Handwashing study in Bangladesh and CDC/Safewater presentations at American Public Health Association Conference

[Campbell, Dan]

Many thanks to Eric Mintz of CDC/Safewater who sent us a copy of the Handwashing/Bangladesh study and notified us of CDC/Safewater presentations at the upcoming APHA conference.
The links to the presentations give a brief summary of the presentations. 

 

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Am. J. Trop. Med. Hyg., 81(5), 2009, pp. 882–887, doi:10.4269/ajtmh.2009.09-0031

Household Characteristics Associated with Handwashing with Soap in Rural Bangladesh

Stephen P. Luby , * Amal K. Halder , Carole Tronchet , Shamima Akhter , Abbas Bhuiya , and Richard B. Johnston

International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, Georgia; Water and Environmental Sanitation Section, UNICEF Bangladesh, Dhaka, Bangladesh

Handwashing with soap prevents diarrhea and respiratory disease, but it is rarely practiced in high-need settings. Among 100 randomly selected villages in rural Bangladesh, field workers enrolled 10 households per village and observed and recorded household activities for 5 hours. Field workers observed 761 handwashing opportunities among household members in 527 households who had just defecated or who cleaned a child’s anus who had defecated. In the final multivariate analysis, having water available at the place to wash hands after toileting (odds ratio = 2.2, 95% confidence interval 1.3, 4.0) and having soap available at the place to wash hands after toileting (odds ratio = 2.1, 95% confidence interval 1.3, 3.4) were associated with washing both hands with soap after fecal contact. Interventions that improve the presence of water and soap at the designated place to wash hands would be expected to improve handwashing behavior and health.

 

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CDC/Safewater APHA Conference Presentations

Epidemic cholera in sub-Saharan Africa: A preventable tragedy  

 

Wednesday, November 11, 2009: 8:50 AM

Nicholas Gaffga, MD, MPH , Epidemiologic Studies Branch, Centers for Disease Control and Prevention, Atlanta, GA

Robert Tauxe, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA

Eric D. Mintz, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA  

 

Epidemic cholera was eliminated from industrialized countries over a century ago, but remains a major cause of morbidity and mortality, and a marker for unsafe drinking water and sanitation, in developing countries. Death from cholera is preventable through oral, or in severe cases, intravenous rehydration. The cholera case-fatality rate therefore reflects access to basic health care. We reviewed World Health Organization (WHO) data on cholera cases and deaths reported between 1960 and 2008. In the 1960's, at the beginning of the 7th cholera pandemic, cholera had an exclusively Asian focus. In 1970, the pandemic reached sub-Saharan Africa, where it has remained entrenched. In 1991, it reached Latin America, resulting in nearly 1 million reported cases from the region within 3 years. In contrast to its persistence in Africa, cholera was largely eliminated from Latin America within a decade. In 2007, 34 (81%) of 42 countries that reported indigenous cases of cholera to WHO were in sub-Saharan Africa. The reported incidence of cholera in sub-Saharan Africa in 2007 (222 cases/million population) was 77 times higher than that in Asia (2.9 cases/million population) and the cholera case fatality rate in sub-Saharan Africa (2.4%) was 7 times higher than in Asia (0.33%); no cholera cases were reported from Latin America. The numbers of cholera cases and deaths in Africa are key indicators of global efforts to reach the Millennium Development Goals for water, sanitation, and child survival, and of the effectiveness of development aid to the region.

Waterborne Diseases 2 (prevention, diagnosis, epidemiology or management)

Tuesday, November 10, 2009: 10:30 AM

 

For the point of use program in Indonesia, chlorination resulted in significantly better microbiologic quality of stored water and a lower, though not significant, proportion of children with diarrhea compared with boiling or use of bottled water. While in Bangladesh being a franchise requires constant negotiation between franchisor and franchisee and the dissemination of a new approach, such as including water treatment as a preventive measure, can be considered as a “diffusion of innovation.” In Malawi, antenatal clinic product distribution and health promotion appeared to be an effective hygiene behavior strategy for reaching rural, poor, less educated women in Malawi. Evidence of product purchase following program exit suggests that program benefits may be sustained. Ethiopia offers important lessons on how to slow the erosion of diarrhea prevention and treatment rates by investing in community health workers While in Uganda results suggest how mapping software can be used to house useful documents and other resources, and connect practitioners in the field for possible collaboration.

 

Session Objectives: In Indonesia, a program describes how to evaluate a point-of-use water treatment program and in Malawi a program demonstrates how to evaluate impact of programs that integrate safe water and hygiene interventions with antenatal care delivery systems. For diarrhea prevention and treatment one presenter evaluates whether or not franchising is an effective model for diffusion of new information to ensure consistent protocol adherence from service providers while in Ethiopia a platform was created at the community level to increase coverage of a combination of diarrhea prevention cornerstones and in Uganda mapping software is reviewed to see if it can be used to house useful documents and other resources, and connect practitioners in the field for possible collaboration.

Moderator:  Hélène Carabin, DVM, PhD

• Boiling Mad: Impact of Point-of-Use Chlorination Compared with Boiling and Bottled Water on Water Quality and Diarrheal Illness —Tangerang, Indonesia, March-June 2008
  Kavita Kishor Trivedi, MD, Samir Sodha, MD, MPH, Elizabeth Blanton, MPH, Abigael Ati, Amy Boore, PhD, MPH, Thai-An Nguyen, MPH, Kristin C. Delea, MPH, REHS, Robert Ainslie, Maria Elena Figueroa, PhD and Rob Quick, MD, MPH  
• Socioeconomic determinants of the success of integrating household water treatment and hygiene promotion with antenatal services in Malawi
  Elizabeth Russo, MD, Anandi Sheth, MD, Manoj Menon, MD, Amose Kudzala, Blessius Tauzie and Robert E. Quick, MD, MPH  
• Introducing POU water treatment as part of a comprehensive approach to diarrhea treatment and management through a franchised health network in Bangladesh
  Juan Carlos Negrette, MBA, Umme Salma Jahan Meena, MD, Setara Rahman, Arefin Amal Islam, MD, Ashraf Haque, Tracey L. P. Koehlmoos, PhD, MHA, James L. Griffin and Betsy Bassan, MA  
• Combining Cornerstone Interventions to Prevent Diarrhea: Ethiopia lessons
  Tesfaye Bulto, MD, MPH, Hailemariam Legesse, MD, Tesfaye Shigute, Yared Mekonnen, PhD and Mary A. Carnell, MD MPH

Existing and Emerging Challenges for Waterborne Disease Prevention: CDC's Domestic and Global Approach to Protecting Public Health

Tuesday, November 10, 2009: 12:30 PM

 

This session will present an overview of some of the most important water-related challenges facing public health in the new century and will highlight the work CDC is engaged in with partners at local, state, national and international levels on both domestic and international water issues. These include improving surveillance systems for waterborne disease and levels of chemical contaminants in drinking water; preventing waterborne disease outbreaks; Estimating accurate population level exposure by geo-referencing spatial extents of community water systems; addressing emerging challenges such as drought, climate change, and water availability, and focusing policy and preventive efforts in domestic issues of chemicals in drinking water, pathogens, such as Legionella, in building distribution systems, and the growing importance of recreational water illness associated with swimming together. The session will also cover the continuing challenges of supplying safe water and sanitation to billions in the non-industrialized world. Participants will gain perspective on the importance of these water-related issues and learn about the work CDC is doing to address these multiple challenges.

Session Objectives: 1) Describe the scope and direction of water-related work occurring at the Centers for Disease Control and Prevention (CDC) 2) Describe the impact of clean drinking water in global settings 3) Describe the impact of recreational and other uses of water (e.g., cooling towers) on transmission of disease in the U.S.

Organizer:  Michael J. Beach, PhD

• Chemicals in drinking water and environmental public health tracking
  Ambarish Vaidyanathan, MS and Judy Qualters, PhD  
• Legionella: New approaches to disease surveillance, outbreak prevention, and environmental control
  Lauri A. Hicks, DO, Nicole Alexander and Barry Fields, PhD  
• Policy and practice in preventing recreational waterborne disease: The national model aquatic health code
  Michele Hlavsa, MPH  
• Point-of-use water treatment, the millennium development goals, and child survival
  Eric Mintz, MD, MPH   

 

 

Dan Campbell, Web Manager
Environmental Health at USAID
1611 North Kent St., Suite 300
Arlington, VA 22209
Ph: 703-247-8722
Email: dcam...@usaid.gov  
Environmental Health at USAID: http://www.ehproject.org
Indoor Air Pollution Updates: http://iapnews.wordpress.com
Sanitation Updates: http://sanitationupdates.wordpress.com
Urban Health Updates: http://urbanhealthupdates.wordpress.com
Cholera Google Group: http://groups.google.com/group/cholera-control
Household Water Treatment Google Group: http://groups.google.com/group/household-water-treatment