Household Water Treatment and Safe Storage in Malawi: A Preliminary Consultative Study

January 22, 2013 · 0 comments

Household Water Treatment and Safe Storage in Malawi: A Preliminary Consultative Study, 2012.

Ryan Rowe. Ministry of Health Department of Preventive Health Services;  Ministry of Water Development and Irrigation Sanitation & Hygiene Unit

At a recent policy workshop, the Government of Malawi commissioned this report to review policies relating to HWTS, identify key stakeholders, assess baseline use, understand current production and marketing practices and distinguish the primary challenges and opportunities involved with increasing the use of HWTS in the country. This report aims to supply the Ministry of Health and the Ministry of Water Development & Irrigation with crucial data that should enable them to make decisions about the development of a national strategy to scale up HWTS. The methods used in the preparation of this report include interviews, a literature review and two opportunities for stakeholders’ feedback.

This report recommends five key actions in order to enable scaling up HWTS. First, the government should finalise its national strategy on HWTS declaring its key priorities, guiding stakeholders and mobilising resources. Second, HWTS should be integrated with key national platforms; health services for pregnant women are a particularly viable option. Third, institutional support and sector coordination can be improved by harmonising existing policy, developing implementation guidelines and formulating product standards. Fourth, the implementation of the national chlorine stock solution programme needs to be strengthened. Fifth, efforts should be made to increase public awareness, while continuing consulting with stakeholders on how to further integrate HWTS.

Using ArcMap, Google Earth, and Global Positioning Systems to select and locate random households in rural Haiti

January 22, 2013 · 0 comments

Int J Health Geogr. 2013 Jan 18;12(1):3.

Using ArcMap, Google Earth, and Global Positioning Systems to select and locate random households in rural Haiti.

Wampler PJ, Rediske RR, Molla AR.

BACKGROUND: A remote sensing technique was developed which combines a Geographic Information System (GIS); Google Earth, and Microsoft Excel to identify home locations for a random sample of households in rural Haiti. The method was used to select homes for ethnographic and water quality research in a region of rural Haiti located within 9 km of a local hospital and source of health education in Deschapelles, Haiti. The technique does not require access to governmental records or ground based surveys to collect household location data and can be performed in a rapid, cost effective manner.

METHODS: The random selection of households and the location of these households during field surveys were accomplished using GIS, Google Earth, Microsoft Excel, and handheld Garmin GPSmap 76CSx GPS units. Homes were identified and mapped in Google Earth, exported to ArcMap 10.0, and a random list of homes was generated using Microsoft Excel which was then loaded onto handheld GPS units for field location. The development and use of a remote sensing method was essential to the selection and location of random households.

RESULTS: A total of 537 homes initially were mapped and a randomized subset of 96 was identified as potential survey locations. Over 96% of the homes mapped using Google Earth imagery were correctly identified as occupied dwellings. Only 3.6% of the occupants of mapped homes visited declined to be interviewed. 16.4% of the homes visited were not occupied at the time of the visit due to work away from the home or market days. A total of 55 households were located using this method during the 10 days of fieldwork in May and June of 2012.

CONCLUSIONS: The method used to generate and field locate random homes for surveys and water sampling was an effective means of selecting random households in a rural environment lacking geolocation infrastructure. The success rate for locating households using a handheld GPS was excellent and only rarely was local knowledge required to identify and locate households. This method provides an important technique that can be applied to other developing countries where a randomized study design is needed but infrastructure is lacking to implement more traditional participant selection methods.

Equity in water and sanitation: Developing an index to measure progressive realization of the human right

January 22, 2013 · 0 comments

Int J Hyg Environ Health. 2013 Jan 16. pii: S1438-4639(12)00143-5.

Equity in water and sanitation: Developing an index to measure progressive realization of the human right.

Luh J, Baum R, Bartram J.

The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, USA.

We developed an index to measure progressive realization for the human right to water and sanitation. While in this study we demonstrate its application to the non-discrimination and equality component for water, the conceptual approach of the index can be used for all the different components of the human right. The index was composed of one structural, one process, and two outcome indicators and is bound between -1 and 1, where negative values indicate regression and positive values indicate progressive realization. For individual structural and process indicators, only discrete values such as -1, -0.5, 0, 0.5, and 1 were allowed. For the outcome indicators, any value between -1 and 1 was possible, and a State’s progress was evaluated using rates of change.

To create an index that would allow for fair comparisons between States and across time, these rates of change were compared to benchmarked rates, which reflect the maximum rates a State can achieve. Using this approach, we calculated the index score for 56 States in 2010 for which adequate data were available and demonstrated that these index scores were not dependent on factors such as achieved level of coverage or gross national income. The proposed index differs from existing measures of inequality as it measures rate of change and not level of achievement, and thus addresses the principle of progressive realization that is fundamental to human rights.

Community mobilization and household level waste management for dengue vector control

January 22, 2013 · 0 comments

Pathog Glob Health. 2012 Dec;106(8):479-87.

Community mobilization and household level waste management for dengue vector control in Gampaha district of Sri Lanka; an intervention study.

Abeyewickreme W, Wickremasinghe AR,Karunatilake K, Sommerfeld J, Axel K. University of Kelaniya, Faculty of Medicine, Thalagolla Road, Ragama, Sri Lanka.

INTRODUCTION: Waste management through community mobilization to reduce breeding places at household level could be an effective and sustainable dengue vector control strategy in areas where vector breeding takes place in small discarded water containers. The objective of this study was to assess the validity of this assumption.

METHODS: An intervention study was conducted from February 2009 to February 2010 in the populous Gampaha District of Sri Lanka. Eight neighborhoods (clusters) with roughly 200 houses each were selected randomly from high and low dengue endemic areas; 4 of them were allocated to the intervention arm (2 in the high and 2 in the low endemicity areas) and in the same way 4 clusters to the control arm. A baseline household survey was conducted and entomological and sociological surveys were carried out simultaneously at baseline, at 3 months, at 9 months and at 15 months after the start of the intervention. The intervention programme in the treatment clusters consisted of building partnerships of local stakeholders, waste management at household level, the promotion of composting biodegradable household waste, raising awareness on the importance of solid waste management in dengue control and improving garbage collection with the assistance of local government authorities.

RESULTS: The intervention and control clusters were very similar and there were no significant differences in pupal and larval indices of Aedes mosquitoes. The establishment of partnerships among local authorities was well accepted and sustainable; the involvement of communities and households was successful. Waste management with the elimination of the most productive water container types (bowls, tins, bottles) led to a significant reduction of pupal indices as a proxy for adult vector densities.

CONCLUSION: The coordination of local authorities along with increased household responsibility for targeted vector interventions (in our case solid waste management due to the type of preferred vector breeding places) is vital for effective and sustained dengue control.

David Lloyd Owen analysis of WASH data in Global Burden of Disease study

January 18, 2013 · 0 comments

David Lloyd Owen is an expert on water and wastewater management. He advises companies, governments and some of largest dedicated funds in the world. He has written six books on water management and markets including the Pinsent Masons Water Yearbook (12th edition in preparation) and ‘Tapping Liquidity’ a look at how the world’s water future spending needs can be financed. His big push now is to try and move the policy agenda forward towards how we can reconcile our water resources with the challenges of population growth, urbanisation and climate change. He lives in West Wales with his family. Source of bio

David Lloyd Owen – Death and disease defined. – Vol 14, Issue 1 (January 2013)

The medical profession prefers a more nuanced demise – and acronyms to match. As well as death pure and simple, it employs DALYs (disability- adjusted life years; the burden of disease on humanity) which consist of YLLs (years of life lost) and YLDs (years lived with disability). Just as data regarding access to water and sanitation is of varying quality, numbers for those affected by poor water quality and sanitation provision have tended to be alarmingly variable.

The Global Burden of Disease Study 2010 is a colossal collaboration aimed at getting a firmer grip on who was affected by which diseases in 1990 and 2010, the findings of which were published in The Lancet last month. For water, 119 separate studies were analysed to gain a better understanding of the situation.

What is most striking about the findings is that they indicate that water and sanitation are a lesser factor in disease than had been previously assumed, and that matters appear to be improving. Unimproved water and sanitation accounted for 0.9% of global DALYs in 2010, against 2.1% in 1990. Interestingly, previous Global Burden of Disease studies pointed to their share being 6.8% in 1990 and 3.7% in 2000.

Deaths directly attributed to unimproved water sources fell from 288,007 in 1990 to 116,126 in 2010, and from 496,986 to 244,106 due to unimproved sanitation. For DALYs, the figures fell from 21.17 million to 7.78 million for water, and from 36.05 million to 14.93 million for sanitation. As a result, poor sanitation was the 26th most important risk factor in 2010 (from 15th highest in 1990), with water falling from 22nd to 33rd over the same timeframe.

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The Cure for Cholera — Improving Access to Safe Water and Sanitation

January 10, 2013 · 0 comments

The Cure for Cholera — Improving Access to Safe Water and Sanitation. New Eng Jnl Med, Jan 9, 2013.

Whenever epidemics of cholera occur, the global public health community is energized. Experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted. In the past two decades, these things happened after cholera appeared in Latin America in 1991, in the wake of the Rwandan genocide and the ensuing refugee crisis in Zaire (now Democratic Republic of Congo) in 1994, in Zimbabwe in 2008, and in October 2010, at the onset of the ongoing epidemic in Haiti (see article by Barzilay et al.).

But even when it is not covered in the news or noticed by the public, cholera occurs regularly in the developing world, and the annual number of cases reported to the World Health Organization (WHO) has increased over the past few years to more than half a million cases and 7816 related deaths reported from all regions in 2011 (see mapCountries Reporting Cholera in 2011.).1 Moreover, these reported numbers grossly underestimate the actual global burden of cholera: the WHO estimates that 3 million to 5 million cases and 100,000 to 200,000 deaths due to cholera occur annually.

Cholera Surveillance during the Haiti Epidemic — The First 2 Years

January 10, 2013 · 0 comments

Cholera Surveillance during the Haiti Epidemic — The First 2 Years. New Eng Jnl Med, Jan 10, 2013.

BACKGROUND – In October 2010, nearly 10 months after a devastating earthquake, Haiti was stricken by epidemic cholera. Within days after detection, the Ministry of Public Health and Population established a National Cholera Surveillance System (NCSS). Within 29 days after the first report, cases of V. cholerae O1 (serotype Ogawa, biotype El Tor) were confirmed in all 10 administrative departments (similar to states or provinces) in Haiti. Through October 20, 2012, the public health ministry reported 604,634 cases of infection, 329,697 hospitalizations, and 7436 deaths from cholera and isolated V. cholerae O1 from 1675 of 2703 stool specimens tested (62.0%). The cumulative attack rate was 5.1% at the end of the first year and 6.1% at the end of the second year. The cumulative case fatality rate consistently trended downward, reaching 1.2% at the close of year 2, with departmental cumulative rates ranging from 0.6% to 4.6% (median, 1.4%). Within 3 months after the start of the epidemic, the rolling 14-day case fatality rate was 1.0% and remained at or below this level with few, brief exceptions. Overall, the cholera epidemic in Haiti accounted for 57% of all cholera cases and 53% of all cholera deaths reported to the World Health Organization in 2010 and 58% of all cholera cases and 37% of all cholera deaths in 2011.

CONCLUSIONS – A review of NCSS data shows that during the first 2 years of the cholera epidemic in Haiti, the cumulative attack rate was 6.1%, with cases reported in all 10 departments. Within 3 months after the first case was reported, there was a downward trend in mortality, with a 14-day case fatality rate of 1.0% or less in most areas.

The joint effects of efficacy and compliance: A study of household water treatment effectiveness against childhood diarrhea

January 10, 2013 · 0 comments

Water Res. 2012 Dec 19. pii: S0043-1354(12)00846-9. doi: 10.1016/j.watres.2012.11.034.

The joint effects of efficacy and compliance: A study of household water treatment effectiveness against childhood diarrhea.

Enger KS, Nelson KL, Rose JB, Eisenberg JN. Department of Fisheries and Wildlife, 13 Natural Resources Building, Michigan State University, East Lansing, MI 48824, USA.

The effectiveness of household water treatment (HWT) at reducing diarrheal disease is related to the efficacy of the HWT method at removing pathogens, how people comply with HWT, and the relative contributions of other pathogen exposure routes. We define compliance with HWT as the proportion of drinking water treated by a community. Although many HWT methods are efficacious at removing or inactivating pathogens, their effectiveness within actual communities is decreased by imperfect compliance. However, the quantitative relationship between compliance and effectiveness is poorly understood.

To assess the effectiveness of HWT on childhood diarrhea incidence via drinking water for three pathogen types (bacterial, viral, and protozoan), we developed a quantitative microbial risk assessment (QMRA) model. We examined the relationship between log(10) removal values (LRVs) and compliance with HWT for scenarios varying by: baseline incidence of diarrhea; etiologic fraction of diarrhea by pathogen type; pattern of compliance within a community; and size of contamination spikes in source water.

Benefits from increasing LRVs strongly depend on compliance. For perfect compliance, diarrheal incidence decreases as LRVs increase. However, if compliance is incomplete, there are diminishing returns from increasing LRVs in most of the scenarios we considered. Higher LRVs are more beneficial if: contamination spikes are large; contamination levels are generally high; or some people comply perfectly.

The effectiveness of HWT interventions at the community level may be limited by imperfect compliance, such that the benefits of high LRVs are not realized. Compliance with HWT should be carefully measured during HWT field studies and HWT dissemination programs. Studies of pathogen concentrations in a variety of developing-country source waters are also needed. Guidelines are needed for measuring and promoting compliance with HWT.

Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply

January 7, 2013 · 0 comments

Global costs and benefits of reaching universal coverage of sanitation and drinking-water supply. Journal of Water and Health, 2012 | doi:10.2166/wh.2012.105

Guy Hutton

6 Chemin des Communaux, 1291 Commugny, Switzerland E-mail: guy.hutton@bluewin.ch

Economic evidence on the cost and benefits of sanitation and drinking-water supply supports higher allocation of resources and selection of efficient and affordable interventions. The study aim is to estimate global and regional costs and benefits of sanitation and drinking-water supply interventions to meet the Millennium Development Goal (MDG) target in 2015, as well as to attain universal coverage. Input data on costs and benefits from reviewed literature were combined in an economic model to estimate the costs and benefits, and benefit-cost ratios (BCRs). Benefits included health and access time savings.

Global BCRs (Dollar return per Dollar invested) were 5.5 for sanitation, 2.0 for water supply and 4.3 for combined sanitation and water supply. Globally, the costs of universal access amount to US$ 35 billion per year for sanitation and US$ 17.5 billion for drinking-water, over the five-year period 2010–2015 (billion defined as 109 here and throughout).

The regions accounting for the major share of costs and benefits are South Asia, East Asia and sub-Saharan Africa. Improved sanitation and drinking-water supply deliver significant economic returns to society, especially sanitation. Economic evidence should further feed into advocacy efforts to raise funding from governments, households and the private sector.

The Human Right(s) to Water and Sanitation: History, Meaning and the Controversy Over Privatization

January 7, 2013 · 0 comments

The Human Right(s) to Water and Sanitation: History, Meaning and the Controversy Over Privatization. Berkeley Journal of International Law (BJIL), Vol. 31, No. 1, 2013.

Sharmila L. Murthy. Harvard University – Harvard Kennedy School (HKS) – Carr Center for Human Rights Policy

The recognition by the United Nations (UN) General Assembly and the UN Human Rights Council in 2010 of a human right to safe drinking water and sanitation has propelled awareness of the global water and sanitation crisis to new heights, while also raising a host of challenging issues. The framing of water and sanitation as a human right can be understood as a response to global water service trends that have increasingly emphasized economic efficiency, environmental sustainability, and privatization. The history of the International Covenant on Economic, Social and Cultural Rights (ICESCR) sheds light on some of the controversies around the scope and meaning of the human right to water and sanitation, including the politics of privatization.

Although international human rights law has historically been neutral with respect to economic models of service provision, human rights principles are relevant as to how to engage the private sector in the provision of basic services. Three key themes that highlight the tensions between human rights and private sector involvement in the water and sanitation sectors are explored: financial sustainability, efficiency, and dispute resolution. Human rights principles are guideposts for regulation, monitoring, and oversight, which are critical elements when the private sector is involved in the delivery of water and sanitation services.

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