SuSanA - Forum Kunena Site Syndication http://forum.susana.org/ Sat, 28 May 2016 13:41:28 +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 Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children - by: F H Mughal http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18104-relationship-between-sanitation-and-hygiene-indicators-and-moderate-to-severe-diarrhea-in-children#18104 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18104-relationship-between-sanitation-and-hygiene-indicators-and-moderate-to-severe-diarrhea-in-children#18104 Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children


In May 2016 issue of PLOS Medicine, an interesting paper, titled: Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study (available at journals.plos.org/plosmedicine/article/a...nal.pmed.1002010.PDF) was published, in which Kelly Baker et al. examined sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to severe diarrhea (MSD) in children less than 5 years of age.

Kelly Baker and colleagues’ Global Enteric Multicenter Study (GEMS) collected data on MSD among children reporting to health centers in seven sites in seven countries from 2007 to 2011, with cases matched to controls by village and homes visited within 90 days to observe sanitation and hygiene conditions.

The authors conclude that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. The World Health Organization/ United Nations Children's Emergency Fund categorize shared sanitation as unimproved.

Jonny Crocker and Jamie Bartram have discussed the paper of Kelly Baker and colleagues (Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea, (blogs.plos.org/everyone/files/2016/04/journal.pmed_.1002011.pdf). The authors say that there are a number of limitations to the sanitation and hygiene indicators that suggest caution in interpreting the findings. The authors say:

“GEMS sanitation and hygiene indicators are at the household, not individual, level and are
indicators of access, not behavior (except child feces disposal). Access does not equate to use,
and behaviors within a household often vary, for example, by age and gender. Survey best
practice is to inquire about individual behaviors both at and away from home, in addition to
observing sanitation facilities. Likewise, the link between available handwashing materials
and behaviors is not a given.”


More than 761 million people rely on shared sanitation facilities (Shared Sanitation versus Individual Household Latrines: A Systematic Review of Health Outcomes, by Marieke Heijnen, Oliver Cumming, Rachel Peletz, Gabrielle Ka-Seen Chan, Joe Brown, Kelly Baker,and Thomas Clasen).

A blog in Sci Dev by Munyaradzi Makoni (Shared toilets increase diarrhoea risk for children - www.scidev.net/global/children/news/toil...3A%2016%20May%202016), says that sizable risk to under-fives results, when two or three households share toilet; and such facilities are only marginally safer for kids than public latrines.

Kelly Baker and colleagues have produced useful paper, collecting data on MSD among children reporting to health centers in seven sites in seven countries from 2007 to 2011, including Pakistan. Discussion by Jonny and Jamie is also interesting.

Despite the fact that 761 million people resort to shared sanitation, my own experience in Sindh province, Pakistan, shows that that sharing toilets among households in Sindh is almost negligible. This is, in part, due to the religion – predominantly Muslim population.

Some might contradicts this, as according to a WSUP report (Can behaviour change approaches improve the cleanliness and functionality of shared toilets? A randomised control trial in Dhaka, Bangladesh – available at
r4d.dfid.gov.uk/pdf/outputs/Wsup/DP009-E...f-shared-toilets.pdf), “Households living in densely populated urban slums often lack the space for their own toilet, making shared sanitation the only viable solution. This is the situation in Dhaka, where many of the city’s low-income residents depend on one of the city’s enormous number of shared compound toilets: a recent study by the International Centre for Diarrhoeal Disease Research Bangladesh estimated that 4.3 million people in Dhaka use such facilities.”

A recent news item in Dawn of 10 May 2016 (www.dawn.com/news/1257403/recruitment-of...ness-at-kp-hospitals) gives an insight as to how religion affect sanitation.

Bangladesh is a Muslim country. However, in case of Sindh, another factor that comes into play is our Sindhi traditions. It is not possible for a Sindhi woman to use a toilet that is used by male from another house.

Shared toilets in Sindh (e.g., school toilets, toilets in offices, toilets in highway restrooms, etc) are most pathetic and, are sure to cause major diseases, let alone diarrhea in children. No wonder, joint monitoring program of WHO and UNICEF calls shared sanitation as unimproved.

F H Mughal]]>
Health issues and connections with sanitation Thu, 26 May 2016 07:18:40 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: jbr http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17992 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17992
"While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs."

We feel that this study gives a fresh perspective on the link between WASH and Health. Tdh uses WASH to support maternal newborn and child health (MNCH) programming, focusing on girls and women of reproductive age. Although we try to influence delayed pregnancy, among the most significant factors in terms of readiness for motherhood are nutritional status, psycho-social well-being, level of education and status within the family. Since we monitor hundreds of girls and women in our protection/health programmes, this puts a new research angle on our radar.

For example, it would be interesting to explore the relationship between age, open defecation and adverse pregnancy outcome.]]>
Health issues and connections with sanitation Wed, 11 May 2016 19:11:16 +0000
Re: Important review on shared sanitation - Global Enteric Multicenter Study (GEMS) - by: KellyKBaker http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17991 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17991
First, the original goal was to use open defecation as the reference for comparison, but OD was too low at some sites so we could not do this systematically for all sites. However, for the sites where open defecation could serve as a reference, we observed a two-fold or more INCREASE in odds of MSD for sharing at any level in Pakistan (semi-urban) and Mozambique (rural), with no significant difference in MSD elsewhere.

Second, pan-site model adjustment was limited by sample sizes in some sanitation access categories for some sites. Two indicators of wealth were chosen since as common higher-level drivers of access to water, soap, food, etc., they were the best options to control for a broad scope of latent variables. However, there was correlation between sanitation access level and other sanitation and hygiene practices at some sites. For the sites where sample sizes permitted more extensive adjustment, the relationship between sharing sanitation and MSD was remarkably stable. Adjusting for handwashing with soap, improved drinking water access, open child feces disposal, and conditions in latrines did not change our conclusions.

Third, in addition to age and gender GEMS cases and controls were matched by village or neighborhood. In theory, this matching process could have controlled for macro-scale community conditions, which would mean that cases and controls might have similar potential for exposure to public domain contamination. However, this matching might not have captured micro-scale differences in conditions, like wealth pockets or living near OD sites. But it does at least hint at the possibility that if effects from shared sanitation were a proxy for some sort of latent factor, it is likely to be in the private domain.

Alternatively, we will soon explore a hypothesis in an unrelated study in Kenya that maternal practices related to where children are allowed to play outside the home is a key mediator of child exposure. We have found extraordinarily complex patterns of enteropathogen exposure in urban child play areas (see Social Microbes study). Maybe mothers who keep a tighter leash on their children buffer their interaction with highly contaminated public areas. Translation to the GEMS study, maybe mothers who prioritized watchfulness of child behavior also prioritized private sanitation, or even latrine cleanliness. The nuances of the GEMS study design make interpretation of our results even more intriguing.

K. Baker]]>
Health issues and connections with sanitation Wed, 11 May 2016 18:54:10 +0000
Re: Important review on shared sanitation - by: JKMakowka http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17930 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17930
GEMS findings suggest access to private household latrines can provide protective benefits against MSD, even in communities like rural western Kenya, where open defecation and open child feces disposal was common. It is unlikely that private latrine access influences whether children play outside the home or not, so this protective effect may reflect protective benefits of private household latrine access on private (domestic) exposure pathways such as contaminated drinking water, food, household play areas, or hands.

This is interesting because it would go against common wisdom that the protective effect of toilets is mainly a community wide effect and thus full ODF should be reached. However I think they have cause and effect slightly confused in this paper with their narrow focus on household toilets Vs. shared facilities.
But a bit further down they seem to at least acknowledge that possibility:
The reverse explanation for this relationship could also be true: households that prioritize safe hygiene practices are more likely to invest in private sanitation facilities than those that do not prioritize hygiene.

And I would add: households that can afford private sanitation facilities are much more likely to be also able to afford other things that have a big effect on occurrences of child MSD.

Edit: they did some social-economic adjustments, but it seems to have been rather limited:
We selected two sociodemographic indicators, a wealth quintile index and having two parents in the home. Although wealth indices are widely used in WASH research, it may not be a robust way of adjusting for sociodemographic confounding.
]]>
Health issues and connections with sanitation Fri, 06 May 2016 00:52:28 +0000
Re: Important review on shared sanitation - by: jonpar http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17929 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17929
As stated by Baker et al "This is a controversial topic, as communal facilities are the most economical and feasible solution for providing sanitation access to the 2.5 billion people without a private facility". Indeed this is the case if we compare the cost of installing one communal toilet compared with the cost of each family installing private facilities. But this does not take into account important issues of space and the fact that many families lack security of tenure and lack incentive to invest in improved latrines. Additionally, private landlords may raise the rent when there is access to a private facility. So, it's certainly a tricky one.

It is apparent why many organisations choose to use funds to construct communal facilities as well-constructed household toilets according to standards are so expensive. It is harder to adopt a CLTS approach and not offer any form of support to build the toilets.

Generally I think it is true to say that donors prefer to go for communal or private but not something in the middle. However container-based sanitation may turn this on it's head as it provides the privacy associated with private on-plot sanitation and is clearly much more affordable. Key factors are usage and quality of service. A poorly maintained facility is likely to become a loci of disease transmission whereas a well-maintained one, even if used by a large number of people, can be an effective means to reduce transmission of diarrhoeal disease provided of course that users practice good hygiene behaviour.

I do agree that with the conclusion that "shared facilities may still have a role in addressing open defecation in challenging settings" but I also agree that "For reasons beyond just health such as dignity and gender equity, we should advocate for private access whenever possible." And if Crocker & Bartram state that this is based on the best dataset yet on diarrheal disease associated with sanitation and hygiene, then that's a compelling case indeed !

p.s. I've attached the articles to this posting to make it even easier for you to find the paper, download and digest.]]>
Health issues and connections with sanitation Thu, 05 May 2016 22:23:45 +0000
Re: Important review on shared sanitation - by: eddyperez http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17928 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17928
This is a very important topic. I encourage all to take a few minutes to read the discussion and conclusion section of the actual paper ( not the review of the paper). It is only a couple of pages and written in accessible language and provides ( in my opinion) a well balanced and nuanced discussion of the issues of private vs. shared and also important to understand the articulated limitations of what the data was able to look at what is was not able to look at.

The discussion in the paper acknowledges that the private household vs shared latrine debate is not helpful in situations were private household latrines are not viable ( such as in extremely densely populated informal urban settlements where over 1 billion people live - see recent Habitat data on slums) and where shared sanitation is the only option - often as public latrines managed by local governments, NGOs or private sector operators. These are indeed often not safely managed and provide inadequate protection from fecal contamination. But given the lack of alternatives, reducing the discussion to HH v Shared often results in a disincentive by governments and development partners to invest in shared sanitation to make more hygienic and reduce public health risks.]]>
Health issues and connections with sanitation Thu, 05 May 2016 19:14:42 +0000
Re: Important review on shared sanitation - by: JKMakowka http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17924 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17924
In general, I suspect that this is rather a correlation and not a causation. Communities that have a lack of private toilets and are thus resorting to sharing with direct neighbors are likely to be less well off economically and also likely more un-hygienic in other aspects as well.]]>
Health issues and connections with sanitation Thu, 05 May 2016 01:34:02 +0000
Re: Important review on shared sanitation - by: jonpar http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17923 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17923
i) Sharing a sanitation facility with 1-2 other households can increase the risk of moderate-to-severe diarrhea in young children, compared to using a private facility.

ii) Evidence confirms that private sanitation often provides greater benefits than shared sanitation.

>> Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of moderate-to-severe diarrhea in children.]]>
Health issues and connections with sanitation Wed, 04 May 2016 21:36:40 +0000
Important review on shared sanitation - Global Enteric Multicenter Study (GEMS) - by: campbelldb http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17919 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-important-review-on-shared-sanitation-global-enteric-multicenter-study-gems#17919
Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study. PLoS Med, May 2016. Authors: Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L., et al.
Full text: http://goo.gl/z0h9P0

Background - Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.


Methods/Findings - The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1–2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India.

Conclusions - This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea. PLoS Med, May 2016. Author: Jonny Crocker, Jamie Bartram
Full text: http://goo.gl/6SzZmr

The draft sanitation ladder for measuring SDG progress allows sharing of improved facilities by fewer than five households to count towards ending open defecation [19]. Higher rungs refer to private facilities and safe excreta management. The indicators also interpret access as including use, which was not included in GEMS. Future research should include indicators on use of facilities and excreta management.

Baker and colleagues provide valuable evidence that confirms that private sanitation often provides greater benefits than shared sanitation. Prior evidence suggests health benefits for use of any sanitation facility (including shared) when compared to open defecation [8–10]. This study will inform policy and programming, yet shared facilities may still have a role in addressing open defecation in challenging settings. For reasons beyond just health such as dignity and gender equity [20,21], we should advocate for private access whenever possible.

Baker and colleagues present the best dataset yet on diarrheal disease associated with sanitation and hygiene. They provide compelling evidence on sanitation and hygiene risk factors for MSD and variability in that risk. Importantly, they also demonstrate the feasibility and value of rigorous data collection on health outcomes, something that future studies should develop yet further.]]>
Health issues and connections with sanitation Wed, 04 May 2016 13:13:09 +0000
Re: The elusive effect of water and sanitation on the global burden of disease - by: muench http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/8989-the-elusive-effect-of-water-and-sanitation-on-the-global-burden-of-disease?limit=12&start=12#17548 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/8989-the-elusive-effect-of-water-and-sanitation-on-the-global-burden-of-disease?limit=12&start=12#17548 Thanks for telling us about this article (title: The Problem With Evidence-Based Policies) which explains nicely the problems with randomized controlled trials (RCTs)!

I bumped into this problem last year while working on the Wikipedia article on "mass deworming" (en.wikipedia.org/wiki/Mass_deworming). You can see here on the talk page (en.wikipedia.org/wiki/Talk:Mass_deworming) how we (in particular Joe Turner) were trying to make sense of new studies (Cochrane Review) that showed no evidence of school based deworming programs on child health, and struggeling to present everything correctly in the article. There were several factors involved but one was that RCTs were regarded by other Wikipedia editors as the "gold standard" of research and if it wasn't an RCT then it was deemed as irrelevant.

In this context, I want to point out to you the famous parachute paper which is pretty revealing and thought provoking (and funny!):
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials




Regards,
Elisabeth

P.S. the person who sent me this parachute paper also wrote the following per e-mail (he used to work for WHO but is now retired; he wants to stay anonymous):

++++++++

I have checked the web page and have a comment regarding evidence on helminthiasis control. The papers you quote are systematic reviews of randomized controlled trials (RCT). Observational studies are, by the Cochrane group, not considered appropriate and are disregarded for decision making and their “golden standard” is that ONLY systematic reviews of RCT should allow for decision making for what works in health and also in public health (PH). Their patronizing message, that they include in most if not all their published papers, is: In modern medicine, the efficacy of an intervention should be investigated in well-designed randomized trials. Results from the trials should be collected in a high-quality systematic review, if possible with a meta-analysis. And finally, the evidence should have its repercussions on practice guidelines.

This in is a wrong starting point. It is wrong as many PH decision have been made by observational studies or simple “expert opinion”, have worked and continue to work for the benefit of millions of people around the world. Vaccination of small pox, “discovered” in 1798, is a typical example that has allowed us to achieve the only eradication yet of a disease. Similarly the evidence for the feasibility of the eradication of guinea worm has never been proved by any RCT. I could go and on with both examples in PH and general medicine. I am attaching a comic paper (parachutes) that was published time ago on the BMJ on parachutes……….the recommendation for the RCTs fundamentalist stands today as it did when it was published!

Regarding worm infections they just do not know what they are speaking about. The issue is due to the “over-dispersed distribution” of worms in infected populations and the difference between macro and micro parasites. As these macro parasites (worms) do not replicate (at least most of them and surely the one we are discussing) in the human final host it takes time to build a worm load and those people that have high worm loads (that are few in an infected population) are those that have the worse effects of worm infections, with associated stunting, malnutrition, anaemia in case of hookworms and schistosomes, etc. Those with few worms have more subtle pathology and morbidity.

As a consequence those that have a high worm load will benefit more from intervention and those that have a few worms will of course benefit less. You do not need a rocket scientist to understand that!!! In an RCT you need to take this into account and to take this into account you need huge sample sizes and compare effects in different groups based on their original worm load. So the design of the study must be based on the host parasite relationship and dynamic of transmission and ecology of the infections. Very few RCT on helminthiasis have done this as it would cost a fortune. Furthermore different parasites have different physio-pathological effects on their hosts. Hookworm will mainly cause anaemia (and this is directly related to the number of hookworms in the host and the species (Necator americanus or Anchilostoma duodenale with A.duodenale having a more important impact on anaemia per worm as they cause more blood loss). Ascaris lumbricoides more an effect on growth, etc.

I am afraid the various Cochrane reviews on helminths did not take into account studies conducted in areas with mainly one parasite transmitted and mixed effects of one species with that of another (stunting for hookworm, etc. when hookworms will have effect on anaemia etc.). They even quoted papers I was involved in areas of hookworm transmission looking at effects on growth! They just have no knowledge on the epidemiology of helminthic infections and reach conclusions based on such biased views as they do not look at papers and read them as parasitologists but as “systematic reviwers” with no biological knowledge.

Furthermore all the present discussion on the relevance of impact large scale chemotherapy against worm infection regards more “subtle” effects such as growth, school performance, work performance and even increased wages of people treated versus workers not treated. This impact is important but forgets another element: large scale interventions prevent also deaths and severe morbidity of a small but important proportion of the population. That is per se sufficient to justify large scale chemotherapy against helminthic infections that WHO defines Preventive Chemotherapy. We could say that similarly the proportion of people with paralytic polio is “small” and that this per se should justify spending a billion USD a year to eradicate this horrid disease. If not one scientist dares to, most appropriately, argue this general point of view why does a small group of “systematic reviewers inquisition fundamentalists” argue so much on large scale Preventive Chemotherapy? What are their real objectives?

In the 19th century, in one of the most elegant studies on Ancylostoma duodenale ever performed, Italian parasitologists observed (observational studies again I am afraid!!) that the Italian workers that were drilling the St Gottard tunnel in Switzerland were becoming anaemic. Coming from the south of Italy most of them were infected with hookworms and due to the conditions of work in the tunnel and complete lack of sanitation they became severely infected with hookworms transmitted in the tunnel itself, consequently becoming very anaemic and many of them eventually dying. In 1880, Edoardo Perroncito first noted the correlation between hookworms and anaemia among miners digging the St. Gottard tunnel in the Alps. They also correlated worm loads with severity of anaemia and Grassi was the first to mention that counting worms was critical to understand the relationship with morbidity. Grassi in 1878 had looked at the importance of the worm load 40 years after Dubini and stated in Italian “la diagnosi viene agevolata dallo studio delle uova…..con queste ricerche arriviamo ad affermare la presenza dell’elminto; ma siccome dal suo numero dipende il grado della malattia, cosi’ fa profitto anche lo stabilire la diagnosi quantitativa. La quale é possibile all’occhio esercitato in base ad un fatto da me ripetutamente certificato, e cioè che la quantità delle uova è direttamente proprozionale al numero degli elminti” (reported by Ivo de Carneri page 253, Parassitologia Generale e Umana 11ª Edizione, 1989). 137 years later do we still need to have proofs that hookworm infection has an impact on anaemia based on intensity of infection and to justify large scale chemotherapy with the safest drugs ever used in medicine like albendazole and mebendazole?

I think the Cochrane group has a mentality similar to that of the 15th century inquisition and is unable to think beyond dogmas: i.e. that if you do not go through a RCTs (and especially their own review, their own “holy inquisition” to get their imprimatur) you will not be allowed to become PH policy. This is deeply and dangerously wrong and the visibility given by the press has been dangerous. Anthelminthic treatment on a large scale is only one of the PH interventions they have reviewed and “dismissed” as not evidence base. Their influence is dangerous and we need to combat it for the benefits of millions of people. For the time being I will continue to be with the heretics, the Giordano Bruno’s of today, and continue to promote large scale preventive chemotherapy, up to the time the Liverpool fundamentalists will get me and try to burn me!

+++++++++++

PH = public health]]>
Health issues and connections with sanitation Fri, 25 Mar 2016 12:55:51 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: muench http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17501 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17501
I have fixed the link, now it is working.

Note to all: make sure you don't put a comma, full stop, semi colon or similar directly behind the URL as it will make the hyperlink not working. And if you find a link that is not working, check if you can just omit the comma, full stop or semi colon at the end to make it work.

Regards,
Elisabeth]]>
Health issues and connections with sanitation Mon, 21 Mar 2016 22:10:58 +0000
RE: [SuSanA forum] Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome (Health issues and connections with sanitation) - by: Gendersan1 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17498 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17498
Thank you for your message. I did not know, the link is not working.
I hope you can access this one:
www.eawag.ch/en/department/sandec/projects/sesp/g-wash/

I am always open to discussion and for exchange.

Kind regards,
Petra]]>
Health issues and connections with sanitation Mon, 21 Mar 2016 16:17:06 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: SusanAko http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17493 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/14326-link-between-poor-sanitation-and-higher-risk-of-adverse-pregnancy-outcome#17493 Thanks for sharing, i am very interested in the research you mentioned but the link does not seem to be working. I will like to know more,can help please.
Very best

Susan]]>
Health issues and connections with sanitation Mon, 21 Mar 2016 13:27:48 +0000
Wider Beneficial of Safe Water and Improved Sanitation - by: F H Mughal http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17366-emergency-triggers-action-in-sanitation-example-zika-epidemic-offers-sanitation-a-chance-in-brazil#17433 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17366-emergency-triggers-action-in-sanitation-example-zika-epidemic-offers-sanitation-a-chance-in-brazil#17433 Wider Benefits of Safe Water and Improved Sanitation


Water and sanitation engineers, generally, are of the view that safe drinking water, improved sanitation, and hygiene (both personal and community hygiene) have wider benefits. For example, they can help in prevention of diseases, and can prevent stunting among children. According to a recent WHO infograph (attached), 23 per cent of all global deaths are linked to the environment

Municipal officials of the local governments in developing countries, who, typically, are not technical persons, do not share these views. Their work is stereo-type – no innovation; no eagerness to seek more knowledge – like approval of the schemes by the provincial government; execution of the schemes; thriving on commissions from the contractors; and completion of the schemes. Most of the schemes, after completion, become non-functional in a short period of time.

As is known, Zika virus has become a major problem in Brazil. The United Nations Special Rapporteur on the human right to safe drinking water and sanitation, Léo Heller has now said that the improved water and sanitation services are answer to the Zika virus.

Leo Heller said: “As the world looks for hi-tech solutions to the Zika virus, we should not forget the appalling state of water and sanitation access of the poor, a key underlying determinant of the right to health.”

“We can engineer sterile mosquitos or use sophisticated Internet tools to map data globally, but we should not forget that today a hundred million people in Latin America still lack access to hygienic sanitation systems and seventy million people lack piped water in their places of residence.”

Leo Heller said: “There is a strong link between weak sanitation systems and the current outbreak of the mosquito borne Zika virus, as well as dengue, yellow fever and chikungunya, and the most effective way to tackle this problem is to improve the failing services.”

The views of Leo Heller are supported by the UN expert on adequate housing, Leilani Farha, who said:
“When people have inadequate living and housing conditions, where they do not have access to safely managed water services, they tend to store water in unsafe ways that attract mosquitos. In addition, poor sanitation systems where wastewater flows through open channels and is disposed of in unsafe pits leads to stagnant water and unfit housing – a perfect habitat for breeding mosquitos.”

Not only that, the views of Leo Heller are also supported by the Special Rapporteur on health, Dainius Pūras, and the Special Rapporteur on extreme poverty, Philip Alston.

More details can be seen at:

www.ohchr.org/EN/NewsEvents/Pages/Displa...D=17212&LangID=E
and
www.un.org/apps/news/story.asp?NewsID=53427#.VubHQlsrLIU

It is encouraging to note the importance of safe water and sanitation given by the UN officials. They need to talk to the municipal governments in developing countries, so that the developing countries also realize the wider benefits of safe water, improved sanitation and proper hygiene.


F H Mughal]]>
Health issues and connections with sanitation Tue, 15 Mar 2016 16:53:53 +0000
Emergency Triggers Action in Sanitation (example: Zika Epidemic Offers Sanitation a Chance in Brazil) - by: F H Mughal http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17366-emergency-triggers-action-in-sanitation-example-zika-epidemic-offers-sanitation-a-chance-in-brazil#17366 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17366-emergency-triggers-action-in-sanitation-example-zika-epidemic-offers-sanitation-a-chance-in-brazil#17366 Emergency Triggers Action in Sanitation


It is common in some developing countries to see the governments’ lack of interest towards pressing problems, especially sanitation. The prime reason being the low priority of the municipal governments towards sanitation, as a result, no action is taken. People suffer because of this, with degree of suffering being faced more by women.

In the informal settlements, typically located at the periphery of the city, the municipal governments do not provide sanitation facilities, and their ready-made reply is: the area is not a sanctioned area in the municipal government’s documents; or, the area is not within our jurisdiction.

With that being said, sometimes, emergency by default, triggers action. A recent post in IPS makes an interesting reading. According to the post (www.ipsnews.net/2016/02/zika-epidemic-of...-a-chance-in-brazil/), “three decades of dengue fever epidemic did not manage to awaken a sense of urgency in Brazil regarding the need for improving and expanding basic sanitation. But the recent surge in cases of microcephaly in newborns, associated with the Zika virus, apparently has.”

“Brazil did not declare all-out war on the Aedes aegypti mosquito until studies showed that Zika can cause microcephaly and other neurological damage in the unborn infants of women infected with the virus in the early months of pregnancy.”

While the Zika episode in Brazil has turned into a major emergency - on 1 February 2016, the World Health Organization declared an international public health emergency after Zika virus was linked to thousands of birth defects in Brazil – the fact remains that in some developing countries, it is somewhat difficult to sensitize the municipal departments in taking action in the field of sanitation.

F H Mughal]]>
Health issues and connections with sanitation Wed, 09 Mar 2016 16:37:55 +0000