Development Solutions Network Financing for Sustainable Development report and its Role of Global Funds in a Post-2015 Development Framework.