Improving sanitation through WASH in remote rural villages

A lack of safe drinking water and sanitation are primary causes of diarrhea: highly prevalent in developing countries, it lead to a staggering 9.2% of child deaths in 2013. In an article recently published in Infectious Diseases of Poverty researchers set out an ambitious longitudinal study that will explore the effectiveness of a WASH (Water, Sanitation and Hygiene) project in Idiofa, Bandundu, Democratic Republic of the Congo. The study will gather much needed evidence on ways to improve sanitation and decrease health risks.

Sanitation: an unfinished global agenda

In 2007, readers of the BMJ (British Medical Journal) chose “sanitation” as the most important medical milestone since 1840. It reminded us of the importance of safe water and sanitation for people’s lives. Still, improving access to sanitation remained an unfinished agenda in the global community.

Globally, 2.4 billion people still do not have access to improved sanitation facilities in 2015, and of these, around 1 billion people have to practice open defecation. Women are suffering from sanitation-related psychosocial stress and risk of health and violence in many developing countries.

Children under five are also huge victims of the low coverage of improved latrines and lack of safe water and hygiene. Diarrhea is solely responsible for 9.2% of child deaths, which are concentrated in low income countries.

There is an increasing demand for evidence on how to increase uptake and utilization of improved sanitation facilities and to decrease health risks, especially of the children under five.

An effort to tackle the sanitation issue 

Given the scarcity of sound evidence on the protective effect of improved sanitation, we decided to test the possibility of small-sized and low-cost WASH (Water, Sanitation and Hygiene) intervention in remote rural villages of Idiofa, Bandundu, Democratic Republic of the Congo.

WASH committees, elected by the people living in each village, take important roles in mobilizing community members to improve latrines and to employ hygienic practices.

We also wanted to clarify the extent to which well-equipped latrines, which are made with locally available material, can have health benefits. Especially in the conditions where the latrine coverage reached the level required to generate herd protection effect against diarrheal diseases.

In implementing this WASH intervention, we will promote a community-based approach. WASH committees, elected by the people living in each village, take important roles in mobilizing community members to improve latrines and to employ hygienic practices. They are also vital in monitoring progress and regularly updating sanitation maps.

A total of 720 children under four were registered for this longitudinal study. The incidence of the diarrhea of the children will be recorded by the mother or caregiver on the Sanitation Calendar distributed to each registered household.

By employing the diary methodology, we expect to prevent the recall bias and reporting fatigue leading to underestimation issues. This will also allow us to capture more precisely the effects of well-equipped latrines on the duration of diarrhea and diarrheal incidence density. Household surveys will be conducted regularly as well in order to collect data on community members’ sanitation and hygienic behavior change.

This study will provide valuable information on the herd protection effect of WASH intervention. We can also expect to see the effect of non-discriminative distribution of material subsidies contingent upon voluntary preparation of some materials for latrine improvement and a commitment of labor in increasing the uptake of well-equipped latrines. We can also test the possibility of employing a sanitation calendar as a cost-effective method to measure progress.

There are already some results. The coverage of latrines reached up to 97% – higher than the target we set. While we expect to see the final results of this WASH intervention at the end of this year, we believe it is sufficient level required to promote the herd protection effect.

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