SuSanA - Forum Kunena Site Syndication Sat, 10 Oct 2015 10:57:24 +0000 Kunena 1.6 SuSanA - Forum en-gb wetland construction plants and salt and drought resistance plants - by: fppirco (suppliers) who of Susan members could give information ?

with best regards;

Mohammad Mojtabaei]]>
Health issues and connections with sanitation Sat, 10 Oct 2015 08:52:24 +0000
Re: WASH awareness and practice among health staff in PHCs (primary health centres) - by: Augustino in my country South Sudan and in my town Malakal in IDPs camp. we have a small PHCs, i was working as daily paid to register the patient that are seeking treatment what we are doing we giving them lesson call health education , give them awareness about affect of hygiene if we didn't take it series and many awareness we give them. and addition of that in the clinic we have a small container fill with clean water for hand washing after visit the latrine that made from wood and plastic sheet after dining it 10 meter deep and provide them with soap same time for washing at home and also the floor of the clinic is always clean by the worker specific for the purpose.

Dak Victor
South Sudan]]>
Health issues and connections with sanitation Thu, 08 Oct 2015 14:39:53 +0000
Re: Sanitation and Alzheimer's Disease - and "Alzheimer’s Disease Epidemic Fueled By Sewage Contamination" - by: caetano In a previous post you comment on mishandling of information and the (unwarranted) fears this can cause with regard to wastewater reuse projects. I believe that here you may be doing that exact same thing.]]> Health issues and connections with sanitation Wed, 07 Oct 2015 13:48:53 +0000 Re: Appeal to SuSanA members for input - by: muench Katharine presented about Sanipath, and about her appeal to SuSanA members, at the SuSanA meeting in September:
See here:

Using the Control+F function you will find her presentation:

Katharine Robb (Emory University): The SaniPath Rapid Assessment Tool:Assessing Public Health Risks from Unsafe Fecal Sludge Management in Poor Urban Neighborhoods

See the video of her presentation here:

Or go to time 14:47 here:

Health issues and connections with sanitation Wed, 07 Oct 2015 13:34:07 +0000
Re: Sanitation and Alzheimer's Disease - and "Alzheimer’s Disease Epidemic Fueled By Sewage Contamination" - by: F H Mughal

While still on the same note, I came across a by article by Gary Chandler titled: Alzheimer’s Disease Epidemic Fueled By Sewage Contamination. The article sent shivers through my spine. It is available at:

The article is rather long. Briefly, the article says:

People are dying of neurological disease at an accelerating rate;

Pathogen associated with neurological disease is spreading uncontrollably. Research suggests that food and water supplies around the world have been contaminated with an unstoppable form of protein known as a prion (PREE-on);

The prion problem is getting worse with rising populations, rising concentrations of people, intensive agriculture, reckless sewage disposal policies and other mismanaged pathways. As the epidemic strikes more people, the pathways for prion exposure explode and intensify. Reckless sewage disposal policies and practices alone are putting billions of innocent people in the crossfire right now. Entire watersheds are endangered thanks to a deadly pathogen that migrates, mutates and multiplies;

Although there are many causes and pathways contributing to the prion disease epidemic, many pathways are being mismanaged, including sewage, biosolids and reclaimed wastewater. As stated earlier, blood, saliva, mucas, urine, feces, milk and cell tissue all carry infectious prions. These human discharges are flushed down toilets and sinks billions of times every day. We all have flushed away toxic or infectious waste that we would never throw on our garden or in our water well. The magic wand at the sewage treatment plant doesn’t phase most of these elements;

Sewage treatment plants can’t detect or stop prions in municipal waste streams. Despite this important technical detail, we’re dumping tons of infectious sewage on crops, gardens, pastures, golf courses, playgrounds and open spaces in our forests every day. Wind, rain and other natural dynamics put the sewage right back into our air, food and water supplies;

Spreading sewage sludge, biosolids, and reclaimed wastewater anywhere is a risk. Dumping them directly into our food and water is reckless, incompetent and criminal. We’re dumping prions into our lifecycle by the trainloads daily. Every nation is guilty;

The condensed sludge from all of these places is then dumped on our farms and ranches by the truckload. Plastic packaging and other large items are often visible in this waste, which means that treatment is extremely minimal. If the Pope waved his hand over the sewage, it would likely receive better treatment than what we see today. Nothing stops a prion, but you would hope that billions of dollars of wastewater treatment would at least take out pill bottles, syringes, needles and used prophylactics;

Thanks to more and more people dying from TSEs, sewage systems are more contaminated with prions than ever. Wastewater treatment systems are now prion incubators and distributors. Sewage sludge, wastewater reuse, biosolids and other sewage byproducts are biohazards causing bioterror. Thanks to questionable policymakers and profiteers, you are eating and drinking from your neighbor’s toilet–and the toilets at the local nursing home and hospital. We might as well dump sewage out of windows again;

Thanks to more and more sewage mismanagement, we’re dumping more deadly prions on farms and ranches than ever. The wastewater industry and their consultants have convinced agricultural operations around the world that sewage and biosolids are safe, effective and profitable for all involved;

As it turns out, today’s sewage isn’t safe. Sewage sludge isn’t an effective fertilizer. The business is profitable, though—until the sickness and disease sets in for the farmers, workers and the consumers. Until the land is condemned for being hopelessly contaminated—making everyone downstream sick.

After reading Gary’s article, I was just wondering whether one should think twice before reusing treated wastewater.

Can anyone comment on this?

F H Mughal]]>
Health issues and connections with sanitation Wed, 07 Oct 2015 09:37:39 +0000
Re: Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh) - by: F H Mughal
I believe, the final report(s) would be issued in Sep 2017. Perhaps, you may consider issuing interim reports.


F H Mughal]]>
Health issues and connections with sanitation Tue, 06 Oct 2015 16:24:51 +0000
Re: Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh) - by: jcolford Health issues and connections with sanitation Tue, 06 Oct 2015 16:13:15 +0000 Re: Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh) - by: F H Mughal
That is a interesting research project. Just one minor query: What was the criteria for selecting Bangladesh and Kenya for conducting research?


F H Mughal]]>
Health issues and connections with sanitation Mon, 05 Oct 2015 16:29:58 +0000
Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh) - by: jcolford
Title of grant: Measuring the benefits of water quality, sanitation, handwashing and nutritional interventions for improving health and child development (WASH Benefits)
  • Subtitle: The WASH Benefits Study: Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya
  • Name of lead organization: University of California, Berkeley
  • Primary contact at lead organization: John M. Colford, Jr. MD PhD, Professor of Epidemiology, School of Public Health
  • Grantee location: Berkeley, CA, USA
  • Developing country where the research is being tested: Bangladesh (selected rural districts north of Dhaka), Kenya (rural parts of Bungoma, Kakamega, and Vihiga counties in Western Province)
  • Start and end date: September 2009, March 2017 (possible extension to Sep 2017)
  • Grant type: Other
  • Grant size in USD: $28,996,341 (see here in BMGF grant database)

Short description of the project:

Enteric infections (e.g., diarrhea due to infectious causes) and growth faltering (also called stunting of children) are major burdens of disease among young children in low-income countries. Improvements in water, sanitation, and handwashing (WASH), together with improvements in nutrition, are thought to reduce these disease burdens. However, there have been few rigorous studies to measure the effects of WASH interventions on growth and the effects of combined interventions (e.g., WASH + Nutrition) compared with single interventions.

The WASH Benefits study includes two highly comparable randomized trials in rural communities -- one in Bangladesh, one in Kenya -- that will measure the effect of providing improved household compound-level WASH and nutritional interventions, alone and in combination, to a large birth cohort of children.

These are efficacy trials: measuring the effect of the interventions delivered by the research project and at no cost to participants (as opposed to delivered in a programmatic setting). Therefore, this project provides WASH hardware and behavior change activities to compounds in rural communities and measures health and child development outcomes among young children receiving these interventions. Child development as measured by communication, gross motor, and personal/social domains. The cost of the interventions is a small fraction of the total cost of the trial.

The trials were not originally designed to evaluate whether joint WASH, nutrition, and anthelminthic treatment (i.e., deworming) interventions affect child growth and development. One reason for this is that the trials measure outcomes among children 0-2 years old, and investigators did not expect sufficiently high enough levels of soil-transmitted helminth infection to justify measurement among this age group until the end of the trial. Thus, soil-transmitted helminth infection is measured at the end of the trials, and to maintain the standard of care in our study populations, all compound members will also be offered deworming at the end of the trials.

Methods and analysis:

WASH Benefits includes two cluster-randomised trials to assess improvements in water quality, sanitation, handwashing and child nutrition—alone and in combination—to rural households with pregnant women in Kenya and Bangladesh. Geographically matched clusters (groups of household compounds in Bangladesh and villages in Kenya) will be randomised to one of six intervention arms or control. Intervention arms include water quality, sanitation, handwashing, nutrition, combined water+sanitation+handwashing (WSH) and WSH+nutrition.

The studies will enrol newborn children (N=5760 in Bangladesh and N=8000 in Kenya) and measure outcomes at 12 and 24 months after intervention delivery. Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea. Secondary outcomes include stunting prevalence, markers of environmental enteropathy, intestinal parasite prevalence and infection intensity, and child development scores (verbal, motor and personal/social). We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests.

The Bangladesh trial will be conducted in selected districts north of Dhaka, the capital of Bangladesh. The study communities must meet the following study criteria:
  • Rural communities
  • Drinking water that has low levels of arsenic and iron, but sources are known to be frequently contaminated with fecal indicator bacteria
  • Low levels of fully hygienic latrine coverage
  • Levels of childhood stunting >30%
  • No previous participation in other studies

The Kenya trial is being conducted in selected rural areas in Bungoma, Kakamega, and Vihiga counties in Kenya. The study communities must meet the following study criteria:
  • The majority of village members collect their water from communal sources located in rural areas
  • The majority of the community members relies on unimproved sanitation facilities
  • There are at least 2 eligible target children in the village whose family owns their home and who have no plans to move away in the next 12 months (neighboring villages are then paired to create clusters with at least 8 eligible pregnant women, 6 of whom must be available for the baseline survey for the cluster to be enrolled in the study)
  • The village cannot already have a chlorine dispenser installed
  • Respondents can speak either English, Kiswahili or Luhya

The goal of the WASH Benefits study is to generate rigorous evidence about the impacts of water quality, sanitation, handwashing and nutritional interventions on child health and development in the first two years of life. The specific objectives, below, outline more detail.


Primary scientific objectives:
  • Measure the impact of sanitation, water quality, handwashing and nutrition interventions (see below for details) on child diarrhoea and linear growth after 2 years of exposure.
  • Determine whether there are larger reductions in child diarrhoea when providing a combined water, sanitation and handwashing intervention compared to each component alone.
  • Determine whether there are larger effects on child diarrhoea and linear growth from combining (A) a comprehensive child nutrition intervention with ( B ) a combined water, sanitation and handwashing intervention compared to A or B alone.

Information about the specific interventions:

Interventions planned for Bangladesh are listed here:

For example: a new or upgraded dual pit latrine for each household in the compound. The behavior change components of the intervention will emphasize the use of the latrine for defecation and the safe disposal of feces in the compound courtyard to prevent contact with young children.

Interventions planned for Kenya are listed here:

For example: a new or upgraded pit latrine for each household in the compound. If participants have a latrine, its structure will be improved if necessary. Plastic slabs will be installed to improve mud or wood floors, and the intervention delivery team will make sure that all latrine structures have walls, doors, roofs that ensure safety and privacy. The behavior change components of the intervention will emphasize the use of the latrine for defecation and the safe disposal of feces in the compound courtyard to prevent contact with young children.

Secondary scientific objectives:
  • Measure the impact of a child nutritional intervention and household environmental interventions on environmental enteropathy biomarkers (e.g., lactulose, mannitol, myeloperoxidase, alpha-1 antitrypsin, neopterin, total IgG), and more clearly elucidate this potential pathway between environmental interventions and child growth and development.
  • Measure the impact of sanitation, water quality, handwashing and nutritional interventions on intestinal parasitic infection prevalence and intensity by conducting Kato-Katz, PCR, and ELISA on stool samples.
  • Measure the association between parasitic infection and other measures of enteric health, including acute diarrhoea and environmental enteropathy biomarkers.

Research or implementation partners:
  • International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b): Implement study activities in Bangladesh, scientific oversight, ethical review, data collection, and laboratory analyses in Bangladesh
  • Innovations for Poverty Action, Kenya (IPAK) : scientific oversight and data collection in Kenya
  • Kenya Medical Research Institute (KEMRI): ethical review and laboratory analyses in Kenya
  • Stanford University, USA: scientific oversight for both Bangladesh and Kenya
  • Emory University, USA: scientific oversight in Kenya and input on design in both countries
  • Johns Hopkins University, USA: guidance of intervention implementation and process evaluations in Bangladesh
  • University at Buffalo, SUNY, USA: guidance on the handwashing intervention
  • Wagner College, USA: laboratory analyses for a portion of the environmental enteropathy assessment
  • University of California, Davis, USA: guidance on the nutrition intervention
  • University of California, Berkeley, USA: scientific oversight, coordination between Bangladesh and Kenya, ethical review, and guidance on design and analysis
  • The Ministries of Health in Bangladesh and Kenya are aware of the trials, but since these are efficacy trials they are not directly connected to Ministry activities.

Links, further readings – results to date:

Current state of affairs:
  • The trials are currently conducting their final round of outcome measurement. We anticipate primary results in late 2016 (Bangladesh) and mid 2017 (Kenya).
  • Although the trials are designed to provide highly comparable evidence, each trial is independently powered and the interventions differ slightly between countries to reflect cultural, demographic, and environmental differences between sites.
  • The intervention programs have been refined over a two-year formative research period, and include hardware and behavior change components to improve water quality, sanitation, handwashing, and nutrition.

Biggest successes so far:
  • Enrollment of 5,551 (Bangladesh) and 8,246 (Kenya) pregnant mothers and their newborns into the trials.
  • Delivery of intensive interventions (e.g. improved latrines, sani-scoops, handwashing stations) to approximately 12,860 study compounds (there is approximately 1 compound per target child)

Main challenges / frustration:

The original timeline for the project included one year for piloting the study interventions, but it took a full two years to adequately develop hardware and software packages that our team was confident could sustain high uptake over the full duration of the study.


Jack Colford, MD PhD
Professor of Epidemiology
UC Berkeley School of Public Health
101 Haviland, MC# 7358,
Berkeley, CA 94720-7358
Health issues and connections with sanitation Thu, 01 Oct 2015 21:03:49 +0000
Contamination of drinking water by algal toxins - by: jnmacart I have chatted with some of you at WEDC and WWW about some of what we are seeing in Bangladesh regarding algal contamination of pond water.

Ponds are used extensively in Bangladesh domestically, even though most of the country has access to tubewells for drinking water. The tubewell water is high in iron and therefore households have gone back to using ponds for cooking, washing and bathing.

I see two cooking concerns with this:
1. Not all pond water is boiled for cooking. Panta Bhat (which is a Bangladeshi rice breakfast porridge) is prepared by soaking left over rice in raw pond water over night.
2. Boiling water with algae in it can lead to cyanobacteria toxic poisoning and is not seen in the diarrhea indicators.

These algal blooms are caused by two things in Bangladesh: ag run-off and fecal matter contamination.

I would love to hear if you have seen this in your areas.
WMI has seen similar cases in Uganda near Lake Victoria

I would also love to hear if you know of any research that is going on in this area or how we can jump start some research.

There is an IWA conference in China next month called "International Workshop on Occurrence and Control of Tastes, Odours, and Algal Toxins in Waters", Oct. 29– Nov. 1, 2015, Xiamen, China.

But I am unable to attend.
Will anyone from the forum be there?

Best regards,

Jess MacArthur | iDE-Bangladesh
Research Team Lead | WASH Technical Advisor]]>
Health issues and connections with sanitation Thu, 03 Sep 2015 03:45:19 +0000
Re: No evidence that this sanitation programme in rural Odisha prevented diarrhoea, soil-transmitted helminth infection, or child malnutrition (study led by Emory University) - by: joeturner
I'm not sure this is saying much that the other report didn't say, but it is quite shocking that the presence of latrines has no particular effect on the diarrhea and helminth infection - even when latrines coverage changed from 9 to 63% of households.

With that big an engineering intervention, one would have expected some measurable change. ]]>
Health issues and connections with sanitation Fri, 28 Aug 2015 16:38:25 +0000
Re: New Lancet study concludes no assumed improvement from TSC (Total Sanitation Campaign, in Odisha, India) - by: muench
This has been an interesting thread which is closely related to another thread called:
"The elusive effect of water and sanitation on the global burden of disease":

(one could even think about merging the two threads but maybe it's better to keep this one separate as it started off with a very specific piece of research in Orissa - I have adjusted the thread title to make it clear what the starting point of the thread was)

I was brought back to this thread today by seeing another publication coming out from the same research team:

Does building more toilets stop the spread of disease? Impact evidence from India

A 3ie-funded impact evaluation research team used a cluster-randomised controlled trial to evaluate the government’s Total Sanitation Campaign in Odisha, India to see if latrine coverage did indeed reduce exposure to disease. The intervention mobilised households in villages characterised by high levels of open defecation to build and use latrines. The study was conducted between May 2010 and December 2013, involving more than 50,000 individuals in 100 villages.

Key policy messages

The study results show that the assumption that more latrines will reduce exposure to faecal pathogens, and therefore disease, does not necessarily hold true.
During the study period, latrine coverage in the intervention villages increased from 9 per cent of households to 63 per cent, compared to an increase from 8 per cent to 12 per cent in the control villages.

The increase in latrine coverage did not prevent diarrhoea or reduce soil-transmitted helminth infection in the intervention villages. The seven-day prevalence of reported diarrhoea in children younger than 5 years was 8.8 percent in the intervention group and 9.1 percent in the control group.

This research was also co-funded by the Bill & Melinda Gates Foundation and you find it here in our project database together with some links:

One of the links takes you to the SuSanA library entry for this project:

Here you find a presentation from January which I find useful and easy to read:

Two very important slides towards the end:

As the Gates grant still goes until 2017 (and perhaps they have more funding from other sources, too), it will be very interesting to see what else is discovered there. Wondering what is meant with "Gram Vikas evaluation"? Gram Vikas is explained here: **

In a way, it is (in hindsight) not really so surprising that just building toilets alone (even if they are used consistently, which they may not), is insufficient to have much of an impact on health indicators.* I guess it should always be coupled with other hygiene measures (e.g. handwashing, dealing with animal faeces in the sourroundings) as well, and probably also with mass deworming.

Kind regards,

* Makes me think of Peter Harvey's question at the WEDC conference to the audience at his keynote: "Even if it was proven that having a toilet has no health benefits whatsoever, would you give up your toilet tomorrow?" - No!

** "Gram Vikas is an Indian non-governmental organization based in Orissa, and founded in 1979.[1] It uses common concerns for water and sanitation to unite and empower rural communities, including adivasi communities."]]>
Health issues and connections with sanitation Fri, 28 Aug 2015 16:21:19 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: Gendersan1
As we are working on related research interests(see "Genderized WASH" Eaawag/Sandec;
"WASH in the context of maternal health and menstrual hygiene in Uganda and India", this is of special interest to us and proves once more the importance of the connections between sanitation and maternal health.

Petra Kohler]]>
Health issues and connections with sanitation Mon, 24 Aug 2015 13:24:37 +0000
Appeal to SuSanA members for input - by: karobb
A. Suggestions about where we can deploy the SaniPath Rapid Assessment Tool?
We're looking for 1) partners working at the city level interested in deploying tool to inform sanitation interventions, 2) partners who can use this type of data to inform their work, and 3) institutions that would be good candidates to learn to use the tool.

B. Suggestions for candidates for the advisory committee?
We're are in the process of assembling an international advisory committee that can provide input on the following questions:
1) What are the greatest challenges facing sanitation decision makers?
2) What scale are decision makers most interested in (city vs. neighborhood level)?
3) How can we best engage potential users of the tool?
4) How can we best convey risk results visually?
5) How can we facilitate the translation of the tool recommendations into actionable interventions.

We welcome and thank you for your input!]]>
Health issues and connections with sanitation Mon, 24 Aug 2015 11:18:23 +0000
Re: The elusive effect of water and sanitation on the global burden of disease - by: muench
Right now we have a big debate going on about mass deworming and its long term health benefits (also difficult to prove with randomized controlled trials, which are supposedly - but maybe not - the gold standard in evaluating health benefits). This is the topic of this thread here:

Coming back to the more general question, I wanted to point out a keynote presentation by Peter Harvey (UNICEF) at the recent WEDC conference which was a real conference highlight for me (and - going by the number of tweets - also a highlight for many others at the conference).

Invited Speaker: Peter Harvey
WASH, Nutrition and Health: A futile quest for evidence?

Peter is Regional Adviser - Water, Sanitation and Hygiene
UNICEF, Eastern and Southern Africa Regional Office
Nairobi, Kenya

Peter has kindly made his presentation available for sharing here:

These two slides caught my particular attention:

Very interesting account of UNCIEF's path with regards to WASH since 1946:

Clearer image:

Limitations to randomized controlled trials (slide 11):

The references that he mentioned on this slide are:

Robert William Sanson-Fisher, Billie Bonevski, Lawrence W. Green, Cate D’Este, Limitations of the Randomized Controlled Trial in Evaluating Population-Based Health Interventions. American Journal of Preventive Medicine Volume 33, Issue 2 , Pages 155-161 , August 2007

Porzsolt, F., Kliemt, H., Ethical and empirical limitations of randomized controlled trials Med Klin (Munich). 2008 Dec 15;103(12):836-42. doi: 10.1007/s00063-008-1132-x


Some points from my notes:
  1. At UNICEF, WASH has always been looked at from a child health perspective... We know that health has an important connection with WASH but there is more to it. It's not (only) about health, it's about burden and convenience as well (Peter asked: "would you give up your toilet tomorrow if someone told you that it had no health benefits?" No!). There are also the human rights aspects.
  2. In the 2014-2017 Strategic Plan, WASH is included and one new element is the link with nutrition
  3. How is evidence applied: Donor priorities, organizational priorities, implementation strategies, geographical targeting

Some tweets that were made py participants during his presentation:

Stephen Jones ‏@stephen_djones 30. Juli
#WASH & nut evidence has implications for donor priorities, geog targeting, units of intervention - Harvey #wedc38

Susan Davis ‏@improve_intl 30. Juli
Harvey:Why do we need to talk about links of #WASH to health? #wedc38

Stephen Jones ‏@stephen_djones 30. Juli
Need to distinguish btwn evidence 4 benefits of #Wash on health & evidence for diff approaches to achieve #WASH + health #wedc38

Stephen Jones ‏@stephen_djones 30. Juli
Harvey: non-health #WASH benefits can be at least as important, or more, but hard to quantify - Harvey #wedc38

Susan Davis ‏@improve_intl 30. Juli
Harvey: #water is a fundamental right, nothing about health, about burden & convenience #wedc38

Cheryl ‏@Cheryl_McD 30. Juli
Peter Harvey @UNICEF - tackling SDG 6 on #WASH will help achieve the other SDGs #WEDC38

Susan Davis ‏@improve_intl 30. Juli
Harvey: sustainability of #water & #sanitation services is an important part of rights based approach #wedc38


If you have comments or questions about Peter's presentation, please put them here. I will alert him to them.

Health issues and connections with sanitation Mon, 17 Aug 2015 15:38:24 +0000