SuSanA - Forum Kunena Site Syndication http://forum.susana.org/ Sun, 24 Jul 2016 04:53:55 +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 Recent sanitation and health studies posted on Sanitation Updates - by: campbelldb http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18370-recent-sanitation-and-health-studies-posted-on-sanitation-updates#18370 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18370-recent-sanitation-and-health-studies-posted-on-sanitation-updates#18370 Sanitation Updates.

RECENT POSTS

- Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal July 6, 2016
- Environmental Transmission of Diarrheal Pathogens in Low and Middle Income Countries July 6, 2016
- Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural India July 5, 2016
- Testing the Implementation Potential of Resource Recovery and Reuse Business Models July 5, 2016
- Beyond hardware: how a portable sink can inspire behaviour change July 5, 2016
- Scientists put $177 billion price tag on cost of poor child growth July 5, 2016
- Positive Progress: 3 Trends in Wastewater Treatment July 5, 2016
- Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa “Cool Foam” System in Kenya June 27, 2016
- Market-based Approaches to Sanitation June 27, 2016
- Fecal Sludge Management Tools – World Bank June 27, 2016]]>
Health issues and connections with sanitation Wed, 06 Jul 2016 15:17:00 +0000
Re: Celebrate Global Handwashing Day 2016! - by: BijanFHI360 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18339-celebrate-global-handwashing-day-2016#18340 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18339-celebrate-global-handwashing-day-2016#18340
For handwashing to be effective it must be practiced consistently at key times, such as after using the toilet or before contact with food. While habits must be developed over time, this theme emphasizes the importance of handwashing as a ritual behavior for long-term sustainability. Habit formation is currently a hot topic in behavior change and the water, sanitation, and hygiene (WASH) sector. This theme taps into that interest and is also a gateway to discussing what the sector knows about how habits are formed.

This theme will drive messaging and events around the world, but it can also be modified for specific contexts if organizations would like to highlight the specific impact of handwashing on key areas, such as a nutrition or education. For instance, an organization could say “Make handwashing a habit because it prevents diarrhea!” or “Make handwashing a habit because it impacts nutrition!”]]>
Health issues and connections with sanitation Thu, 30 Jun 2016 21:21:43 +0000
Celebrate Global Handwashing Day 2016! - by: BijanFHI360 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18339-celebrate-global-handwashing-day-2016#18339 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18339-celebrate-global-handwashing-day-2016#18339
To help support event organizers, the Global Public-Private Partnership for Handwashing will publish an updated Planner's Guide, develop a social media toolkit, and coordinate planning calls. To stay up-to-date on Global Handwashing Day plans, or questions about the day, please write us at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or learn more on the Global Handwashing Day website.]]>
Health issues and connections with sanitation Thu, 30 Jun 2016 21:14:27 +0000
Re: Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: bowenarrow http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18324 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18324 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 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18307 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18307
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 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18302 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/18302-human-fecal-and-pathogen-exposure-pathways-in-rural-indian-villages-and-the-effect-of-increased-latrine-coverage#18302 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.

Highlights

- 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: Review on shared sanitation - Global Enteric Multicenter Study (GEMS) - Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children - by: KellyKBaker http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18185 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18185
The longer answer requires more space than reasonable for a blog, but is basically that no one really knows just yet whether the interactions between humans, the environment, and human pathogens or the indicators used as proxies can be easily reduced to simple relationships. I think that (mostly) everyone acknowledges that it is necessary - the WASH sector needs to get better about objectively evaluating policy and interventions/programs. Do shared latrines pose higher risks of exposure, and if so how? Are improvements in sanitation coverage reducing open defecation? How much impact will latrines have given all of the other sources of feces and pathways to infection?

Unfortunately, all the evidence suggests that in places like Kisumu, the story may be more complex than we hope. And the easiest to use, lowest cost indicators are not appropriate for many of these questions although they are quite useful for drinking water/food/hands where tolerance for any contamination is low. The starting point begins with using rigorous science like microbial fingerprinting to understand how humans, animals, etc. affect safety of the environment and to figure out which indicators best measure risks from different sources. Second is to validate those patterns across sites with similar developmental challenges. Then we will are equipped to have an evidence based discussion about observable factors or indicator assays for risk evaluation by utilities and others.

I hope that doesn't come across as a non-answer, but I think we have to be transparent about current knowledge gaps.

Kelly]]>
Health issues and connections with sanitation Wed, 08 Jun 2016 00:56:36 +0000
Re: Review on shared sanitation - Global Enteric Multicenter Study (GEMS) - Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children - by: SusannahClemence http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18184 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18184 In general, people might quite rationally choose open defecation, especially in the bush, as more hygienic for the individual defecator even though it's less hygienic for everyone else.]]> Health issues and connections with sanitation Tue, 07 Jun 2016 20:57:04 +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 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa-and-appeal-to-susana-members-for-input#18181 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/13099-sanipath-assessment-of-fecal-exposure-pathways-in-low-income-urban-settings-emory-university-usa-and-appeal-to-susana-members-for-input#18181
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” (journals.plos.org/plosone/article?id=10....journal.pone.0142346).

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 (sanipath.org/wp-content/uploads/2016/04/...rin-Policy-Brief.pdf) 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!

Kate

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: Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children - by: JKMakowka http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18174 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18174 en.wikipedia.org/wiki/Community_Fingerprinting ) could become part of a risk-evaluation tool set of a urban utility company responsible for sanitation services for example.

Maybe you have already thought about the possible practical applications in more detail and would be willing to share some thoughts on it here?]]>
Health issues and connections with sanitation Tue, 07 Jun 2016 01:08:35 +0000
Re: Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children - by: KellyKBaker http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18173 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18173 I knew about Susana, but a colleague that works for an NGO involved in EcoSan projects reminded me that this is a great forum where researchers like myself can understand the priorities and perceptions of practioners, and maintain awareness of projects that may not necessarily wind up in journals or text books. As a researcher hoping to advance the science of global development evaluation - this is important!

We are working on the Social Microbes manuscripts now. But some details from a UNC conference presentation last fall are here: www.researchgate.net/publication/2834211...urban_slums_in_Kenya

So far our major take-away observations (from Kisumu, Kenya) are:

1. The microbial diversity of fecal pathogens detected in neighborhoods with low sanitation coverage and limited domestic animal management is extraordinary. We found ~14 - 19 (depending upon neighborhood) different fecally-transmitted diarrhea or helminth pathogens in soil and surface water in Kisumu in just one 1-week rapid assessment during a dry to wet transitional season. There is a great deal of overlap between the top 5 pathogens detected in <5 children's stool in GEMS and what we are detecting in the environment. In comparison, at a "control" site in Iowa, areas impacted by cattle and pig farms, we typically detected only 1 pathogen (Crypto) at far lower frequencies.

2. We can tell the difference between sites impacted by domestic animals or open defecation. Animals and OD increase the risk of detecting any fecal pathogen in communal areas, and more importantly they increase the risk of simultaneously detecting multiple fecal pathogens. We are also detecting greater fecal pathogen diversity at the neighborhood level as well, although we are still working on disentangling whether those differences are due to differences in sanitation coverage vs other factors like infrastructure, tenancy, wealth, etc. The fecal fingerprint (diversity) for animal impact on environmental contamination versus OD are different, suggesting different potential indicators for risk evaluation.

3. Children playing in communal areas can be ingest multiple potentially-infectious pathogens per day from relatively infrequent contact behaviors.

This was for all practical purposes a pilot project, and we are hoping to expand on this study soon to address many of the questions relevant to this forum.
Kelly]]>
Health issues and connections with sanitation Mon, 06 Jun 2016 16:10:01 +0000
Re: Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children - by: muench http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18164 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18164
Great to see you here on the forum, as one of the authors whose paper is being discussed here. I am really happy about that (did someone alert you to this thread or did you just happen to come across it?).

You wrote:
We have found extraordinarily complex patterns of enteropathogen exposure in urban child play areas (see Social Microbes study)

Which Social Microbes study do you mean?

Regards,
Elisabeth]]>
Health issues and connections with sanitation Mon, 06 Jun 2016 03:15:36 +0000
Re: Relationship Between Sanitation and Hygiene Indicators and Moderate-to-Severe Diarrhea in Children - by: Mnyororo http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18163 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18163 Health issues and connections with sanitation Sun, 05 Jun 2016 16:38:48 +0000 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/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#18104 http://forum.susana.org/forum/categories/26-health-issues-and-connections-with-sanitation/17919-review-on-shared-sanitation-global-enteric-multicenter-study-gems-sanitation-and-hygiene-specific-risk-factors-for-moderate-to-severe-diarrhea-in-young-children?limit=12&start=12#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