Water Currents: WASH and Neglected Tropical Diseases

The U.S. Government Global Water Strategy identifies poor hygiene and the lack of adequate water and sanitation as a leading cause of disease and death worldwide and a contributor to the spread of many neglected tropical diseases (NTDs).

The World Health Organization (WHO) WASH and NTD global strategy (2015–2020) emphasizes the urgent need to focus efforts on the provision of safe water, sanitation, and hygiene (WASH) to eliminate NTDs. Despite the urgency, according to the WHO strategy, WASH and NTDs have received little attention.

This issue features new NTD toolkits from the WHO and the International Coalition for Trachoma Control (ICTC), as well as news from USAID’s NTD Program, studies and reports with overviews on WASH and NTDs, and recently published updates on schistosomiasis, soil-transmitted helminths, and trachoma. It also includes links to some earlier but key WASH and NTD reports.

We would like to thank staff from Global Water 2020 for reviewing and providing content for this issue, as well as the International Coalition for Trachoma ControlSchistosomiasis Control Initiative, and SightSavers for providing content.

Events
10th Neglected Tropical Disease NGO Network Conference, September 17–19, 2019. The Neglected Tropical Disease NGO Network (NNN) and Royal Society of Tropical Medicine and Hygiene will co-convene the 10th annual NNN Conference in Liverpool, U.K., alongside the 11th European Congress on Tropical Medicine and International Health. The conference, themed “Our Vision Beyond 2020: Many Partners, One Voice,” also marks the 5th anniversary of the NNN WASH Working Group. The deadline for workshop submissions is Wednesday, May 15.

WASH and Neglected Tropical Diseases—Improving Inclusion and Health, August 27, 2019. The WHO, NNN, Sustainable Sanitation Alliance, German WASH Network, German Network Against NTDs, and the Ethiopian Federal Ministry of Health will convene a session on WASH and NTDs at this year’s World Water Week in Stockholm. The event will address WASH and NTD collaboration, present results and methods for WASH access and disease distribution, and share tools to support these multisectoral partnerships.

News
Taking Action to End NTDsUSAID Neglected Tropical Diseases Program, February 2019. Last year USAID announced a combined $500 million investment for two new five-year flagship awards that will lead the Agency’s next generation of NTD programming.

Toolkits
WASH and Health Working Together: A ‘How-To’ Guide for Neglected Tropical Disease ProgrammesWHO; NNN, January 2019. This toolkit provides step-by-step guidance to NTD program managers and partners on how to engage and work collaboratively with the WASH community to improve delivery of WASH services to underserved populations affected by NTDs. It includes a series of tools to help build multisectoral partnerships and design, implement, and evaluate interventions. The WHO also hosted a recent webinar on the toolkit and Facebook Live Q&A.

Transition Planning for Facial Cleanliness and Environmental Improvement. ICTC, April 2019. This toolkit for transition planning is one of three planning documents ICTC recommends for program managers and implementing partners to support transition from elimination efforts to routine public services.

NTD General
Taking a Systems-Change Approach to Ending NTDsDevex, November 2018. While NTDs are often portrayed as simple problems with easy solutions, the reality is far more complex. The prioritization of interventions such as mass drug administration over other critical interventions, including water and sanitation, will not solve the problem.

Guidelines on Sanitation and HealthWHO, October 2018. These guidelines provide comprehensive advice on maximizing the health impact of sanitation interventions. They summarize evidence on the links between sanitation and health, provide evidence-informed recommendations, and offer guidance for international, national, and local sanitation policies and program actions. Chapters 6 and 8, “Excreta-Related Pathogens” and “Evidence on the Effectiveness and Implementation of Sanitation Interventions” are particularly useful for those working on NTDs.

Fact Sheets on the Five Main WASH-Related NTDsWHO, March and April 2019. TrachomaSchistosomiasis, and Soil-Transmitted Helminth Infections (roundworm, whipworm, hookworm). These updated online resources provide a snapshot of each disease with information on prevalence, transmission, and strategies for control.

The Role of Community Participation for Sustainable Integrated Neglected Tropical Diseases and Water, Sanitation and Hygiene Intervention Programs: A Pilot Project in TanzaniaSocial Science & Medicine, April 2018. In this paper, the authors present the results of a pilot undertaken between November 2015 and April 2016 that adopted a mixed-methods case study approach to implement an enhanced development governance model. They found that model was associated with a significant reduction in the prevalence of schistosomiasis and diarrhea.

Schistosomiasis
Schistosoma Haematobium Infection Status and its Associated Risk Factors among Pregnant Women in Munyenge, South West Region, Cameroon Following Scale-Up of Communal Piped Water Sources from 2014 to 2017: A Cross-Sectional StudyBMC Public Health, April 2019. In 2014, a study in Munyenge revealed a high prevalence of urogenital schistosomiasis (UGS) among pregnant women. This follow-up study investigated the prevalence and risk factors of UGS in pregnancy following scale-up of piped water sources from 2014 to 2017.

Schistosomiasis Infection in Pre-School Aged Children in Uganda: A Qualitative Descriptive Study to Identify Routes of ExposureBMC Infectious Diseases, February 2019. Preschool children age 2–4 years are at a high risk of exposure to schistosomiasis while caretakers conduct activities in infested water bodies. Prevention interventions should target children in their early stages of life to control schistosomiasis in this vulnerable population.

Improving Spatial Prediction of Schistosoma Haematobium Prevalence in Southern Ghana through New Remote Sensors and Local Water Access ProfilesPLoS Neglected Tropical Diseases, June 2018. This study helps to understand localized drivers of schistosomiasis transmission, specifically how unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection.

The Effectiveness of Water Treatment Processes against Schistosome Cercariae: A Systematic ReviewPLoS Neglected Tropical Diseases, April 2018. Researchers carried out a systematic review to summarize the existing knowledge on the effectiveness of water treatment for the removal or inactivation of cercariae, by processes including chlorination, filtration, UV disinfection, heating, and water storage. This is the first review of its kind and provides a concise summary of what is known to-date regarding water treatment against cercariae of different Schistosoma species.

Soil-Transmitted Helminths (STH)
Challenges and Opportunities for Control and Elimination of Soil-Transmitted Helminth Infection Beyond 2020PLoS Neglected Tropical Diseases, April 2019. The STH community has largely avoided establishing an approach for addressing WASH or engaging with the WASH sector. However, the recent development of the WHO global strategy (2015–2020) provides an entry point and guidance for improved communication, coordination, and collaboration.

Predicted Short and Long-Term Impact of Deworming and Water, Hygiene, and Sanitation on Transmission of Soil-Transmitted HelminthsPLoS Neglected Tropical Diseases, December 2018. The impact of WASH interventions on STH transmission is hard to measure in the context of preventive chemotherapy programs and other variables. Still, researchers showed a clear added benefit of WASH to sustain the gains made by preventative chemotherapy treatment (PCT) in the long term, such that PCT may be scaled down or even stopped altogether.

What Mathematical Models Tell Us about the Impact of WASH on STH Control and EliminationBugBitten, March 2019. This article summarizes the above study, which used mathematical model simulations to predict the short- and long-term impact of WASH interventions on STH control.

Tailoring Water, Sanitation, and Hygiene (WASH) Targets for Soil-Transmitted Helminthiasis and Schistosomiasis ControlTrends in Parasitology, January 2018. Soil-transmitted helminthiasis and schistosomiasis cannot be controlled without primary prevention strategies, underscoring the importance to the NTD agenda of developing appropriate WASH targets and indicators.

Effect of an Integrated Intervention Package of Preventive Chemotherapy, Community-Led Total Sanitation and Health Education on the Prevalence of Helminth and Intestinal Protozoa Infections in Côte d’IvoireParasites & Vectors, February 2018. Researchers targeted an integrated package of interventions to five communities in Côte d’Ivoire. This paper describes how the interventions reduce the prevalence of helminth and intestinal protozoa infection.

Trachoma
Report of the 21th Meeting of the WHO Alliance for the Global Elimination of Trachoma by 2020WHO, March 2019. The alliance recognizes the progress made toward eliminating trachoma, but still urges endemic countries to support a coordinated multisectoral approach for wider access to safe WASH to help achieve the 2020 elimination goal.

Impact of the Global Trachoma Mapping Project (GTMP)Ophthalmic Epidemiology, December 2018. The GTMP surveyed more than 1,546 districts and examined more than 2.6 million people across 29 countries in three years, making it the largest infectious disease survey ever undertaken. Articles in this issue discuss the epidemiology and prevalence of trachoma in Ethiopia, Nigeria, Senegal, Yemen, and other countries.

Making Gains Sustainable: Partnering with WASH to Stop the Transmission of TrachomaCommunity Eye Health Journal, May 2018. The progress of countries toward the elimination of trachoma is increasing the importance of expanded partnerships and strategies to implement facial cleanliness and environmental improvements that further prevent the transmission of trachoma.

Sanitation and Water Supply Coverage Thresholds Associated with Active Trachoma: Modeling Cross-Sectional Data from 13 CountriesPLoS Neglected Tropical Diseases, January 2018. Findings support the plausibility of community-level or herd protection from trachoma with increasing water and sanitation coverage. The results suggest that access to adequate water and sanitation can be an important component in working toward the 2020 target of eliminating trachoma.

Interventions to Maximize Facial Cleanliness and Achieve Environmental Improvement for Trachoma Elimination: A Review of the Grey LiteraturePLoS Neglected Tropical Diseases, January 2018. The WHO employs a "SAFE" strategy for the elimination of trachoma—Surgery for trichiasis, Antibiotics, Facial cleanliness, and Environmental improvement. Efforts are underway to scale up the facial cleanliness and environmental improvement (F&E) components of strategy. This review provides information regarding gaps in F&E intervention and delivery that relevant stakeholders can use to understand why some interventions have not worked as intended. 

Engaging Different Audiences in Behaviour Change ProgrammesBond, January 2019. Influencing behavior to prevent infection can be as important as treating it when trying to keep communities free of trachoma. This painful eye condition is extremely infectious, so improved sanitation and hand and face washing can make a huge difference in stopping its spread.

Earlier Publications
Water Sanitation and Hygiene for Accelerating and Sustaining Progress on Neglected Tropical Diseases: A Global Strategy 2015–2020WHO, 2015. Meeting the global NTD roadmap targets requires an urgent focus on WASH, especially for NTDs where transmission is most closely linked to poor WASH conditions such as soil-transmitted helminthiasis, schistosomiasis, trachoma, and lymphatic filariasis.

All You Need for F&E: A Toolkit for Planning and PartneringICTC, August 2015. This toolkit aims to strengthen critical coordination and maximize impacts between trachoma program managers in the field and their WASH partners.

Global and Country WASH and NTD ManualChildren Without Worms, December 2013. This WASH and NTD manual serves as a practical guide to practitioners working to implement, support, and sustain WASH interventions at the country level.

Websites
USAID Neglected Tropical Diseases Program – This website includes information on the USAID NTD Program, including a donor landscape, fact sheets, and program evaluation, along with program news and updates.

WHO Neglected Tropical Diseases – WHO’s NTD website has a collection of NTD-related publications, events, data, and news.

Neglected Tropical Disease NGO Network – The NNN is a global forum of NGOs working to control NTDs and consists of various disease-specific and cross-cutting working groups, including a WASH working group. The website provides disease-specific information, resources, blogs, and news.

InfoNTDs – This website curates articles, e-journals, and e-books on cross-cutting issues in the NTD sector.

Uniting to Combat Neglected Tropical Diseases – This website houses an impact dashboard and Africa-specific NTD league table to track progress on NTDs.

Water Currents
Publication Date: 
7 May 2019
Produced By: 
USAID Water Office