Toys and toilets: cross-sectional study using children’s toys to evaluate environmental faecal contamination

March 26, 2014 · 0 comments

Toys and toilets: cross-sectional study using children’s toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices. Trop Med Intl Health, March 2014.

Authors: Jelena Vujcic, et al.

Objective – To evaluate household faecal contamination using children’s toys among 100 rural Bangladeshi households categorised as ‘cleaner’ (toilet that reliably separates faeces from the environment and no human faeces in/around living space) or ‘less clean’ (no toilet or toilet that does not reliably separate faeces from the environment and human faeces in/around living space).

Methods – We distributed toy balls to each household and rinsed each study toy and a toy already owned by the household in 200 ml of Ringer’s solution. We enumerated faecal coliforms and faecal streptococci from each rinse using membrane filtration methods.

Results – Study toys from 39 cleaner households had lower mean faecal coliform contamination than toys from 61 less clean households (2.4 log10 colony-forming units (CFU)/200 ml vs. 3.2 log10 CFU/200 ml, P = 0.03). However, wealth measures explained a portion of this relationship. Repeat measures were moderately variable [coefficient of variation (CV) = 6.5 between two toys in the household at the same time, CV = 37.6 between toys in the household at two different times 3–4 days apart]. Too few households owned a non-porous toy to compare groups without risk of bias.

Conclusion – In rural Bangladesh, improved sanitation facilities and practices were associated with less environmental contamination. Whether this association is independent of household wealth and whether the difference in contamination improves child health merit further study. The variation found was typical for measures of environmental contamination, and requires large sample sizes to ascertain differences between groups with statistical significance.

Adaptation to Climate Change in Water, Sanitation and Hygiene Assessing risks and appraising options in Africa

March 26, 2014 · 0 comments

Adaptation to Climate Change in Water, Sanitation and Hygiene: Assessing risks and appraising options in Africa, 2014.

Naomi Oates, et al. Overseas Development Institute.

This report presents the findings of research into the risks to delivery of WASH results posed by climate change in Africa, drawing on rapid case study reviews of WASH programming in Malawi, Sierra Leone and Tanzania. A separate Case Study Report provides further detail on country background and findings.

USAID – Water and Development Strategy: Implementation Field Guide

March 26, 2014 · 0 comments

Water and Development Strategy: Implementation Field Guide, 2014. USAID.

This document is intended to serve as a reference tool to help Operating Units understand and apply the Strategy. The Guide provides an overview of:

  • The intended procedures and expectations for operationalizing the Strategy and transitioning the Agency’s water portfolio to align with the Strategy
  • Key principles, best practices, and approaches for programming related to the Strategy’s two SOs
  • Specific funding parameters related to programming in each of the two SOs, including eligible attribution of water directive funding
  • Expectations of Operating Units related to monitoring, evaluation, and reporting, including required indicators, the timing, and procedures for annual performance reporting
  • Expected contributions of Operating Units to ongoing Agency knowledge management, collaboration, and learning in the water sector

May 2014 Update of the Sawyer Filter Bibliography

March 18, 2014 · 3 comments

Below are links to third-party publications (grey literature and peer-reviewed) on the Sawyer Filter that were shared by members of the International Network on Household Water Treatment and Safe Storage following a request from Ryan Rowe, Daniele Lantagne and Carolyn Meub.

There is also a response from Sawyer Products about comments made in Derek Baker’s review of the Sawyer Filter.

May 2014 Update

A Cluster Randomized Controlled Trial to Reduce Childhood Diarrhea Using Hollow Fiber Water Filter and/or Hygiene-Sanitation Educational Interventions. Am J Trop Med Hyg. 2014 May 27.

Lindquist ED et al.

Safe domestic potable water supplies are urgently needed to reduce childhood diarrheal disease. In periurban neighborhoods in Cochabamba, Bolivia, we conducted a cluster randomized controlled trial to evaluate the efficacy of a household-level hollow fiber filter and/or behavior change communication (BCC) on water, sanitation, and hygiene (WASH) to reduce the diarrheal disease in children less than 5 years of age. In total, 952 households were followed for a period of 12 weeks post-distribution of the study interventions. Households using Sawyer PointONE filters had significantly less diarrheal disease compared with the control arm during the intervention period, which was shown by diarrheal prevalence ratios of 0.21 (95% confidence interval [95% CI] = 0.15-0.30) for the filter arm and 0.27 (95% CI = 0.22-0.34) for the filter and WASH BCC arm. A non-significant reduction in diarrhea prevalence was reported in the WASH BCC study arm households (0.71, 95% CI = 0.59-0.86).

Annotated Bibliography on the Sawyer Filter
Baker, Derek. (2013) Merits and Limitations of the Sawyer Filter. (PDF, 132KB)

“The Sawyer Squeeze Filter for outdoor travelis convenient for water treatment. I think it would be great as a light‐weight,occasional‐use device. For disaster relief it would also make sense to distribute Sawyer filters to make drinking water safer until permanent infrastructure can be reestablished.However as a long‐term water treatment device for remote rural areas where there is no supply chain and no one to pay for the replacement filter when the donated one clogs or breaks, I think it would be unsuitable.”

Brune, Lia, et al. (2013) Monitoring and Evaluation of a Point-­‐of-­‐Use Water Treatment Pilot Project in the Peruvian Amazon. (PDF, 1.9MB)
CONAPAC is currently piloting a point-­‐of-­use (POU) water treatment system that incorporates a Sawyer membrane filter in three communities located on the Amazon and Napo river, The small population and distance between the homes of these communities has made the installation of water treatment plants an inefficient solution. As a result, these communities were selected for a pilot project to test the effectiveness of POU treatment systems in the area.

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Effect of Water, Sanitation, and Hygiene on the Prevention of Trachoma

March 12, 2014 · 0 comments

Effect of Water, Sanitation, and Hygiene on the Prevention of Trachoma: A Systematic Review and Meta-Analysis. PLoS Medicine, Feb 2014.

Authors: Meredith E. Stocks, et al.

Background - Trachoma is the world’s leading cause of infectious blindness. The World Health Organization (WHO) has endorsed the SAFE strategy in order to eliminate blindness due to trachoma by 2020 through “surgery,” “antibiotics,” “facial cleanliness,” and “environmental improvement.” While the S and A components have been widely implemented, evidence and specific targets are lacking for the F and E components, of which water, sanitation, and hygiene (WASH) are critical elements. Data on the impact of WASH on trachoma are needed to support policy and program recommendations. Our objective was to systematically review the literature and conduct meta-analyses where possible to report the effects of WASH conditions on trachoma and identify research gaps.

Methods and Findings - We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through October 27, 2013 with no restrictions on language or year of publication. Studies were eligible for inclusion if they reported a measure of the effect of WASH on trachoma, either active disease indicated by observed signs of trachomatous inflammation or Chlamydia trachomatis infection diagnosed using PCR. We identified 86 studies that reported a measure of the effect of WASH on trachoma. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. If three or more studies reported measures of effect for a comparable WASH exposure and trachoma outcome, we conducted a random-effects meta-analysis. We conducted 15 meta-analyses for specific exposure-outcome pairs. Access to sanitation was associated with lower trachoma as measured by the presence of trachomatous inflammation-follicular or trachomatous inflammation-intense (TF/TI) (odds ratio [OR] 0.85, 95% CI 0.75–0.95) and C. trachomatisinfection (OR 0.67, 95% CI 0.55–0.78). Having a clean face was significantly associated with reduced odds of TF/TI (OR 0.42, 95% CI 0.32–0.52), as were facial cleanliness indicators lack of ocular discharge (OR 0.42, 95% CI 0.23–0.61) and lack of nasal discharge (OR 0.62, 95% CI 0.52–0.72). Facial cleanliness indicators were also associated with reduced odds of C. trachomatis infection: lack of ocular discharge (OR 0.40, 95% CI 0.31–0.49) and lack of nasal discharge (OR 0.56, 95% CI 0.37–0.76). Other hygiene factors found to be significantly associated with reduced TF/TI included face washing at least once daily (OR 0.76, 95% CI 0.57–0.96), face washing at least twice daily (OR 0.85, 95% CI 0.80–0.90), soap use (OR 0.76, 95% CI 0.59–0.93), towel use (OR 0.65, 95% CI 0.53–0.78), and daily bathing practices (OR 0.76, 95% CI 0.53–0.99). Living within 1 km of a water source was not found to be significantly associated with TF/TI or C. trachomatis infection, and the use of sanitation facilities was not found to be significantly associated with TF/TI.

Conclusions - We found strong evidence to support F and E components of the SAFE strategy. Though limitations included moderate to high heterogenity, low study quality, and the lack of standard definitions, these findings support the importance of WASH in trachoma elimination strategies and the need for the development of standardized approaches to measuring WASH in trachoma control programs.

 

Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution

March 11, 2014 · 1 comment

Assessing the Impact of Water Filters and Improved Cook Stoves on Drinking Water Quality and Household Air Pollution: A Randomised Controlled Trial in Rwanda. PLoS One, March 2014.

Authors: Ghislaine Rosa, et al.

Diarrhoea and respiratory infections remain the biggest killers of children under 5 years in developing countries. We conducted a 5-month household randomised controlled trial among 566 households in rural Rwanda to assess uptake, compliance and impact on environmental exposures of a combined intervention delivering high-performance water filters and improved stoves for free. Compliance was measured monthly by self-report and spot-check observations. Semi-continuous 24-h PM2.5 monitoring of the cooking area was conducted in a random subsample of 121 households to assess household air pollution, while samples of drinking water from all households were collected monthly to assess the levels of thermotolerant coliforms.

Adoption was generally high, with most householders reporting the filters as their primary source of drinking water and the intervention stoves as their primary cooking stove. However, some householders continued to drink untreated water and most continued to cook on traditional stoves. The intervention was associated with a 97.5% reduction in mean faecal indicator bacteria (Williams means 0.5 vs. 20.2 TTC/100 mL, p<0.001) and a median reduction of 48% of 24-h PM2.5 concentrations in the cooking area (p = 0.005). Further studies to increase compliance should be undertaken to better inform large-scale interventions.

Editorial – The elusive effect of water and sanitation on the global burden of disease

March 10, 2014 · 1 comment

Editorial – The elusive effect of water and sanitation on the global burden of disease. Tropical Medicine and  International Health, Feb 2014.

by  Wolf-Peter Schmidt, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK. Tel.: +44-20-7636 8636, E-mail: Wolf-Peter.Schmidt@lshtm.ac.uk

Introduction
About 2.5 billion people lack access to improved sanitation, and 1 billion have no access to any form of sanitation (UNICEF 2013). About 780 million people lack access to an improved water source, a figure that is based on a fairly generous definition incorporating little with respect to reliability, proximity and convenience of access (UNICEF 2013).

While the ancient Romans may already have been aware of it (Bradley 2012), water and sanitation came to be regarded as key to improve health in the growing cities of Europe and America in the late 19th and early 20th centuries. A number of notable observational studies were carried out that even with the limited epidemiological tools available at the time all but proved the direct link between water, sanitation and health (Snow 1860; Pringle 1910). By contrast, in the early days of development aid in the post-colonial era, water and sanitation were often not regarded as a health issue, but primarily provided with the aim of making people’s life easier and enable developmental activities. Whoever tried to argue for more investment on health grounds was faced by a lack of epidemiological studies conducted in low-income settings, which led to a renewed interest in research from the 1970s.

Simple before/after and case-control studies to evaluate water and sanitation programmes
The studies on water and sanitation conducted in low-income settings since the 1970s were usually simple in design (Rubenstein et al.1969; Aziz et al. 1990; Zhang et al. 2000, 2005; Azurin & Alvero 2007). Typically, a programme to improve water access would be implemented in one or two villages, with latrine construction and some form of hygiene education being provided at the same time. Disease (for example diarrhoea, schistosomiasis or soil-transmitted helminths) would be measured at baseline and then again after the intervention. A couple of not too distant villages with ‘similar socio-economic conditions’ would have been followed up as a control group. Allocation of the intervention was unlikely to be random. Villages might have received the intervention because they had many diseases or were the poorest in the region. They might have been chosen for having been the least or the most accessible, the politically most influential or the most neglected. The commonly small number of allocated villages enabled a close supervision of the intervention, assuring that everything was carried out according to plan. However, the within-village (‘-cluster’) correlation of disease meant that statistically not much could be made of any difference between intervention and control arm if there were <5 or 6 villages on either side. Accounting for the baseline levels of disease allowed strengthening the causal inference (Norman & Schmidt 2011), but only to some extent. Larger, randomised studies were deemed unfeasible given the logistical and engineering complexities involved, and the low budgets available at the time.

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CAWST – Newly updated Drinking Water Quality Testing Manual

March 10, 2014 · 0 comments

Newly updated Drinking Water Quality Testing Manual. CAWST, 2014.

CAWST – Centre for Affordable Water and Sanitation Technology – has released a newly-updated Drinking Water Quality Testing manual that provides introductory information and resources on drinking water quality testing.

The manual is for WASH implementers interested in doing drinking water quality testing as part of the implementation, monitoring or evaluation of household water treatment and safe storage (HWTS) projects. 

Among the updates, the manual has been broadened to include drinking water quality testing for small-scale community water systems (in addition to HWTS). The updates also address unique conditions in different regions, featuring customized country fact sheets. The manual now features an expanded water sampling section, including step-by-step instructions, illustrations and guidance on how to sample different HWT technologies. 

Additional highlights from the manual:

  • Guidance to help determine if drinking water quality testing is an appropriate tool for your project
  • Characteristics of safe drinking water
  • Planning for drinking water quality testing
  • Sanitary surveys as a means to observe water quality
  • New product sheets for various water quality testing products and equipment
  • Testing options, including portable field kits and laboratories
  • Physical, chemical and microbiological parameters and test procedures
  • Updated to reflect the latest Guidelines for Drinking Water Quality issued by the WHO

When the Aquaya Institute was preparing a three-month water sampling and testing campaign for the Port Harcourt Water Corporation and the Ministry of Water in Port Harcourt, Nigeria, the organization incorporated CAWST’s newly-updated drinking water quality materials into the training. 

“The interactive activities were particularly effective and compelling – our participants commented on how much they liked activities more than presentations,” Aquaya Research Associate Emily Kumpel said. “Having access to these materials hugely decreased our prep time and let us focus on other things that we needed to handle directly, such as logistics, staffing and getting the testing program up and running.”

The manual outlines the advantages and limitations of both low-tech and high-tech testing methods, as well as the relationships between each method.

The new section on sanitary inspections – including sanitary inspection forms – expands the monitoring tools available to those working in areas where logistical and economic hurdles make it difficult to test drinking water quality as a means to protect public health.

Smaller community water supply and HWTS projects that are just starting often do not conduct water quality testing, although many project implementers have shown initial interest in drinking water quality testing. This is due to implementers often finding that testing can be a difficult and expensive task.

In some cases no testing is done or they may do random testing that is not part of a regular and structured monitoring program. Doing occasional or random tests may provide a false sense of security or inconclusive results as water quality can vary widely and rapidly.

This observation and the overall lack of testing available in developing countries highlighted the need for a manual that provides guidance for implementing rapid, simple and inexpensive test methods.

Implementers exploring how to use, adapt or customize these or other CAWST materials can contact CAWST for free consulting support at resources@cawst.org.

 

 

Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality

February 26, 2014 · 0 comments

Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Intl Health, Feb 2014.

Authors – Lenka Benova, Oliver Cumming and Oona M. R. Campbell

Objective – To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes.

Methods – Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO since 1980.

Results – Fourteen articles were found. Four of five ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72–5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal
mortality. The only individual-level study looking at the adjusted effect of water showed a significant association with maternal mortality (OR = 1.50, 95% CI 1.10–2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality.

Conclusions – There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through
which such associations may operate.

Evaluation of the Compartment Bag Test for the Detection of Escherichia coli in Water

February 26, 2014 · 0 comments

Evaluation of the Compartment Bag Test for the Detection of Escherichia coli in Water. J Microbiol Methods. 2014 Feb 21.

Authors: Stauber C, Miller C, Cantrell B, Kroell K

AIMS: Annually, more than 2 million diarrheal disease deaths can be attributed to the lack of access to water, sanitation and hygiene. These deaths occur mostly in developing countries where water quality testing resources are limited. Several tests are currently used to detect and quantify E. coli and other fecal bacteria in drinking water, however they can be expensive, complex, and technically demanding. There is a need for a simple, reliable, low-cost water quality test that can be used in resource limited settings. Therefore, the purpose of this research was to perform a rigorous evaluation of the recently developed compartment bag test for detection and quantification of E. coli against the standard method of membrane filtration.

Methods And Results: A total of 270 water samples were collected from forty-five various naturally contaminated water sources around metro-Atlanta from August 2011 through April 2012. Samples were processed using the compartment bag test and membrane filtration with mI agar. Concentrations of E. coli were significantly correlated with a correlation coefficient of 0.904 (95% CI 0.859 – 0.950). Sensitivity and specificity were 94.9% and 96.6%, respectively.

CONCLUSIONS: These results suggest that the compartment bag test produces results consistent with those produced by membrane filtration on mI agar. Based upon its performance, the compartment bag test has the potential to be used as a reliable, affordable drinking water quality test globally where other microbial water quality testing resources are not readily available, and can be implemented in monitoring activities for microbial water quality to provide reliable and actionable data.

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