SuSanA - Forum Kunena Site Syndication Sun, 26 Oct 2014 08:26:18 +0000 Kunena 1.6 SuSanA - Forum en-gb Here is a way to promote handwashing - by: lvolat Health, hygiene and disability issues Fri, 24 Oct 2014 20:16:14 +0000 Re: Ebola KnowledgePoint - by: ulrichl
Thanks for this information!
The following has nothing to do with the website, but I found it fits nicely into this thread and it could be of interest to the sanitation community:
The Guardian created an excellent visualization of how Ebola compares to other infectious diseases:

A guote from that site:
With Ebola panic spreading, we thought it might be timely to visualise the data on the infectiousness of various pathogens.
To give a universal metric for infectiousness, we’ve used the average ‘basic reproduction number’ (also ratio or rate). It’s a statistical measure of how likely and widespread an infectious disease outbreak might be - if nothing is done to control the situation.
Every disease has a basic reproduction number but the numbers are scattered across the literature. We’ve web-crawled and gathered them all here in one graphic, plotting them against the average case fatality rate - the % of infectees who die. This hopefully gives us a data-centric way to understand the most infectious and deadly diseases and contextualise current events.

Health, hygiene and disability issues Wed, 22 Oct 2014 14:41:36 +0000
Re: Ebola KnowledgePoint - by: rkaupp
Thank you for moving the thread. KnowledgePoint is an initiatie by a few NGOs (WaterAid, RedR, Practical Action, EngineerAid, IRC...) to provide a place to ask technical questions, where specialists can answer. This is because these NGOs all had their internal "technical support" services, but without good platforms to do so). So KnowledgePoint is used both internally (for instance in WaterAid we use it to link fundraising and comms teams to technical advisors), and to allow people from other NGOs or the public to ask questions as well.

The main website is on where you can ask questions anonymously or register, and there are sub-sites for specific organisations, and for instance for Ebola as well.

So, to use it, just search for existing answers, or ask a new question, it's free to use! There are no dedicated times for Q&As as it is not "live", more a repository of knowledge. As it is broader than WASH as it goes into energy, infrastructure, organisational issues, etc.

Best wishes,
Health, hygiene and disability issues Wed, 22 Oct 2014 10:31:26 +0000
Re: Ebola KnowledgePoint - by: muench
thanks for that, interesting initiative.
Could you tell us more about how this "Knowledge Point" website works? Does it have a Q&A session on different topics for certain time periods? I tried to access earlier Q&A sessions on other topics but couldn't find them.

I vaguley remember hearing about this Knowledge Point initiative in the past but can't remember any details about it.


P.S. I have moved the thread from Announcements to the Health section if that's OK by you.]]>
Health, hygiene and disability issues Wed, 22 Oct 2014 09:26:11 +0000
Ebola KnowledgePoint - by: rkaupp
Since WASH plays a crucial role in ebola, I just wanted to point out that the Q&A website KnowledgePoint now has a sub-section dedicated to ebola, with specialists answering questions on

Best wishes,
Health, hygiene and disability issues Wed, 22 Oct 2014 08:30:18 +0000
Re: Sanitation interventions during Ebola epidemic - by: jonpar Health, hygiene and disability issues Tue, 21 Oct 2014 14:49:19 +0000 Re: Sanitation interventions during Ebola epidemic - by: arno Ebola Outbreak: NEJM Live Audio Webcast.

A special invitation for valued readers of the New England Journal of Medicine, a publication of NEJM Group.

NEJM Live Audio Webcast:
Ebola Outbreak
Experts discuss virology, epidemiology, and clinical care
October 22, 2014 | 2:00 pm - 3:30 pm ET

What Clinicians Need to Know
International experts with hands-on experience provide the latest information on the Ebola outbreak, including recent events in the U.S., protection for health care professionals and the general public, and projections for the future.

Learn more about this free live audio webcast hosted by the New England Journal of Medicine, including the full agenda and guest speakers. Webcast participants will also have an opportunity to submit questions live or in advance by sending their questions to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Christopher Dye, D.Phil.
World Health Organization

Paul Farmer, M.D.,Ph.D.
Partners in Health

Jeremy Farrer, M.D.,Ph.D.
Wellcome Trust

Armand Sprecher, M.D.
Médecins Sans Frontières

Jeffrey M. Drazen, M.D.
Editor-in-Chief The New England Journal of Medicine

Lindsey Baden, M.D.
Deputy Editor The New England Journal of Medicine

Follow the live event on Twitter: #NEJMEbola]]>
Health, hygiene and disability issues Mon, 20 Oct 2014 20:28:02 +0000
Re: Sanitation interventions during Ebola epidemic - by: joeturner
Tuladhar, Era, et al. "Residual viral and bacterial contamination of surfaces after cleaning and disinfection." Applied and environmental microbiology 78.21 (2012): 7769-7775.

Full text:


Environmental surfaces contaminated with pathogens can be sources of indirect transmission, and cleaning and disinfection are common interventions focused on reducing contamination levels. We determined the efficacy of cleaning and disinfection procedures for reducing contamination by noroviruses, rotavirus, poliovirus, parechovirus, adenovirus, influenza virus, Staphylococcus aureus, and Salmonella enterica from artificially contaminated stainless steel surfaces. After a single wipe with water, liquid soap, or 250-ppm free chlorine solution, the numbers of infective viruses and bacteria were reduced by 1 log10 for poliovirus and close to 4 log10 for influenza virus. There was no significant difference in residual contamination levels after wiping with water, liquid soap, or 250-ppm chlorine solution. When a single wipe with liquid soap was followed by a second wipe using 250- or 1,000-ppm chlorine, an extra 1- to 3-log10 reduction was achieved, and except for rotavirus and norovirus genogroup I, no significant additional effect of 1,000 ppm compared to 250 ppm was found. A reduced correlation between reduction in PCR units (PCRU) and reduction in infectious particles suggests that at least part of the reduction achieved in the second step is due to inactivation instead of removal alone. We used data on infectious doses and transfer efficiencies to estimate a target level to which the residual contamination should be reduced and found that a single wipe with liquid soap followed by a wipe with 250-ppm free chlorine solution was sufficient to reduce the residual contamination to below the target level for most of the pathogens tested.
Health, hygiene and disability issues Mon, 20 Oct 2014 14:50:15 +0000
Re: Sanitation interventions during Ebola epidemic - by: joeturner

The paper seems to make clear that wiping and the use of detergent is not enough to clean surfaces of the virus. The use of a bleach, preferably with surfaces wiped beforehand, seems to be the advice given in this paper to reduce risks.]]>
Health, hygiene and disability issues Mon, 20 Oct 2014 14:32:50 +0000
Re: Sanitation interventions during Ebola epidemic - by: arno Here is a paper on Noroviruses transferred via faeces on environmental surfaces. Drawing parallels with Filoviruses isn't really a long shot. Protecting against the highly contagious and persistent Noroviruses should provide the proper safety to protect against Ebola.

Effects of cleaning and disinfection in reducing the spread of Norovirus contamination via environmental surfaces by J. Barker, I.B. Vipond, S.F. Bloomfield.
Journal of Hospital Infection. Volume 58, Issue 1, September 2004, Pages 42–49

A reverse transcriptase polymerase chain reaction assay was used to study the transfer of Norovirus (NV) from contaminated faecal material via fingers and cloths to other hand-contact surfaces. The results showed that, where fingers come into contact with virus-contaminated material, NV is consistently transferred via the fingers to melamine surfaces and from there to other typical hand-contact surfaces, such as taps, door handles and telephone receivers. It was found that contaminated fingers could sequentially transfer virus to up to seven clean surfaces. The effectiveness of detergent– and disinfectant-based cleaning regimes typical of those that might be used to decontaminate faecally contaminated surfaces and reduce spread of NV was also compared. It was found that detergent-based cleaning with a cloth to produce a visibly clean surface consistently failed to eliminate NV contamination. Where there was faecal soiling, although a combined hypochlorite/detergent formulation at 5000 ppm of available chlorine produced a significant risk reduction, NV contamination could still be detected on up to 28% of surfaces. In order consistently to achieve good hygiene, it was necessary to wipe the surface clean using a cloth soaked in detergent before applying the combined hypochlorite/detergent. When detergent cleaning alone or combined hypochlorite/detergent treatment failed to eliminate NV contamination from the surface and the cleaning cloth was then used to wipe another surface, the virus was transferred to that surface and to the hands of the person handling the cloth. In contrast, were surfaces where contaminated with NV-infected faecal suspension diluted to 1 in 10 and 1 in 80, intended to simulate surfaces that have become contaminated after secondary transfer, treatment with a combined bleach/detergent formulation, without prior cleaning, was sufficient to decontaminate surfaces and prevent transfer.]]>
Health, hygiene and disability issues Mon, 20 Oct 2014 14:22:46 +0000
Re: Sanitation interventions during Ebola epidemic - by: Sowmya [Start of Page 3 of the discussion]

I think your point is very important. In Ebola containment, we need to think of toilets that may be in bad condition also (built too long ago or not constructed properly, etc.,) - cleaning / disinfecting would be all the more difficult in such cases. If it is not possible to use disinfectant chemicals (because the discharge might get mixed with the compost / fertilizer to be added to the fields), there could be a risk of infection.

Taking all these factors into consideration, it might be best to adopt the normal cleaning procedure for the toilet with the proviso that users wash their hands and feet thoroughly with soap and water outside the toilet (preferably with the water going into a small hole in the ground so that there is no unsightly pool of dirty water stagnating near the toilet) and, after drying, to dust their hands and feet with antiseptic / germicidal powder.

The small hole should probably be not more than 1-1.5 feet deep and 1-1.5 feet diameter as the hole should not be large enough to allow children or small animals to get hurt while running and preferably be kept closed with a lid that will not break into sharp shards if someone stamps on it accidentally - maybe a plastic / rubber ring (eg., a used pressure cooker gasket) with brightly-colored plastic cover on it. Or, can always use bamboo like the ones used for making baskets to make the ring. Probably better solutions are available but I am just thinking of the most resource scarce situation possible and without the possibility of quickly distributing required materials.

A germicidal solution, like Dettol or Savlon, could also be used instead of germicidal powder (I do not have scientific evidence but if other proven options are not available, this could probably be used). Further, for public toilets, a good solution could be the arrangements MSF had made for the hospital in Kitwit (please see article referred by Joe) to have a footbath. Individuals going from one area to the other had to wade through a tray filled with disinfectant (Pedi-Luve or foot bath). The material used had been developed, adapted and tested by MSF during previous emergency situations. 0.2% Calcium Hypochlorite solution 70% was used for the footbath. Something similar could also be used in households, if possible.

Warm regards,

Health, hygiene and disability issues Fri, 17 Oct 2014 13:59:56 +0000
Re: Sanitation interventions during Ebola epidemic - by: joeturner
We have been talking about the risks of stored faeces, should we also be thinking about the risks associated with 'fresh' faeces from ebola victims?

It seems that there is little information about the risks of infection from faeces, but it also seems that one does not need to be exposed much of the virus to get infected.

Should we, therefore, be also talking about the risks of the toilet (delivery) part of sanitation systems?

[End of Page 2 of the discussion]]]>
Health, hygiene and disability issues Fri, 17 Oct 2014 10:15:44 +0000
Re: Sanitation interventions during Ebola epidemic - by: joeturner]]> Health, hygiene and disability issues Thu, 16 Oct 2014 18:14:20 +0000 Re: Sanitation interventions during Ebola epidemic - by: Sowmya

Please find below some additional points:
  1. Soiled linen (of infected patients) disposal in household / community setting.
  2. (i) Disposal of feces of infants and very small children admitted in isolation wards; (ii) where infants have cloth diapers and not disposable diapers, what is the protocol for management of soiled linen? Low-income households may not have the financial resources to dispose cloth diapers after each use, so soaking the cloth diaper in Dettol or Savlon is good practice (because it is anyway recommended practice)? In case Dettol or Savlon is not available, would phenol or sodium bicarbonate be more easily available and effective? (Please see Wiki page for list of commonly used antiseptics.]
  3. How to ensure sanitation workers are fully informed particularly (i) where sanitation workers are employed by projects which are managed only locally and not connected to a municipal or panchayat committee and (ii) where some people undertake sanitation as a tradition / indigenous occupation? Any other situation where sanitation workers may not be connected to a system that can transfer information?
  4. Information to households that maintain the toilets by themselves (for instance, shift an Arborloo, etc.,), how to ensure the right information reaches them?
  5. The 2014 WHO Interim Guidelines for Management of Ebola does not have a section on sanitation. It would be great to have sanitation guidelines during Ebola epidemic. The guidelines could also have a format of records that could be maintained so that field information gets aggregated (at least for post-epidemic research) with adequate harmonization of terms, etc.
  6. (i) How to clean sanitation equipment after use? (ii) would there be any difference in cleaning protocol for a shovel compared to motorized equipment?
  7. Any factors to be considered with respect to toilets in airplanes and airports? Most planes have chemical toilets. As per the Wiki page on chemical toilets, a chemical toilet deodorizes the waste. Does deodorizing include disinfection? Also, what factors should be considered with respect to faucets in airport toilets ? Though, I guess, even if the faucets are not hands-free, using soap & water and closing the tap after washing hands with a clean paper towel would solve any problems provided there is adequate supply of paper towels.
  8. (i) What factors need to be considered for toilets in train & bus stations which do not have chemical toilets and can have significant usage? (ii) What factors need to be considered in case of gatherings of people (like village shanties, melas, etc.,)?
  9. Not sure if windrows are used in countries currently facing Ebola outbreak but where excreta is taken from the site for community composting elsewhere, how to prevent humans or animals from going near it? This could potentially be a problem if the windrows presently do not have fencing.
  10. Significance of pest control to ensure pests do not carry infected excreta on them?
  11. Any factors to be considered with respect to menstrual hygiene during Ebola outbreak?
  12. Given that sanitation workers may be illiterate or not highly educated (compared to health professionals), should the communication and training strategy for sanitation workers be modified? If so, how?
  13. In some communities, houses may be constructed near trees where fruit bats reside. Stepping barefoot on excreta of fruitbats has been found to be one of the transmission modes. How to clear animal droppings in the area surrounding households? In areas affected by the outbreak, do sanitation workers clean the common areas around houses? Any special considerations relating to handling of domestic animals (to prevent the virus from breaking the species barrier)?

Question 3: What are some options for dealing with excreta and avoiding open defecation / exposed fecal matter?

Instead of incineration, collect feces (in bags and place them without closing the lid) in a container and pour adequate quantities of bleach (or other appropriate disinfectant) into the container to immediately disinfect the excreta. Useful in places with no toilets (ie., only OD) or even in hospital settings where use of common toilets may present additional risk of disease spread. The flip side is that the chemically disinfected excreta cannot be used as organic fertilizer but this solution is only for places with no sanitation or particularly resource-constrained hospital settings. It can also be incinerated later.

Warm regards,

Health, hygiene and disability issues Thu, 16 Oct 2014 14:28:46 +0000
Re: New Lancet study concludes no assumed improvement from TSC (Total Sanitation Campaign, in Odisha, India) - by: Sowmya
Incidence and prevalence:

Incidence is “the number of new cases per population at risk in a given time period” (please see Wiki page on incidence). Prevalence is the “proportion of population found to have a condition ... arrived at by comparing the number of people found to have the condition with the total number of people studied, and is usually expressed as a fraction, as a percentage or as the number of cases per 10,000 or 100,000 people” (please see Wiki page on prevalence).

In other words, prevalence measures the number of children with diarrhoea at a given point of time while incidence measures the number of children who had diarrhoea during a given time period. Since the study talks of incidence, it is “during a given time period” and not “at any point of time”. I was unable to find more details about this report, and so cannot say over what time period this statistic refers to (during a period of one year or six months, etc.,).

When we will reach “dramatic improvement”:

With regard to “dramatic improvement”, I was writing more from the perspective of cost-effectiveness. Think of the technology adoption lifecycle (TALC) and see when the 30%, 95% and 100% coverage is reached.

30% is reached after the innovators, early adopters and half of the early majority have shifted to indoor sanitation. They are the easiest to reach (compared to other categories) and yet, the diarrhoea incidence rate is around 40%. We should also note that with half of the country's population already having toilets, after taking into account the disparities in sanitation uptake between communities (for instance, villages close to major towns and cities are likely to have larger proportion of households with toilets compared to villages in remote areas and its households scoring low on development indicators), it is likely that, broadly, the innovators and early adopters already have toilets within the existing setup (ie., with thinking that toilets are costly, ability to ensure O&M given that sanitation-related activities are taboo, etc.,).

Therefore, with the same KAP-technology framework*, we would have much higher incremental cost of reaching 95% of the population (which includes till most of long-tail category have taken to indoor sanitation) and yet, 25% of the children would still have diarrhoea episodes.

* KAP - Knowledge, Attitude and Practices, all of which have been found to be critical determinants of sanitation uptake in India and elsewhere.

What is “dramatic”?

Does reduction from 40% to 25% seem dramatic? Yes, it seems dramatic but only if we do not consider the incremental cost (financial resources, time and effort) of getting to 25%. Additionally, from a programme objective & targets point of view, is 25% acceptable? Diarrhoea is a child killer by itself and also results in secondary / long-term consequences (the most discussed consequence being stunting / malnutrition). Reaching 25% means reaching most of the long-tail category and it takes the last 5% (of the same long-tail category most of which should have been already reached) to bring diarrhoeal incidence down to less than 10%. If we can reach out to most of the long-tail category, probably the last 5% will shift in an accelerated manner because of herding effect. We do not have scientific evidence for how the last 5% will behave with respect to toilets, so why leave them out of programme targets? Why give up by not even planning to achieve the goal?

So, yes, I would say that we should aim at 100% ODF communities.

Warm regards,

Health, hygiene and disability issues Thu, 16 Oct 2014 06:05:37 +0000