The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: a Cluster-Randomized Trial in Kenya. Am J Public Health. 2013 Nov 14.
Dreibelbis R, Freeman MC, Greene LE, Saboori S, Rheingans R.
Objectives. We examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children.
Methods. We conducted a cluster-randomized trial among 185 schools in Kenya from 2007 to 2009. We assigned schools to 1 of 2 study groups according to water availability. Multilevel logistic regression models, adjusted for baseline measures, assessed differences between intervention and control arms in 1-week period prevalence of diarrhea and 2-week period prevalence of clinic visits among children younger than 5 years with at least 1 sibling attending a program school.
Results. Among water-scarce schools, comprehensive WASH improvements were associated with decreased odds of diarrhea (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.27, 0.73) and visiting a clinic (OR = 0.36; 95% CI = 0.19, 0.68), relative to control schools. In our separate study group of schools with greater water availability, school hygiene promotion and water treatment interventions and school sanitation improvements were not associated with differences in diarrhea prevalence between intervention and control schools.
Conclusions. In water-scarce areas, school WASH interventions that include robust water supply improvements can reduce diarrheal diseases among young children.
Heavy Rainfall Events and Diarrhea Incidence: The Role of Social and Environmental Factors. Am J Epidemiol. 2013 Nov 19.
Carlton EJ, Eisenberg JN, Goldstick J, Cevallos W, Trostle J, Levy K.
The impact of heavy rainfall events on waterborne diarrheal diseases is uncertain. We conducted weekly, active surveillance for diarrhea in 19 villages in Ecuador from February 2004 to April 2007 in order to evaluate whether biophysical and social factors modify vulnerability to heavy rainfall events. A heavy rainfall event was defined as 24-hour rainfall exceeding the 90th percentile value (56 mm) in a given 7-day period within the study period. Mixed-effects Poisson regression was used to test the hypothesis that rainfall in the prior 8 weeks, water and sanitation conditions, and social cohesion modified the relationship between heavy rainfall events and diarrhea incidence. Heavy rainfall events were associated with increased diarrhea incidence following dry periods (incidence rate ratio = 1.39, 95% confidence interval: 1.03, 1.87) and decreased diarrhea incidence following wet periods (incidence rate ratio = 0.74, 95% confidence interval: 0.59, 0.92).
Drinking water treatment reduced the deleterious impacts of heavy rainfall events following dry periods. Sanitation, hygiene, and social cohesion did not modify the relationship between heavy rainfall events and diarrhea. Heavy rainfall events appear to affect diarrhea incidence through contamination of drinking water, and they present the greatest health risks following periods of low rainfall. Interventions designed to increase drinking water treatment may reduce climate vulnerability.
Assessing Appropriate Technology Handwashing Stations in Mali, West Africa, 2013.
Colleen Claire Naughton
This study developed and implemented a comprehensive monitoring strategy of five usage variables (i.e., soap usage, functionality, presence of cleansing agent, ground wetness under station, amount of water in the jug) for 42-64 appropriate technology handwashing stations. These stations were monitored throughout 2011-2013 in two communities in Mali, West Africa. Statistically significant (p < 0.05) results include: 1) a 29% decrease in soap usage from dry (October-June) to rainy seasons (July-September), 2) 35% decrease in stations with presence of cleansing agent between 2011 and 2012, 3) higher station usage for stations in households with higher scores on the Progress out of Poverty Index® , 4) 27% less of the stations far from a water source (35 meters-172 meters away) had a cleansing agent present than stations close to a water source (less than 35 meters) during the rainy season. Station usage also differed based on gender of the handwashing station owner in the two communities where stations built by women were used more in Zeala than those in Nci’bugu. In contrast to Zeala, handwashing stations built by men in Nci’bugu had higher soap usage and usage variable proportions than those built by women. Handwashing training and promotions resulted in 98% of households reporting that they wash their hands with soap in 2012 from 0% in 2011. Altogether, this study designed and
implemented a robust monitoring system that succeeded in quantifying handwashing station usage for over two years. In-depth analysis of the data established six sustainability factors for handwashing stations (gender, training, water, seasonality, wealth, and monitoring) that are critical for lasting handwashing behavior change and successful hygiene interventions to save lives.
Mainstreaming disability and ageing in water, sanitation and hygiene programmes; A mapping study carried out for WaterAid UK, 2013.
Hazel Jones, WEDC.
WEDC was commissioned by WaterAid to carry out a desk study to present an overview of the current state of disability and ageing issues in WASH, from the perspective of the WASH sector. This report presents the findings from this study. Both disabled and older people were looked at together, because many frail older people, although they may reject the label ‘disabled’, experience impairments that limit their daily activities, which result in them facing similar kinds of barriers to accessing WASH.
There is an increasing body of literature related to access to WASH for disabled and older people. The problems caused by this lack of access are widely documented for disabled people including the impact on their health and well-being. To a lesser extent, comparable literature is beginning to emerge for older people. In terms of solutions to the problems, the most widely documented are ‘hardware’ solutions, ie the technology required to improve physical accessibility and use, which appear to be straightforwardnd do not have to be expensive.
Less has been documented about the ‘software’ aspects of service delivery: what changes need to be made in the way organisations work, and in the way programmes are planned and implemented, to deliver accessible and inclusive services. A range of general programming guidance is available, mainly produced by the disability/ageing sector, about mainstreaming disability/ageing into programme approaches. However, the devil is in the lack of detail – on consultation with disabled and older people, on appropriate information about low-cost technology options, on inclusive design and its cost, on capacity building and attitude and behaviour change, etc.
The Added Value of Water, Sanitation, and Hygiene Interventions to Mass Drug Administration for Reducing the Prevalence of Trachoma: A Systematic Review. Journal of Environmental and Public HealthVolume 2013, Article ID 682093.
A Travers, et al.
Trachoma is the leading cause of infectious blindness worldwide.The SAFE strategy, the World Health Organization recommended method to eliminate blinding trachoma, combines developments in water, sanitation, surgery, and antibiotic treatment. Current literature does not focus on the comprehensive effect these components have on one another.
The present systematic review analyzes the added benefit of water, sanitation, and hygiene education interventions to preventive mass drug administration of azithromycin for trachoma. Trials were identified from the PubMed database using a series of search terms. Three studies met the completecriteria for inclusion.Though all studies found a significant change in reduction of active trachoma prevalence, the research is still too limited to suggest the impact of the “F” and “E” components on trachoma prevalence and ultimately its effects on blindness.
Water quality risks of ‘improved’ water sources: evidence from Cambodia. Trop Med Intl Health, Nov 2013. A. Shaheed, et al.
Objectives -The objective of this study was to investigate the quality of on-plot piped water and rainwater at the point of consumption in an area with rapidly expanding coverage of ‘improved’ water sources.
Methods - Cross-sectional study of 914 peri-urban households in Kandal Province, Cambodia, between July–August 2011. We collected data from all households on water management, drinking water quality and factors potentially related to post-collection water contamination. Drinking water samples were taken directly from a subsample of household taps, stored tap water, other stored water and treated stored water for basic water quality analysis for Escherichia coli and other parameters.
Results – Household drinking water management was complex, with different sources used at any given time and across seasons. Rainwater was the most commonly used drinking water source. Households mixed different water sources in storage containers, including ‘improved’ with ‘unimproved’ sources. Piped water from taps deteriorated during storage. Stored non-piped water (primarily rainwater) had a mean E. coli count of 1500 cfu/100 ml (CV: 4.1), not significantly different from stored piped water. Microbial contamination of stored water was significantly associated with observed storage and handling practices, including dipping hands or receptacles in water, and having an uncovered storage container
Conclusions - The microbial quality of ‘improved’ water sources in our study area was not maintained at the point of consumption, possibly due to a combination of mixing water sources at the household level, unsafe storage and handling practices, and inadequately treated piped-to-plot water. These results have implications for refining international targets for safe drinking water access as well as the assumptions underlying global burden of disease estimates, which posit that ‘improved’ sources pose minimal risks of diarrhoeal diseases.
Opportunities to improve domestic hygiene practices through new enabling products: a study of handwashing practices and equipment in rural Cambodia. Int Health. 2013 Nov 8.
Jenkins MW, Anand AR, Revell G, Sobsey MD.
Department of Civil and Environmental Engineering, University of California at Davis, Davis, CA, USA.
BACKGROUND: Lack of a dedicated place and equipment for handwashing has been associated with poor practice of handwashing with soap in the home in developing communities where the practice is needed to reduce diarrhea diseases and respiratory infections.
METHODS: We conducted formative research on handwashing knowledge, attitudes, practices and equipment and investigated the need and demand for dedicated handwashing equipment to enable improved hygiene practices and enhance handwashing performance for health in rural Cambodian homes where water is collected and stored. Responses to closed and open-ended questions and structured observation of a demonstration of handwashing by the mother or another female adult child caretaker in 79 households were used to identify handwashing occasions, evaluate handwashing equipment and competency, investigate attitudes and structural barriers to handwashing with soap, and assess use of and interest in dedicated handwashing equipment.
RESULTS: We found significant evidence of the need for handwashing enabling equipment to eliminate unsafe domestic water handling during handwashing and reduce structural barriers to routine handwashing with soap in Cambodian homes dependent on stored water supplies. Substantial interest in dedicated handwashing equipment and in specific equipment features was measured.
CONCLUSIONS: Findings suggest household demand for and uptake of affordable household handwashing facilities incorporating desired features and functionality could be generated in Cambodia to support improved domestic hygiene practices.
Understanding household water practices using ethnographic research methods, 2013.
Water Information Network (WIN-SA), South Africa.
This study had no hidden agenda or desired outcome. It was non-interventionist. Its only aim was to provide the community with different perspectives on their own practices. What they decided to do with the information was entirely up to them.
This study was innovative in a number of ways, due to its non-interventionist nature: It was designed to give a visual tool to a rural community to capture, analyse, interpret and present their household practices from their own as well as from other perspectives.
The community had the opportunity to interrogate, analyse and interpret other perspectives against their own perspective. This generated debate and learning about their own practices.
This study has clearly shown that the ethno-visual tool can be used in a participatory noninterventionist manner in rural communities. Apart from the film footage, other material collected was graphically and visually provided to the elders in the community, allowing for debate on a level previously unknown to them.
Although further development and/or shaping of the tool may be required to fit the profiles and problems of specific communities, it is envisaged that the ethno-visual tool would have substantial value in similar situations in other communities, specifically to contribute to the discourse on community led participation. It would also allow for comparison of the use of the tool with other participatory rural research methods.
Post 2015 WASH Targets and Indicators, 2013.
Joint Monitoring Programme
When consolidated, the proposals developed by each of the four working groups – Water, Sanitation, Hygiene, and Equity and Non-Discrimination – yield the following, detailed targets.
Target 1: By 2025, no one practices open defecation, and inequalities in the practice of open defecation have been progressively eliminated.
Target 2: By 2030, everyone uses a basic drinking water supply and handwashing facilities when at home, all schools and health centres provide all users with basic drinking water supply and adequate sanitation, handwashing facilities and menstrual hygiene facilities, and inequalities in access to each of these services have been progressively eliminated.
Target 3: By 2040, everyone uses adequate sanitation when at home, the proportion of the population not using an intermediate drinking water supply service at home has been reduced by half, the excreta from at least half of schools, health centres and households with adequate sanitation are safely managed, and inequalities in access to each of these services have been progressively reduced.
Target 4: All drinking water supply, sanitation and hygiene services are delivered in a progressively affordable, accountable, and financially and environmentally sustainable manner.