A new international study published today in The Lancet provides the clearest picture yet of the impact and most common causes of diarrheal diseases, the second leading killer of young children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa.

GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, confirmed rotavirus – for which a vaccine already exists – as the leading cause of diarrheal diseases among infants and identified other top causes for which additional research is urgently needed. GEMS found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhea (MSD) each year, which increased children’s risk of death 8.5-fold and led to stunted growth over a two-month follow-up period.

“Until now, comprehensive data on the burden of diarrheal diseases in Asia and sub-Saharan Africa has been limited,” said Dr. Myron M. Levine, GEMS Principal Investigator and Professor at the University of Maryland School of Medicine. “By filling critical gaps in knowledge, we hope GEMS will help countries across these two highest-burden regions focus their efforts to improve child health.” Despite many causes, GEMS found that targeting just four pathogens could prevent the majority of MSD cases. Expanding access to vaccines for rotavirus, the leading cause of MSD among infants at every site, could save hundreds of thousands of lives. Likewise, GEMS data suggests that accelerating research on vaccines, treatments and diagnostics for the three other leading pathogens – Shigella, Cryptosporidium and ST-ETEC, a type of E. coli – could have a similar impact.

Prior to GEMS, Cryptosporidium was not considered a major cause of diarrheal disease and as a result there is currently little research on this pathogen underway. “The GEMS findings help set priorities for investments that could greatly reduce the burden of childhood diarrheal diseases,” said Dr. Thomas Brewer, deputy director of the Enteric & Diarrheal Diseases team at the Bill & Melinda Gates Foundation, which funded the study. “Vaccines and treatments available today can save thousands of children right now but targeted research to develop new tools to combat severe diarrhea could save many more lives in the future.”

The GEMS findings also suggest that longer-term monitoring and care of children with diarrheal diseases could reduce mortality and developmental delays. Children with MSD grew significantly less in height in the two months following the diarrheal episode when compared with control children without diarrhea, and were 8.5 times more likely to die over the course of the two-month follow-up period. Notably, 61 percent of deaths occurred more than a week after the initial diarrheal episode, with 56 percent of deaths happening after families had returned home from a healthcare facility.

“GEMS strongly indicates that follow-up care after the initial diarrheal episode is critical to protect the health and wellbeing of children,” said Professor George Griffin, Senior Co-Chair of the GEMS International Strategic Advisory Committee and Professor at St. George’s, University of London. “By focusing only on the acute diarrhea that brings children to hospitals, we overlook a significant portion of diarrheal diseases’ burden.” Expanding access to existing interventions that protect against or treat all diarrheal diseases, including oral rehydration solutions, zinc supplements, clean water and sanitation, can save lives and improve the health of children immediately.

“GEMS is a landmark study for the child health community,” said Professor Fred Binka, Co-Chair of the GEMS International Strategic Advisory Committee and Vice-Chancellor at the University of Health and Allied Sciences, Ghana. “By using consistent methods across countries, GEMS sites generated data that can guide evidence-based decision making at both the local and global levels.” Release of the GEMS findings follows last month’s announcement by the World Health Organization and UNICEF of the first-ever Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD). The GEMS findings add to the scientific evidence cited in the GAPPD strategy for effectively controlling pneumonia and diarrhea, which together are the two leading causes of death among young children globally. ### About GEMS GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, was a case-control study conducted at seven diverse, high-burden sites in Asia and Africa: the Gambia, Kenya, Mali, Mozambique, Bangladesh, India and Pakistan. The study enrolled 22,568 children under five years of age, a sample size that is large enough to provide comprehensive data on the causes, incidence and impact of the range of diarrheal diseases affecting children around the world. GEMS established a network of well-equipped laboratories in the study countries that can be used to accelerate future research on diarrhea and other child health priorities. Investigators have provided open access to their data, which can provide baselines for further studies. Supplemental materials on GEMS methods and sub-studies can be found in Clinical Infectious Diseases (volume 55, supplement 4, and December 2012) and the American Journal of Tropical Medicine and Hygiene. Additional analyses of GEMS data are ongoing. For further information, please visit http://medschool.umaryland.edu/GEMS/. About the Center for Vaccine Development The Center for Vaccine Development (CVD) at the University of Maryland School of Medicine in Baltimore has earned an international reputation as an academic vaccine development enterprise. Since its inception in 1974, the Center is known for creating and testing vaccines against cholera, typhoid fever, paratyphoid fever, non-typhoidal Salmonella disease, shigellosis (bacillary dysentery), Escherichia coli diarrhea, malaria, and other infectious diseases, including influenza. Its global staff includes molecular biologists, microbiologists, immunologists, internists, pediatricians, epidemiologists, malariologists, biostatisticians and informaticians. The CVD is engaged in the full range of vaccinology, from basic laboratory science research through vaccine development, early clinical evaluation, large-scale pre-licensure field studies and post-licensure assessments. In addition to its research and outpatient facilities in Baltimore, Maryland, the CVD has facilities to conduct clinical studies in Mali, West Africa, Malawi, Southern Africa and Santiago, Chile and undertakes time-limited field studies in many other countries in Africa, Asia and Latin America.

Source: University of Maryland, May 13, 2013.

• Link to full text, pdf

Eliminating open defecation is increasingly seen as a key health outcome, with links to reduced stunting, improved educational and positive health outcomes for children. In Sub Saharan Africa, over 35 countries are implementing some form of CLTS, ranging from TATS in Tanzania to CLTSH in Ethiopia. Since the introduction of CLTS in 2005 in the region, rapid scale-up has been achieved with suggested numbers of ODF communities in the range of 30,000 affecting over 15 million people in SubSaharan Africa. Several countries have set aggressive targets for elimination of Open Defecation in rural areas for the next five years which often include not only safe disposal of faeces but handwashing facilities, cleanliness and solid waste management.

Sustaining the progress made through the application of the CLTS process is emerging as a challenge with experience suggesting that sustainability is determined by the process followed to achieve ODF. Rapid scale up in SSA is arguably linked to the fact that CLTS is based on the concept of triggering community-wide behaviour change, requires no subsidies and integrates easily into existing health programming structures. Current focus is on ‘triggering’ communities into action; while considerably less resources and emphasis on following up and mentoring of communities ‘post-triggering’.

This paper reviews process and protocol for defining, reporting, declaring, certifying ODF and sustaining ODF, highlighting where the process varies between countries and potential determinants of sustainability within the process itself. Critical questions include what elements (should) constitute an ODF protocol, what are the determinants of sustainability and what impact does target-setting have on achievement of ODF goals in country?

WSA selected Indah Water “to be in a technical committee formed by the Bill and Melinda Gates Foundation to propose immediate, medium- and long-term solutions for sanitation services in WSA member countries”. In 2011-2012 WSA received three Gates Foundation grants totalling US$ 7.2 million, one of which to develop sanitation financing models for urban poor and another to set an African Sanitation Think Tank.

Chief Executive Officer Datuk Abdul Kadir Mohd Din said that the Gates Foundation “had sent a team of wastewater experts from the United States to visit Indah Water after visiting the African continent and Asean countries”.

Indah Water is Malaysia’s national sewerage company. In 1994, the Federal Government awarded the company the concession for nationwide sewerage services which before were the responsibility of local authorities.

Water and Sanitation for Africa (WSA) is a Pan African Inter-governmental Agency based in Burkina Faso, previously known as the African Regional Centre for Water and Sanitation (CREPA). WSA has a presence in 32 African countries.

Source: Bernama, 16 May 2013

Therefore, WSSCC is now calling for proposals by 7 June 2013 for “GSF Mid-Term Evaluation Consulting Services”. For more information about the consultancy, please click on this link:

http://www.wsscc.org/about-us/jobs

The mid-term evaluations of GSF programmes in ten countries will be clustered in two batches of five countries in 2013 and 2014/2015 respectively. The assignment covers design and implementation of the mid-term evaluations as well as analysis, consolidation and dissemination of findings as per the Terms of Reference.

As of 31 March 2013, the GSF programmes are implemented in ten countries: Cambodia, Ethiopia, India, Madagascar, Malawi, Nepal, Nigeria, Senegal, Tanzania and Uganda. In addition, programme preparation is on-going in another six countries; Bangladesh, Benin, Burkina Faso, Kenya, Pakistan and Togo. Sanitation and hygiene awareness-raising and promotion activities in the first ten countries with GSF programmes has resulted in 1.4 million people having improved toilets, and more than 1 million people in nearly 4,000 communities who are now living in open defecation free environments.

Everyone on North Tarawa now has access to improved sanitation. Photo: ABC Radio Australia / UNICEF Pacific.

North Tarawa in Kiribati is the first island in the Pacific to be declared open defecation free, thanks to the “Kiriwatsan I Project”. The Ministry of Public Works is implementing this project with technical support from UNICEF and funding from the European Union.

North Tarawa is made up of a string of islets with a combined population of 6,102 (2010) and a land area of 15.26 sq.km.  Previously about 64 per cent of people used the beaches and mangroves for defecation and dumping their rubbish.

UNICEF spokeswoman Nuzhat Shahzadi says that diarrhoeal diseases cause 15 per cent of the deaths of children under five in Kiribati.

In March 2013, North Tarawa adopted the Community-Led Total Sanitation (CLTS) approach following a training of trainers course conducted by Dr Kamal Kar. The CLTS pioneer wrote that he had convinced Kiribati President Anote Tong to set December 2015 as the target date for the whole nation to become open defecation free.

The villagers of North Tarawa dig shallow pits and use local materials like brick and coconut leaves to build the toilet superstructure. They keep water and soap in one corner. After using the toilet, the villagers sprinkle ash to stop the smell and flies getting in, and then keep it covered.

Ms Shahzadi said that the women and girls were very happy that no longer have to go out on the beach in the middle of the night if they need to use the toilet.

Source: UNICEF, 11 May 2013 ; Radio New Zealand International, 13 May 2013 ; ABC Radio Australia, 14 May 2013

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

• WHO – Cholera
• CDC – Cholera
• MSF Field Research – Cholera

Source: UNICEF, 15 May 2013

“If women can have moustaches we can all talk about menstruation”. With this message WASH United kicked off May MENSTRAVAGANZA, a 28-day campaign to raise awareness and break the silence around menstruation and menstrual hygiene.

Messages are posted on the campaign website:
wash-united-may-menstravaganza.tumblr.com and
on Twitter using hashtag #MENSTRAVAGANZA

Map showing frequency & severity of violence against
women in Bhalswa slum, Delhi. Shirley Lennon/SHARE.

The lack of safe toilets for women and girls is often linked to an increased risk of sexual harassment and rape. Earlier studies [1] from Kenya, Uganda and India, and now a recent BBC news item are some of the few sources to actually quantify this risk.

Senior police official Arvind Pandey from the Indian state of Bihar told the BBC that 400 women would have “escaped” rape in 2012 if they had toilets in their homes. The rapes take place when women go outside to defecate early in the morning and late evening. These “sanitation-related” rapes make up nearly half of the more than 870 cases of rape in Bihar in 2012.

The BBC news item lists three specific cases:

• On 5 May, an 11-year-old girl was raped in Mai village in Jehanabad district when she was going to the field at night
• On 28 April, a young girl was abducted and raped when she had gone out to defecate in an open field in Kalapur village in Naubatpur, 35km (21 miles) from the state capital, Patna
• On 24 April, another girl was raped in similar circumstances on a farm in Chaunniya village in Sheikhpura district. She told the police that two villagers had followed and raped her. One of them has been arrested

In Bihar , 75.8% of homes have no toilet facilities (Census 2011). Some 49% of the households without a toilet wanted one for “safety and security” for women and children, according to a study by Population Service International (PSI),   Monitor Deloitte and Water for People.

[1] Heise, L., 2013. Danger, disgust and indignity : women’s perception of sanitation in informal settlements. Powerpoint presented at “Making connections: Women, sanitation and health”, 29 April 2013, London School of Hygiene and Tropical Medicine (LSHTM). Video version available at:  http://www.youtube.com/watch?v=AS9ulpJqh7s

Related news:

• Request for Proposals: The effects of poor sanitation on women and girls in India, Sanitation Updates, 07 Mar 2013
• India, Delhi: how sexual violence against women is linked to water and sanitation, E-Source, 27 Mar 2012

Source: Amarnath Tewary, BBC, 09 May 2013

Septage disposal. Sri Lanka/Nuwara Eliya sanitation project, 2008, Photo: Flickr/USAID.

An international research institute is helping the government of Sri Lanka to improve septage management in the country.

On 8 May 2013, the Colombo-based International Water Management Institute (IWMI) and the Ministry of Water Supply and Drainage signed a Memorandum of Understanding that provides a collaborative framework for sustainable septage management in Sri Lanka.

IWMI will contribute research data for the drafting of a septage management component of the national sanitation policy. The Ministry will lead implementation of the policy through an advisory committee headed by Minister Dinesh Gunawardena.

Only about 3% of Sri Lankans have a sewerage connection while the rest rely on latrines and septic tanks for sanitation. Safe disposal of septage (fecal sludge) is a problem because of a lack of treatment facilities in large parts of the country.

IWMI is studying a new approach in cities around the world, which treats the sludge so that it can be safely reused as agricultural fertiliser. With the rising costs of imported fertiliser, such an approach would not only benefit farmers but also allow better sanitation and environmental protection for all.

Related news:

• The business of the honey-suckers in Bengaluru (India), E-Source, 27 Sep 2012
• WASHplus Weekly: Focus on Fecal Sludge Management, Sanitation Updates, 30 Nov 2012

Related web sites:

• IWMI - Resource Recovery and Re-use
• Ministry of Water Supply and Drainage
• SuSanA - WG 5 – Food security and productive sanitation systems and Library – Fecal sludge management

 Source: IWMI, 8 May 2013

Posted created in 1940 by John Buczak for the US Federal Art Project. Collection Library of Congress

During the Great Depression in the 1930s, the US Government launched a series of economic programmes collectively known as the New Deal. The largest  of these programmes, run by WPA, the Works Progress Administration (renamed in 1939 as the Work Projects Administration), employed millions of unemployed people to carry out public works projects. Most famous was the WPA Federal Art Project (FAP) that employed musicians, artists, writers, actors and directors in large arts, drama, media, and literacy projects.

The FAP created over 200,000 separate works including 2,000 posters. Shown  here are several posters promoting sanitation and hygiene from the WPA poster collection of the Library of Congress.

Poster created by unknown artist for the WPA Federal Art Project. Collection Library of Congress.

Poster created by Robert Muchley between 1941 and 1943 for the WPA Federal Art Project . Collection Library of Congress [

Poster created by Erik Hans Krause between 1936 and 1939 for the WPA Federal Art Project, Collection Library of Congress

Poster created by unknown artist in 1936 or 1937 for the WPA Federal Art Project. Collection Library of Congress.

2013

• May 4: Water & Food Security
• Apr 26: Focus on Cookstoves & the Environment
• Apr 19: Focus on Handwashing
• Apr 12: Focus on Financing WASH Services
• Apr 5:  Focus on Urban Sanitation
• Mar 29: Focus on Household Air Pollution
• Mar 21: Focus on World Water Day 2013
• Mar 15: Focus on WASH Sustainability
• Mar 8: Focus on Gender Issues
• Feb 22: Focus on Sanitation Marketing
• Feb 15: Focus on Household Water Treatment & Safe Storage
• Feb 8: Focus on Neglected Tropical Diseases
• Feb 1: Focus on Cookstove Stacking
• Jan 25: Focus on WASH & Maternal Health
• Jan 18: Focus on Post-2015 MDG Goals
• Jan 11: Focus on WASH and Environmental Conservation

2012

• Dec 21: Focus on HAP & the Global Burden of Disease
• Dec 14: Focus on Community-Led Total Sanitation
• Dec 7: Focus on Water Kiosks
• Nov 30: Focus on Fecal Sludge Management
• Nov 16: Focus on World Toilet Day 2012
• Nov 9: Focus on World Pneumonia Day 2012
• Nov 2: Focus on Water Conflicts
• Oct 26: Focus on Climate Change
• Oct 19: Focus on Waste Pickers
• Oct 12: Focus on Global Handwashing Day 2012
• Oct 5: Focus on Water Technologies
• Sept 28: Focus on WASH & Household Energy Entrepreneurs
• Sept 14: Focus on Household Water Treatment & Safe Storage
• Sept 7: Focus on WASH & Child Survival

• Aug 31: Focus on Biogas for Cookstoves
• Aug 24: Focus on Multiple-Use Water Services
• Aug 17: Focus on WASH & Food Security
• Aug 10: Focus on Cholera Prevention & Control
• Aug 3: Focus on Menstrual Hygiene Management
• July 27: Focus on Marketing Cookstoves
• July 20: Focus on HIV/AIDS & WASH
• July 13: Focus on Soil-Transmitted Helminth Infections
• July 6: Focus on Community-Led Total Sanitation
• June 29: Focus on WASH in Emergencies
• June 8: Focus Public-Private Partnerships
• June 1: Focus on WASH-related Diseases
• May 25: Focus on WASH & Indoor Air Pollution
• May 18: Focus on Water Security
• May 11: Focus on Sludge Management
• May 4: Focus on Self-Supply
• Apr 27: Focus on Cookstove Adoption
• Apr 20: Focus on Small-Scale WASH Service Providers
• Apr 13: Focus on Hygiene Behavior
• Apr 6: Focus on the Informal Sector & Solid Waste Management
• Mar 30: Focus on Nanotechnology
• Mar 23: Focus on Urban Health
• Mar 8: Focus on Gender Issues in WASH and IAP
• Mar 2: Focus on Multiple-Use Water Services
• Feb 24: Adoption of WASH & IAP Interventions
• Feb 17: Focus on Ecological Sanitation
• Feb 10: Focus on Neglected Tropical Diseases
• Feb 3: Focus on Household Water Treatment & Safe Storage
• Jan 27: Focus on Health Impacts of WASH & IAP Interventions
• Jan 20: Focus on Community-Led Total Sanitation
• Jan 6: Focus on WASH & IAP Technologies

2011

• Dec 16: Focus on Financing WASH & IAP Interventions
• Dec 9: Focus Water Safety Plans
• Dec 2: Focus on Rainwater Harvesting
• Nov 18: Focus on World Toilet Day
• Nov 11: Focus on Pneumonia Prevention
• Nov 4: Focus on Water Point Mapping
• Oct 28: Focus on Menstrual Hygiene Management
• Oct 21: Focus on Carrying Water
• Oct 14: Focus on Climate Change
• Oct 7: Focus on Handwashing
• Sep 30: Focus on Humanitarian Assistance
• Sep 23: Focus on Sanitation Marketing
• Sep 9: Focus on Reuse in Sanitation
• Sep 2: Focus on WASH for the Disabled
• Aug 19: Focus on Sludge Management
• Aug 12: Focus on Cholera Prevention & Control
• Aug 5: Focus on Indoor Air Quality
• July 29: Focus on Prevention of Diarrhea
• July 22: Focus on Drinking Water Quality
• July 15: Focus on HIV/AIDS & WASH
• July 8: Focus on Marketing Approaches
• July 1: Focus on Household Water Treatment & Safe Storage
• June 24: Focus on Hygiene Behavior
• June 17: Focus on Mobile Technologies
• June 10: Focus on Monitoring & Evaluation
• June 3: Focus on Health Impacts
• May 27: Focus on Financing
• May 20: Focus on WASH & Urban Issues
• May 13: Focus on Community-Led Total Sanitation
• May 6: Focus on Gender & WASH
• Apr 29: Focus on WASH & IAQ in Schools
• Apr 22: Focus on WASH & IAP Integration
• Apr 15: Focus on Household Water Treatment & Safe Storage
• Apr 8: Focus on Handwashing
• Apr 1: Focus on Sanitation
• Mar 1: WASHplus Updates

Published on May 3, 2013 - Presentation by Rose George (journalist and author of ‘The Big Necessity’ http://www.rosegeorge.com) at “Making connections: Women, sanitation and health” event.

Published on May 3, 2013 – “Making connections: Women, sanitation and health” took place on 29th April 2013 at London School of Hygiene and Tropical Medicine (LSHTM). It was convened by LSHTM and WaterAid as partners of the SHARE Research Consortium. The event brought together a diverse mix of academics, journalists, practitioners and activists from the WASH, gender and health sectors to present and debate critical issues on linking gender, sanitation and health including violence against women and girls, maternal health and menstrual hygiene.

The BRAC WASH programme in Bangladesh has produced a new handwashing promotion video. It shows slides of handwashing promotion sessions for different groups (children, adolescent girls, women, men), as well as for schools, village WASH committees and mosques (imams).

The video was released on 5 May to coincide with the World Health Organization’s (WHO) annual global campaign  to promote better hand hygiene in health care.

Cover of the Cartoon “The Magic Glasses.

Educational cartoon boosts worm infection prevention | Source: News-Medical, Apr 29, 2013 |

Researchers in China have found that a health education package targeted at schoolchildren can improve hygiene behaviors and reduce the incidence of soil-transmitted helminth infection.

The study, published in the New England Journal of Medicine, included 1718 school children aged 9 to 10 years, of whom 893 attended control schools (n=19), and 825 attended intervention schools (n=19). The research was conducted in rural Linxiang City District, Hunan province, where there is a high prevalence of helminth infection but limited awareness or educational activity about the risks.

Both control and intervention schools displayed an awareness poster. However, in the intervention schools, students also took part in an educational package, including a 12-minute cartoon promoting knowledge and prevention awareness, followed by classroom discussions. They also took part in drawing and writing competitions that reinforced the cartoon’s messages, and received a pamphlet summarizing the main points. All students received albendazole treatment at baseline.

Over 9 months, the rate of helminth infection fell from 10.0% in the intervention schools to 4.1%, which was 50% lower than the rate observed in control schools (8.4%), report Donald McManus (Queensland Institute of Medical Research, Herston, Australia) and colleagues.

Results from a questionnaire measuring knowledge, attitudes, and practices around soil-transmitted helminths, showed that students in the intervention group scored significantly higher at 63.3% than students in the control group at 33.4%. Additionally, students without infection at follow-up scored on average 9.9 percentage points higher than patients who were infected.

In 10 control and 10 intervention schools where researchers covertly observed hand washing behavior, 98.9% of students in the intervention schools washed their hands after using the toilet compared with 46.0% at baseline. In contrast, the rate of hand washing showed no change in the control group (54.2 vs 54.0% at baseline). Hand washing practices also significantly correlated with questionnaire scores.

The authors also note that the intensity of infections fell in both groups during the study period. They also found that, overall, boys were significantly more likely to be infected than girls at follow-up, and that girls scored slightly but significantly higher on the questionnaire than boys (1.7 percentage points on average).

While the World Health Organization currently advocate mass drug administration, McManus and colleagues say it is inevitable that the parasites will develop drug resistance. They believe strategies such as theirs can complement pharmacologic treatment and reduce the number of treatment cycles required.

“Efforts to reduce the overall incidence of infection with soil-transmitted helminths require an integrated approach consisting of pharmacologic treatment to reduce morbidity and the prevalence of the infection and other interventions (e.g., improvements in hygiene achieved through health education) to prevent reinfection,” they conclude.

Bieri, FA. … [et al.], 2013. Health-education package to prevent worm infections in Chinese schoolchildren. N Engl J Med; 368:1603-1612 April 25, 2013. DOI: 10.1056/NEJMoa1204885

• Full text

Sumpter C, Torondel B

Background – Differing approaches to menstrual hygiene management (MHM) have been associated with a wide range of health and psycho-social outcomes in lower income settings. This paper systematically collates, summarizes and critically appraises the available evidence. 

Methods – Following the PRISMA guidelines a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. The search was conducted in May 2012 and had no date limit. Data was extracted and quality of methodology was independently assessed by two researchers. Where no measure of effect was provided, but sufficient data were available to calculate one, this was undertaken. Meta-analysis was conducted where sufficient data were available.

Results – 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in 7 papers. Methodologies however varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM (OR: 1.07, 95% CI: 0.52–2.24). No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.

Conclusion – The management of menstruation presents significant challenges for women in lower income settings; the effect of poor MHM however remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect improving MHM may have on girls’ attendance at school

Organised by: International Water Association (IWA)

Small water and wastewater treatment plants play an important role in the management of water quality in  rural and small communities to treat their domestic and industrial effluents. Resource oriented sanitation concepts promote ecologically socially and economically sound approaches.

Themes:

• Water resources management
• Environmental management systems
• Government laws
• Decentralised domestic and industrial wastewater collection and treatment systems
• Aerobic and anaerobic treatment
• Low technology treatment systems
• Ecological sanitation
• Biofilm reactors
• Sequencing batch reactor
• Operation and monitoring of small wastewater treatment plant
• Wastewater reclamation and reuse
• Sludge management
• Nutrient removal
• Environmental microbiology & population dynamics

Abstract deadline: 28 February 2014

Latinosan is held every three years.

Latinosan 2013 consists of two events: a technical conference and a meeting of senior officials that will result in the Declaration of Panama.

Main topics:

• the status of sanitation at regional and country levels
• institutions and public policy
• human rights and sustainable development
• post-2015 goals: regional and global

For more information visit the conference website: latinosanpanama2013.com (Spanish only)

• Link to full-text, pdf

An Excerpt: The tools outlined by this document were developed based on actual field research in testing, done as a collaborative effort between UNICEF and Salima District Council. Salima was selected for the research and testing of new hand washing triggering tools because they already had experience attempting to incorporate hand washing into their triggering process, and also have data showing high numbers of new hand washing facilities being built after CLTS. Also, Salima was selected because they implement CLTS continuously as part of their routine extension staff work.

Nine different tools were tested for how well they instilled a realization of the importance of hand washing with soap (HWWS). When these tools were used, hand washing practice increased by 69% and soap availability at hand washing facilities increased by 15%, compared to when CLTS didn’t include specific
tools to trigger HWWS. However please take these guidelines with a grain of salt, as they are based on a small sample size, overall only a few villages.

THE 10 FIELD-TESTED HAND WASHING TRIGGERING TOOLS OUTLINED IN THIS DOCUMENT:

• Anal Cleansing Materials
• Shit and Shake
• Cassava/Egg Demonstration
• Charcoal
• Smelly Hands
• Charcoal Smearing
• Scratch & Smell
• Wall Contamination
• Food Sharing
• Dirt Under Fingernails

Description: WEDC and WaterAid have developed a new set of ‘Equity and Inclusion in WASH’ learning materials.

We have been collaborating to develop practical training materials for WASH practitioners, to help them analyse and address the problems faced by the most disadvantaged people in accessing WASH services. Extensively field-tested by WaterAid and WEDC in Africa and Asia, the materials are participatory and interactive, and are ideal to facilitate practical collaboration and problem-solving between disabled people and technical service providers. They can be used as stand-alone activities, or as part of a broader training programme. Although rooted in the social model of disability, the scope of the analysis framework has been broadened to encompass exclusion of all kinds. This makes the materials useful in building alliances with groups working on other issues, e.g. gender, HIV, ageing.

What does this webinar aim to do:

• Showcase the training materials
• Explain how you can use them and when, where and with whom
• Present examples of where they have already been put into practice and the impact of their use
• Answer any questions and receive feedback on the materials

Who will present:

• Hazel Jones – Hazel is a Research Associate involved in research, teaching and capacity building at WEDC (Water, Engineering and Development Centre) at Loughborough University, UK. Her specialist area is in accessibility to water and sanitation services and facilities for vulnerable groups, especially for disabled and elderly people. This has taken the form of research into accessible solutions and approaches; production of resource materials for use by programme implementers, and capacity-building for WASH implementers.

When is the Webinar?

• Wednesday 8th May 2013 – 2.00pm – 3.30pm British Summer Time (15:00 to 16:30 Central European Summer Time, 09:00 to 10:30 Eastern Daily Time, 18:30 to 20:00 Indian Standard Time)
• This is the link to join the webinar.

You can click this link anytime from 1.00pm British Summer Time to give the webinar time to load, and then come back to it when the webinar will start at 2.00pm British Summer Time.

Shamila Jansz
Learning, Research and Documentation Advisor
WaterAid
020 7793 4596
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The Global Public-Private Partnership for Handwashing with Soap (PPPHW) gave WASHplus permission to share this summary of recent hand washing literature that was recently prepared for the partnership. It includes 13 studies published in 2012 and one published in 2013. In one such study the authors suggest that hand washing promotion could improve child well‐being and societal productivity. According to the literature review, very little has been published in peer‐reviewed journals on motivators and barriers to hand washing behavior and the impact of hand washing promotion in humanitarian emergency settings. Links are provided to the abstracts or full text of articles in the citations section. 

Periodic Overview of Hand Washing Literature: Summary of Selected Peer‐Reviewed and Grey Literature Published July–December 2012. 

Prepared for the PPPHW by: Jelena Vujcic (University at Buffalo), Pavani K. Ram (University at Buffalo), Dan Campbell (CARE), and Katie Carroll (FHI 360).

RISK FACTORS AND DIARRHEAL DISEASE PREVALENCE

• A systematic review of cohort studies that reported diarrhea incidence in low- and middle-income countries showed that diarrhea incidence rates are declining slightly (1.9 billion episodes of childhood diarrhea in 1990 compared to almost 1.7 billion episodes in 2010), but the total burden on child health is still large (Fischer Walker et al. 2012).
• One study in Tanzania found that hands and water are important sources of both viral and bacterial pathogens that cause diarrhea, underscoring the importance of efforts to promote hand washing (Mattioli et al. 2012).

Takeaway for implementers:

• The burden of diarrheal disease among children is still unacceptably high in low- and middle-income countries.
• Hands are an important vector of diarrheal pathogens.

HAND WASHING AND HEALTH OUTCOMES

• A randomized controlled trial in informal settlements in Karachi, Pakistan, found children whose families received hand washing promotion during their first 30 months had global development quotients of 0.4 SDs greater than those in the control group. These gains are comparable to “at risk children enrolled in publicly funded preschools in the U.S.” Child growth was not different between groups that did and did not receive hand washing promotion. The authors suggest that hand washing promotion could improve child well‐being and societal productivity (Bowen et al. 2012).
• In a subset of participants in the Nyando Integrate Child Health and Education Project researchers found that students in primary schools (Kenya) that received a school‐based hygiene and water treatment program sustained improvement in hygiene knowledge (although still around 50 percent) and had a decreased risk of respiratory infections compared to students who had not yet received the program. There were no differences in diarrhea prevalence; however, overall illness was low (Patel et al. 2012).
• Researchers in South Africa evaluated a comprehensive family hygiene promotion program in peri‐urban Cape Town. Neighborhoods (and thus all households in that area) were purposely selected into three groups: a control group, an education-only group, and an education plus hygiene product group (bar soap, surface disinfectant, and skin antiseptic). They found children (under five years old) in the control group were more likely to have gastrointestinal illnesses and respiratory illnesses compared to children that received either intervention. Children living in households that received hygiene education only were 2.5 times more likely to have gastrointestinal illness and 4.6 times more likely to have respiratory illness compared to children who received hygiene education and products. These estimates were adjusted for age, gender, and socio‐economic indicators (Cole et al. 2012).
• In Colombia where water supply is limited, researchers found that children (one to five years old) who attended child care centers that received education about alcohol‐based hand rub, dispensers, and replenishment of the hand rubs were less likely to have acute diarrhea and acute respiratory illness compared to children who attended control child care centers (Correa et al. 2012).
• In Thailand, researchers found that children in kindergarten classrooms who were taught to apply hand sanitizer hourly had less influenza‐like illness compared to those who were taught to apply it every two hours or only at lunch time (Pandejpong et al. 2012).

Takeaway for implementers:

• Hand washing promotion to mothers of young children may improve child development, and thereby increase a child’s well‐being and societal productivity. Hygiene promotion alone can result in significant reductions in gastrointestinal and respiratory illness among young children, but provision of hygiene products in addition to hygiene education can yield greater reductions. Promotion of hand washing in primary schools improves knowledge about hand washing among students and can reduce the risk of respiratory illness among these students. In child care centers, promotion of hand sanitizer use and the provision of these products can reduce acute diarrhea and respiratory illness in children one to five years old that attend these facilities. In kindergarten classrooms, hourly use of hand sanitizer was a more optimal time interval for preventing respiratory illness in children attending these facilities.

FACTORS THAT AFFECT HAND WASHING BEHAVIOR

• The Alive & Thrive (http://www.aliveandthrive.org) program in Bangladesh, which aims to improve infant and young child nutrition though hand washing and complementary feeding initiatives, identified three common barriers to hand washing through formative research: (1) a lack of convenience of materials where food is prepared and children are fed, (2) mothers of young children are not convinced that hand washing and complementary feeding are beneficial for the child’s health, and (3) a lack of social norms for hand washing before feeding a child or preparing food (Alive & Thrive 2012). The authors also describe Trials of Improved Practices and design of the communication strategy and campaign activities used in Bangladesh.
• A qualitative study of clean delivery practices among mothers, community members, and health care providers in rural Ghana, found that hand washing during and/or after delivery by family/community members was not frequently reported. Grandmothers play a crucial role in delivery practices. There is a disconnect between health care providers and community members regarding clean practices during delivery (Moyer et al. 2012).

Takeaway for implementers:

• Understanding barriers to hand washing with soap that are specific to critical times of interest (such as feeding, food preparation, or clean/safe delivery) can help the implementer design a more relevant behavior change approach. Family or community members who have influence on birthing practices could be important barriers to behavior change and therefore important to consider when designing such a program.

HAND WASHING PROMOTION NESTED IN OTHER PROGRAMS

• Two different studies evaluated the use of the Hazard Analysis, Critical Control Point (HACCP) approach (commonly used in industrialized countries for food hygiene) to reduce fecal contamination that can occur during the food preparation or feeding process at home. Using this approach, the researchers identified “critical control points” for food contamination then identified corrective measures to address those critical control points, including hand washing with soap. In Bamako, Mali, researchers tested this approach with mothers of children six to 18 months and reported a significant reduction in weaning food contamination after the intervention and some sustained reductions three months after the intervention (Toure et al. 2013).
• In Bangladesh, researchers used the same approach and found significant decreases in weaning food contamination after the HACCP intervention as well as three months later (Islam et al.2012). However, the authors did note some reactivity to observer presence.
• In long‐term refugee camps in Thailand, Ethiopia, and Kenya, researchers found that 30 percent of key hand washing opportunities were accompanied by soap use, and 20 percent of times when latrines were used were followed by hand washing with soap. Availability of soap was variable and reflected the extent of free soap distribution. Lack of free soap and prioritization of soap for laundry were barriers to safe hand washing practice. Authors suggest that differences in education and place of origin may need to be taken into account when designing a program (Biran et al. 2012).
• Proper hand hygiene is one component of the WHO safe birth checklist for health facilities (Link to checklist). This list contains 29 items that address major causes of maternal and neonatal mortality (including infection). Researchers in India evaluated one such program comparing pre‐/post‐intervention practices of health facility workers who perform or are involved with deliveries. At follow‐up, authors report improvement in safe delivery practices, including hand hygiene, among those who were taught to use the checklist (Spector et al. 2012).

Takeaway for implementers:

• The HACCP approach, which includes hand washing with soap at critical junctions, seems effective in decreasing fecal contamination of foods fed to children at risk for diarrhea. Long‐term behavior change and health outcomes of this approach have not been researched in low- and middle-income settings. The extent to which this method is feasible at larger scale is also not clear. In three different refugee camps, the practice of hand washing was low, and resource constraints (and therefore decisions about prioritization of such resources) were reported as a barrier to ensuring good hand washing practice. Overall, very little has been published in peer‐reviewed journals on motivators and barriers to hand washing behavior and the impact of hand washing promotion in humanitarian emergency settings.

HAND WASHING MEASUREMENT

• This World Bank Water and Sanitation Program technical paper outlines one approach to measure determinants of hand washing behavior using the FOAM framework and Likert scale questions. The authors discuss several of lessons learned from implementing this strategy in their programs in Vietnam and Peru and provide examples of their scales and how they were developed (Hernandez et al. 2012).

Takeaway for implementers:

• Understanding determinants of good hand washing behavior is important to identify triggers of that behavior that could be incorporated into hand washing promotion programs. If implementers or their evaluation partners seek to understand components/determinants of good hand washing behavior, this is one approach to meet such goals. Measuring determinants/components of good hand washing behavior requires sufficient resources to support the process, which means at a minimum, resources to support piloting, adequate sample size, and appropriate statistical skills for analysis of the data.

​Citations

• Alive & Thrive. 2012. Alive & Thrive Handwashing and Complementary Feeding Initiative: Summary of Handwashing Initiatives. (Full text)
• Biran A, Schmidt WP, Zeleke L, Emukule H, Khay H, Parker J, and Peprah D. 2012.Hygiene and sanitation practices amongst residents of three long‐term refugee camps in Thailand, Ethiopia and Kenya. Trop Med Int Health 17(9):1133‐1141.(Abstract)
• Bowen A, Agboatwalla M, Luby S, Tobery T, Ayers T, and Hoekstra RM. 2012.Association between intensive handwashing promotion and child development in Karachi, Pakistan: a cluster randomized controlled trial. Arch Pediatr Adolesc Med, 166(11):1037‐1044. (Abstract)
• Cole E, Hawkley M, Rubino J, Crookston B, McCue K, Dixon J, Maqelana T, Cwayi J, Adams C, and Kim J. 2012. Comprehensive family hygiene promotion in peri‐urban Cape Town: gastrointestinal and respiratory illness and skin infection reduction in children aged under 5. South African Journal of Child Health, 6(4):109‐117. (Full text)
• Correa JC, Pinto D, Salas LA, Camacho JC, Rondon M, and Quintero J. 2012. A cluster‐randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia. Rev Panam Salud Publica, 31(6):476‐484.(Full text)
• Fischer Walker CL, Perin J, Aryee MJ, Boschi‐Pinto C, and Black RE. 2012. Diarrhea incidence in low‐ and middle‐income countries in 1990 and 2010: a systematic review. BMC Public Health, 12:220. (Full text)
• Hernandez O, Devine J, Karver J, Chase C, and Coombes Y. 2012. WSP Technical Paper. Global Scaling Up Handwashing Project: measuring the behavioral determinants of handwashing with soap. (Full text)
• Islam MS, Mahmud ZH, Gope PS, Zaman RU, Hossain Z, Mondal D, Sharker MA, Islam K, Jahan H, Bhuiya A et al. 2012. Hygiene intervention reduces contamination of weaning food in Bangladesh. Trop Med Int Health, 18(3): 250-8.(Abstract)
• Mattioli MC, Pickering AJ, Gilsdorf RJ, Davis J, and Boehm AB. 2012. Hands and water as vectors of diarrheal pathogens in Bagamoyo, Tanzania. Environ Sci Technol, 47(1): 355-63. (Full text)
• Moyer CA, Aborigo RA, Logonia G, Affah G, Rominski S, Adongo PB, Williams J, Hodgson A, and Engmann C. 2012. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs. BMC Pregnancy Childbirth, 12:50. (Full text)
• Pandejpong D, Danchaivijitr S, Vanprapa N, Pandejpong T, and Cook EF. 2012.Appropriate time‐interval application of alcohol hand gel on reducing influenza‐like illness among preschool children: a randomized, controlled trial.Am J Infect Control, 40(6):507‐511. (Abstract)
• Patel MK, Harris JR, Juliao P, Nygren B, Were V, Kola S, Sadumah I, Faith SH, Otieno R, Obure A et al. . 2012. Impact of a hygiene curriculum and the installation of simple handwashing and drinking water stations in rural Kenyan primary schools on student health and hygiene practices. Am J Trop Med Hyg,87(4):594‐601. (Abstract)
• Spector JM, Agrawal P, Kodkany B, Lipsitz S, Lashoher A, Dziekan G, Bahl R, Merialdi M, Mathai M, Lemer C et al. 2012. Improving quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. PLoS One, 7(5):e35151. (Full text)
• Toure O, Coulibaly S, Arby A, Maiga F, and Cairncross S. 2013. Piloting an intervention to improve microbiological food safety in peri‐urban Mali. Int J Hyg Environ, 216(2): 138-145. (Abstract)

Each WASHplus Weekly highlights topics such as Urban WASH, Indoor Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus knowledge resources specialist, at dacampbell@fhi360.org.

• Link to full text

CARE.

Summary – CARE has provided water+ services to developing countries for over 55 years and is currently working on more than 180 such projects in over 40 countries. Throughout the years CARE has focused on both emergency response and long-term development; recently the organization has emphasized building the capacity of local institutions, strengthening community-led water resource management (WRM) and total sanitation, and adopting an integrated water resource management (IWRM) approach. 

PROGRESS AGAINST OUR THEORY OF CHANGE
In 2010 CARE USA’s water team developed a theory of change for our work in water. Our theory of change has been used as a measure of activities leading to impact in this report; however, a theory of change is one of many guides to understanding change and we are fully aware of its limitations. This report is based on a review of 51 reports, mostly mid-term or final evaluations dated between 2006 and 2012. A scoring tool was developed to score the reports against the three domains of the water+1 theory of change.

Domain 1: Secure and Sustainable Access to Water+ Services
Programming focused on provision of water, sanitation and access to hygiene facilities. On the whole CARE demonstrated excellent work in water, sanitation and hygiene (WASH), WRM and multiple uses of water; however, improvements are needed to strengthen sustainability and collaboration approaches. The mostcommon criticism of CARE’s programming was a lack of sustainability, many times caused by Inattentiveness to supportive factors such as access to supply chains or qualified technicians for repair. One evaluation showed the effects of CARE’s training had almost vanished 8 years after project completion.

Domain 2: Gender-Sensitive Water+ Policies, Institutions and Social Norms
CARE was scored on items such as deliberate influence of policy or policy implementation and community empowerment and capacity building. The evaluations revealed that CARE has done some strong work in strengthening community-based organizations and in working with government for increasing access to water+ programs. A major shortcoming is that these types of interventions are not consistent. Though the programs did promote behavior change and thus provided an avenue for re-shaping social norms, more could have been done to consistently analyze and evaluate existing norms and power relationships to influence and challenge social and political infrastructures to achieve change at a large scale.

Domain 3: Gender-Equitable Control over Water+ Services
Women living in traditional communities are not usually allowed to serve on public committees. Yet water committees give them a unique opportunity for leadership because water for domestic use is seen largely as the woman’s domain. Several evaluations noted results favorable to women and girls, including a decreased burden of fetching water, increased attendance of girls in school, a cleaner personal appearance and women having more authority in the community. On the other hand men are often seen to have a greater say when it comes to water for productive use; for example, the land and livestock benefiting from the water are more likely to be owned by heads of households who are still predominantly male.Few of the initiatives examined tools for analyzing social structures and power relations within communities, disaggregated benefits by gender or employed empowerment methodologies. CARE’s traditional strength in community organization is evident but should be leveraged for more ambitious, socially oriented approaches driven by empowerment objectives rather than solely water+ ones.

CASE STUDIES ON IMPACT AND APPROACHES
Ten case studies from within country offices and at global level showcase CARE’s efforts in making water+ services available to the poor. They demonstrate both impact and the approaches taken to reach that impact, highlighting strengths that varyingly correspond to one or more of the domains of the theory of change. For example, the case study from Madagascar documents the effective use of public-private partnerships in delivering secure and sustainable access to water+ services (domain 1), but the case study from Vietnam explores a community visioning approach to WRM that does justice to the individual and communal agency and empowerment-in-action spirit of domain 3 (gender-equitable control over water+ services). The global case studies on learning, partnership, advocacy and emergency WASH prove trickier to subject to the water+ theory of change lens, created as it was on a model of change within a country context where some element of direct implementation (domain 1) is presupposed. Nonetheless, collectively, these case studies highlight some strong achievements in a global picture.

The Water and Sanitation Program (WSP) conducted research with local partners in Peru, Senegal, Tanzania, and Vietnam to understand the factors that affect an individual’s decision to practice handwashing with soap.  The research informed the implementation of handwashing project activities in the four countries. 

Following national and local government implementation, WSP and its partners gathered valuable lessons, which inform this handwashing with soap toolkit. The toolkit, intended for practitioners interested in behavior change, is organized into four modules, each with reports and presentations about the lessons learned from the projects, as well as mass media, direct consumer contact, and interpersonal communication tools used throughout the project.

• Toolkit Link

Childhood Pneumonia and Diarrhea. Lancet, April 12, 2013

• Link

Summary

The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea. The first paper assesses the global burden of these two illnesses, comparing and contrasting them, and includes new estimates of severe disease and updated mortality estimates for 2011. Findings from the second paper show that a set of highly cost-effective interventions can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. Furthermore, the paper estimates what the cost of scale up will be. The third paper presents the results of consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward. The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025. 

Papers
Global burden of childhood diarrhoea and pneumonia
Christa L Fischer Walker, Igor Rudan, Li Liu, Harish Nair, Evropi Theodoratou, Zulfiqar A Bhutta, Katherine L O’Brien, Harry Campbell, Robert E Black

• Full Text | PDF

 Interventions to address deaths from childhood diarrhoea and pneumonia equitably: what works and at what cost?

Zulfiqar A Bhutta, Jai K Das, Neff Walker, Arjumand Rizvi, Harry Campbell, Igor Rudan, Robert E Black, for The Lancet Diarrhoea and Pneumonia Interventions Study Group

• Full Text | PDF

Bottlenecks, barriers, and solutions: results from multi-country consultations focused on reduction of childhood diarrhoea and pneumonia deaths
Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion McNabb, Samira Aboubaker, Shamim Qazi, Zulfiqar A Bhutta

• Full Text | PDF

Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal
Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan, Li Liu, Robert E Black, Zulfiqar A Bhutta

• Full Text | PDF

• Full text, pdf

Emory University; Unicef.

EXCERPTS: Understanding the mechanisms by which children are excluded from WASH in Schools is essential to ensuring adequate and equitable access for all school-aged children.

‘Equity of Access to WASH in Schools’ presents findings from a six-country study conducted by UNICEF and the Center for Global Safe Water at Emory University. This research was carried out in collaboration with UNICEF country offices in Kyrgyzstan, Malawi, the Philippines, Timor-Leste, Uganda and Uzbekistan and their partners. The six case studies presented together contribute to the broader understanding of inequities in WASH in Schools access by describing various dimensions that contribute to equitable or
inequitable access across regions, cultures, gender and communities.

The researchers identified key dimensions of equity through formative investigations that included discussions with service delivery providers and policymakers. In some countries, inequity existed but was found to be linked to poverty and the prioritization of other health and development objectives, rather than a specific policy. In other cases, some dimensions could not be fully investigated, usually due to lack of data. Because it was not feasible to explore every equity dimension in each of the six countries, focus areas were prioritized for each case study.

Some dimensions were found to be relevant across country contexts. Limited access to WASH in Schools compromised children’s health, educational attainment and well-being, and exacerbated already existing inequities and challenges in each of the countries.

Gender was identified as a key aspect of inequity in all six countries, but the mechanisms and manifestations of gender inequities varied within each context. Menstruating girls in Malawi and Uganda faced consistent challenges in obtaining adequate access to WASH in Schools facilities, preventing them
from comfortably practising proper hygiene. In this context, a lack of access to school WASH facilities is a potential cause of increased drop-out rates. Girls in Kyrgyzstan and Uzbekistan were affected by the poor maintenance of facilities and lack of privacy, rather than by overall lack of basic access. In these settings, lack of doors and private latrine stalls, coupled with proximity to boys’ latrines, led to girls avoiding the use of school WASH facilities, which may have deleterious health effects.

Accessibility of WASH facilities for children with disabilities was identified as an issue in all countries. In Malawi and Uganda, concerted effort has been made to include school sanitation, water and hand-washing facilities appropriate for children with disabilities. The designs for facilities, however, were often found to inadequately address students’ needs, and hand-washing facilities remain largely inaccessible, compromising students’ health.

WaterAid Australia have exciting news! We are recruiting for a Program Effectiveness Manager to join the leadership group of the International Programs department in Melbourne.

We are looking for an experienced and passionate individual to support program staff in Southeast Asia and the Pacific and provide leadership on program quality and learning. The person should have detailed knowledge and experience on current best practice thinking on WASH approaches, technologies and methodologies and be able to adapt them to our programs.

They will spend a significant amount of time in our Country Programs and will work with staff in WaterAid Australia and partners to develop and deepen their understanding on sanitation approaches, hygiene promotion and rural water supply systems. The person will be a key driver to embed our monitoring and evaluation systems and action learning culture.

• More information about the role

Tanya Stelmach, Regional Programs Officer
WaterAid Australia
Level 7, 176 Wellington Parade, East Melbourne, VIC 3002 Australia
Direct Line: +61(0)3 9001 8241
Fax: +61(0) 3 9001 8260
Email: tanya.stelmach@wateraid.org.au

Create a world where everyone has access to clean water www.wateraid.org/australia

In WSUP programmes, the local context is often suited to community or to private management models. But in practice, WSUP often seeks to go beyond this “community” versus “private” dichotomy, to try to get “the best of both worlds”. For instance, CBO operators are often encouraged to adopt commercial practices and achieve business efficiency. Similarly, entrepreneurs are encouraged to be more supportive of the needs of the community, and more responsive to poverty and gender issues.

In this Topic Brief, the approaches used by WSUP in Nairobi, Kumasi and Antananarivo under the African Cities for the Future (ACF) programme are examined from this perspective of blending community and private management models. The Topic Brief concludes with practical guidance on this issue for programme managers. Click on the image below to download the Topic Brief.

ORLANDO, Fla., Apr 02, 2013 (BUSINESS WIRE) — Clean the World announces the appointment of former White House director of events Laura Schwartz and government relations consultant Kelly Cohen to the non-profit’s board of directors. The organization helps save lives around the world by collecting and recycling soap and shampoo products discarded by the hospitality industry. 

Schwartz produced more than 1,000 events as the White House director of events for the Clinton administration, and is now a professional speaker, television commentator and author of the best seller Eat, Drink & Succeed. She appears on screens and stages all over the world motivating people to succeed both professionally and personally.

“I am inspired by the staff, volunteers and partners of Clean the World who truly are saving lives and revolutionizing hygiene at home and abroad,” Schwartz said. “It is an honor to be part of Clean the World’s critical mission, which has distributed more than 12 million bars of soap in over 65 countries, and diverted more than 750 tons of landfill waste in the U.S. alone.”

Schwartz is a member of the National Speakers Association, and serves on the boards of the American Heart Association and Event Solutions Magazine. She was named one of the “100 Most Influential Women in Chicago” by Today’s Chicago Woman Magazine, and one of Chicago’s “5 Most Bold and Beautiful” by Chicago Magazine.

Cohen is the managing partner of Southern Strategy Group’s Orlando office. She is recognized as a forceful advocate for clients, with her primary focus on local and state government, transportation, land use, economic development, public-private partnerships, and business development.

About Clean the World

Clean the World Foundation Inc. is a 501 (c) (3) charitable organization with the mission of saving millions of lives around the globe. Clean the World leads a global hygiene revolution to distribute recycled soap and hygiene products from more than 1,700 hospitality partners to children and families suffering from high death rates due to the top two killers of children worldwide – acute respiratory infection (pneumonia) and diarrheal diseases (cholera). Since 2009, Clean the World has distributed more than 12 million bars of soap. Through the “ONE project” launched in late 2012, Clean the World provides hygiene kits domestically to the homeless and families in transition. More information: http://www.cleantheworld.org.

The aim of the consultancy to “craft a simple, scalable and sustainable strategy, program and tools based on the EHCP [Essential Health Care Program] that would lead to improved and sustained hygiene practice and toilet use”.

The EHCP is the Department of Education’s “flagship national health program for promoting group handwashing with soap, group toothbrushing with toothpaste and biannual deworming in public elementary schools”.

The consultancy will build on the findings of the Sustainable Sanitation in Schools Project, which was launched in 2011 by UNICEF, GIZ and Fit for School.

The main research question is: “Does daily group hand washing with soap in school result in the independent practice of hand washing with soap at critical times, particularly after using the toilet in school and before eating/handling food?”

Project Duration: 12 months (May 1, 2013 – April 30, 2014)

Deadline for submission: 10:00 am (GMT) on Monday, 15 April 2013

For more information read the full RFP.