Category Archives: Sanitation and Health

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.

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.

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.

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.

Cloth, cow dung, cups: how the world’s women manage their periods

Cloth, cow dung, cups: how the world’s women manage their periods. The Guardian, April 2019.

For women living without access to basic sanitation, menstruation can be especially challenging. Their resourcefulness knows no bounds mhm.jpg

From animal skins and old rags to cow patties and silicon cups, women around the world use all sorts of materials to manage their periods each month.

Basic necessities for dealing properly with menstruation, such as access to clean water or a decent toilet, are simply unavailable to millions of women and girls.

Without these services, menstruation can negatively affect women’s health as well as their involvement in social and economic activities, says Louisa Gosling of WaterAid, which has published a photo gallery detailing the various ways women around the world manage their periods.

Read the complete article.

WASH in health care facilities: Practical steps to achieve universal access to quality care

WASH in health care facilities: Practical steps to achieve universal access to quality care. WHO; UNICEF, April 2019. hcf

In 2018, the United Nations (UN) Secretary-General issued a Global Call to Action to elevate the importance of and prioritize action on WASH in all health care facilities. The call recognises the important role WASH plays in preventing infections and saving lives. As such, UN agencies, Member States, and partners are now mobilizing resources to invest more in this fundamental element for providing universal, quality care.

The purpose of this document is to present eight practical actions that Member States can take at the national and sub-national level to improve WASH in health care facilities. It also summarizes the global response to the UN Secretary General’s Call to Action. This document is a companion to the WHO and UNICEF JMP 2019 SDG baseline report for WASH in health care facilities, which provides the first national, regional and global baseline estimates for monitoring SDG 6 in health care facilities.

The main audiences for this document are national health policy makers, district health managers, professionals leading quality initiatives, and health facility administrators and staff. Additional audiences include global WASH and health partners, national water and sanitation policy-makers, practitioners, researchers, and civil society.

Related links

WASH in health care facilities: Global baseline report 2019. World Health Organization; UNICEF.

WASH in health care facilities: Global baseline report 2019. World Health Organization; UNICEF, April 2019.  hcf

WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), have produced regular updates on water, sanitation and hygiene (WASH) since 1990.

Together, they are responsible for monitoring the 2030 Sustainable Development Goal (SDG) targets 6.1 and 6.2 and supporting global monitoring of other WASH-related SDG targets and indicators.

This first JMP report on WASH in health care facilities introduces new service ladders for basic services and establishes national, regional and global baseline estimates that contribute towards global monitoring of SDG targets 6.1 and 6.2 –universal access to WASH.

The 2019 WHO and UNICEF “WASH in health care facilities. Practical steps for universal access” is intended as a companion document to this report.

The social dynamics around shared sanitation in an informal settlement of Lusaka, Zambia

The social dynamics around shared sanitation in an informal settlement of Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development, March 2019.

This study explored the social dynamics affecting collective management of shared sanitation in the Bauleni compound of Lusaka, Zambia. In-depth interviews were conducted with landlords (n = 33) and tenants (n = 33). Elinor Ostrom’s eight design principles for the management of common-pool resources was used as a framework to analyse the data. jnl

Social capital within plots was also assessed. Pit latrines were predominantly shared by landlords and tenants on residential plots. However, unwelcome non-plot members also used the latrines due to a lack of physical boundaries. Not all plot members fulfilled their cleaning responsibilities equally, thereby compromising the intended benefits for those conforming. Landlords typically decided on latrine improvements independent of tenants.

Latrines were not systematically monitored or maintained, but punishment for non-conformers was proportionate to the level of infraction. There was no system in place for conflict resolution, nor local organizations to regulate the management of sanitation. Lastly, there were few enterprises associated with peri-urban sanitation.

Social capital was moderately high, and tenants were willing to invest money into improving sanitation. The social dynamics illuminated here provide an important basis for the development of a behavioural intervention targeted towards improving urban sanitation.

OPINION: If you’re safe from cholera, thank my dad, a plumber (and thank the ancient Romans)

OPINION: If you’re safe from cholera, thank my dad, a plumber (and thank the ancient Romans). by Lindsay Denny, USA Today, March 11, 2019.

I come from a family of plumbers, and we’ve heard our share of plumber’s crack jokes. But there’s nothing funny about sanitation in public health.

My father once told me that plumbers were the original public health professionals. Growing up, I never gave the sentiment much thought. Mostly, I just heard a lot of plumber’s crack jokes as a kid, and our family’s vacation photos were punctuated with unique toilets my dad came across on our travels. That’s because plumbing is our family business — quite literally.


The author and her father, Scott Denny, in Madrid, Spain, in 2016. (Photo: Family handout)

He and all of his brothers are plumbers, just like their father and uncle. Many of my cousins have worked for the family’s company at some point. Yet, even as I pursued a degree in global health, I never paused to consider the long-standing health impact of their work.

So I will never forget the look on my dad’s face when I told him that I had been hired to bring awareness to a newly recognized, massive gap in health care — the lack of clean water and sanitation, and by extension hygiene, inside tens of thousands of hospitals in developing countries.

Read the complete article.