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Godfrey S.,Water and Environmental Sanitation Section | Van Der Velden M.,UNICEF Mozambique | Muianga A.,UNICEF Mozambique | Vigh M.,VU University Amsterdam | And 2 more authors.
Waterlines | Year: 2014

This paper presents the findings of a longitudinal study that measures the public health impact of a multiple intervention rural water and sanitation programme termed the One Million Initiative in Central Mozambique. Data from a 2008 multiple indicator panel survey baseline is compared with results from the 2010 midline using a random selection of 1,600 households divided over 80 clusters (control and intervention communities). The study reports the impact using two statistical methods: 1) statistical analysis of double differencing; and 2) calculation of DALYs (disability adjusted life years). The results indicate a self-reported reduction from 30 per cent to 14 per cent in cases of waterborne diseases between 2008 and 2010 in the intervention areas. Regression analysis suggests that 3.1 percentage points of this 16 point decline can be attributed to interventions under the programme. Furthermore the paper noted a 2 per cent reduction in DALYs between 2008 and 2010 in the target communities. © Practical Action Publishing, 2014. Source

Luby S.P.,International Center for Diarrhoeal Disease Research | Luby S.P.,Centers for Disease Control and Prevention | Halder A.K.,International Center for Diarrhoeal Disease Research | Huda T.,International Center for Diarrhoeal Disease Research | And 2 more authors.
PLoS Medicine | Year: 2011

Background: Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea. Methods and Findings: Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.57-1.05), washed both hands with water only (OR = 0.67; 95% CI = 0.51-0.89), or washed at least one hand with soap (OR = 0.30; 95% CI = 0.19-0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR = 0.45; 95% CI = 0.26-0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child's anus who defecated and subsequent child diarrhea. Conclusions: These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea. Source

Halder A.K.,International Center for Diarrhoeal Disease Research | Tronchet C.,Water and Environmental Sanitation Section | Akhter S.,International Center for Diarrhoeal Disease Research | Bhuiya A.,International Center for Diarrhoeal Disease Research | And 3 more authors.
BMC Public Health | Year: 2010

Background. We analyzed data from the baseline assessment of a large intervention project to describe typical handwashing practices in rural Bangladesh, and compare measures of hand cleanliness with household characteristics. Methods. We randomly selected 100 villages from 36 districts in rural Bangladesh. Field workers identified 17 eligible households per village using systematic sampling. Field workers conducted 5-hour structured observations in 1000 households, and a cross-sectional assessment in 1692 households that included spot checks, an evaluation of hand cleanliness and a request that residents demonstrate their usual handwashing practices after defecation. Results. Although 47% of caregivers reported and 51% demonstrated washing both hands with soap after defecation, in structured observation, only 33% of caregivers and 14% of all persons observed washed both hands with soap after defecation. Less than 1% used soap and water for handwashing before eating and/or feeding a child. More commonly people washed their hands only with water, 23% after defecation and 5% before eating. Spot checks during the cross sectional survey classified 930 caregivers (55%) and 453 children (28%) as having clean appearing hands. In multivariate analysis economic status and water available at handwashing locations were significantly associated with hand cleanliness among both caregivers and children. Conclusions. A minority of rural Bangladeshi residents washed both hands with soap at key handwashing times, though rinsing hands with only water was more common. To realize the health benefits of handwashing, efforts to improve handwashing in these communities should target adding soap to current hand rinsing practices. © 2010 Halder et al; licensee BioMed Central Ltd. Source

Sultana S.,University of Dhaka | Ahmed K.M.,University of Dhaka | Mahtab-Ul-Alam S.M.,University of Dhaka | Hasan M.,University of Dhaka | And 8 more authors.
Journal of Hydrologic Engineering | Year: 2014

Fresh water resources are scarce in rural communities in the southern deltaic plains of Bangladesh where both shallow and deep groundwater is frequently brackish, and fresh water ponds have been increasingly salinized by inundation during storm surges and brackish-water aquaculture. Low-cost aquifer storage and recovery (ASR) schemes were constructed at 13 villages in three coastal districts by developing storage in shallow confined fine to medium sand aquifers overlain by variable thicknesses of silt and clay. A typical ASR scheme consisted of a double-chambered graded sand filtration tank with a volume of 19.5 m3 that feeds filtered pond water to four to six large diameter (d = 30.5 or 56 cm) infiltration wells through PVC pipes fitted with stop valves and flow meters. The infiltration wells were completed at 18-31 m below ground and filled with well-sorted gravel capped with a thin layer of fine sand that acts as a second stage filter. Infiltration rates at 13 sites averaged 3 m3/day (range: 3-6 m3/day) over one year of operation. At 11 sites where water was abstracted, the recovery rate ranged from 5 to 40%. The source pond source water frequently had turbidity values of ≥100 NTU. After sand filtration, the turbidity is typically 5 NTU. Despite this, clogging management involving frequent (monthly to weekly) manual washing to remove fine materials deposited in the sand filtration tank and the infiltration wells is found to be necessary and effective, with post-manual-washing operational infiltration rates restored to annual average values. E. coli counts in recovered water are greatly reduced compared to raw pond water, although E. coli is still detected in about half of the samples. Arsenic in recovered water was detected to be at level of > 100 μg/L repeatedly at three sites, suggesting that As risks must be carefully managed and require further investigation. © 2014 American Society of Civil Engineers. Source

Zheng Y.,Water and Environmental Sanitation Section | Zheng Y.,Queens College, City University of New York | Zheng Y.,Lamont Doherty Earth Observatory | Hakim S.A.I.,Water and Environmental Sanitation Section | And 3 more authors.
Journal of Water Sanitation and Hygiene for Development | Year: 2013

Household surveys in Bangladesh between 1994 and 2009 assessed sanitation access using questions that differed significantly over time, resulting in apparently inconsistent findings. Applying the WHO and UNICEF Joint Monitoring Programme's 2008 definition for open defecation and improved sanitation facilities excluding shared facilities to the compiled data set, sensible sanitation coverage trends emerge. The percentage of households openly defecating declined at a rate of about 1.8% per year from 30% in 1994 to 6.8% in 2009, primarily due to changes in rural areas. Access to individual improved sanitation facilities nearly doubled from about 30% in 2006 to 57% in 2009, with both rural and urban areas showing impressive progress. Access to shared improved latrines also nearly doubled from about 13% in 2006 to 24% in 2009, with the urban slums recording the greatest gain from 17% in 2006 to 65% in 2009. Shared improved latrines are only slightly less clean than individual ones. Dependence on shared improved latrines increases with population density. In 2007, 20% of the poorest households still openly defecated, although more of them (38%) shared a latrine of any type. A poverty reduction program is recommended to address this equity issue, although applying consistent definitions is crucial to documenting progress. © IWA Publishing 2013. Source

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