Gates Foundation awards $10.9 million to study impacts of sanitation on diseases

Researchers at the University of California, Berkeley, have received a five-year, $10.9 million grant from the Bill & Melinda Gates Foundation to evaluate several interventions to combat diarrheal disease in developing countries.

Dr. Jack Colford

Dr. Jack Colford, professor of epidemiology at UC Berkeley’s School of Public Health, will coordinate the project, working with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and Innovations for Poverty Action (IPA).

An estimated 2.2 million children under the age of 5 die from diarrheal diseases each year, according to the World Health Organization. Most of these diseases are thought to be preventable with improvements in sanitation, water quality and hygiene.

Due to the high cost of developing and maintaining large infrastructure projects, such as networked water, there is now a movement toward simpler, alternative methods to improve health in rural areas. However, there is almost no evidence that allows direct comparison of the health benefits or cost effectiveness of these simpler interventions, such as improved latrines, household water treatment and hand washing with soap.

The goal of the new project is to determine how sanitation interventions, delivered alone or as part of combined intervention packages, impact child health and well-being. In addition to improved sanitation, the intervention packages will include drinking water improvements and hand washing solutions. The results have the potential to influence how billions of dollars are directed towards long-term improvements in health and economic outcomes for millions of children each year, said Colford.

“Increasingly, foundations, governments, the World Bank and development agencies such as the MCC (Millennium Challenge Corporation) are demanding evidence of effectiveness when awarding development funds,” said Colford. “Right now, it is unknown whether single interventions are as cost effective as combinations of these interventions. This grant will fund the first large-scale, randomized impact evaluation designed to gather rigorous evidence about this question.”

The study will test the impact of these sanitation, water and hygiene interventions using a large-scale, randomized impact evaluation in Bangladesh and Kenya. These two countries are representative of the two regions that account for the majority of the world’s gastrointestinal disease burden: Southeast Asia and sub-Saharan Africa. The researchers expect to enroll a total of 23,000 children in the trials, which will be monitored by several institutional review boards.

Of the $10.9 million, about $7.9 million will be subcontracted out to the two field sites. Dr. Stephen Luby, head of the Programme on Infectious Diseases and Vaccine Sciences with ICDDR,B, and Michael Kremer, Ph.D., a research affiliate with IPA, will lead the trials in Bangladesh and Kenya, respectively. They will be joined by a team of experts from various disciplines, including public health, economics, behavioral change, nutrition, cognitive development and tropical enteropathy.

Source: Linda Anderberg, UC Berkely News, 05 Nov 2009

Call for proposals – Conflict and Cooperation over Natural Resources in Developing Countries [Deadline 03 Nov 2009]

WOTRO Science for Global Development has recently launched the first call of the research programme Conflict and Cooperation over Natural Resources in Developing Countries (CoCooN) – integrated projects.

One of the three themes is: Water resources, conflict and cooperation.

CoCooN is a knowledge, research and innovation programme funded by the Directorate General of Development Cooperation (DGIS) of the Ministry of Foreign Affairs of the Netherlands and the Netherlands Organisation for Scientific Research (NWO). Its aim is to contribute to sustainable development, poverty reduction and the realisation of the Millennium Development Goals (positive change). The objective is to contribute to evidence based policy development and practice in the field of conflict and cooperation over natural resources, and to adequately manage, resolve and learn from conflicts over natural resources.

An Integrated Project (IP) should make clear how it will constitute and operationalise activities and projects for three facilities:

• Knowledge sharing
• Trans-disciplinary research
• Capacity development and training

An IP has to be directed by a consortium and thus the application for an IP has to be submitted by the consortium. A consortium consists of representatives of at least four different partner institutes. These partners include

1. a Southern-based research institute;
2. a Northern-based research institute;
3. a Southern-based non-research institute and
4. a Northern-based non-research institute.

At least one of the institutes should be based in a partner country of Dutch bilateral development cooperation. The consortium nominates a coordinator, who will act as the main applicant.

Read more

Deadline: 03 November 2009

Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries

Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries

Hugh Waddington, Birte Snilstveit, Howard White, and Lorna Fewtrell
Corresponding author email: hwaddington [at] 3ieimpact.org
August 2009
Synthetic review 001
International Initiative for Impact Evaluation (3ie).

Full text

Summary

This report is a synthetic review of impact evaluations examining effectiveness of water, sanitation and hygiene (WSH) interventions in reducing childhood diarrhoea.

The review has been conducted to Campbell/Cochrane Collabo ration standards of systematic review, as well as employing mixed methods of data analysis to assess not only which interventions are effective, or not, but why and under what circumstances. The review provides an update of previous reviews conducted in this area, notably Fewtrell and Colford (2004).

A comprehensive search was conducted of published and unpublished materials. Studies were identified for inclusion which employed rigorous impact evaluation techniques, using experimental (randomised assignme nt) and quasi-experimental methods, and which evaluated the impact of water, sanitation and/or hygiene interventions on diarrhoea morbidity among children in low- and middle-income countries. 65 rigorous impact evaluations were identified for quantitative synthesis, covering 71 distinct interventions assessed across 130,000 children in 35 developing countries during the past three decades. Each study was coded for a range of variables relating to type of intervention, effect size and precision, internal validity (relating to evaluation quality) and external validity (relating to context and behavioural mechanisms). Interventions were grouped into five categories: water supply improvements, water quality, sanitation, hygiene and multiple interventions involving a combination of water and sanitation and/or hygiene. Data were collected and synthesised on both quantitative and qualitative information presented in the evaluations.

The results challenge the notion that water quality treatment in the household (at point -of-use) and sanitation ‘software’ (hygiene) interventions are necessarily the most efficacious and sustainable interventions for promoting reduction of diarrhoea.

While point-of-use water quality interventions appear to be highly effective – and indeed, more effective than water supply or source treatment in reducing diarrhoea – much of the evidence is from trials conducted over small populations and short time periods. More evidence is needed on sustainability, as water quality interventions conducted over longer periods tend to show smaller effectiveness, while compliance rates, and therefore impact, appear to fall markedly over time.

Hygiene interventions, particularly provision of soap for hand-washing, are effective in reducing diarrhoea morb idity, and there does not appear to be evidence that compliance falls over time. The analysis suggests that sanitation ‘hardware’ interventions are also highly effective. However, relatively few studies have been conducted in this area to-date and studies are particularly needed that quantify the possible environmental spillovers from sanitation provision.

Evidence on the combined impact of multiple interventions is mixed. Further primary studies employing factorial design – that is, comparing different interventions using multiple treatment arms – are needed for more conclusiveness on whether water and sanitation/hygiene interventions are substitutes or complements in the health production function.

The study highlights the importance of behavioural factors in determining up-take and sustainable adoption of WSH technologies. Insights from diffusion theory suggest that preventive interventions tend to be adopted more slowly as benefits are difficult to observe and users presumably discontinue treatment as they perceive that the costs of using the intervention outweigh the benefits. These problems are more relevant for interventions aiming to reduce disease prevalence which do not have additional benefits, for example time savings. Unfortunately, few impact evaluations addressing sustainability collect data on the reasons for the levels of compliance and acceptance found among beneficiaries. This information is an essential guide to fostering long-term impact.

Survey of Food-hygiene Practices at Home and Childhood Diarrhoea in Hanoi, Viet Nam

Survey of food-hygiene practices at home and childhood diarrhoea in Hanoi, Viet Nam
Jnl Health, Pop & Nutri, Oct. 2009,  P. 602-611
Full-text

Authors: Kumiko Takanashi, Yuko Chonan, Dao To Quyen, Nguyen Cong Khan, Krishna C. Poudel, and Masamine Jimba

1Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Japan, 2International Life Sciences Institute Japan Center for Health Promotion, Japan, and 3National Institute of Nutrition, Hanoi, Viet Nam

ABSTRACT

A cross-sectional study was conducted to investigate the potential factors of food-hygiene practices of mothers on the prevalence of diarrhoea among their children. Mothers who had children aged 6 months–5 years were recruited in a hamlet in Viet Nam. The food-hygiene practices included hand-washing, method of washing utensils, separation of utensils for raw and cooked food, and the location where foods were prepared for cooking. A face-to-face interview was conducted, and data on 206 mothers were analyzed. The risk of diarrhoea was significantly higher among children whose mothers prepared food for cooking somewhere other than the table (typically on the ground) compared to children whose mothers prepared food on the table (adjusted odds ratio=2.85, 95% confidence interval 1.11-7.28). The results indicate that food-hygiene practices of mothers, such as avoiding preparing food for cooking on the ground, has a potential impact in preventing diarrhoea among children in Viet Nam.

Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources

Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial
doi:10.1111/j.1365-3156.2009.02381.x
Published Online: 4 Sep 2009

Sangya-Sangam K. Tiwari 1 , Wolf-Peter Schmidt 2 , Jeannie Darby 1 , Z. G. Kariuki 3 and Marion W. Jenkins 1
1 Department of Civil and Environmental Engineering, University of California, Davis, CA, USA
2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
3 Ministry of Health, Nakuru District, Nakuru, Kenya

Objective Measure effectiveness of intermittent slow sand filtration for reducing child diarrhoea among households using unimproved water sources in rural Kenya.

Methods A randomized controlled trail was conducted among populations meeting a high-risk profile for child diarrhoea from drinking river water in the River Njoro watershed. Intervention households (30) were provided the concrete BioSand Filter and instructed on filter use and maintenance. Control households (29) continued normal practices. Longitudinal monthly monitoring of diarrhoea (seven-day daily prevalence recall) and of influent, effluent, and drinking water quality for fecal coliform was conducted for 6 months.

Results Intervention households had better drinking water quality than control households (fecal coliform geometric mean, 30.0 CFU vs. 89.0 CFU/100 ml, P < 0.001) and reported significantly fewer diarrhoea days (86 days over 626 child-weeks) compared to controls (203 days over 558 child-weeks) among children up to 15 (age-adjusted RR 0.46; 95 % CI = 0.22, 0.96). Greater child diarrhoea reduction due to the intervention (age-adjusted RR 0.23, 95 % CI = 0.10, 0.51) was observed among the sub-group using unimproved water sources all of the time.

Conclusion Intermittent slow sand filtration, a non-commercial technology, produces similar observed effects on child diarrhoea as commercial POU products, adding to the range of effective options for poor populations (chlorination, ceramic filtration, solar disinfection, flocculation/disinfection).

Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure

Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure
Tropical medicine & international health
Published Online: 30 Sep 2009
doi:10.1111/j.1365-3156.2009.02404.x

Wolf-Peter Schmidt 1 , Robert Aunger 1 , Yolande Coombes 2 , Peninnah Mukiri Maina 3 , Carol Nkatha Matiko 3 , Adam Biran 1 and Val Curtis 1
1 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
2 Water and Sanitation Program, World Bank, Nairobi, Kenya
3 Steadman Group Kenya, Riverside Drive Riverside, Nairobi, Kenya

E-mail: wolf-peter.schmidt [at] lshtm.ac.uk

Background To explore how structural constraints such as lack of reliable water supply, sanitation, educational and other socio-economic factors limit the adoption of better hygiene.

Methods In preparation for the Kenya National Handwashing Campaign, we conducted a nationwide cross sectional survey in 800 households with two components: (i) direct structured observation of hygiene practices at key junctures (food handling, cleaning a child after defaecation, toilet use), followed by (ii) a structured interview addressing potential socio-economic, water access and behavioural determinants of handwashing.

Results We observed a total of 5182 critical opportunities for handwashing, and handwashing with soap at 25% of these. Handwashing with soap was more often practised after faecal contact (32%) than in connection with food handling (15%). In univariate and multivariate analysis, water access, level of education, media exposure and media ownership were associated with handwashing with soap. Only households with very poor access to water and sanitation, and with the lowest levels of education and media exposure, washed their hands markedly less than the majority of the households.

Conclusion The results underscore that structural constraints can limit hygiene practices in the very disadvantaged sections of a population, thus jeopardizing the potential success of hygiene promotion campaigns in those most at risk of disease. Nevertheless, the strong association of handwashing with media ownership and exposure supports the view that mass media can play a role in hygiene promotion.

Data gaps in evidence-based research on small water enterprises in developing countries

Melissa C. Opryszko, Haiou Huang, Kurt Soderlund and Kellogg J. Schwab (2009). Data gaps in evidence-based research on small water enterprises in developing countries. Journal of water and health ; vol. 7, no. 4 ; p. 609–622. doi:10.2166/wh.2009.213

Abstract

Small water enterprises (SWEs) are water delivery operations that predominantly provide water at the community level. SWEs operate beyond the reach of piped water systems, selling water to households throughout the world. Their ubiquity in the developing world and access to vulnerable populations suggests that these small-scale water vendors may prove valuable in improving potable water availability. This paper assesses the current literature on SWEs to evaluate previous studies and determine gaps in the evidence base. Piped systems and point-of-use products were not included in this assessment. Results indicate that SWEs are active in urban, peri-urban and rural areas of Africa, Asia and Latin America. Benefits of SWEs include: no upfront connection fees; demand-driven and flexible to local conditions; and service to large populations without high costs of utility infrastructure. Disadvantages of SWEs include: higher charges for water per unit of volume compared with infrastructure-based utilities; lack of regulation; operation often outside legal structures; no water quality monitoring; increased potential for conflict with local utilities; and potential for extortion by local officials. No rigorous, evidence-based, peer-reviewed scientific studies that control for confounders examining the effectiveness of SWEs in providing potable water were identified.

Hygienic effects and gas production of plastic bio-digesters under tropical conditions

Vo Thi Yen-Phi, Joachim Clemens, Andrea Rechenburg, Björn Vinneras, Christina Lenßen and Thomas Kistemann (2009). Hygienic effects and gas production of plastic bio-digesters under tropical conditions. Journal of water and health ; vol. 7, no. 4 ; p. 590–596. doi:10.2166/wh.2009.127

Abstract

Plastic plug-flow bio-digesters have been promoted as a good option for improved treatment of manure and wastewater in developing countries although minimal information has been published on their hygienic status. This bench-scale study replicates bio-digester conditions to evaluate the reduction of pathogen and indicator microorganisms at three different hydraulic retention times (HRT) in the anaerobic treatment of pig manures at 30°C for 50 days. Results showed that physicochemical values differed between HRTs. Gas production efficiency was better for longer HRTs. The accumulated sludge at the reactor’s base increased with longer HRT. Phages and bacteria examined were reduced, but none was completely eliminated. Log10 reduction of bacteria ranged from 0.54 to 2.47. Phages ranged from 1.60 to 3.42. The reduction of organisms at HRT = 30 days was about one log10 unit higher than HRT = 15 days and about two log10 units higher than HRT = 3 days. The results indicate that the reduction of tested organisms increases with HRT. However the hygienic quality of the liquid effluent does not meet required quality values for surface and irrigation water. Longer HRTs are recommended to increase gas yield and achieve higher pathogen reduction. More barriers should be applied while handling bio-digester outputs to minimise risks to environmental and human health.

Shower heads can make you ill

New research suggests that many shower heads are teeming with Mycobacterium avium, a bacteria that can cause lung disease. A third of the 50 shower heads checked contained a film coating of “significant levels” of the bacteria inside concluded  a scientists report from The University of Colorado . “If you are getting a face full of water when you first turn your shower on, that means you are probably getting a particularly high load of Mycobacterium avium, which may not be too healthy,” said lead researcher Norman Pace. (But how many people are facing the shower head when they turn on the water?) Anyway, from the BBC News:
Water spurting from shower heads can distribute bacteria-filled droplets that suspend themselves in the air and can easily be inhaled into the deepest parts of the lungs, say the scientists from the University of Colorado at Boulder…

While it is rarely a problem for most healthy people, those with weakened immune systems, like the elderly, pregnant women or those who are fighting off other diseases, can be susceptible to infection…

Since plastic shower heads appear to “load up” with more bacteria-rich biofilms, metal shower heads may be a good alternative, said Professor Pace.
Source:BoingBoing, http://www.boingboing.net/2009/09/15/many-shower-heads-fi.html, by David Pescovitz, September 15, 2009.
Related news: http://news.bbc.co.uk/2/hi/health/8254206.stm

Quantifying the burden of disease associated with inadequate provision of water and sanitation in selected sub-Saharan refugee camps

Cronin, A.A. … [et al.] (2009). Quantifying the burden of disease associated with inadequate provision of water and sanitation in selected sub-Saharan refugee camps. Journal of water and health ; vol. 7, no. 4 ; p. 557-68. DOI: 10.2166/wh.2009.089

A WHO methodology is used for the first time to estimate the burden of disease directly associated with incomplete water and sanitation provision in refugee camps in sub-Saharan African countries. In refugee camps of seven countries, containing just fewer than 1 million people in 2005, there were 132,000 cases of diarrhoea and over 280,000 reported cases of malaria attributable to incomplete water and sanitation provision. In the period from 2005 to 2007 1,400 deaths were estimated to be directly attributable to incomplete water and sanitation alone in refugee camps in Ethiopia, Kenya and Tanzania. A comparison with national morbidity estimates from WHO shows that although diarrhoea estimates in the camps are often higher, mortality estimates are generally much lower, which may reflect on more ready access to medical aid within refugee camps. Despite the many limitations, these estimates highlight the burden of disease connected to incomplete water and sanitation provision in refugee settings and can assist resource managers to identify camps requiring specific interventions. Additionally the results reinforce the importance of increasing dialogue between the water, sanitation and health sectors and underline the fact that efforts to reduce refugee morbidity would be greatly enhanced by strengthening water and sanitation provision

Contact: Aidan A. Cronin, Public Health and HIV Section, United Nations High Commissioner for Refugees, Switzerland, E-mail: aacronin [at] gmail.com.