The elusive effect of water and sanitation on the global burden of disease
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TOPIC: The elusive effect of water and sanitation on the global burden of disease

Re: The elusive effect of water and sanitation on the global burden of disease 26 Jun 2014 11:23 #9088

  • bracken
  • Working throughout Africa since 1996 in development cooperation. Involved with sustainable sanitation systems since 2002. Currently working for the AHT GROUP AG (a private consultancy office in Germany).
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[Start of Page 2 of this discussion thread; access Page 1 with the page button above or below]

This certainly is proving to be quite an interesting discussion, with equally interesting tangential issues coming in with every post.

Firstly, with regards to the "downgrading" of potential financial returns on the health benefits of improved WASH services, I can understand the argumentation very well. The (increased) degree of uncertainty of the health benefits makes a mockery of any claims to exact calculations. But rather than simply downgrading, I imagine a fuzzy logic approach to estimates could prove more useful. I'm not sure at all how this would work in practice but do see it as offering a way out of definitive, carved in stone declarations. This would not necessarily imply a downgrading, but more a blaring of the edges of what the likely benefits could be within a framework of possibilities.

Secondly, having read the GIZ supported report from the Philippines I have to say, I think in a way it highlighted exactly the issues Wolf-Peter Schmidt was talking about in his editorial. Not being an expert in clinical methodology I confess to not having understood all the fine points of the report, however it did strike me as strange that the experimental group was entirely on a small island, whilst the control group was on a different, much larger island - meaning the external boundary conditions were likely to be quite different.
Also, as far as I could see, in essence from a hygiene point of view, the only main difference between the experimental group presented and the external concurrent control group was (apart from the toothbrushing) that they washed their hands once a day with soap and clean water as a supervised activity in the school. Both groups were biannually dewormed. The noted improvements in the experimental group, particular with regards to improved mean Body Mass Index didn't seem to me to be particular dramatic (from 14.73 as baseline to 14.88 after 1 year) as the children remained well in the "underweight" category (< 18.5 according to the hospital authority of Hong Kong). Given that the only difference really seems to be the handwashing once a day and that children's daily lives includes a lot more than that one handwashing moment within school, I personally think its stretching more than a little bit to draw a direct causation between the EHCP and the slight improvement of mean BMI after one year.

And thirdly, I'm not at all convinced about a causal link between the quality of social services and peace. I would rather imagine peace is more directly related to the equity of access to essential resources to enable households / social groups to fulfill their basic needs (this would thus include land, water, other natural resources). And whilst access to SOME of these may be improved through social services, social services in themselves are not a determining factor, but rather can serve to buffer temporary variations in access to essential resources.

all the best,
Water and Sanitation Specialist
Management & Engineering
D-45128 Essen, Huyssenallee 66-68
Last Edit: 26 Jun 2014 12:30 by muench.

Re: The elusive effect of water and sanitation on the global burden of disease 27 Jun 2014 18:04 #9144

  • christian.rieck
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Dear Cor,
unfortunately I am not able to share the deskstudy in public due to some internal information included. It had not produced additional or surprising information to what Schmidt had already elaborated in his article.
Sustainable sanitation program
GIZ, Germany
and SuSanA secretariat
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Re: The elusive effect of water and sanitation on the global burden of disease 05 Jul 2014 12:34 #9247

  • bagayam
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Hi. I was asked to comment on the Fit for School Health Outcome Study. As far as i can see from this preliminary report, this study had similar problems as most of us have when we research complex interventions. Study design was largely driven by operational constraints which are perhaps greater in our than in any other field. Hence the poor evidence base despite clear biological plausibility.
On the plus side:
-objective outcomes
-a credible intervention with fairly clear pathways to changing the outcomes, especially dental health
On the minus side
-the biggest issue is that the number of clusters is very small. As far as I could tell there were only 4 schools in the intervention and 3 schools in the control. In such cases, direct comparison between intervention and control become impossible. All that one can do is test whether the intervention changed the outcomes in the intervention arm, with the control arm serving only to demonstrate absence of secular trends. But there were secular trends, for example for worm infections.
-i cannot see a very consistent intervention effect across the different outcomes. Some show promise others not. If a primary outcome has not been specified, then its not easy to make much of it.
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