Category Archives: WASH

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.

Friday Reading List

Connecting the Dots: Greater Integration between WASH and NTDs

 

Photo by Esther Havens

Photo by Esther Havens

Over the past month, we’ve heard many times from the neglected tropical disease (NTD) and water, sanitation and hygiene (WASH) communities about the importance of cross-sector collaboration (see here and here). Momentum has especially been building, though, in the past two weeks.

Just last week, as the part of events recognizing the second anniversary of the London Declaration, we celebrated new commitments from WaterAid and Dubai Cares that will advance integrated deworming and WASH interventions.

This week, the Global Network and partners gathered with the former President of Ghana and Global Network’s NTD Special Envoy, H.E. John Kufuor – who also serves as Chair of the Sanitation and Water for All (SWA) Partnership – to discuss the cost-effective and sustainable strategies our sectors and private industry can take.

Another important conversation also occurred this week: “Why water and toilets matter in foreign aid,” hosted by WaterAid at the National Press Club. Barbara Frost, chief executive of WaterAid UK; Henry Northover, head of policy at WaterAid UK; and Lisa Schechtman, director of policy and advocacy at WaterAid America spoke about how WASH can advance many U.S. interests. WaterAid also invited Dr. Neeraj Mistry, Global Network’s managing director, to weigh in about the health implications of poor WASH circumstances.

Lisa observed that there’s been increasing “recognition that development component isn’t just good for moral authority but that it helps bolster defense and diplomacy components.” The 2012 National Intelligence Estimate on Global Water Security emphasizes that water can be a tool of conflict or peace and makes the connection that poverty reduction – through WASH – can increase security.

Similarly, the U.S. Center for Disease Control and other collaborators published a Global Health Security Agenda in February to thwart risk of infectious diseases.

Barbara then stressed the impact that WASH has on “women’s health, girls’ lives, empowerment and what it means for their healthy development.” For instance, in many vulnerable communities, “girls drop out of school because they are carrying water or because there aren’t adequate toilets when they go through puberty.”

In the same way, NTDs disproportionately impact females. When END7 campaign ambassador Abhishek Bachchan visited a lymphatic filariasis clinic in Orissa State, India, he heard from women about how the stigma and misinformation associated with the disease prevented their daughters from getting married and participating equally in society. Women and girls with a certain form of schistosomiasis, one of the most common NTDs, are also three times more likely to contact HIV.

Henry, who noted that “dirty water is the vector for so many of the diseases that you see under the microscope,” also reflected on global challenges in the WASH community. Most importantly was that some serious challenges on how aid is targeted.

Global health is a fraction of one percent of the federal $1.012 trillion budget – and the budget for NTDs is even smaller. But this tiny amount has a huge impact, which is why the Global Network is urging the public to encourage key members of Congress to protect funding for this critical program.

Then Neeraj emphasized, “this is not an either or measure – we have to do both [WASH and NTDs] to have a significant and sustainable impact on many of these diseases.” While WASH and NTDs “may seem like disparate thematic issues in the development agenda, we are looking at similar thematic platforms” to make positive changes, in schools or during child health weeks.

Ultimately, we will not stop the transmission of NTDs without clean water, improved sanitation, and better hygiene practices, and even with good water, we need to distribute treatments to protect against disease. The Global Network looks forward to continuing its support as collaboration and dialogue between both sectors grows.