Tag Archives: hygiene

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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Can WASH deliver more than just sanitation?

Through successful WASH intervention, communities access a new service that improves their quality of life, and also learn about equity and inclusion.

Blog by development expert Suvojit Chattopadhyay

The abysmal state of access to safe water and sanitation facilities in the developing world is currently a major cause for alarm; 580,000 children die every year from preventable diarrheal diseases. This is due largely to the 2.5 billion people around the globe who do not have access to safe sanitation. Not only can an effective WASH intervention save lives, it can also engineer changes in the social fabric of communities that adopt these behavioural changes. This points to a key attribute of a successful WASH intervention – that through these programmes, communities not only access a new service that improves their quality of life, but they also learn from being part of a concrete intervention that emphasises equity and inclusion.

Let me explain how. Safe sanitation is essentially ‘total’. In a community, even one family practising open defecation puts the health of other families at risk. Also, unsafe sanitation practices pollute local potable and drinking water sources in the habitations. Together, this can undo any gains from partial coverage of WASH interventions. This much is now widely accepted by sanitation practitioners around the world. However, there remains a serious challenge when it comes to the implementation of this concept.

When a community is introduced to a WASH-focused behaviour change campaign, there are often variations in the levels of take-up in different families. This could be because of several barriers – financial ability, cultural beliefs, education levels, etc. In response, external agencies have many options. They can focus more on families in their behaviour change campaigns, offer them material and financial support or incentives, or exert peer pressure (which may in some cases become coercive, etc).

However, the best approach – whether facilitated by an external agent or not – is for a community to devise a collective response. The issue should be framed as a collective action problem that requires solving for the creation of a public good. In many instances, communities have come together to support the poorest families – social engineering at its finest. At its best, recognising the needs of every member of a community will lead to a recognition of the challenges that the typically marginalised groups face. It is this recognition that could prompt a rethink of social norms and relationships.

Read the full article on the WSSCC Guardian partner zone.

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.

WASHplus Weekly: Focus on Hygiene

WASHplus Weekly – Issue 190| May 8, 2015 | Focus on Hygiene

This issue focuses on hygiene advocacy, hygiene promotion, and hygiene in emergency settings. Included are webinars; a toolkit; a literature review from the Global Public-Private Partnership for Handwashing; a blog post by Orlando Hernandez, USAID/WASHplus project; IRC and BRAC reports on handwashing promotion; World Health Organization (WHO) hygiene guidelines for Ebola and other emergencies; and other studies and resources. WASHPlus_HTMLbanner_weekly_600x159


Healing Hands: The Role of Hand Hygiene in Healthcare Globally. May 2015. Global Public-Private Partnership for Handwashing (PPPHW). Link
PPPHW hosted this webinar to discuss the importance of hand hygiene in health care, the challenges of achieving good hand hygiene, and lessons for improving hand hygiene in health care settings. The speakers included Benedetta Allegranzi, the WHO’s Lead for the Clean Care is Safer Care program, Cyrus Engineer, director of the Healthcare Management Program at Towson University, and Robert Aunger from the London School of Hygiene and Tropical Medicine.

Handwashing and Global Food Hygiene: A World Health Day Webinar. April 2015. PPPHW. Link
This webinar explores why food hygiene matters for child health in the global context. It includes a case study from the London School of Hygiene and Tropical Medicine about a creative food and handwashing behavior change intervention in Nepal; WASHplus’s Julia Rosenbaum talks about small doable actions; and UNICEF discusses the successes and challenges associated with its group handwashing and mid-day meal program in India.


Hygiene Advocacy Toolkit, 2015. PPPHW. Link
Developed by PPPHW, in cooperation with the UNICEF/WHO Joint Monitoring Programme’s Advocacy and Communications Group, this hygiene advocacy toolkit is an evidence-based resource that outlines why hygiene must be a priority in the post-2015 development agenda and beyond. The role of hygiene in the global development agenda is misunderstood. This toolkit seeks to address any confusion and provide the necessary facts and talking points to successfully advocate for the inclusion of hygiene in the Post-2015 Sustainable Development Goals.

Community Handwashing Guide: Utilizing Available Resources to Initiate a Handwashing InterventionWorld Med Health Policy, Mar 2014. MP Sandhu. Link (The full text of this article can be downloaded free of charge through May 2015.)
In this article, the current handwashing recommendations and their applicability to hygiene interventions in developing nations were examined. The results of this review suggested that a new handwashing paradigm is needed to address the varying resources available for hand hygiene. Thus, a novel community handwashing guide was developed. This guide emphasizes the importance of increasing access to physical handwashing resources in developing communities, and can be applied to communities regardless of their socioeconomic status. The community handwashing guide promotes sustainable, incremental improvements in hygiene within a community, and is a more feasible approach than previous recommendations.


Handwashing Research Summary: What We Learned about Handwashing in the First Quarter of 2015.  L McCay, PPPHW. Link
Between January and March 2015, 16 relevant peer-reviewed handwashing studies were published. This review discusses studies on the benefits of handwashing, measurement of handwashing behavior, handwashing “hardware,” and other topics.

Improving Household Food Hygiene in a Development Context, 2015. M Woldt, FANTA. Link
This literature review presents information on foodborne disease and key areas and considerations at the household level to reduce foodborne contaminants in developing countries. Recommendations on potential programmatic and research activities related to foodborne disease are also included.

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Estimates on the WASH-related Global Burden of Disease

Below are abstracts and links to the full-text of articles in the August 2014 issue of  Tropical Medicine and International Healthtmih

Focus on the Global Burden of Disease from Water
While the methods of Global Burden of Disease (GBD) study continue to evolve, recent changes raise questions about the basis of new estimates of the risk associated with water, sanitation and hygiene and warrant consideration of alternative approaches.

  • ​Inadequate water, sanitation and hygiene are estimated to have caused 842,000 deaths from diarrhoea in 2012, i.e., 1.5% of deaths worldwide. These include 361,000 deaths of children under five years.
  • ​A systematic review of the global prevalence of handwashing with soap and its effect on diarrhoeal diseases estimates that only 19% of the world’s population washes hands with soap after contact with excreta and that handwashing reduces the risk of diarrhoeal disease by 23%–40%.
  • ​Based on over 300 studies from a systematic review, an estimated 1.1 billion people are exposed to a drinking water source of moderate to high risk.
  • ​A meta-regression shows that risks of diarrhoea from inadequate drinking water and sanitation could be reduced considerably through targeted interventions. Risk differences depend on type of intervention.

1 – Authors:  Clasen, Thomas, Pruss-Ustun, Annette, Mathers, Colin D., et al.

TI  – Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods
Abstract – http://onlinelibrary.wiley.com/doi/10.1111/tmi.12330/abstract
AB  – The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted.

2 – Authors: Prüss-Ustün, Annette, Bartram, Jamie, Clasen, Thomas,  et al.

TI  – Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

Objective – To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases.

Methods – For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.

Results – In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group.
Conclusions – This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.

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WSUP animation – welcome to the world of urban WASH programming!

How do you design and implement an effective urban WASH programme? In WSUP’s recent publication “The Urban Programming Guide” we set out the many activities involved, from planning and capacity building to improving services and promoting behaviour change. This short animation brings the publication to life and takes you on a virtual tour of some of these activities in action: enjoy the ride!

You can download the Urban Programming Guide for free from our website.