Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China

August 15, 2012 · 0 comments

Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China, Bull World Health Organ 2012;90:578–587.

Elizabeth J Carlton, Song Liang, Julia Z McDowell, Huazhong Li,Wei Luo & Justin V Remais.

Objective – To estimate the disease burden attributable to unsafe water and poor sanitation and hygiene in China, to identify high-burden groups and to inform improvement measures.

Methods – The disease burden attributable to unsafe water and poor sanitation and hygiene in China was estimated for diseases resulting from exposure to biologically contaminated soil and water (diarrhoeal disease, helminthiases and schistosomiasis) and vector transmission resulting from inadequate management of water resources (malaria, dengue and Japanese encephalitis). The data were obtained from China’s national infectious disease reporting system, national helminthiasis surveys and national water and sanitation surveys. The fraction of each health condition attributable to unsafe water and poor sanitation and hygiene in China was estimated from data in the Chinese and international literature.

Findings – In 2008, 327 million people in China lacked access to piped drinking water and 535 million lacked access to improved sanitation. The same year, unsafe water and poor sanitation and hygiene accounted for 2.81 million disability-adjusted life years (DALYs) and 62 800 deaths in the country, and 83% of the attributable burden was found in children less than 5 years old. Per capita DALYs increased along an east–west gradient, with the highest burden in inland provinces having the lowest income per capita.

Conclusion – Despite remarkable progress, China still needs to conduct infrastructural improvement projects targeting provinces that have experienced slower economic development. Improved monitoring, increased regulatory oversight and more government transparency are needed to better estimate the effects of microbiologically and chemically contaminated water and poor sanitation and hygiene on human health.

Saving a Life-Year and Reaching MDG 4 with Investments in Water and Sanitation: A Cost-Effective Policy?

August 14, 2012 · 0 comments

Saving a Life-Year and Reaching MDG 4 with Investments in Water and Sanitation: A Cost-Effective Policy? European Journal of Development Research, 9 August 2012; doi: 10.1057/ejdr.2012.24

Isabel Günthera and Günther Fink

ETH Zürich, Zürich, Switzerland.
Harvard School of Public Health, Boston, MA.

Using household survey data from 40 developing countries, we estimate the mortality impact of improved water and sanitation access. We find that the average mortality reduction achievable by investment in water and sanitation infrastructure is 8 and 22 deaths per 1000 children born for basic and advanced technologies, respectively.

These reductions account for 11 per cent (basic technologies) to 32 per cent (advanced technologies) of the gap between current child mortality rates and the 2015 target set in the Millennium Development Goal 4. Our estimates suggest that full household coverage with water and sanitation infrastructure could lead to a reduction of 0.6 to 1.7 million child deaths per year in the developing world.

The average cost per life-year saved is about 30 per cent of developing countries’ annual GDPs per capita for high-end technologies and about 80 per cent of annual per capita GDP for basic water and sanitation infrastructure.

SODIS: A review from bench-top to roof-top

August 14, 2012 · 1 comment

Solar Water Disinfection (SODIS): A review from bench-top to roof-top, Journal of Hazardous Materials, 6 August 2012

Kevin G. McGuigan, Ronán M. Conroy, Hans-Joachim Mosler, Martella du Preez, Eunice Ubomba-Jaswac, Pilar Fernandez-Ibañez.

Email: kmcguigan@rcsi.ie

Solar water disinfection (SODIS) has been known for more than 30 years. The technique consists of placing water into transparent plastic or glass containers (normally 2 L PET beverage bottles) which are then exposed to the sun. Exposure times vary from 6 to 48 hours depending on the intensity of sunlight and sensitivity of the pathogens. Its germicidal effect is based on the combined effect of thermal heating of solar light and UV radiation.

It has been repeatedly shown to be effective for eliminating microbial pathogens and reduce diarrhoeal morbidity including cholera. Since 1980 much research has been carried out to investigate the mechanisms of solar radiation induced cell death in water and possible enhancement technologies to make it faster and safer. Since SODIS is simple to use and inexpensive, the method has spread throughout the developing world and is in daily use in more than 50 countries in Asia, Latin America, and Africa.

More than 5 million people disinfect their drinking water with the solar disinfection (SODIS) technique. This review attempts to revise all relevant knowledge about solar disinfection from microbiological issues, laboratory research, solar testing, up to and including real application studies, limitations, factors influencing adoption of the technique and health impact.

 

 

Why does piped water not reduce diarrhea for children? Evidence from urban Yemen

August 14, 2012 · 0 comments

Why does piped water not reduce diarrhea for children? Evidence from urban Yemen, 2012.

Tobias Lechtenfeld, Georg-August-University Göttingen

This paper investigates why household connections to piped water supply can increase diarrheal diseases among under-5-year-old children. Using a unique mix of household data, microbiological test results and spatial information from urban Yemen it is possible to distinguish the adverse impacts of malfunctioning water pipes from unhygienic household behavior on water pollution and health outcomes.

The analysis consists of three parts: First, exogenous variation of pipe construction is used to quantify the health impact of access to piped water, which is found to increase the risk of child diarrhea by 4.6 percentage points.

Second, by exploiting the spatial correlation of pollution among households connected to the same water pipe, it is shown that broken pipes and interruptions of water supply are responsible for most of the water pollution.

Third, unhygienic water storage and handling at household level additionally increases water pollution. These results show for the first time that water rationing can jeopardize the intended health benefits of access to clean drinking water.

Importantly, these results apply to most urban areas in Africa and the Middle East where water resources are limited and water supply is frequently interrupted.

Oxfam Cholera Outbreak Guidelines, 2012

August 14, 2012 · 1 comment

Source: Oxfam Policy and Practice Blog, Aug 13, 2012, by Elizabeth Lamond, HSP Public Health Engineer Coordinator

Oxfam’s Cholera Outbreak Guidelines were developed as an internal resource, but today we are sharing them externally in order to seek input from the international humanitarian community. We hope that this feedback will inform later editions in order to develop a powerful resource for anyone looking to prepare for, prevent and control a cholera outbreak. Here, one of the authors of the Guideline, Bibi Lamond, explains more. 

I have been responsible for implementing and coordinating cholera outbreak programmes since 2006. In my work I have found that, although there are numerous documents and books on medical intervention for cholera control, there are no comprehensive water, sanitation and hygiene promotion (WASH) guidelines.

Oxfam’s new publication, the Cholera Outbreak Guidelines aims to meet this need and could set standards for other emergency WASH actors.

The content of the Guidelines has evolved from firsthand field experience in Oxfam’s emergency cholera programmes in Haiti, Democratic Republic of Congo, Ethiopia and Zimbabwe. It has also drawn on information from other NGOs, such as Médecins Sans Frontières, renowned for their cholera work in the field.

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Assessing rural small community water supply in South Africa: Water service benchmarks and reliability

August 10, 2012 · 1 comment

Science of the Total Environment 2012; 435-436:479–486

Assessing rural small community water supply in Limpopo, South Africa: Water service benchmarks and reliability.

Majurua B, Jagals P, Hunter PR.

Although a number of studies have reported on water supply improvements, few have simultaneously taken into account the reliability of the water services. The study aimed to assess whether upgrading water supply systems in small rural communities improved access, availability and potability of water by assessing the water services against selected benchmarks from the World Health Organisation and South African Department of Water Affairs, and to determine the impact of unreliability on the services.

These benchmarks were applied in three rural communities in Limpopo, South Africa where rudimentary water supply services were being upgraded to basic services. Data were collected through structured interviews, observations and measurement, and multi-level linear regression models were used to assess the impact of water service upgrades on key outcome measures of distance to source, daily per capita water quantity and Escherichia coli count.

When the basic system was operational, 72% of households met the minimum benchmarks for distance and water quantity, but only 8% met both enhanced benchmarks. During non-operational periods of the basic service, daily per capita water consumption decreased by 5.19 l (p < 0.001, 95% CI 4.06–6.31) and distances to water sources were 639 m further (p ≤ 0.001, 95% CI 560–718).

Although both rudimentary and basic systems delivered water that met potability criteria at the sources, the quality of stored water sampled in the home was still unacceptable throughout the various service levels. These results show that basic water services can make substantial improvements to water access, availability, potability, but only if such services are reliable.

SWASH+ Top Ten Findings – 2012

August 8, 2012 · 1 comment

SWASH+ Kenya was developed from a pilot initiative funded by the Coca Cola Africa Foundation. The initiative began in 2005, when the Millennium Water Alliance, CARE, Water.org (formerly Water Partners International), and Kenya-based SANA implemented a school and community WASH project. SWASH+ Kenya’s current partners are CARE, Emory University’s Center for Global Safe Water, Water.org, and the Kenya Water and Health Organisation. It is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge

SWASH+ Top Ten Findings – 2012

Excerpts:

1 – IMPACT ON ABSENTEEISM— Schools in two geographic clusters that received a water treatment and hygiene promotion intervention had a 58% reduction in girls’ absence or an average reduction of six days per year per girl (controlling for grade and age). The same intervention had no effect on boys’ absenteeism.

2 – COMMUNITY BEHAVIOUR CHANGE— Household water treatment in communities increased with the initiation of school WASH. The increase was significant, but modest. School WASH interventions should be combined with
other programs more specifically targeted to parents and families for optimal behaviour change in communities.

3 – SUSTAINABILITY— Three years after implementing the Safe Water System (SWS) school WASH intervention, only 36% of schools continued to provide drinking water and only 9% had measurable levels of chlorine in their drinking water. Inappropriate technology, cost, limited access to water and lack of institutional support are among the key barriers to long-term provision of safe water at schools.

4 – DIARRHEAL DISEASE— Among schools in the water ‘scarce’ group (schools without a dry season water source within 1km), provision of a comprehensive school-based WASH intervention was effective in reducing the risk of diarrheal disease by 66%. The significant overall reduction in diarrhea prevalence was similar for boys and girls; however, diarrhea prevalence was not impacted at schools without water supply improvements and who only were provided water treatment and/or sanitation.
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Impact of a Hygiene Curriculum and the Installation of Simple Handwashing and Drinking Water Stations

August 8, 2012 · 0 comments

Am J Trop Med Hyg. 2012 Aug 6.

Impact of a Hygiene Curriculum and the Installation of Simple Handwashing and Drinking Water Stations in Rural Kenyan Primary Schools on Student Health and Hygiene Practices.

Patel MK, Harris JR, Juliao P, Nygren B, Were V, Kola S, Sadumah I, Faith SH, Otieno R, Obure A, Hoekstra RM, Quick R.

Epidemic Intelligence Service and Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Kenya Medical Research Institute, Nairobi, Kenya; Nyando Integrated Child Health and Education (NICHE) Project, Kisumu, Kenya.

School-based hygiene and water treatment programs increase student knowledge, improve hygiene, and decrease absenteeism, however health impact studies of these programs are lacking. We collected baseline information from students in 42 schools in Kenya. We then instituted a curriculum on safe water and hand hygiene and installed water stations in half (“intervention schools”).

One year later, we implemented the intervention in remaining schools. Through biweekly student household visits and two annual surveys, we compared the effect of the intervention on hygiene practices and reported student illness. We saw improvement in proper handwashing techniques after the school program was introduced.

We observed a decrease in the median percentage of students with acute respiratory illness among those exposed to the program; no decrease in acute diarrhea was seen. Students in this school program exhibited sustained improvement in hygiene knowledge and a decreased risk of respiratory infections after the intervention.

Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes

August 3, 2012 · 0 comments

Int. J. Environ. Res. Public Health 2012, 9(8), 2772-2787

Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes

Christian Jasper1 , Thanh-Tam Le2 and Jamie Bartram1,
1 The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, NC 27599, USA
2 Department of Biology, University of North Carolina at Chapel Hill, 120 South Road, Chapel Hill, NC 27599, USA

A systematic review of the literature on the effects of water and sanitation in schools was performed. The goal was to characterize the impacts of water and sanitation inadequacies in the academic environment. Published peer reviewed literature was screened and articles that documented the provision of water and sanitation at schools were considered. Forty-one peer-reviewed papers met the criteria of exploring the effects of the availability of water and/or sanitation facilities in educational establishments.

Chosen studies were divided into six fields based on their specific foci: water for drinking, water for handwashing, water for drinking and handwashing, water for sanitation, sanitation for menstruation and combined water and sanitation. The studies provide evidence for an increase in water intake with increased provision of water and increased access to water facilities.

Articles also report an increase in absenteeism from schools in developing countries during menses due to inadequate sanitation facilities. Lastly, there is a reported decrease in diarrheal and gastrointestinal diseases with increased access to adequate sanitation facilities in schools. Ensuring ready access to safe drinking water, and hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health.

Additional studies that examine the relationship between sanitation provisions in schools are needed to more adequately characterize the impact of water and sanitation on educational achievements.

An annotated bibliography on boiling drinking water

August 2, 2012 · 0 comments

This annotated bibliography has 11 journal articles and 1 fact sheet that were published from 1985 through August 2012 on boiling drinking water. Links to the full-text are included when possible. Please contact WASHplus if you have other studies and reports to add to this bibliography.

2012

1 – Boiling as Household Water Treatment in Cambodia: A Longitudinal Study of Boiling Practice and Microbiological Effectiveness, Am J Trop Med Hyg. 2012 Jul 23.

Brown J, Sobsey MD.Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.

This paper focuses on the consistency of use and microbiological effectiveness of boiling as it is practiced in rural Cambodia. We followed 60 randomly selected households in Kandal Province over 6 months to collect longitudinal data on water boiling practices and effectiveness in reducing Escherichia coli in household drinking water.

Despite > 90% of households reporting that they used boiling as a means of drinkingwater treatment, an average of only 31% of households had boiled water on hand at follow-up visits, suggesting that actual use may be lower than self-reported use. We collected 369 matched untreated and boiled water samples. Mean reduction of E. coli was 98.5%; 162 samples (44%) of boiled samples were free of E. coli (< 1 colony-forming unit [cfu]/100 mL), and 270 samples (73%) had < 10 cfu/100 mL. Storing boiledwater in a covered container was associated with safer product water than storage in an uncovered container.

2 – Prevalence of Anemia and Its Risk Factors Among Children 6–36 Months Old in Burma, Amer Jnl Trop Med Hyg, Aug 2012.

Ai Zhao, Yumei Zhang*, Ying Peng, Jiayin Li, Titi Yang, Zhaoyan Liu, Yanli Lv and Peiyu Wang*

Address correspondence to Yumei Zhang or Peiyu Wang, School of Public Health, Peking University Health Science Center, Beijing, 100191 China. E-mails: zhangyumei111@gmail.com or wpeiyupku@gmail.com

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. In this study, children from 6 to 36 months were investigated to determine (1) the prevalence of anemia and (2) risk factors associated with anemia. Convenience sampling was used to select three villages in three different regions in Burma. Hemoglobin and anthropometric indicators were measured for 872 children. Logistic regression analyses were used to determine factors associated with anemia.

The overall prevalence of anemia was 72.6%, with 40.0% having severe anemia. Predictors of anemia are a young age (P < 0.001), mother with anemia (P < 0.001), height-for-age Z score < −2 (P = 0.017), low family income (P < 0.001), mothers without primary education (P = 0.007), drinking unboiled water (P = 0.029), and fever in the last 3 months (P = 0.001). There is a high prevalence of anemia in children, and their nutritional status is quite poor. To control anemia, humanitarians and governments should launch comprehensive interventions.

2011

3 – Coping with poor water supplies: empirical evidence from Kathmandu, Nepal, J Water Health. 2011 Mar;9(1):143-58.

Katuwal H, Bohara AK. 1915 Roma Ave NE, University of New Mexico, MSC05 3060, Albuquerque, NM 87131, USA. katuwalh@unm.edu

The authors examined the demand for clean drinking water using treatment behaviors in Kathmandu, Nepal. Water supply is inadequate, unreliable and low quality. Households engage in several strategies to cope with the unreliable and poor quality of water supplies. Some of the major coping strategies are hauling, storing, and point-of-use treatment. Boiling, filtering, and use of Uro-guard are some of the major treatment methods.

Using Water Survey of Kathmandu, the authors estimated the effect of wealth, education, information, gender, caste/ethnicity and opinion about water quality on drinking water treatment behaviors. The results show that people tend to increase boiling and then filtering instead of only one method if they are wealthier. In addition, people boil and then filter instead of boiling only and filtering only if they think that waterdelivered to the tap is dirty. Exposure to information has the strongest effect in general for the selection of all available treatment modes.

4 – Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia, Environ Sci Technol. 2011 Jul 15;45(14):6095-101.

Psutka R, Peletz R, Michelo S, Kelly P, Clasen T. London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7H, United Kingdom.

Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a six-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported “always” or “almost always” boiling their water before drinking it. Source and householddrinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs, and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100 mL, 95% CI, 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100 mL, 95% CI, 3.1-5.1) (p < 0.001), although both are relatively low levels of contamination.

Only 60% of drinking water samples were reported to have actually been boiled at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiological quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling. The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling.

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