Where There Is No Toilet: Water and Sanitation Environments of Domestic and Facility Births in Tanzania

September 11, 2014 · 0 comments

Where There Is No Toilet: Water and Sanitation Environments of Domestic and Facility Births in Tanzania. PLoS One, Sep 2014.

Authors: Lenka Benova, Oliver Cumming, Bruce A. Gordon, Moke Magoma, Oona M. R. Campbell

Background – Inadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN) environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives.

Methods – We used the most recent Tanzania Demographic and Health Survey (DHS) to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones.

Results – 42.9% (95% confidence interval: 41.6%–44.2%) of all births occurred in the woman’s home. Among these, only 1.5% (95% confidence interval: 1.2%–2.0%) were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%–42%). Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone.

Conclusion – Existing data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of WATSAN-safe environments, both at home and in facilities.

Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation

September 11, 2014 · 0 comments

Cholera at the Crossroads: The Association Between Endemic Cholera and National Access to Improved Water Sources and Sanitation. Am J Trop Med Hyg. 2014 Sep 8. pii: 14-0331.

Authors: Nygren BL1, Blackstock AJ2, Mintz ED2. 1Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia bnygren@cdc.gov.
2Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the trade off between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.

Researchers create novel water purifying filter

August 27, 2014 · 0 comments

Researchers create novel water purifying filter – Source: SciDevNet, Aug 25, 2014

[CAPE TOWN] A team of researchers have developed a membrane-based water filter that can provide up to 300 litres of clean drinking water.

The WHO says about 780 million people worldwide, especially those in Sub-Saharan Africa, lack access to improved water source.

The researchers from the Swiss Federal Institute of Technology in Zurich (ETHZ) in Switzerland announced last month (22 July) that DrinkPure filter, which they have developed, is based on a simple screw-top design that fits onto any plastic bottle.

Wendelin Stark, a professor of functional materials engineering at ETHZ, who helped create the innovation, says: “It requires no manual, no electricity, and no additional tools or training needs. You simply screw it on, and you drink [the water].”

[click to continue…]

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Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

August 27, 2014 · 0 comments

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility. Int. J. Environ. Res. Public Health 2014, 11(8), 8319-8346.

Marion W. Jenkins 1,2,*, Matthew C. Freeman 3 and Parimita Routray 2
1 Department of Civil and Environmental Engineering, University of California Davis, One Shields Ave., Davis, CA 95616, USA
2 Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
3 Department of Environmental Health, Rollings School of Public Health, Emory University, Atlanta, GA 30322, USA
* Author to whom correspondence should be addressed.

Abstract: Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household’s defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility.

The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.

Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level

August 27, 2014 · 0 comments

Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level. Glob Health Action. 2014 Aug 21;7(1):24895. doi: 10.3402/gha.v7.24895.

Authors: Diouf K1, Tabatabai P2, Rudolph J3, Marx M4.
1Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Katharina.Diouf@gmx.de.
2Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany.
3Programme Sectoriel Eau – German Development Cooperation/Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Bujumbura, Burundi.
4Institute of Public Health, University of Heidelberg, Heidelberg, Germany.

BACKGROUND: Diarrhoea is the second leading cause of child mortality worldwide. Low- and middle-income countries are particularly burdened with this both preventable and treatable condition. Targeted interventions include the provision of safe water, the use of sanitation facilities and hygiene education, but are implemented with varying local success.

OBJECTIVE: To determine the prevalence of and factors associated with diarrhoea in children under five years of age in rural Burundi.

DESIGN: A cross-sectional survey was conducted among 551 rural households in northwestern Burundi. Areas of inquiry included 1) socio-demographic information, 2) diarrhoea period prevalence and treatment, 3) behaviour and knowledge, 4) socio-economic indicators, 5) access to water and water chain as well as 6) sanitation and personal/children’s hygiene.

RESULTS: A total of 903 children were enrolled. The overall diarrhoea prevalence was 32.6%. Forty-six per cent (n=255) of households collected drinking water from improved water sources and only 3% (n=17) had access to improved sanitation. We found a lower prevalence of diarrhoea in children whose primary caretakers received hygiene education (17.9%), boiled water prior to its utilisation (19.4%) and were aged 40 or older (17.9%). Diarrhoea was associated with factors such as the mother’s age being less than 25 and the conviction that diarrhoea could not be prevented. No gender differences were detected regarding diarrhoea prevalence or the caretaker’s decision to treat.

CONCLUSIONS: Diarrhoea prevalence can be reduced through hygiene education and point-of use household water treatment such as boiling. In order to maximise the impact on children’s health in the given rural setting, future interventions must assure systematic and regular hygiene education at the household and community level.

The Drivers of Non-Revenue Water How Effective Are Non-Revenue Water Reduction Programs?

August 21, 2014 · 0 comments

The Drivers of Non-Revenue Water How Effective Are Non-Revenue Water Reduction Programs? 2014

Caroline van den Berg, World Bank.

This paper applies a panel data analysis with fixed effects to determine the major drivers of non-revenue water, which is define as the volume of water losses per kilometer of network per day. The analysis uses data from the International Benchmarking Network for Water and Sanitation Utilities, covering utilities in 68 countries between 2006 and 2011. The analysis finds that non-revenue water is driven by many factors. Some of the most important drivers are beyond the control of the utility, such as population density per kilometer of network, the
type of distribution network, and the length of the network, which are largely the result of urbanization and settlement patterns in the localities that the utility serves. The opportunity costs of water losses are also key in explaining what drives non-revenue water. The paper finds that very low opportunity costs of water losses have an adverse effect on the reduction of non-revenue water. Country fixed effects turn out to be important, meaning that the environment in which the utility operates has an important impact on non-revenue water levels. An important conclusion is that the design of non-revenue water reduction programs should study the main drivers of non-revenue water to provide utility managers with a better understanding of what can be achieved in terms of non-revenue water reduction and whether the benefits of these reductions exceed their costs.

Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls?

August 20, 2014 · 0 comments

Water, Sanitation and Hygiene Conditions in Kenyan Rural Schools: Are Schools Meeting the Needs of Menstruating Girls? Water 2014, 6(5).

Kelly T. Alexander, et al. Email: kel4@cdc.gov

Water, sanitation and hygiene (WASH) programs in African schools have received increased attention, particularly around the potential impact of poor menstrual hygiene management (MHM) on equity for girls’ education. This study was conducted prior to a menstrual feasibility study in rural Kenya, to examine current WASH in primary schools and the resources available for menstruating schoolgirls. Cross-sectional surveys were performed in 62 primary schools during unannounced visits. Of these, 60% had handwashing water, 13% had washing water in latrines for menstruating girls, and 2% had soap. Latrines were structurally sound and 16% were clean. Most schools (84%) had separate latrines for girls, but the majority (77%) had no lock. Non-governmental organizations (NGOs) supported WASH in 76% of schools. Schools receiving WASH interventions were more likely to have: cleaner latrines (Risk Ratio (RR) 1.5; 95% Confidence Intervals [CI] 1.0, 2.1), handwashing facilities (RR 1.6, CI 1.1, 2.5), handwashing water (RR 2.7; CI 1.4, 5.2), and water in girls’ latrines (RR 4.0; CI 1.4, 11.6). Schools continue to lack essential WASH facilities for menstruating girls. While external support for school WASH interventions improved MHM quality, the impact of these contributions remains insufficient. Further support is required to meet international recommendations for healthy, gender-equitable schools.

Improving performance of WASH actors: Capacity Self-Assessments of SHAW partner NGOs

August 20, 2014 · 0 comments

Improving performance of WASH actors: Capacity Self-Assessments of SHAW partner NGOs, 2014. IRC.

Implementing large-scale water, sanitation and hygiene programmes requires expert technical and management skills to ensure that programme goals and targets are realised. Capacity self-assessments help organisations deepen their understanding of their existing capacities and future capacity needs and enable them to formulate capacity development action plans. These plans guide them in the continuous strengthening of their capacities. This paper describes IRC’s experience and lessons learned in conducting Capacity Self-Assessment workshops as part of the SHAW programme.

CSAs can be a powerful tool to help organisations take responsibility for improving individual skills as well as organisational capabilities. A well-designed, flexible and guided workshop enables participants to embrace change towards their own capacity development. Impact of the CSA is heavily dependent on quality facilitation and follow up support after the initial assessment workshop.

Designing Programme Implementation Strategies to Increase the Adoption and Use of Biosand Water Filters in Rural India

August 18, 2014 · 0 comments

Designing Programme Implementation Strategies to Increase the Adoption and Use of Biosand Water Filters in Rural India. Water Alternatives, 7(2) 2014.

Authors: Tommy K.K. Ngai. Centre for Affordable Water and Sanitation Technology (CAWST), Calgary, Alberta, Canada; tngai@cawst.org

Richard A. Fenner. Centre for Sustainable Development, Department of Engineering, University of Cambridge, Cambridge, England; raf37@cam.ac.uk

Abstract: Low-cost household water treatment systems are innovations designed to improve the quality of drinking water at the point of use. This study investigates how an NGO can design appropriate programme strategies in order to increase the adoption and sustained use of household sand filters in rural India. A system dynamics computer model was developed and used to assess 18 potential programme strategies for their effectiveness in increasing filter use at two and ten years into the future, under seven scenarios of how the external context may plausibly evolve. The results showed that the optimal choice of strategy is influenced by the macroeconomic situation, donor funding, presence of alternative options, and the evaluation time frame.

The analysis also revealed some key programme management challenges, including the trade-off between optimising short- or long-term gains, and counter-intuitive results, such as higher subsidy fund allocation leading to fewer filter distribution, and technology advances leading to fewer sales. This study outlines how an NGO can choose effective strategies in consideration of complex system interactions. This study demonstrated that small NGOs can dramatically increase their programme outcomes without necessarily increasing operational budget.

Two CAWST reviews on biosand filter design

August 18, 2014 · 1 comment

Chapter 42: Global review of the adoption, use, and performance of the biosand filter
Chapter 43: Recent advances in household biosand filter design

Authors: Tommy Ngai and Derek Baker, CAWST.

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