Category Archives: WASH

Eliminating Diseases by Investing in WASH

 

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This blog was originally posted in Huffington Post as part of the “WASH and the MDGs: The Ripple Effect” blog series, in partnership with WASH Advocates.

At the turn of the century, world leaders came together at the United Nations in New York to develop the Millennium Development Goals (MDGs), a set of eight ambitious goals and targets meant to significantly reduce poverty by the year 2015. As the window to achieve these goals closes this year, we reflect on progresses made and look ahead to the sustainable development goals (SDGs) that will shape the development agenda for the next 15 years.

A number of MDG targets have already been met, including efforts to reduce cases of HIV/AIDS, malaria and other diseases (MDG 6) and improving access to safe drinking water (MDG 7). Moving forward, addressing neglected tropical diseases (NTDs) will be a critical component when working toward meeting both of these goals. NTDs are bacterial, parasitic and viral infections that affect the most marginalized communities across the world and are often the result of inadequate water supply, limited access to sanitation facilities and poor hygiene. Areas with stagnant water are breeding grounds for insects that carry NTDs, notably mosquitoes which transmit malaria, but also dengue fever, lymphatic filariasis and chikungunya. By promoting integrated vector management and improved water control measures in endemic countries, we can simultaneously work to combat HIV/AIDS and malaria, while also working to control and eliminate NTDs.

Since 2000, there has been significant advancement in the fight against HIV/AIDS, particularly by increasing access to life-saving antiretroviral therapy (ART) for people living with HIV. The United Nations estimates that ART has saved 6.6 million lives since 1995. As with malaria, there are additional opportunities for integration that not only have the potential to reduce rates of HIV infection but also significantly improve water, sanitation and hygiene (WASH) conditions. For example, in many developing countries, women remain disproportionately vulnerable to HIV infection due to greater social safety issues, such as lacking access to safe and accessible latrines. By not having access to a safe lavatory, women are forced to use public spaces to openly defecate and manage their menstrual needs, making them increasingly susceptible to infections as well as sexual violence. Globally, more than two billion people lack access to a proper toilet. Many common, poor hygiene practices, such as open defecation and failure to wash one’s hands, promote the spread of disease. These factors combined perpetuate the cycle of NTD infections and other serious infections.

The proposed SDGs currently consist of 17 goals with 169 targets that aim to end poverty and hunger, improve health and education, make cities more sustainable, combat climate change, and protect oceans and forests. Goal 3 encompasses a number of health-related objectives and targets, including ending the epidemics of AIDS, tuberculosis, malaria, NTDs and water-borne diseases by 2030. Meeting these targets will go hand-in-hand with Goal 6 — achieving access to adequate and equitable sanitation and hygiene for all, ending open defecation, and paying special attention to the needs of women and girls and those in vulnerable situations.

There are many ways that enhancing WASH conditions unswervingly leads to NTD control and elimination. For example, by improving access and quality of water, sanitation and hygiene, we can significantly reduce the number of people suffering from trachoma, an infectious eye disease and leading cause of preventable blindness, which results from limited access to clean water and proper sanitation. By simply providing access to clean water, we can reduce the number of trachoma cases by 27 percent. Similarly, having better sanitation in place can decrease cases of schistosomiasis, a parasitic disease carried by fresh water snails infected with parasites. Women are especially vulnerable, given that cases of female genital schistosomiasis (FGS) result in three times greater chances of contracting HIV. It is estimated that at least 16 million women may be infected with FGS in Africa.

It is evident that WASH interventions have a multiplier effect and positively impact other health issues and development goals. As the window to achieve the MDGs comes to a close this year and we grow closer to confirming the goals and targets that will shape the next 15 years, we must emphasize the important synergies between WASH and the control and elimination of NTDs.

This blog post is part of the “WASH and the MDGs: The Ripple Effect” blog series, in partnership with WASH Advocates, addressing the importance of water, sanitation and hygiene (WASH) to global development. To see all the other posts in the series, click here. To learn more about WASH, visit the WASH Advocates website, and for more information about the Millennium Development Goals, click here.

Water is Crucial to Ending Blinding Trachoma

 

Photo from International Trachoma Initiative

Photo from International Trachoma Initiative

By Elizabeth Kurylo
Communications manager, International Trachoma Initiative

Every morning and every night, I turn on the hot and cold water taps, adjusting them so the temperature is just warm enough to wash my face. I take for granted that the water will flow. I would be shocked if it didn’t. This easy access to water is a luxury not enjoyed by hundreds of millions of people around the world.

As we mark World Water Day, it is worth noting that 748 million people do not have access to an improved source of drinking water and 2.5 billion do not use an improved sanitation facility. For them, the lack of water can mean poor health, disability and even death.

Water and sanitation is especially important in the prevention and control of trachoma and other neglected tropical diseases (NTDs). Trachoma is an ancient eye disease caused by a bacterial infection. Left untreated, it can lead to blindness. But we can stop it with the World Health Organization-endorsed SAFE strategy – Surgery, Antibiotics, Facial cleanliness and Environmental improvement.

Water is crucial to facial cleanliness, and key to ending blinding trachoma.  But in many places where trachoma is endemic, water is scarce, and rationed for uses other than hygiene, such as cooking. Face washing is not a priority.

The global trachoma community has made much progress since 1998, when Pfizer began donating the antibiotic Zithromax®, which treats and prevents trachoma. More than 444 million doses of Zithromax® have been shipped to trachoma endemic countries to date. And seven countries have reported reaching their elimination goals.

Under the leadership of WHO and the Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020), national trachoma programs have steadily scaled up implementation. In 2014, WHO’s Weekly Epidemiological Report (WER) said trichiasis surgeries and antibiotic distribution were tenfold higher in 2013 compared to 2004.

The International Coalition for Trachoma Control (ICTC) has galvanized the global trachoma community’s commitment to reaching elimination by 2020.  Collaboration on game-changing initiatives with governments, health officials and trachoma endemic communities has led to the mobilization of more than 150 million dollars of new funding from DFID, USAID and the Queen Elizabeth Diamond Jubilee Trust.  That is in addition to the national government domestic budget allocations and support already provided by many non-governmental development organizations as well as other donors such as the Lions Clubs International Foundation, Conrad N Hilton Foundation and the Bill & Melinda Gates Foundation.  The WASH sector also is collaborating with the NTD sector to achieve shared goals of improving health and eliminating disease.

Still, there is much work to do. An estimated 232 million people in 51 countries live in trachoma endemic areas. Globally, 31 countries are implementing the SAFE strategy to eliminate trachoma, which signifies that 20 countries are still in need of help.

In 2015, ITI plans to ship 115 million doses of Zithromax®, donated by Pfizer. That is more than twice the amount approved for shipment in 2014.  “We are doing everything we can to accelerate access to Zithromax® needed by people who are at risk of blindness from trachoma,” said Dr. Paul Emerson, Director of ITI. “We are empowering national programs so that those at risk of going blind from trachoma can be treated.”

Empowering people in trachoma endemic communities to prioritize water for hygiene also has lasting benefits. I saw this in Ethiopia, where I met Amarech Haluka, the mother of three young girls, one of whom had experienced the pain of trachoma. Health workers introduced the SAFE strategy to Amarech’s community, which received donated Zithromax® and education about the importance of using latrines and keeping their faces clean to avoid trachoma. Amarech and her husband got a loan to install a water pump in their back yard, and she now routinely washes her children’s faces twice a day. Even though she cannot adjust the temperature of the water that flows from her pump, her children’s faces are clean, and her family is free of trachoma.

Intervention with Impact: Integrating Safe Drinking Water, Sanitation, and Hygiene to prevent Undernutrition and NTDs

 

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By: Jordan Teague, Program Associate at WASH Advocates

My niece turned two years old on Sunday. It was a joyful occasion, celebrating that she can now speak in full sentences, gives full-blown hugs and started pre-school in the fall. The entire family gathered this weekend with presents, cake and a birthday outing to a fire truck parade. During the festivities, it occurred to me that my niece is now past the first 1,000 days of her life, the most critical time with regard to her nutrition. We are fortunate that because we live in the United States, we have not had to worry about undernutrition or the illnesses related to that condition, but what if she had been born somewhere else?

In many places around the world, undernutrition is not the only worry that families have for their small children and themselves. Over 1.4 billion people in Africa, Asia, and Latin America and the Caribbean are affected by at least one of the neglected tropical diseases (NTDs). These diseases largely overlap in areas where undernutrition is prevalent and magnify its impact on childhood growth and micronutrient deficiencies. In fact, all of the 34 countries with the highest levels of malnutrition are endemic for NTDs. Several NTDs like schistosomiasis and soil-transmitted helminthiasis (STH) are underlying contributors to stunting and undernutrition. Not only do they affect child health and survival, but they also have detrimental impacts on cognitive development, educational outcomes and economic growth.

A lack of safe drinking water, adequate sanitation and proper water, sanitation and hygiene (WASH) contributes to both NTDs and undernutrition. Safe WASH is key to preventing, controlling and eliminating five NTDs: Soil transmitted helminthes (also known as intestinal worms), schistosomiasis, trachoma, lymphatic filariasis and Guinea worm. Similarly, poor sanitation and unsafe drinking water cause diarrheal disease and environmental enteropathy, which inhibit nutrient absorption and lead to stunting and undernutrition. Improved WASH allows for the absorption and use of vital nutrients and calories, leading to improved nutrition and health.

Given the myriad of linkages between WASH, NTDs and nutrition, joint policies and programming have significant potential to scale up the impact of the individual efforts. For example, in 2013 Dubai Cares launched an integrated Home Grown School Feeding Program that includes elements of all three sectors. This program includes in-school meals prepared from local foods and commodities in addition to deworming treatment and provision of WASH interventions in the schools. This program shows how different stakeholders can collectively use their diverse expertise to make a larger impact on the health of a community.

WASH interventions support the sustainability of progress made through NTD and nutrition programs on reducing disease and improving health. Real and sustainable impacts can be achieved when investments in NTDs and nutrition go hand-in-hand with efforts to provide WASH.

Jordan Teague is the Program Associate at WASH Advocates, where she focuses on sustainability within the WASH sector and the integration of WASH with other development efforts such as nutrition, NTDs and education.

Honduras: Leading the Way in the Americas through Integrated Efforts to Treat Neglected Tropical Diseases

 

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Honduras is one of Latin America’s leaders in health and integration; their nation-wide effort to control and eliminate neglected tropical diseases (NTDs) draws upon the institutionalized infrastructure of the country’s national vaccination week activities, and works across multiple sectors to deworm as many children as possible throughout the country.

Honduras’ unique and successfully-integrated approach to fighting NTDs is highlighted in a recently published success story, Honduras: Leading the Way in the Americas through Integrated Efforts to Treat Neglected Tropical Diseases (click here to read in Spanish).The success story highlights one of the country’s pilot programs which dewormed children aged one – four as part of the country’s vaccination week activities and scaled up to reach all preschool children at-risk, as well as Honduras’ efforts to deworm all school-aged children across the country.

In Honduras, 870,816 preschool children and 2 million school-age children are at risk for soil transmitted helminth infections (also known as intestinal worms). Intestinal worm infections are wide-spread and have a 50 percent prevalence rate in nearly half the country’s municipalities. These infections can cause severe anemia and contribute to pregnancy complications in women and severe malnutrition in children. NTDs also pose a threat to the development for endemic countries like Honduras by trapping the most vulnerable populations in cycles of poverty.

To address the heavy NTD burden within the country, Honduras’ NTD program leverages two platforms: Vaccination Week in the Americas and the Escuelas Saludables program. During Vaccination Week in the Americas, the deworming of children aged one-four occurs alongside a variety of other health interventions like vitamin A supplementation and vaccinations. And concurrently, Honduras’ Ministry of Health works with the Ministry of Education and Social Development, the World Food Programme and others to deworm school children across the country. Just last year, the Global Network partnered with these groups, the Pan American Health Organization (PAHO), Operation Blessing and the MAMA Project to deworm more than one million school children.

And beyond just deworming, Honduras is integrating water, hygiene and sanitation (WASH) practices into its NTD prevention efforts. Because NTDs are easily spread by contaminated water sources and a lack of hygiene and sanitation practices, health workers and teachers promote hygiene education among children through the Escuelas Saludables program. Additionally, four safe water systems (hydrochlorinators) were installed in the municipalities of Marcovia and El Triunfo.

Honduras’ deworming program has been successful not only because of its integrated nature, but also because of its political and public support. For example, in 2010 Honduras formed a National NTD Committee, called the Mesa Tecnica, which includes NTD experts from the Ministry of Health, PAHO country office and various other partners including academia and nongovernmental organizations. The Mesa Tecnica has led efforts to map the prevalence of intestinal worms and develop the national NTD plan.

Honduras also has the support of Global Network NTD Special Envoys including Dr. Mirta Roses Periago, former PAHO Director, His Excellency, President Ricardo Lagos Escobar of Chile and His Excellency, President Alvaro Arzú Iriogoyen of Guatemala.

This combination of political and public support, and a well-designed and integrated NTD program have solidified Honduras’ position as a leader in NTD control and elimination efforts in the region. To learn more about Honduras’ efforts and to read the full success story, click here.