SuSanA - Forum Kunena Site Syndication http://forum.susana.org/ Fri, 29 May 2015 06:07:39 +0000 Kunena 1.6 http://forum.susana.org/components/com_kunena/template/default/images/icons/rss.png SuSanA - Forum http://forum.susana.org/ en-gb Re: Water, Sanitation and Hygiene – WASH - by: pkjha http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13430-water-sanitation-and-hygiene--wash-the-neglect-of-hygiene-promotion-in-developing-countries#13436 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13430-water-sanitation-and-hygiene--wash-the-neglect-of-hygiene-promotion-in-developing-countries#13436
Thanks for the informative post.
Sanitation is always lagging behind water. One of the reasons is both the sectors are clubbed together under the same budgetary head and water sector always get higher share than sanitation. Secondly Public health engineers are more interested with water than sanitation as it not considered as a dignified work.
In India there is a separate Ministry for water and sanitation for rural areas having separate Joint Secretary with separate budget for the water and sanitation. The result is good.
Sanitation has direct linkage with health. However, it has been observed that Health Department is rarely involved with sanitation program. If a patient suffering from water borne diseases go to Doctor, he gets some antibiotics. Doctor never advise such patients not to go for open defecation and use only toilets. The sanitation program can be more effective in achieving its goals when Health Department / Doctors in villages get involve into the program.
Pawan]]>
Health issues and connections with sanitation Mon, 25 May 2015 11:39:07 +0000
AfricaSan4 sideevent : tomorrow Productive Sanitation , Food Security and Resilient livelyhood - by: madeleine http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13431-africasan4-sideevent--tomorrow-productive-sanitation--food-security-and-resilient-livelyhood#13431 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13431-africasan4-sideevent--tomorrow-productive-sanitation--food-security-and-resilient-livelyhood#13431 AfrikaSan4 is about to start and we would like to invite you all in Senegal now to our very exiting Side event tomorrow 25 May 2015 17:40 -19.10
We are very honored that the Minister of Agriculture will chair our session.
We can promise a very exiting session with lesson learned from a decade of implementation of Productive Sanitation in Africa. Most welcome to you all.

Productive sanitation, taken to scale, could be a key to broad-ranging sustainable development in many African countries. An SEI side event at AfricaSan 4 will revisit past experiences for lessons on how to make it happen.

Food security and access to decent sanitation and hygiene services are fundamental to healthy and productive lives; but far too many people in low- and middle-income countries lack both. In sub-Saharan Africa (SSA) a quarter of the population were undernourished in 2011-2013, 80% have no electricity access, and a staggering 70% – 640 million people – still use substandard sanitation systems or none at all, despite marked improvements in recent years.

All of these are urgent challenges, particularly with the population growth and rapid urbanization projected for the region in the coming decades. But as diverse as the challenges are, they do not always need separate solutions. In particular, filling the region’s huge sanitation gap would not only vastly improve the health and living standards of that 640 million people, but in the process it could make a significant contribution to improving food security and meeting a range of other sustainable development targets.

Crucial to achieving this would be large-scale implementation of so-called productive sanitation systems – systems that make productive (and safe) use of nutrients, organic matter and water content of human excreta and wastewater for crop and energy production. The nitrogen, phosphorous and potassium in one person’s human excreta can boost yields by around 50 kg of cereals per year, on a conservative estimate, much more cheaply than commercial synthetic fertilizers. Productive sanitation can also strengthen local livelihoods and increase resilience to external pressures such as rising fertilizer prices and climate events.

Productive sanitation can take many forms, from household dry toilets or decentralized community-level systems right up to municipal scale. It is most immediately and obviously relevant to rural communities, and particularly smallholder farmers, who too often neglect to consider recycling human excreta even as they carefully manage local natural resources to ensure sustained crop production. It can also reduce pollution and degradation of local water resources. However, there is also vast potential in SSA’s fast-growing urban centres, where existing sewerage networks and sewage treatment systems often meet only a fraction of even today’s demand.

Looking back and looking ahead

Productive sanitation has proved its value in smaller, local projects. The question is how to take it to scale, and do so sustainably. Productive sanitation has to contend with all of the barriers and difficulties inherent in implementing conventional “disposal-oriented” sanitation in areas of low coverage – for example, the upfront investments, ensuring that the governance arrangements, technical capacity and financing models are in place to keep the systems working – and more on top. For example, productive sanitation demands long-term planning and cooperation between several government sectors: water, agriculture, energy, health and others. At the same time, people need to be convinced and supported to safely handle and reuse human excreta, and to trust foods fertilized with humanure,.

One of the central aims of the new SEI Initiative on Sustainable Sanitation is to see what we can learn from experiences with implementing productive sanitation and, in particular, to cast a fresh eye over some of the ostensible success stories of the past. Are they still working a few years after the final project evaluation? Which aspects of the system have changed and which have stood the test of time? And what can we learn from that about what is needed to sustain productive sanitation?

A side event hosted by SEI at AfricaSan 4, in Dakar, Senegal, on Monday 25 May will be a chance to do just that. The side event, titled Productive Sanitation, Food Security and Resilient Livelihoods, will start by looking back and learning. Among the presentations, Savadogo Karim, of CEFAME/SNV, will talk about experiences with taking ecological sanitation (ecosan) to scale in Burkina Faso. Kailou Hamadou of the Niger Ministry of Hydraulics and Sanitation will reflect on the legacy of a productive sanitation project in Aguié, Niger, five years on. Dr Sudhir Pillay of the Water Research Commission will talk about experiences in South Africa. (For a full list of presentations download the session programme in English or French.)

The second part of the session will look ahead. To be implemented in a sustainable way, productive sanitation systems need to be socially acceptable, economically viable, and technically and institutionally appropriate. An expert panel will guide discussions on how to overcome the barriers to scale and sustainability.]]>
Health issues and connections with sanitation Sun, 24 May 2015 12:49:11 +0000
Water, Sanitation and Hygiene – WASH - The neglect of hygiene promotion in developing countries - by: F H Mughal http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13430-water-sanitation-and-hygiene--wash-the-neglect-of-hygiene-promotion-in-developing-countries#13430 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13430-water-sanitation-and-hygiene--wash-the-neglect-of-hygiene-promotion-in-developing-countries#13430 Water, Sanitation and Hygiene – WASH

The mindset of politicians and decision-makers in the developing countries is such that they always give priority to water – when it comes to giving priority. They avoid talking about sanitation. Sanitation is given a low priority. However, in India, the government is giving high priority to sanitation.

Hygiene component, however, has not yet received the priority in developing countries. It has failed to receive the attention of decision-makers in developing countries – even to this day.

Recently, I happen to lay my hands on the paper: The neglect of hygiene promotion in developing countries, as shown by the Global Analysis and Assessment of Sanitation and Drinking-Water survey. The paper is authored by Alejandro Jiménez, Sue Cavill and Sandy Cairncross.

The abstract reads:

“The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) report is one of the three periodic UN reports dealing with water supply, sanitation and hygiene. This paper analyses the data on hygiene promotion which were collected for the 2012 edition, but not included in the report. Despite the limitations of the information, this is the best picture available of the global status of hygiene promotion in developing countries. Results show the low priority given to hygiene when it comes to implementation. On average, the staff in place meets 40% of the estimated needs to achieve national targets. Countries report that over 60% of their population is reached by hygiene promotion messages, but we estimate that there are barely enough hygiene promoters to reach 10% of the people. Government officials’ greatest concerns are the lack of human resources and funds, but they also point to the absence of strategy, responsible agency and basic coordination and monitoring mechanisms as challenges. This has serious implications for the poor working conditions and low recognition of hundreds of thousands of hygiene promoters, who in most cases are women capable of playing a crucial role for public health. There is an urgent need for further development of capacity for hygiene promotion in developing countries.”

The abstract clearly indicates that low priority given to hygiene. Only 10% of the population is impacted by hygiene promotion.

A recent blog post by Hanna Woodburn, Deputy Secretariat Director for the Global Public-Private Partnership for Handwashing, has an eye-catching caption: Harnessing the “H” in WASH: The need to ensure hygiene’s place in the SDGs.

In her post, Hanna highlights the importance of including targets and indicators on hygiene, into the post-2015 development agenda under the Sustainable Development Goals (SDGs).

She points out that, while the proposed goal for water under the SDGs is a step in the right direction, there is a need to develop global level indicators that more accurately assess progress on hygiene. She calls hygiene as an overlooked area. Hanna underlines the need to develop global level indicators on hygiene.

An important comment in her post reads:

“Some of the world’s greatest development challenges have the simplest solutions. If you are reading this blog, you likely know the facts about water, sanitation, and hygiene (WASH). You probably know that diarrhea and pneumonia are the top killers of children under the age of five, and that WASH can make a big difference in saving these lives. You might be able to cite statistics about how many days of school children miss due to diarrhea (272 million per year, in case you were wondering), or be able to describe the impact that a lack of facilities have on menstruating girls’ education.”

Hanna’s post can be seen here: washfunders.org/Blog/harnessing-the-h-in...+WASHfunders.org+%29

These two references show importance of hygiene. But, the key point is how to motivate and sensitize the politicians, decision-makers and key government functionaries, so that priority is given to hygiene. At the moment, I think, the top-brass of the government, and the officials working in the relevant department in the developing countries, are miles away from hygiene.


F H Mughal]]>
Health issues and connections with sanitation Sun, 24 May 2015 06:01:09 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: YWAN446 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13309 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13309
I can explain in some more detail how the SaniPath analysis is planning to deal with the issue of sample variability.

The SaniPath study has three phases so far (Phase 1, Phase 1.5, and Phase 2). Right now we are working on a methodology to incorporate the variability from samples into our results. We have used phase 1 data, which has a larger sample size, to decide what types of distributions the environmental concentrations and frequencies of behavior follow. In order to see how robust a sample size of 10 was for each pathway, we used the bootstrap method and found that the variance of the mean of the log 10 concentrations for ten random samples was small. This enabled us to compare pathways on a log 10 scale. In order to prioritize pathways, we don't need an accurate estimate of the dose for each pathway, we just need the ranking. Since our goal is to distinguish 100 from 1000 rather than 20 from 50, ten samples are enough. Currently, we are conducting more analysis and trying to use a larger sample size for those pathways with a larger variability to increase the accuracy and robustness.

Furthermore, Bayesian Analysis (en.wikipedia.org/wiki/Bayesian_inference) can be used to estimate the distribution of both the environmental concentration and frequency of behavior, which account for variability. For example, if you sampled from the distribution and you had one accidentally highly contaminated sample while others were very clean, our new output could tell us that most of time this pathway is clean, but that there is a small probability that it could be very contaminated. This should be a good estimate of reality. If we sampled from the distribution again and we got ten samples that were all very clean, we could get results similar to the first time given the assumptions about the distribution. Though we didn't pick a highly contaminated sample the second time around, the distribution assumption can still inform us that there is a very small probability of getting a highly contaminated sample. Our results would depend on both the assumption of the distribution, which comes from our larger SaniPath phase 1 study, and the data people collect when they use the tool. I hope this helps answer your question about how our tool is trying to deal with chance variability.

Thanks,
Yuke (Andrew) Wang

Yuke Wang, MSPH
Data Analyst
Emory University
Rollins School of Public Health–Hubert Department of Global Health
Center for Global Safe Water
1518 Clifton Road, NE
MS: 002-7BB CNR6040B
Atlanta, GA 30322
Phone: 404-727-2238
Fax: 404-727-4590]]>
Health issues and connections with sanitation Tue, 12 May 2015 13:37:14 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: YWAN446 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13308 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13308
I work as a biostatistician/data analyst in SaniPath group. I hope I can answer your questions about QMRA.

The QMRA wiki website qmrawiki.canr.msu.edu/index.php?title=Qu...ial_Risk_Assessment_(QMRA)_Wiki summarizes some concepts about QMRA. On this website, QMRA was defined as a framework and approach that brings information and data together with mathematical models to address the spread of microbial agents through environmental exposures and to characterize the nature of the adverse outcomes. As far as I understand, using quantitative data (microbial and behavioral) and mathematical models distinguishes QMRA from traditional risk assessments . As for the mathematical models and calculations, they don’t have to be as complex as Bayesian Analyses or Monte Carlo Simulations. They could be as simple as multiplying frequency of behavior and dose per contact together.

SaniPath is an application of QMRA. However, since our goal for SaniPath is to provide overall fecal microbe exposure information instead of information specific to one pathogen, the SaniPath methodology doesn't use a dose response model, which must correspond to one specific pathogen. Therefore, the SaniPath methodology functions as an exposure assessment rather than an estimate of the probability of infection.

An exposure assessment is a two part process that includes 1) evaluation of pathways that allow microorganisms to be transported from the source to the point of contact with human beings and 2) estimation of the amount of exposure that is possible between humans and contaminants. Conducting a realistic exposure assessment is important for good risk characterization as well as risk management. (ref: qmrawiki.canr.msu.edu/images/Introduction.pdf)

The SaniPath exposure assessment for the Phase 1 in-depth analysis tracks back the source of fecal microbes that enters the human body and estimates its amount using a huge Monte Carlo Simulation. The microbial and behavioral data are all based on distributions, which are estimated using Bayesian Analysis. We can provide more detailed information about our exposure assessment after our exposure paper is finished.

Thanks,
Yuke (Andrew) Wang

Yuke Wang, MSPH
Data Analyst
Emory University
Rollins School of Public Health–Hubert Department of Global Health
Center for Global Safe Water
1518 Clifton Road, NE
MS: 002-7BB CNR6040B
Atlanta, GA 30322
Phone: 404-727-2238
Fax: 404-727-4590]]>
Health issues and connections with sanitation Tue, 12 May 2015 13:02:32 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: muench http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13292 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13292
This might be a stupid question but could you please explain to me how QMRA* relates to your Sanipath tool, i.e. is Sanipath an application of QMRA or an extension (or simplification) of it?
You mentioned QMRA once in your project description under objectives:
o Conduct an exposure assessment and quantitative microbial risk assessment (QMRA).


Thanks,
Elisabeth

* QMRA = Quantitative Microbiological Risk Assessment, see also: en.wikipedia.org/wiki/Quantitative_Micro...ical_Risk_Assessment]]>
Health issues and connections with sanitation Mon, 11 May 2015 09:48:12 +0000
Infants’ Faeces and Handwashing - by: F H Mughal http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13164-infants-faeces-and-handwashing#13164 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13164-infants-faeces-and-handwashing#13164 Infants’ Faeces and Handwashing

Despite advancement in the sanitation field, some uncalled-for myths still remain among the people. In the rural areas of Sindh province, Pakistan, women still consider infant’s faeces as harmless, and therefore, do not wash hands with soap after cleaning the infants, other than just a quick dab or splash of water on contaminated hand.

A recent publication (Infant and Young Child Faeces Management: Potential enabling products for their hygienic collection, transport, and disposal in Cambodia, 2015, WaterSHED; London School of Tropical Medicine and Hygiene. Authors: Molly Miller-Petrie, Lindsay Voigt, Lyn McLennan, Sandy Cairncross, Marion Jenkins) shows that in Cambodia, only 20 per cent of children’s faeces were disposed of in an improved sanitation facility according to the 2010 Demographic and Health Survey.

While the publication does not clearly say anything about handwashing with soap by the mothers, one can interpret that only 20 per cent women in Cambodia consider infants’ faeces harmful. While the publication acknowledges that there is evidence of children’s faeces playing a major role in diarrheal disease transmission through the contamination of the household environment, it points out of relatively little priority in this field.

According to the publication, the results of the study demonstrate a need for interventions targeting the hygienic management of faeces of children under five in Cambodia, and particularly for children under two.

UNICEF is the major international player that targets children. It would be helpful, if UNICEF focus on this particular aspect and, adopt widespread plans for ending the myth. Infants’ faeces are harmful and, the mothers should wash their hands with soap, after cleaning the infants.

The publication can be accessed at: www.watershedasia.org/wp-content/uploads...aeces-Management.pdf

F H Mughal]]>
Health issues and connections with sanitation Sun, 03 May 2015 07:00:25 +0000
Viruses in WWTP and the Microbiome - by: KeithBell http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13161-viruses-in-wwtp-and-the-microbiome#13161 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13161-viruses-in-wwtp-and-the-microbiome#13161 virome is a hot topic, but little is known about how viruses affect general health via interaction with bacteria. But we do know viruses are hugely abundant in wastewater.

Why are we still mixing waste with water, infecting ourselves and creatures everywhere?

Our view of the virome in our intestines is changing, now seen as part of our immune system, actually protective. But out of balance with other microbes, viruses cause disease:

news.wustl.edu/news/Pages/27891.aspx
www.cell.com/abstract/S0092-8674(15)00003-3



Did you know 95% of all polio cases are asymptomatic? Interaction with certain bacteria dramatically increase polio infectivity. In one study, the bacillus, B. cereus, was found to increase poliovirus infectivity over 500%.
Intestinal microbiota promote enteric virus replication and systemic pathogenesis
www.ncbi.nlm.nih.gov/pmc/articles/PMC3222156/

Similar studies about bacterial interaction with measles virus do not exist. So, why would measles be a mild childhood disease in most people, but lethal in others? Lack of a protective microbial balance . . .

Viruses bind to the sugar (LPS, etc.) in the cell wall of bacteria to increase infectivity. There's also a genetic component where viruses bind to host glycans. But a diet high in sugar and starch is more important than genes in shifting flora associated with viral disease.

This new paper reveals how we've been impudently releasing viruses into surface water:
The Detection Rate of Enteric Viruses and Clostridium difficile in a Waste Water Treatment Plant Effluent, 2015
link.springer.com/article/10.1007%2Fs12560-015-9183-7

And here we see how airborne viruses put WWTP workers at risk of gastrointestinal imbalance:
Assessment of airborne virus contamination in wastewater treatment plants, 2014
www.sciencedirect.com/science/article/pii/S0013935114001959

"20 out of 174 wastewater samples were positive" for polio in Switzerland:
Isolation of Sabin-Like Polioviruses from Wastewater in a Country Using Inactivated Polio Vaccine
www.ncbi.nlm.nih.gov/pmc/articles/PMC2547022/

Vaccination masks the issue: poor sanitation: polio in 7 Italian cities
Sporadic Isolation of Sabin-Like Polioviruses and High-Level Detection of Non-Polio Enteroviruses during Sewage Surveillance in Seven Italian Cities, after Several Years of Inactivated Poliovirus Vaccination, 2014
www.ncbi.nlm.nih.gov/pmc/articles/PMC4148784/]]>
Health issues and connections with sanitation Sat, 02 May 2015 17:18:48 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: sjraj http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13158 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13158
Variability is definitely an issue- particularly when we deal with limited samples and survey sizes, and as you mentioned sampling variability/chance effects. In an effort to stay simple, this first version of our tool's analysis calculated risk of exposure using point estimates, which do not take into account variability. However, we recognize that variability is a concern and we are currently working on utilizing the distribution of sample and survey data so that variability can be better accounted for.]]>
Health issues and connections with sanitation Fri, 01 May 2015 19:57:24 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: joeturner http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13143 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13143
I think your worker in the video I posted was mentioning that the soil around the school and even the school desks were highly polluted - so I'm guessing a similar analysis had been used to show that these were areas to address to reduce infection rates.

One thought I had was around variability of the sampling - and chance effects. If a municipality used the tool and found that the school soil (for example) was an area to prioritise, it might set in place a policy to reduce that risk. If it then reanalysed using this tool, is it possible that a sample with low E.coli rates could be seen as a 'success' - when in reality it was just accidental? Or alternatively maybe the particular desk where a single child was sitting was particularly contaminated, whereas the others were cleaner. How robust is your tool to these kinds of variations?]]>
Health issues and connections with sanitation Thu, 30 Apr 2015 19:32:01 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: sjraj http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13141 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13141
-Suraja]]>
Health issues and connections with sanitation Thu, 30 Apr 2015 18:48:47 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: joeturner http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13129 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13129
I have been watching this video from your website, which is very interesting but does not seem to explain much about using the tool

]]>
Health issues and connections with sanitation Thu, 30 Apr 2015 10:54:05 +0000
SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - by: sjraj http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13099 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa#13099



Title of grant: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings

  • Name of lead organization: Center for Global Safe Water at Emory University
  • Primary contact at lead organization: Christine L. Moe, PhD, (Principal Investigator); Suraja Raj, MPH (Research Project Coordinator)
  • Grantee location: Atlanta, GA (USA)
  • Developing country where the research is being or will be tested: Accra, Ghana; Vellore, India; Maputo, Mozambique, other locations to be determined
  • Start and end date: 09 November 2010 to 31 December 2015
  • Grant type: Global Development Grant
  • Grant size in USD: $3,721,284 as per the BMGF grant database: www.gatesfoundation.org/How-We-Work/Quic...s/2010/11/OPP1016151

Short description of the project:

Rapid urbanization has led to a growing sanitation crisis in urban and peri-urban areas of low-income countries. Currently, over half of the global population reside in urban areas, with cities in Asia and Africa projected to experience the greatest increase in population. Rapid population growth in developing countries has outpaced existing infrastructure, including water and sanitation systems, leading increasing numbers of urban dwellers, especially those in informal settlements, to live in very polluted environments. Despite the considerable sanitation needs of urban and peri-urban communities, there are little data to inform strategies to mitigate risks of fecal exposure in developing countries. Consequently there is a need for site-specific evidence to help make decisions about sanitation investments.

Phase 1 on the study involved in-depth data collection on behavior and environmental contamination along multiple pathways of exposure in Accra, Ghana. Examples of pathways of exposure to fecal contamination include drinking water, recreational water, waste-water irrigated produce, surfaces in public latrines, drain water, etc. Based on lessons from Accra, we have been developing the SaniPath Rapid Assessment Tool to assess key pathways of exposure in urban, low-income settings. The tool guides users in collecting much needed data on exposure to fecal contamination in low income, urban neighborhoods, and synthesizes these data for community, government, and service providers’ decision-making. The pathways are characterized by taking into consideration the frequency of exposure to a particular pathway along with the dose (the amount of E.coli ingested per ingestion event). The tool, which consists of training material, protocols, as well as data entry/analysis software, is publicly available on our website or on a USB flash drive and is intended for non-governmental organizations, funders, and government institutions.




Goal(s):

To improve our understanding of risks from fecal contamination in urban and peri-urban settings in developing countries and ultimately develop effective strategies and inform investments and policies to reduce these risks.


Objectives:

The objectives of the SaniPath Study are to :
  • Conduct an exposure assessment and quantitative microbial risk assessment (QMRA) with Phase 1 behavioral and environmental data from Accra, Ghana to understand exposure to fecal contamination in low-income, urban neighborhoods.
  • Use lessons learned from Phase 1 in developing the SaniPath Rapid Risk Assessment Tool, which utilizes a mixed methods approach to understanding exposure to fecal contamination (i.e. environmental sample collection, individual and group surveys, key informant interviews, GPS mapping, etc.)
  • Synthesize these data for community, government, and service providers’ decision-making
  • Create a tool whose results will be used to characterize a neighborhood or city according to a matrix of fecal exposure pathways. The outputs will serve as a simplified, but still informative, means of identifying priorities for sanitation investments or interventions.

Research or implementation partners:
o Noguchi Memorial Institute for Medical Research (Accra, Ghana)
o The London School of Hygiene & Tropical Medicine (London, UK)
o The International Water Management Institute (IWMI) (Accra, Ghana)
o Water Research Institute (WRI) (Accra, Ghana)
o TREND Group (Accra, Ghana)
o Research Triangle Institute (RTI) (Raleigh, NC, USA)
o Christian Medical College, Vellore (Vellore, India)
o Georgia Institute of Technology (Atlanta, GA, USA)

Links, further readings – results to date:
Our project website: www.Sanipath.com
Documents in SuSanA library (includes my recent presentation at the FSM3 conference in Hanoi): www.susana.org/en/resources/library/details/2192

See my presentation on video here (it starts at 1 min. 33 s):



Direct link to where my part starts
youtu.be/g8ZfQzJLUws?t=1m33s




Current state of affairs:

Phase 1 was completed in 2012 as a 15-month in-depth interdisciplinary exposure assessment in Accra, Ghana in order to identify, characterize and prioritize fecal exposure pathways in both the public and private domains using environmental sampling to quantify contamination and social science methods to investigate behaviors that lead to exposure. Phase 1.5 was completed in 2013, and involved the development and piloting of the first version of the SaniPath Rapid Assessment Tool. Phase 2 included further development of the tool (including softwar e), piloting of the tool in Vellore, India, as well as additional data collection through collaboration with the Mal-ED study in Vellore (mal-ed.fnih.org/) in order to understand the relationship between environmental exposure risk and enteric infection rates.

Data from Phase 1 and 2 are currently being analyzed and prepared into publications . We recently finished baseline data collection in Maputo, Mozambique through a collaboraion with the Georgia Institute of Technology’s MapSan study (tinyurl.com/labgubb)Through this collaboration we hope to understand the applications of the SaniPath tool in monitoring sanitation interventions. Over the next few months, we will be refining components of the SaniPath Rapid Assessment Tool based on lessons learned from tool deployments and input from target user groups. Improvements we are exploring include enhanced flexibility, improved data visualization and analysis components of the software, and adaptation for mobile data collection (with mobile phones).

Biggest successes so far:
  • Development of simple protocols for behavioral and environmental data collection (www.sanipath.com/manual/)
  • Identification of relevant pathways of fecal contamination in the public domain (i.e. shared spaces and areas actionable by government policies and programs)
  • Collection of data from field sites in Ghana, India, and Mozambique on exposure to fecal contamination
  • Development a pilot version of a software that is freely available to the public, see: www.sanipath.com/download-sanipath/

Main challenges / frustrations:
  • Fecal exposure pathways may be very complex and thus difficult to fully characterize. To mitigate this risk our interdisciplinary exposure assessment investigates a range of potential exposure pathways. The mixed methods approach (i.e. environmental sample collection, individual and group surveys, key informant interviews, mapping, etc.) gives us more opportunities to characterize complex and intersecting exposure pathways.
  • Data collection and microbial quantification methods can be challenging to perform in a setting with limited resources. To facilitate successful data collection we have partnered with institutions in Ghana, India, and Mozambique with established track-records of maintaining dependable infrastructure and results.
  • Developing a rapid risk assessment tool that provides relevant and useful information, but maintains a level of simplicity is challenging. Identifying audiences (such as NGOs/CNGOs, city planners and government officials, contractors, or funding agencies) who would be most likely to use the tool as well as the degree of flexibility that is (or is not) needed has been key to improving the usability of our tools and protocols. Lastly, the long term sustainability of maintaining such a tool is an important consideration as we move forward.


Please feel free to post with any questions or comments!

Regards,
Suraja]]>
Health issues and connections with sanitation Tue, 28 Apr 2015 16:53:09 +0000
Re: Sanitation in Hospitals - WASH in Health Care Facilities for better health care services (WHO report) - by: RobynChristine http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/12537-sanitation-in-hospitals-wash-in-health-care-facilities-for-better-health-care-services-who-report#12712 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/12537-sanitation-in-hospitals-wash-in-health-care-facilities-for-better-health-care-services-who-report#12712
Great to hear about work with Terres des Hommes - there is for sure lots of potential for collaborating. We have collaborated with the SoapBox on assessment tools as well! Check this out for what has been done so far - the toolkit has since been adapted and used in Zanzibar as well

soapboxcollaborative.org/?page_id=3232]]>
Health issues and connections with sanitation Wed, 01 Apr 2015 20:24:20 +0000
Re: Sanitation in Hospitals - WASH in Health Care Facilities for better health care services (WHO report) - by: jbr http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/12537-sanitation-in-hospitals-wash-in-health-care-facilities-for-better-health-care-services-who-report#12696 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/12537-sanitation-in-hospitals-wash-in-health-care-facilities-for-better-health-care-services-who-report#12696
Robyn, it will be very interesting to hear back about WaterAid's internal discussions. Terre des hommes has begun to develop and test a risk monitoring tool for WASH in health faclities, mainly focusing on hygiene practices and proper use and maintenance of equipment. In the early stages, we could use some collaborative support in this direction.

Moreover, as Marijn mentions, the push for and monitoring of better WASH practices in health facilities will need to come from the Ministries. Wouldn't it be great to see national level WASH practitioner alliances forming with support from WHO and development community to engage with authorities?]]>
Health issues and connections with sanitation Tue, 31 Mar 2015 21:42:13 +0000