Category Archives: Sanitation and Health

Moving Towards ODF Status in Cambodia: iDE Shares Findings in New Tactic Reports

3-2-iDE-Cambodia WASH DIB-PR-07_Photo by Chhom DinatSince the beginning of iDE Cambodia’s sanitation marketing initiative in 2009, we have facilitated the sale of over 325,000 latrines, while sanitation coverage has increased from 23% to over 70% in the provinces where we work. Our latest tactic reports provide new insight into how this expansion of sanitation coverage was achieved:

Reaching Open Defecation Free Status with Grassroots Partnerships

iDE is supporting the further development of a sustainable sanitation ecosystem, to and beyond Open Defecation Free status. Our Cambodia team’s Public Private Partnership Department is facilitating deeper connections between the private sector and government, while generating, sharing, and applying market data to help communities bridge the gap to ODF. 

Reaching the Poorest with Sanitation Through Targeted Subsidies

A recent World Bank report describes several common pitfalls of the delivery of WASH subsidies worldwide, including being pervasive and poorly targeted, non-transparent, expensive for implementers, and distortionary for markets. iDE developed its targeted subsidy model to address each of these issues and help poor household sustainably participate in the Cambodian sanitation market.

Addressing Fecal Sludge Management in Rural Locations

iDE is scaling supply and sales of a new type of Alternating Dual Pit product. Equipped with lime treatment service and a device to indicate when the new pit is filling, this technology allows customers to alternate pits back and forth and empty safely composted waste indefinitely. Guiding businesses deeper into the sanitation market has been a challenge, and in order to more smoothly facilitate this process iDE has increased support for businesses on ways to retain staff, provide adequate protection and equipment, and follow a cleaner, safer installation protocol.


iDE pioneered the market-based approach in sanitation, incorporating private businesses, NGOs, and government stakeholders. In 2003, iDE launched the world’s first market-based sanitation program in Vietnam, and, since then, the model has been successfully replicated across iDE’s global portfolio and by other organizations.

The association of water carriage, water supply and sanitation usage with maternal and child health

The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries. Authors: Jo-Anne L. Geere and Paul R. Hunter. International Journal of Hygiene and Environmental Health

Results: Compared to households in which no-one collects water, water fetching by any household member is associated with reduced odds of a woman giving birth in a health care facility. hw

Adults collecting water is associated with increased relative risk of childhood death, children collecting water is associated with increased odds of diarrheal disease and women or girls collecting water is associated with reduced uptake of antenatal care and increased odds of leaving a child under five alone for one or more hours, one or more days per week.

Unimproved water supply is associated with childhood diarrhea, but not child deaths, or growth scores.

When the percentage of people using improved sanitation is more than 80% an association with reduced childhood death and stunting was observed, and when more than 60%, usage of improved sanitation was associated with reduction of diarrhea and acute undernutrition.

Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection

Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection. Cochrane Database Syst Rev. 2019 Sep; 2019(9): CD011055. cochrane

Authors: Fiona Majorin, Belen Torondel, Gabrielle Ka Seen Chan, and Thomas Clasen

Evidence suggests that the safe disposal of child feces may be effective in preventing diarrhea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very‐low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.

While child feces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of feces of children of different age groups.

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017. Lancet Infectious Diseases, October 30, 2019.

Authors – GBD 2017 Diarrhoeal Disease Collaborators: Collaborators listed at the end of the Article lancet

An excerpt – Diarrhea was responsible for an estimated 533 768 deaths among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhea mortality per 100 000 globally decreased by 69·6% between 1990 and 2017.

Among the risk factors considered in this study, those responsible for the largest declines in the diarrhea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4).

Diarrhea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhea mortality.

Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhea that have already reduced diarrhea mortality could further avert many thousands of deaths due to this illness.

Surveillance of water, sanitation and hygiene in schools: A practical tool – WHO; UNICEF

Surveillance of water, sanitation and hygiene in schools: A practical tool. WHO; UNICEF, 2019. eehh

Adequate access to water, hygiene and sanitation (WASH) in schools is every child’s right, as recognized in the 2030 Agenda for Sustainable Development, the Protocol on Water and Health and the Ostrava Declaration on Environment and Health.

Access to WASH in schools in the pan-European region presents many and diverse challenges. A key step to improve the situation, bringing better educational and health outcomes, is high-quality surveillance to raise awareness and drive progress.

This publication provides a practical tool to support countries in strengthening surveillance of WASH in schools. The findings will inform the development of supportive regulations and improvement planning to safeguard children’s health, well-being, dignity and cognitive performance.

The tool also enables countries to use the data collected to facilitate policy dialogue and inform international reporting, including on progress towards achieving the Sustainable Development Goal targets related to WASH in schools.

Water Currents: WASH and Antimicrobial Resistance

Water Currents: WASH and Antimicrobial Resistance – October 1, 2019

Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria or virus change to resist the action of antimicrobials (e.g., antibiotics). Currently, it is estimated that at least 700,000 people die each year due to drug-resistant diseases.

Each year, more and more common diseases are becoming untreatable and lifesaving medical procedures are becoming much riskier due to AMR. A recent UN report on AMR (“No Time to Wait,” listed below) states that drug-resistant diseases could cause 10 million deaths each year by 2050, and that by 2030, AMR could force up to 24 million people into extreme poverty. amr

This issue of Water Currents contains recent studies on the connection between AMR and water and sanitation, the One Health approach to tackling AMR, country situation reports, and other AMR–related topics.

USAID’s priorities under the U.S. Government Global Water Strategy—improving good governance, water access, and sanitation and hygiene—are considered essential to prevent and counteract the spread of global microbial resistance. In addition, USAID’s Bureau for Global Health works with international organizations and local governments, academia, and private sector partners across Asia and Africa to promote prudent use of antimicrobials in the livestock, aquaculture, and crop production sectors to minimize the likelihood of AMR development and spread.

We would like to thank staff from the Sanitation and Hygiene Applied Research for Equity (SHARE) project, Emory University’s Center for Global Safe Water, Sanitation, and Hygiene, and Global Water 2020 for suggesting AMR as a topic and for contributing content to this issue.

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Overviews 
Antimicrobial Resistance: An Emerging Water, Sanitation and Hygiene IssueWorld Health Organization (WHO), 2015. This briefing note provides an overview on the role of water and waste in combating AMR and identifies key areas to explore related to risk assessment management, policy, and research.

No Time to Wait: Securing the Future from Drug-Resistant InfectionsWHO, April 2019. AMR is a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals. Because the drivers of AMR lie in humans, animals, plants, food, and the environment, a sustained One Health response is essential to engage and unite all stakeholders around a shared vision and goals.

Differential Drivers of Antimicrobial Resistance Across the WorldAccounts of Chemical Research, March 2019. Researchers show that high population densities in cities that suffer from poor sanitation and solid-waste disposal can potentially impact the dissemination of resistance.

Global Antimicrobial Resistance: A Complex and Dire Threat with Few Definite AnswersTropical Medicine and International Health, March 2019. Global AMR data and projections are simply alarming. Despite widespread recognition of the issue’s magnitude and urgency, the key drivers of global AMR dissemination, and how best to contain it, remain poorly defined.

The Economics of Antimicrobial Resistance and the Role of Water and Sanitation ServicesWASHeconomics, January 2019. Water, wastewater, and feces play a key role in the carriage of microorganisms and their genetic material. For example, water can act as a reservoir of antimicrobial-resistant bacteria and exposure route to humans (and animals).

Read the complete issue.

A Bibliography of WASH and Cholera Studies

A Bibliography of WASH and Cholera Studies, September 17, 2019

In response to an information request, we have compiled a bibliography of 29 studies and reports published in 2018 and 2019 that discuss WASH-related aspects of cholera epidemiology and prevention/control. Please add additional studies to this google document or contact us to add additional resources such as videos, webinars, etc.

Overviews

Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030. J Infect Dis. November 2018.  The roadmap consists of targeted multi-sectoral interventions, supported by a coordination mechanism, along 3 axes: (1) early detection and quick response to contain outbreaks; (2) a multisectoral approach to prevent cholera recurrence in hotspots; (3) an effective partnership mechanism of coordination for technical support, countries capacity building, research and M&E, advocacy and resource mobilization.

syriaBroad approaches to cholera control in Asia: Water, sanitation and handwashing. Vaccine, August 2019.  Increased research to develop and policy flexibility to implement a new generation of solutions that are designed specifically to address the physical, financial and political constraints of low-income communities offers the best prospect for reducing the burden of cholera across Asia.

Cholera Treatment Centers/Healthcare Facilities

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health, 2019. This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

Technical Note: Water, Sanitation and Hygiene and Infection Prevention and Control in Cholera Treatment Structures. Global Task Force on Cholera Control, January 2019. Cholera treatment facilities provide inpatient care for cholera patients during outbreaks. Proper case management and isolation of cholera patients is essential to prevent deaths and help control the spread of the disease.

Assessment of Recommendation for the Containment and Disinfection of Human Excreta in Cholera Treatment Centers. Water, January 2019. These findings suggest that the use of 30% hydrated lime suspensions or 2% chlorine solutions may offer a simple public health protection measure for the containment, safe handling, and disinfection of human excreta during humanitarian emergencies.

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