The usefulness of a handwashing proxy in large household surveys

WASHplus’s Monitoring, Evaluation, Research, and Learning Advisor, Orlando Hernandez, co-authored a paper on the usefulness of a handwashing proxy in large household surveys. An abstract of the paper is provided below.

“Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies or only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted.”

Read the paper here.

Citation: Victoria Shelus and Orlando L. Hernandez, The usefulness of a handwashing proxy in large household surveys, Available Online 20 August 2015, DOI: 10.2166/washdev.2015.184

 

 

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Voices from Bangladesh: Reflections on SACOSAN VI

Reblogged from PPPHW blog.

julia rosenbaumBy Julia Rosenbaum, Senior Behavior Change Advisor USAID/WASHplus Project

I recently attended the 6th South Asian Conference on Sanitation (SACOSAN VI), held in Dhaka, Bangladesh. Given the clear ties between sanitation and hygiene, I was asked to provide commentary on the prevalence and discussion around hygiene at SACOSAN. A commentary on hygiene, however, first begs the question, “What is hygiene?”, as it means many things to many sacosanpeople. To some, hygiene pertains exclusively to handwashing with soap. To others, it includes food hygiene and treatment and safe storage of household water. To others, still, it means any “software” or promotional aspect of within water, sanitation, and hygiene (WASH) generally, such as behavior change. It is fair to generalize that hygiene was comprehensively defined at SACOSAN including the “software” side of WASH, specifically regarding sanitation, handwashing, and menstrual hygiene management.

A major theme throughout the conference was a renewed call for representation and inclusion through the human right to sanitation. This was true in terms of hygiene, too.

Representation and inclusion were perhaps best represented in a session that highlighted a new publication and spotlighted issues facing women, adolescent girls, the elderly, persons with disabilities, and those in the sanitation workforce. Leave No One Behind, a stunning new publication of Freshwater Action Network South Asia and the Water Supply and Sanitation Collaborative Council, seeks to give voice to those too often neglected and excluded from both political processes and access to sanitation and hygiene services. The objective of the publication and the initiative is to assure inclusion and representation, considered essential to achieving the newly agreed upon Sustainable Development Goals.

The session corresponding with the Leave No One Behind report illuminated the tremendous obstacles and humiliation suffered by these individuals and the corresponding consequences—including indignities, poorer health, and safety concerns. Yet, despite the many conversations about access, what was most poignant to me was the overall inaccessibility of the conference center despite efforts to find a more accessible venue. Clearly, in many contexts, access needs to be better ensured and not merely discussed. While the focus of this session was to highlight the “voices” of those featured in the report, there was a striking absence of positive examples and best practices that have been refined over the past decade and do provide access to many who might otherwise be left behind. Showcasing ways that access can be achieved—for instance, displays of simple latrine and handwashing station modifications to allow access to the differently abled, the elderly, the deaf, blind, and mute—or outlining inclusion strategies and approaches gaining prominence could have prompted session participants to not merely discuss the need for inclusion but also inspired action.

While I wish that the accessibility issues faced by participants had been addressed, there were many highlights of the conference. It was heartening to see participants spontaneously organize a special side session on menstrual hygiene management (MHM), as it was not prominently included in the program. Facilitated by WaterAid and featuring a wide range of panelists including government officials, global leaders, and community representatives, this lively session filled a gap and helped to prioritize menstrual hygiene management in the SACOSAN declaration and commitments.

The meeting’s hygiene promotion session was coordinated by the Afghani Delegation. The four technical papers that comprised this session—including one co-authored by USAID/WASHplus—comprehensively defined hygiene promotion. As a result, there was a large focus on sanitation best practice and innovation, such as improving sanitation and hygiene (mostly handwashing) practices in geographically-challenged areas, fostering strategies to improve sanitation coverage and developing approaches to improving sanitation practice (i.e., latrine use) and consistent and correct handwashing with soap. A forth session focused on MHM, and boldly shared the failures attributed to not thoroughly consulting with school girls and administration, as well as successes.

Hygiene was also prominent in a plenary session chaired by BBC Media Action (formerly BBC World Service Trust). Via a provocative video presentation, behavior change specialist Dr. Val Curtis with the London School of Hygiene and Tropical Medicine, highlighted three elements—surprise, revaluation, and performance—as fundamental and effective at improving WASH. This video was followed by prominent national journalists who discussed how to get the public to engage in topics considered unpleasant and often taboo by capturing audience attention and greater media visibility.

The linkages between sanitation and hygiene are clear, and it is encouraging that hygiene was featured prominently in the meeting’s Declaration and Commitments where every mention of sanitation included “… and hygiene”. I am hopeful that the calls for representation and inclusion of the vulnerable and underserved that were made during SACOSAN will lead to a truly enabling environment, and that we will learn from our oversights and collaborate going forward to improve access to sanitation and hygiene for all.

9 AM EST, Feb 16 Webinar: WASHing Away Diseases, Two Hands at a Time

WASH NTDs webinar

On February 18 at 9:00 AM EST, please join the Global Public-Private Partnership for Handwashing and the USAID/WASHplus project for a webinar discussing why water, sanitation, and hygiene (WASH) matter to neglected tropical diseases (NTDs), and addressing the need for new approaches for multi-sector initiatives to promote equity, poverty alleviation, health, and well-being.

Register here today!

Featuring experts from WaterAid, Sightsavers, the FHI 360-led USAID/WASHplus project, and USAID, this webinar is an excellent opportunity for those working in both WASH and NTDs to learn about the global landscape of WASH/NTD strategy and glean practical insights from projects that are operating in this context.

This webinar will include brief presentations on:

  • The link between WASH and NTDs
  • How we can work together to achieve common goals through the World Health Organization’s Joint WASH-NTD strategy; and
  • Integration in practice.

About the panelists:

  • Renuka Bery, MPH, Senior Program Manager for the USAID/WASHplus project, has an extensive background in WASH integration.
  • Sophie Boisson, PhD, Technical Officer for Water, Sanitation, Hygiene and Health at the World Health Organization (invited).
  • Edouard Tianhoun, RN, MSc, WASH-NTD Coordinator for the USAID/WASHplus Burkina Faso pilot project, has been in involved in WASH programs in his native Burkina Faso since 2011.
  • Yael Velleman, MSc, Senior Policy Analyst on Health and Sanitation, leads WaterAid’s strategy, advocacy, and research agenda on health.
  • Merri Weinger, MPH, Senior Environmental Health Advisor at USAID’s Bureau for Global Health, has over 30 years of experience in health programs at USAID, WHO, and PAHO.
  • Geordie Woods, MPH, Technical Adviser-NTDs at Sightsavers, specializes in health behavior and strategic communication with a technical focus that includes NTDs and WASH.

Following the presentations there will be a Question & Answer session.

Register now!

Celebrating World Health Day: Why Food Hygiene Matters

You are what you eat

It is estimated that 2 million deaths occur every year from contaminated food or drinking water. Diarrheal disease alone kills an estimated 1.5 million children annually, and most of these cases are attributed to contaminated food or drinking water, according to the World Health Organization (WHO). 

In Uganda, the WASHplus project worked closely with USAID implementing partners including Community Connector, SPRING, STAR-SW, FANTA, and others to integrate WASH and aspects of food hygiene, among other interventions, into HIV care and support. WASHplus developed a series of job aids to support outreach workers and clinical counselors to integrate WASH into their home-based and clinical practice. The job aids are available in English, and two local languages, Rukiga and Rufumbira. Also, notable in WASHplus’s work in Uganda is the application of the small doable action approach to food hygiene to address local challenges of keeping food safe.

Resources developed by WASHplus are provided below.

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes. A Training Resource Pack for Uganda, 2014.

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmmes

In Uganda, the WASHplus project is integrating WASH into to Nutrition and Feed the Future Programming. Integrating WASH into nutrition focuses on the importance of improving household sanitation and nutritional needs in a child’s first 1,000 days. By building capacity of implementing partners and district focal and community resource personnel, WASHplus facilitated the integration of WASH into clinical nutrition assessment, home visits with householders of small children and families affected by HIV, and through community mobilization campaigns. For example, Community Connector now not only includes WASH as part of the model homes in its 1,000 days campaign, the project included WASH in its community drama initiatives, radio talk show, behavior change communication materials, and field day exhibition, which emphasized the integration of nutrition, agriculture, income, and WASH. Integrating WASH into the District Nutrition Coordination Committees further emphasized the importance of WASH and nutrition integration during the budgeting process, implementation, and supervision of district efforts to fight undernutrition.

Small Doable Actions for Improving Household Water, Sanitation, and Hygiene Practices. Job Aids for Village Health Teams, Peer Educators, and their Supervisors (English, RufumbiraRukiga), 2104.

Small Doable Actions for Improving Household Water, Sanitation, and Hygiene Practices -Job Aids for Village Health Teams_Peer Educators_Supervisors

Small Doable Actions for keeping food safe

Working with SPRING, WASHplus created the first-ever job aids promoting small doable actions for food hygiene, based on the World Health Organization’s “Five Keys to Safer Food.” The job aids address issues of food safety during preparation, serving, and related to storage. This initiative directly addressed the contribution of poor food handling in spreading contamination that leads to diarrhea. Other job aids highlight safe disposal of infant and animal/poultry feces, which may be significant contributors of undernutrition and inhibitors of growth according to a growing evidence base. Feces from these sources find their way to a child’s mouth through food or water contamination or through direct ingestion, causing diarrhea, enteropathy, and contributing to the excessive growth stunting documented in the region.

Additional WASHplus Resources

You Are What You Eat: Why Food Hygiene Matters for Child Growth. Julia Rosenbaum, FHI 360/Deputy Director of the USAID funded WASHplus Project, and Merri Weinger, USAID/Bureau for Global Health/Environmental Health Team leader. A presentation at the USAID Mini-University, March 2015.

Why WASH Matters for Improved Child Health, Nutrition & Growth: A Knowledge Sharing Event. Julia Rosenbaum, FHI 360/Deputy Director of the USAID funded WASHplus Project, June 2014.

Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh, Islam et. al. Tropical Medicine and International Health, Volume 18, no 3, pages 250–258, March 2013.

Small Doable Actions: Simple Steps That People Can Take to Improve WASH

Small doable actions are simple steps that people can take to improve WASH in their communities!

WASHplus Presents at USAID Global Infrastructure Conference 2014

In December 2014, the USAID/Washington E3 Bureau invited Jonathan Annis to present learning from his experiences supporting public-private partnerships in Madagascar on day two of USAID’s Global Infrastructure Conference. The session was well attended by a diverse mix of domestic and overseas USAID staff working on WASH, infrastructure, and environmental compliance.

View Jonathan presentation here: http://www.washplus.org/sites/default/files/annis-fsm3_conference2015.pdf

WASHplus Uganda Project Transitions to Local Actors

Three girls sew their own menstrual pads.
Girls take menstrual hygiene management into their own hands as they make reusable menstrual pads, one of the many small doable actions WASHplus helped to promote in Uganda.

In November 2014 WASHplus concluded a busy year and a half of work in Uganda (May 2013–November 2014) to reduce diarrhea and improve the health and resilience of key populations in three districts—Kabale, Kisoro, and Kanungu. This multidisciplinary initiative focused on integrating water, sanitation, food hygiene, and hand washing into nutrition and Feed the Future activities as well as community and clinically based HIV activities. WASHplus also worked to strengthen the capacity of local districts to plan, budget, implement, and monitor water, sanitation, and hygiene (WASH)–related activities. A WASH forum was held in collaboration with USAID implementing partners December 2 to celebrate project accomplishments and mark the official transition to district actors. The project produced a number of publications and materials for field use that are now available, including training and resource packages on Integrating Safe Water, Sanitation, and Hygiene into HIV Programmes and Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes, and job aids/assessment cards in English and two local languages—Rufumbira and Rukiga (available on the WASHplus website). Districts will reproduce these materials in even larger quantities using their USAID WASH grants. An end-of-project review is also available here.