Burden of disease from inadequate WASH for selected adverse health outcomes: An updated analysis

Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. International Journal of Hygiene and Environmental Health, 12 May 2019.

Authors: Annette Prüss-Ustün; Jennyfer Wolf; Jamie Bartram; Thomas Clasen; OliverCumming; Matthew C. Freeman; Bruce Gordon; Paul R.Hunter; Kate Medlicott; Richard Johnston wateraid

Background – To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries.

Methods – For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.

Findings – An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016.

Conclusions – Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.

An Emergency WASH Update – May 15, 2019

NEWS

OFDA Meet Our Experts – Trevor White. OFDA, May 7, 2019. Trevor White is a Water, Sanitation, and Hygiene (WASH) Advisor at USAID/OFDA. As part of the USAID/OFDA WASH team, Trevor provides support at the country level during natural disasters and conflicts, but also at a global level to support efforts to improve the quality of future WASH responses. emergencies

BLOG POSTS

Cash transfers can help Yemen’s conflict-affected children. IFPRI Blog, May 6, 2019. As a result, the transfers helped preserve children’s dietary diversity in critical early developmental stages 6-23 months. The program also led to improved breastfeeding and water treatment practices, which further enhanced the nutritional environment.

JOURNAL ARTICLES

Efficacy of the SuperTowel: An Alternative Hand-washing Product for Humanitarian Emergencies. The American Journal of Tropical Medicine and Hygiene, May 2019. Given that the ST is more lightweight than soap and longer lasting, we envisage that the ST would also be beneficial to humanitarian actors working in areas where logistical and security issues make regular hygiene product distribution challenging. We recommend that further testing should be carried out to assess the efficacy of the ST under conditions that more closely mirror real-world hand-washing practices.

REPORTS

Urban WASH programming in Protracted Conflict Contexts: Aleppo’s Experience, Syria. UNICEF, March 2019. The focus of this Field Note is Syria’s urban WASH programme, documenting the experience in implementing WASH in a city which has endured years of protracted conflict, and is designed as a learning note for the organization as it strengthens its role in urban areas.

Private Sector & Refugees—Pathways to Scale. IFC, 2019. Multinational corporations like Mastercard, regional and national businesses such as Equity Bank and PowerGen, social enterprises like NaTakallam and Sanivation, and a range of others across industries, are demonstrating the potential roles of the private sector in supporting refugees and host communities.

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How to fill the non-sewered sanitation skills gap – IWA

How to fill the non-sewered sanitation skills gap. IWA, April 2019.

The Source asked a global panel of experts: ‘How can the water sector respond to the skills gap that must be filled if we are to make the most of opportunities presented by urban non-sewered sanitation?’ iwa.png

Professor Dr Damir Brdjanovic, Director, Global Sanitation Graduate School

The sector is in need of quality training and education, cooperation between academic and professional institutions, a recognised framework with assured quality, prestigious degrees and diplomas, platforms for alumni career development, and many other ingredients that will help people have healthier and productive lives.

In response to the growing need for leaders in developing countries and the implementation of non-sewered sanitation (NSS), the IHE Delft Institute for Water Education and partners – supported by the Bill & Melinda Gates Foundation – have launched the Global Sanitation Learning Alliance, to help develop and disseminate knowledge on sanitation.

Recently, IHE Delft has started a new MSc in sanitation – a unique interdisciplinary programme with a focus on the delivery of NSS services to urban communities. It is designed for people from diverse backgrounds, acknowledging the complexity of urban sanitation.

Read the complete article.

Building partnerships for change – WSUP

Building partnerships for change. WSUP, April 2019.

Our Chair, Lord Paul Boateng, recently visited Nairobi where he highlights the challenges caused by poor access to clean water and safe sanitation. wsup-logox2

Key to addressing this challenge is partnerships – at the local and national level – including city authorities tasked with delivering city-wide services, and community leaders who are a vital link between low-income residents and utilities.

Watch the video here:

Blog 3 of 3: Accelerating improved sanitation in Africa through market based approaches

This is the final blog in the series, which is being released after AfricaSan 5 where the African sanitation community came together to assess progress against the Ngor commitments on Sanitation and Hygiene. Learning gained from the side-session on Market-based Rural Sanitation held on February 22nd also shapes this final blog.

Introduction

Blog one in this series was about the opportunities for market shaping in West and Central Africa and blog two shared the experience of the SHAWN project in Nigeria. This third blog looks at how market based sanitation (MBS) might be a means to accelerate the scale of improved sanitation uptake in Africa including amongst the poorest and most marginalised households and communities. It draws upon both the regional sanitation industry consultation (see report here) and the Bill and Melinda Gates Foundation, UNICEF and USAID side-session on market based rural sanitation held as part of AfricaSan5. unicef

Recent reports have highlighted that neither MBS nor CLTS or other behaviour change approaches alone will be adequate for everyone, everywhere, all of the time (1, 2 and 3). It is increasingly recognised by practitioners that being effective calls for context-specific policies and practices that are less rigid or dogmatic about what approaches are used (4, 5 and 6). Interventions need to be flexible and adaptable and be designed with the priorities of target groups, including the products and services that they want, at the forefront. Furthermore, approaches need to be responsive to context and different stages of a programme both of which should inform decision-making (6).

Conducive contexts for MBS

With this in mind, which contexts are most conducive for MBS? Where and how can it be made more effective? Under what conditions are we most likely to find scenarios where the poorest and most vulnerable are climbing the sanitation ladder? And where is the market creating opportunities for people as consumers, entrepreneurs, and artisans?

A WaterAid-Plan-UNICEF joint rural sanitation guidance document (see document here) shared in Abuja and at AfricaSan5 recommends beginning with an analysis of the current sanitation situation, economic and social contexts, the physical environment and the enabling environment. Such an analysis forms the basis to determine what approaches will be appropriate for increasing basic sanitation in that particular context.

Read the complete article.

WASH & Neglected Tropical Diseases: Water Currents, May 7, 2019

The U.S. Government Global Water Strategy identifies poor hygiene and the lack of adequate water and sanitation as a leading cause of disease and death worldwide and a contributor to the spread of many neglected tropical diseases (NTDs).

The World Health Organization (WHO) WASH and NTD global strategy (2015–2020) emphasizes the urgent need to focus efforts on the provision of safe water, sanitation, and hygiene (WASH) to eliminate NTDs. Despite the urgency, according to the WHO strategy, WASH and NTDs have received little attention. ntds

This issue features new NTD toolkits from the WHO and the International Coalition for Trachoma Control (ICTC), as well as news from USAID’s NTD Program, studies and reports with overviews on WASH and NTDs, and recently published updates on schistosomiasis, soil-transmitted helminths, and trachoma. It also includes links to some earlier but key WASH and NTD reports.

We would like to thank staff from Global Water 2020 for reviewing and providing content for this issue, as well as the International Coalition for Trachoma ControlSchistosomiasis Control Initiative, and SightSavers for providing content.


News
Taking Action to End NTDsUSAID Neglected Tropical Diseases Program, February 2019. Last year USAID announced a combined $500 million investment for two new five-year flagship awards that will lead the Agency’s next generation of NTD programming.

Toolkits
WASH and Health Working Together: A ‘How-To’ Guide for Neglected Tropical Disease ProgrammesWHO; NNN, January 2019. This toolkit provides step-by-step guidance to NTD program managers and partners on how to engage and work collaboratively with the WASH community to improve delivery of WASH services to underserved populations affected by NTDs. It includes a series of tools to help build multisectoral partnerships and design, implement, and evaluate interventions. The WHO also hosted a recent webinar on the toolkit and Facebook Live Q&A.

Transition Planning for Facial Cleanliness and Environmental Improvement. ICTC, April 2019. This toolkit for transition planning is one of three planning documents ICTC recommends for program managers and implementing partners to support transition from elimination efforts to routine public services.

NTD General
Fact Sheets on the Five Main WASH-Related NTDsWHO, March and April 2019. TrachomaSchistosomiasis, and Soil-Transmitted Helminth Infections (roundworm, whipworm, hookworm). These updated online resources provide a snapshot of each disease with information on prevalence, transmission, and strategies for control.

Read the complete issue.

Globalwaters.org update | WASH research

Check out the new home page design of Globalwaters.org and a recent update includes the blog post, USAID Releases New Standard Indicators for Water and Sanitation.

Also be sure to check out the USAID Water Team YouTube Channel. The Channel has 14 videos and 13 playlists so far. wateraid

UPCOMING EVENTS

May 14 – Water as a Tool for Resilience in Times of Crisis – Please join the Environmental Change and Security Program, USAID’s Sustainable Water Partnership, and Winrock International for a discussion on where the challenges lie and what practitioners and policymakers can do to bolster effective water management for the world’s most vulnerable communities.

REPORTS

The Role of Desalination in an Increasingly Water-Scarce World. World Bank, March 2019. The cost of desalination has been plummeting over the years. As a result, desalination has become a viable option for certain strategic uses. Today, over 20,000 desalination plants in more than 150 countries supply about 300 million people with freshwater every day.

Fintech for the Water Sector: Advancing Financial Inclusion for More Equitable Access to Water. World Bank, March 2019. The emerging field of financial technology (fintech) can help address barriers to financial inclusion in the water sector while potentially reducing or eliminating the need for subsidy.

JOURNAL ARTICLES

Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. Env Sci Technol, May 2019. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.

Addressing how multiple household water sources and uses build water resilience and support sustainable development. NPJ Clean Water, March 2019. ” In this Perspective, we explain the nature and scope of multiple water source use (MWSU) at the household level in developing countries. We also describe the implications of MWSU for human health and water resilience, and identify key knowledge gaps, risks, and opportunities associated with MWSU.

BLOG POSTS

Sanitation: saving lives in developing countries. Institute for Fiscal Studies, May 2. IFS and Royal Holloway researchers, in partnership with WaterAid, provide new evidence on the effectiveness of one of the most popular interventions used by policy-makers and NGOs to improve rural sanitation practices in developing countries. The Nigeria study shows that Community-Led Total Sanitation only works in poorer communities and does not cause everyone in the community to adopt safe sanitation practices.

NEW WEBSITES

iDE WASH Markets – Developing Marketplaces for Latrines in the World’s Poorest Locations