Category Archives: Sanitation and Health

Microplastics in drinking-water – WHO

Microplastics in drinking-water. WHO, 2019.

Recommendations microplastics

  • Water suppliers and regulators should continue to prioritize removing microbial pathogens and chemicals from drinking-water that are known significant risks to human health. As part of water safety planning, water suppliers should ensure that control measures are effective, including optimizing water treatment processes for particle removal and microbial safety, which will incidentally improve the removal of microplastic particles. Routine monitoring of microplastics in drinking-water is not necessary at this time.
  • To better assess the human health risks and inform management actions, researchers should undertake targeted, well-designed and quality-controlled investigative studies to better understand the occurrence of microplastics in the water cycle and in drinking-water throughout the water supply chain, the sources of microplastic pollution and the uptake, fate and health effects of microplastics under relevant exposure scenarios.
  • Irrespective of any human health risks posed by exposure to microplastics in drinking-water, measures should be taken by policy makers and the public to better manage plastics and reduce the use of plastics where possible, to minimize plastics released into the environment because these actions can confer other benefits to the environment and human well-being.

WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhea

The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrheaLancet Global Health, August 2019.wateraid

Summary: Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household.

We have completed three randomised efficacy trials testing improved household-level WASH with and without improved infant and young child feeding (IYCF) on stunting and diarrhoea in Bangladesh, Kenya, and Zimbabwe. In all trials, improved IYCF had a statistically significant benefit, but WASH had no effect on linear growth.

In observational analyses of data from the control groups of the three trials, baseline sanitation was a strong risk factor for stunting in the study populations, suggesting this frequently reported association might be confounded by unmeasured factors of household wellbeing. WASH interventions reduced diarrhoea in Bangladesh, but not in Kenya or Zimbabwe.

Intervention promoters visited participants six times per month in Bangladesh compared with monthly in Kenya and Zimbabwe; a review of the literature shows that virtually all published studies that have reported an effect on diarrhoea through home-based water treatment and handwashing promotion achieved high adherence by visiting participants at daily to fortnightly intervals.

Despite achieving substantial behavioural change and significant reduction in infection prevalence for some enteric pathogens, detection of enteropathogens among children in the WASH groups of the trials was typically at ten times higher prevalence compared with high-income countries.

Considering these results, we recommend that future research in the WASH sector focus on developing and evaluating interventions that are radically more effective in reducing faecal contamination in the domestic environment than the interventions implemented in these trials.

Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India

Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India. BMC Public Health, July 10, 2019.

Authors: David M. Berendes, Juan S. Leon, Amy E. Kirby, Julie A. Clennon, Suraja J. Raj, Habib Yakubu, Katharine A. Robb, Arun Kartikeyan, Priya Hemavathy, Annai Gunasekaran, Sheela Roy, Ben Chirag Ghale, J. Senthil Kumar, Venkata Raghava Mohan, Gagandeep Kang and Christine L. Moe

Open drains are common methods of transporting solid waste and excreta in low-income urban neighborhoods. Open drains can overflow due to blockages with solid waste and during rainfall, posing exposure risks. The goal of this study was to evaluate whether pediatric enteric infection was associated with open drains and flooding in a dense, low-income, urban neighborhood.

Children in areas susceptible to open drain flooding had increased odds of enteric infection as rainfall increased. Results suggested that infection increased with rainfall due to neighborhood infrastructure (including poor fecal sludge management) and not frequency of contact. Thus, these exposures may not be mitigated by changes in personal behaviors alone. These results underscore the importance of improving the neighborhood environment to improve children’s health in low-income, urban settings.

An Ebola Update – Emergency WASH Biweekly Update, June 28, 2019

financeNews Articles/Blog Posts

Ebola in the DRC: everything you need to know. The Guardian, June 25, 2019. Key facts about the second largest outbreak of the disease in history.

“Ebola will be eradicated…it doesn’t mean it won’t come back.” BBC Podcast, June 28. Dr Tedros Adhanom Ghebryesus – Chief Executive of the World Health Organisation – has recently got back from a fact-finding visit to the DRC and neighboring Uganda.

Uganda: Ebola Now Under Control, Says Govt. AllAfrica, June 28, 2019. Government has said they are on top of the game in preventing the further spread of the Ebola Viral Disease (EVD), which has ravaged neighboring Democratic Republic of Congo (DRC) for a year now.

USAID chief: Key to containing Ebola is transparency. Devex, June 19. Research from John Hopkins University found that a lack of understanding of the disease and a lack of trust in institutions to put in place a control strategy could be a reason the virus has spread more rapidly in recent months than it did at the beginning of the outbreak.

STUDIES/REPORTS

Ebola virus disease – Democratic Republic of the Congo, Disease outbreak news: Update, 27 June 2019. WHO. In the 21 days, between 5 to 25 June 2019, 67 health areas within 19 health zones reported new cases, representing 10% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 252 confirmed cases were reported.

Effectiveness of Dettol Antiseptic Liquid for Inactivation of Ebola Virus in Suspension. Nature, Scientific Reports, April 2019. The rapid and substantial inactivation of EBOV/Mak by DAL suggests that use of this hygiene product could help prevent the spread of Ebola virus disease during outbreaks.

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Menstrual hygiene management in humanitarian situations

May 28, 2019 is Menstrual Hygiene Day and below are excerpts from the May 23, 2019 issue of Water Currents: Menstrual Hygiene Day 2019 on menstrual hygiene management in humanitarian situations.

Events
Menstrual Hygiene Day 2019 – This global advocacy platform for MH Day brings together the voices and actions of nonprofits, government agencies, individuals, the private sector, and the media to promote MHM for all women and girls. This website contains campaign materials for this year’s theme—It’s Time for Action—and a list of events and resources. mhday2019

WASH Innovation Challenge on Menstrual Hygiene Management (MHM) and Incontinence – Elrha’s Humanitarian Innovation Fund is launching a challenge May 23, 2019, and will be seeking innovative projects exploring how to design safe and dignified MHM spaces in emergency camp settings and how to better engage with and understand the needs of people with incontinence in emergencies. We will especially welcome applications from broad partnerships that include NGOs as well as designers, academic institutions and local organisations, and we expect that any approach would take a participatory and user-centred approach to developing the innovation. Additional information will soon be posted on the Elrha’s website. You can also get in touch with Cecilie Hestbaek, c.hestbaek@elrha.org, and Sophie Van Eetvelt, s.vaneetvelt@elrha.org, for more information and advice on how to prepare for the call.

MHM and Humanitarian Situations
Pilot Study Findings on the Provision of Hygiene Kits with Reusable Sanitary PadsUnited Nations Refugee Agency (UNHCR), December 2018. In collaboration with AFRIpads, UNHCR Sub-Office Mbarara implemented a three-month pilot intervention to test the acceptability of introducing reusable sanitary pads to schoolgirls in the refugee context.

Periods Don’t Stop in Emergencies: Addressing the Menstrual Hygiene Needs of Women and GirlsHumanitarian Innovation Fund, August 2018. This article discusses the challenges that women and girls face around menstrual hygiene in emergencies.

Exploring Menstrual Practices and Potential Acceptability of Reusable Menstrual Underwear among a Middle Eastern Population Living in a Refugee SettingInternational Journal of Women’s Health, July 2018. Primary data analysis of narratives around the beliefs, behaviors, and practices of menstrual hygiene in this population revealed key themes related to the physical environment; the social environment; cleanliness, comfort, and health; and adaptation and coping.

Pilot Testing and Evaluation of a Toolkit for Menstrual Hygiene Management in Emergencies in Three Refugee Camps in Northwest TanzaniaJournal for International Humanitarian Action, June 2018.  This paper describes the development and pilot testing of the Menstrual Hygiene Management in Emergencies Toolkit in three camps hosting Burundian and Congolese refugees in northwest Tanzania.

Improving Menstrual Hygiene Management in Emergency Contexts: Literature Review of Current PerspectivesInternational Journal of Women’s Health, April 2018. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts to understand the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations’ menstrual needs.

Menstrual Hygiene Management in Emergencies ToolkitColumbia University Mailman School of Public HealthInternational Rescue Committee, 2017. The toolkit provides streamlined guidance to support organizations and agencies seeking to rapidly integrate MHM into existing programming across sectors and phases.

MHM and Waste Disposal
Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the LiteratureInternational Journal of Environmental Research and Public Health, November 2018. A literature review showed that MHM and sanitation value chains often neglect the disposal of menstrual waste, leading to improper disposal and negative impacts on users, sanitation systems, and the environment.

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal of Environmental and Public Health, February 2018. At home, women dispose of menstrual products with other domestic waste. Outside of the home, they often flush them in public toilets without knowing the consequences of choking sewer pipelines.

Menstrual Waste Management: A Simple GuideMinistry of Drinking Water and Sanitation, Government of India, 2019. This guide discusses composting and small-scale incineration of disposed menstrual hygiene products.

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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.


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.