SuSanA - Forum Kunena Site Syndication Mon, 16 Jan 2017 12:48:42 +0000 Kunena 1.6 SuSanA - Forum en-gb Re: Squatting vs. Sitting - by: F H Mughal
F H Mughal]]>
Health issues and connections with sanitation Sat, 07 Jan 2017 04:52:11 +0000
Re: Squatting vs. Sitting - by: muench Then again, perhaps women who are used to squatting for using the toilet (or for "sitting" around and waiting, like I have observed vendors to do in Thailand for example), are less impacted even during the later stages of pregnancy. Perhaps you could ask around amongst women that you know in Pakistan where squatting is the norm for toilet use? Could be interesting.

I have read that also the elderly may find it harder, and that grab bars attached to the wall would make a bit difference (also for people with disabilities).
See also posts by Carol and Kris here:]]>
Health issues and connections with sanitation Sat, 07 Jan 2017 00:07:16 +0000
Re: Squatting vs. Sitting - by: F H Mughal
Would the pregnant women still can squat, if she is a bit over-weight?


F H Mughal]]>
Health issues and connections with sanitation Wed, 04 Jan 2017 05:44:13 +0000
Re: squat for money - The Squatty Potty - "healthy colon - healthy life" (product from the US) - by: muench defecation postures ( brought me back to this forum thread. That's because one of the other Wikipedians posted some interesting information on the article's talk page here:

He posted a link to this promotional video for the squatty potty:

Accompanying article:

"Squatty Potty's CEO Ignored Everyone, Made an Insane Video and Boosted Sales 600% Bold marketing helps bring in $15 million"

My fellow Wikipedian also asked:
I can't help but wonder whether it makes a difference whether you squat with a toilet seat supporting your body, as seen in the Squatty Potty video above, or whether you support your weight with your legs/feet, as is done in Japan. --Guy Macon (talk) 17:44, 7 December 2016 (UTC)

He also provided some references for health benefits from squatting although I think none of them stacks up as being good enough for Wikipedia's really high level of references for medical/health content which is explained here
- and which disqualifies primary research and individual small study results.

I guess it is an under-researched topic so not easy to come by the very high quality large studies that would be required to be sure of the possible health benefits from squatting versus sitting ("sure" in the sense of Wikipedia articles' citations, not "sure" in the sense of your own personal experiences).

This is just another example of how Wikipedia work can help us in learning and identifying knowledge gaps and connecting with other interested people.

Health issues and connections with sanitation Tue, 03 Jan 2017 14:31:31 +0000
PLoS journals launch important WASH collection - by: campbelldb Sanitation Updates.

The 2016 studies include:

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea
Jonny Crocker, Jamie Bartram
PLOS Medicine : 03 May 2016

The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections
PLOS Neglected Tropical Diseases : 15 Sep 2016

Scaling up Rural Sanitation in India
PLOS Medicine : 26 Aug 2014

WASH Research
Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands
PLOS Neglected Tropical Diseases : 22 Aug 2016

Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Camb…
PLOS Neglected Tropical Diseases : 22 Aug 2016

Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment
PLOS ONE : 17 Aug 2016

High-Resolution Spatial Distribution and Estimation of Access to Improved Sanitation in Kenya
PLOS ONE : 12 Jul 2016

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter St…
PLOS Medicine : 03 May 2016

A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content
PLOS ONE : 17 Mar 2016

School Water, Sanitation, and Hygiene, Soil-Transmitted Helminths, and Schistosomes: National Mapping in Ethiopia
PLOS Neglected Tropical Diseases : 08 Mar 2016

Have You Heard of Schistosomiasis? Knowledge, Attitudes and Practices in Nampula Province, Mozambique
PLOS Neglected Tropical Diseases : 04 Mar 2016

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-S…
PLOS Neglected Tropical Diseases : 03 Mar 2016

The Ecological Dynamics of Fecal Contamination and Salmonella Typhi and Salmonella Paratyphi A in Municipal Kathma…
PLOS Neglected Tropical Diseases : 06 Jan 2016

* Added by moderator: What is PLos?
According to Wikipedia:
PLOS (for Public Library of Science) is a nonprofit open access scientific publishing project aimed at creating a library of open access journals and other scientific literature under an open content license.
See for more information.
Health issues and connections with sanitation Mon, 21 Nov 2016 18:07:49 +0000
The Ebola Crisis and Innovative WASH Solutions: Webinar recap - by: BijanFHI360
Sustaining long-term water, sanitation, and hygiene (WASH) practices are essential for strong public health systems which are influential in preventing the resurgence of diseases such as Ebola and preventing future outbreaks. For this reason, the Global Public-Private Partnership for Handwashing hosted a webinar in collaboration with Global Communities, UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC) exploring how innovative WASH and social behavior change (SBC) solutions were critical in halting the West Africa Ebola crisis and how their programs are supporting the recovery process and promoting ongoing community health and wellbeing.

Global Communities Program Development Manager, Alice Urban, and WASH Specialist, Franky Li assessed the impact of community-led total sanitation (CLTS) interventions on helping contain and prevent the spread of Ebola in Liberia. They also described how CLTS engagement in other health-related activities has raised government awareness about the need for more targeted support to the community-level health system and demonstrates a low-cost, sustainable option. CLTS can be more than just a tool for sanitation promotion. Community momentum should be leveraged to promote other community health and development objectives.

Learn more about the CLTS methodology used in Liberia here and a report on the community-led response here.

Gaelle Fohr, a sanitation and hygiene consultant who worked as a specialist between 2014 and 2016 for UNICEF’s West and Central Africa program (WCARO), delivered a presentation on the impact of hygiene kits that were distributed in schools when they reopened in early 2015. Together with handwashing promotion, these kits helped form new norms and improved knowledge of handwashing with soap. Ultimately, hygiene kits became part of the safe school protocol. UNICEF continues to incorporate lessons learned from the Ebola response into their approach towards other infectious disease outbreaks. Programs, such as this, can lead to a stronger evidence base when projects have efficient knowledge management guidelines that work in conjunction with the monitoring and reporting processes.

Read how UNICEF launched global response to the Ebola outbreak in West Africa here and WCARO’s efforts here.

CDC’s Infection Prevention & Control program (IPC) was described by Dr. Nora Chea, Medical Epidemiologist. Dr. Chea demonstrated how improved WASH interventions in healthcare settings drove the success of IPC in Sierra Leone and how key results might be replicated in response to future outbreaks. IPC interventions—which include providing clean water, improving environmental cleaning and environmental waste management practices, and proper disinfection of medical equipment—can have a greater impact when technical guidance and evidence-based knowledge are provided at the regional and global levels and information management systems are supported. Integration is a current hot topic in development, and it is applicable in this context, too. Clearly defining cross-sectoral monitoring between sectors and response clusters can reduce gaps or duplicity between IPC and WASH programs. Dr. Chea concluded his presentation by emphasizing that IPC programs within healthcare structures must integrate improved WASH practices at all levels. WASH is critical in healthcare settings—both for IPC and for promoting public health.

Information about CDC’s ongoing IPC work may be found here. CDC has also produced Ebola outbreak communication resources, available here.

Learn more about key takeaways from these programs by accessing the webinar recording and downloading the presentation slides here. If you’d like to learn more about how handwashing with soap can help prevent Ebola virus transmission, read our one-page summary here.]]>
Health issues and connections with sanitation Wed, 05 Oct 2016 14:57:45 +0000
Webinar Announcement: “The Ebola Crisis and Innovative WASH Solutions” (recording available) - by: BijanFHI360 September 28 at 10:00 am EDT.

In 2015, Sierra Leone, Liberia, and Guinea began to enter periods of Ebola-free recovery. We know that innovative water, sanitation, and hygiene (WASH) interventions, specifically handwashing behavior change programs, played a critical role in halting the crisis and promoting ongoing community health. Now, we must ask ourselves “What’s next?” How can we ensure that the lessons learned from this crisis are incorporated into how the WASH sector promotes sustained behavior change? Can the response to the Ebola crisis frame how the world responds other to infectious disease outbreaks?

Experts from the U.S. Centers for Disease Control and Prevention and Global Communities will share key takeaways on the impact of infection prevention and control programs, community-led total sanitation approaches, and WASH interventions in schools.

Join the Global Public-Private Partnership for Handwashing for this interactive webinar on to discuss these questions and more.

Confirmed Speakers
U.S. Centers for Disease Control and Prevention
Global Communities

Please register here

Health issues and connections with sanitation Wed, 21 Sep 2016 15:25:49 +0000
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment - by: neilpw
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment


Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. These indicators should be measured routinely in order to inform improvements.

Citation: Gon G, Restrepo-M?ndez MC, Campbell OMR, Barros AJD, Woodd S, Benova L, et al. (2016) Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment. PLoS ONE 11(: e0160572. doi:10.1371/journal.pone.0160572

Full text here:]]>
Health issues and connections with sanitation Tue, 30 Aug 2016 18:18:36 +0000
Re: Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: bowenarrow Ross]]> Health issues and connections with sanitation Sun, 26 Jun 2016 00:33:36 +0000 Re: Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: JKMakowka
For example a tube-well can hardly be considered "improved" if Giardia is still found (this is a large protozoa that should be very effectively filtered by the soil, indicating that the tube-well did not have a functioning sanitary seal at the top to prevent surface water intrusion).

The latrine findings are also not that surprising if one looks at the overall coverage, with was only 10% vs 38%, meaning high levels of open-defecation even after the intervention and thus obviously no impact could be found (the summary is a bit misleading in that regard).
However later they mention that there is also evidence of an increase in contamination of ground water due to the pour-flush pit-latrines used, which again is a well known fact that these lead to higher groundwater contamination if installed in areas with high ground-water tables.

So while this study is certainly very interesting, the conclusions made are somewhat misleading as there seems to have been neither really improved tube-wells nor an appropriate sanitation technology used in the area.]]>
Health issues and connections with sanitation Wed, 22 Jun 2016 04:15:11 +0000
Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: campbelldb Sanitation Updates

Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage. Water Research, Volume 100, 1 September 2016, Pages 232–244.

Authors: Mitsunori Odagiri, Alexander Schriewer, et al.


- Application of Bacteroidales MST to evaluate improved sanitation impacts
- Widespread human and animal fecal contamination detected in homes.
- Pathogens detected in drinking sources associated with subsequent child diarrhea.
- Public ponds used domestically were heavily contaminated with multiple pathogens.
- No decrease in human fecal or pathogen contamination from increased latrine coverage.

In conclusion, the study demonstrates that

(1) improved sanitation alone may be insufficient and further interventions needed in the domestic domain to reduce widespread human and animal fecal contamination observed in homes,
(2) pathogens detected in tubewells indicate these sources are microbiologically unsafe for drinking and were associated with child diarrhea,
(3) domestic use of ponds heavily contaminated with multiple pathogens presents an under-recognized health risk, and
(4) a 27 percentage point increase in improved sanitation access at village-level did not reduce detectable human fecal and pathogen contamination in this setting.]]>
Health issues and connections with sanitation Tue, 21 Jun 2016 15:46:09 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - and appeal to SuSanA members for input - by: karobb
Thanks so much for your message and apologies on the delay in getting back to you!
Thanks for bringing up the important point regarding wastewater irrigation and health. One of the key findings from the in-depth SaniPath study in Accra was that the dominant pathway of exposure to fecal contamination for young children was through the food supply. This has important implications for the WASH sector – that typically ignores food safety. As you point out, urban agriculture is a key contributor to the food supply in many cities, and wastewater irrigation is a common practice. Our study demonstrates that this pathway for exposure combines high frequency of exposure and high “doses” of fecal contamination – making it a high-risk pathway that should be a priority for intervention. We’ve recently submitted a manuscript by Wang et al. detailing this finding to the American Journal of Tropical Medicine and Hygiene and we can send you a copy once it’s published. We also conducted a sub-study lead by a PhD student at the London School of Hygiene and Tropical Medicine, Prince Antwi-Agyei. The results of that work can be found in a journal article entitled “A Farm to Fork Risk Assessment for the Use of Wastewater in Agriculture in Accra, Ghana” (

Regarding your question about applying SaniPath in rural or peri-urban areas, we’ve put some thought into this in the past but don’t currently have plans to develop a version of the tool for rural areas. However, we do have plans to apply the tool in peri-urban areas and smaller towns where sanitation investments are planned through a partnership with EAWAG.

We've also recently circulated a policy brief on public toilets based the SaniPath study in Accra, Ghana ( that may be of interest.

We really value you taking the time to contact us and for sharing your insights! Please do keep in touch!


Katharine Robb, MPH
Associate Director, Research Projects
The Center for Global Safe WASH
Emory University
This e-mail address is being protected from spambots. You need JavaScript enabled to view it ]]>
Health issues and connections with sanitation Tue, 07 Jun 2016 17:37:18 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: jbr
"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: The elusive effect of water and sanitation on the global burden of disease - by: muench 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" ( You can see here on the talk page ( 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


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
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.

Health issues and connections with sanitation Mon, 21 Mar 2016 22:10:58 +0000