Category Archives: Sanitation and Health

WHO update on cholera in 2018

November 29, 2019 – Weekly Epidemiological Record

An excerpt – While the true global disease burden is not entirely captured by annual reporting of cholera epidemiological indicators by Member States to WHO, the overall number of cholera cases was 60% lower in 2018 than in 2017. who

The decrease in the global cholera burden is attributable to a large reduction in the number of cases in Yemen and significant decreases in other countries, such as the Democratic Republic of Congo (DRC), Somalia and South Sudan.

Overall, in 2018, 34 countries reported 499 447 cholera cases and 2990 cholera deaths to WHO, with a case-fatality rate (CFR) of 0.6% (Figure 1, Map 1 and Table 1).

Africa – Overall, in 2018, 34 countries reported 499 447 cholera cases and 2990 cholera deaths to WHO, with a case-fatality rate (CFR) of 0.6% (Figure 1, Map 1 and Table 1). After exclusion of cases reported in Yemen (where reporting is imprecise), the total numbers of cases and deaths reported globally in 2018 were 128 121 and 2485, respectively, a 34% decrease in the number of cases and a 27% decrease in that of deaths from 2017. The case load represents the fewest cases reported worldwide since 2004, when there were 101 383 cases (with 2345 deaths).

The epidemiology of cholera on the African continent showed the typical regional tendency. In West Africa, cholera transmission was high in Nigeria (with 45 000 cases in 2018 and only 12 000 in 2017), with subsequent spill-over into Cameroon and Chad. Other countries in the West African region saw no cholera cases, and only 2 cases were reported in Liberia.

Middle East and Asia – As in 2017, Yemen reported by far the most cholera cases in a single country in 2018, with 371 326 cases and 505 deaths (Figure 2). This nevertheless represented a great improvement over the previous year, with a 64% decrease in the number of cases and a 78% decrease in the number of deaths. While the way in which cholera cases were reported changed during the year, the decreases in numbers of cases and deaths represented greater mobilization by the Government and partners in improving water, sanitation and hygiene and in providing adequate medical care of cases.

The Americas – In Haiti, a strategy for an integrated rapid response to outbreaks resulted in 2018 in the fewest cases since the start of the cholera epidemic in 2010 (Figure 2). The Dominican Republic continues to report relatively few cases, and the number is decreasing over time, in parallel with the numbers in Haiti.

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Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper

Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper, November 2019. Children wash their hands outside school in Samabogo, Mali.

The WHO/UNICEF position paper summarizes the studies, contextualizes the findings within the wider body of evidence and distills the implications for future investments. The paper is accompanied by a recorded interview with the heads of WASH for WHO and UNICEF and the lead author of a consensus statement from leading researchers.

An excerpt – What are the implications for WASH programming?

The findings of WASH Benefits and SHINE are not a reason to do less on WASH. Conversely, the historical significance of WASH in disease control, the strong conceptual basis for WASH (Box 2) and the need for WASH to reduce the potential for outbreaks in addition to breaking endemic transmission all indicate that the WASH sector collectively needs to do more and better to reach the ambitious targets of the SDGs.

The findings also highlight blind spots in typical WASH programming – particularly the role of animal waste and fecal contamination of food during irrigation and food preparation that are often overlooked in WASH programme design.

Many have called for transformative WASH In response to the studies but with some ambiguity around what is meant. While the consensus is that this implies interventions that lead to a comprehensively clean environment (Box 1), the path to this result is not universally agreed.

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh. World Bank, November 2019.

Despite Bangladesh’s notable progress toward the eradication of open defecation, the country still faces severe deficits in the availability of improved sanitation. bank

This paper analyzes the impact of exposure to unimproved sanitation early in childhood on primary school enrollment status, using pseudo-panel data for children ages six to nine years in Bangladesh.

The results indicate that unimproved sanitation has a negative and significant impact on primary school enrollment. A child’s early exposure to unimproved sanitation decreases the likelihood of being enrolled in primary school by eight to ten percentage points on average compared with a child with access to improved sanitation.

The effect is particularly strong — a difference of 8 to 10 percentage points — for children ages six to seven. It is also strong in rural areas. The results are statistically robust to errors due to potential omitted variable bias.

What Makes Ghanaians More Likely to Stop Open Defecation and Build Latrines?

What Makes Ghanaians More Likely to Stop Open Defecation and Build Latrines? Global Comunities, November 2019.

This brief focuses on the findings from studies in Ghana. This knowledge product is developed by Global Communities in order to make the findings and recommendations of the full report more accessible and actionable by the Government of Ghana Ministry of Sanitation and Water Resources (MSWR) as well as by other development partners working in rural sanitation in Ghana. global

The Government of Ghana MSWR has basic sanitation guidelines to achieve 100% open defecation-free (ODF) status and equitable and adequate access to sanitation and hygiene for all by 2030, with special emphasis on the poor and vulnerable.

This knowledge product is part of the USAID-funded WASH for Health program to provide sustainable access to dignified, safe, and improved water supply and sanitation, and to educate people on the knowledge and behaviors necessary to live a healthy lifestyle. In particular, the WASH for Health program targets rural communities where these services are needed the most and helps achieve the goals of the MSWR in Ghana.

Key Findings

  • Factors that determine the success of CLTS interventions are attendance rate of participants during the triggering event, the number of community leaders participating in the triggering event, whether participants believed they would receive rewards like installation of water wells and materials for toilets, and the number of follow-up visits provided by facilitators weeks after triggering.
  • Households that socially identify strongly with their communities are more likely to construct latrines after CLTS interventions.
  • Combining CLTS with other behavior change models did not significantly increase intervention effects.

Health, safety and dignity of sanitation workers – WaterAid

Health, safety and dignity of sanitation workers. WaterAid, November 2019.

Sanitation workers provide an invaluable public service, vital to our daily lives and the environment. Yet they often work in conditions that expose them to the worst consequences of poor sanitation – debilitating infections, injuries, social stigma and even death – every day. wateraid.jpg

We have joined forces with the World Bank, the World Health Organization and the International Labour Organization to shed light on this neglected issue. Our report is the most extensive global exploration of the topic to date.

In it we analyse the problems sanitation workers face – focusing on those emptying pits and tanks and maintaining sewers – and explore good practices around the world. We suggest areas of action to ensure sanitation workers: have their rights recognized; are supported to organize as a labour force; and have their working conditions improved and progressively formalized.

Read the complete article.

Crossing the Finish Line:  Sustaining Behavior Change for the Prevention and Elimination of NTDs

Crossing the Finish Line:  Sustaining Behavior Change for the Prevention and Elimination of NTDs

By the NNN WASH Working Group

Access to water, sanitation and hygiene (WASH) is a fundamental human right. Improvements in health and increasing life expectancy across much of the world can be attributed to investments that improve environmental conditions and healthy behaviors.

However, inequities in accessing services mean that many of the world’s poorest and most vulnerable communities still lack sustained access to WASH infrastructure of sufficient quality.

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Shelmel Terefa, a school teacher, demonstrates face washing to students at his school in Aware-Golje village in the North Shewa Zone, Oromia, Ethiopia. Photo credit: Michael Amendolia/The Fred Hollows Foundation

This leads to ill-health, including neglected tropical diseases (NTDs), which exacerbate social and economic challenges and can trap entire communities in a cycle of poverty and marginalization.

The presence of NTDs is an indicator of the need to improve access to WASH. Many NTDs, such as trachoma, soil transmitted helminths and schistosomiasis, are preventable through practicing the same behaviors, such as reducing open defecation, maintaining sanitation facilities, and hand and face washing with soap.

Other NTDs require WASH access to treat the symptoms caused by the disease, such as personal hygiene to reduce the occurrence of acute attacks in people with lymphedema due to lymphatic filariasis.

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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.