Hygienic environments for infants and young children: a literature review

 

Making sense of the WASH literature

Within the world of WASH (Water, Sanitation and Hygiene) interventions it is beneficial for any stakeholder to delve into the academic literature in order to grasp the theories, arguments and gaps which exist. As with any developing and evolving industry, the literature can sometimes prove to be overwhelming and complex. Luckily, a recent (5 April 2018) webinar hosted by USAID WASHPaLS (Water, Sanitation & Hygiene Partnerships for Learning and Sustainability) shed light on the current status quo. WASHPaLS is a 5 year (2016-2021) research and technical assistance project, which seeks to enhance global learning and the adoption of programmatic foundations needed to achieve the SDGs and strengthen USAID’s WASH programming at the country level.

 
 
Over 90% of the cause of diarrheal deaths is unsafe drinking-water, poor sanitation, and insufficient hygiene.
 
Lakeside scene, Niassa Province, Mozambique. Source: personal photo

Lakeside scene, Niassa Province, Mozambique. Source: personal photo

 

Time to update the F-diagram model?

To date, much of the literature and accompanying theories on WASH has made use of the WHO’s 1958 F-diagram model of disease transmission. While slightly nuanced versions of the model have developed over time, at its core this model conveys key transmission routes and barriers which exist between human fecal matter and disease transmission. The focal routes are seen as being Fluids, Fingers, Flies and Fomites (fields, floors and surfaces). The webinar suggested, however, that the model underemphasizes the role of animal faeces transmission, despite the potential for an abundance of animal faecal pathogens during instances of animal husbandry. Furthermore, to date much of the research conducted in the WASH field has been conducted on a household level as opposed to community level. Other key takeaways included that the relative magnitudes of transmission pathways in infants and young children are not well defined, making it hard to conclude which pathways represent the highest risk to this group and where to target interventions accordingly.

 
 

Original sources: Wagner and Lanoix 1959, World Bank Group 2013). Image: ceowatermandate.org

Paving the way for further research and new interventions

Further questions and research gaps were also raised. As previously mentioned, it is critical to continue examining underemphasized sources and pathways of faecal pathogen transmission, which will require more research and evidence-based intervention guidance. Direct ingestion of pathogens via eating faeces, dirt and mouthing behaviours also represent important paths of transmission. Furthermore, technological and behavioral measures that reduce exposure to excreta in play spaces are of growing interest for the protection of infant and child health. 

SaniTap: disrupting inaccessible handwashing

SaniTap - a revolutionary, effective and affordable tool for handwashing in the absence of running water- is a crucial intervention barrier for the transmission of pathogens from fecal matters, whether this is of human or animal form and on household or community level. As the old adage goes, prevention is better than cure. Handwashing with soap at critical times remains a underutilised and simple mechanism with which to halt the spread of a host of diarrheal diseases, which can lead to stunted growth and mortality, particularly in the under 5s. 

When introduced to communities, washing hands with soap can reduce the risk of diarrhoeal diseases by up to 47%. Handwashing by mothers and birth attendants was associated with a 40-44% reduction in neonatal mortality in a recent study in Nepal. 

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The webinar 'Towards a Hygienic Environment for Infants and Young Children' was hosted by USAID WASHPaLS and:

Jeff Albert (Deputy Director, WASHPaLS)

Julia Rosenbaum (Senior Behaviour Change Specialist, WASHPaLS)

Francis Ngure, (Research Advisor, WASHPaLS)

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REFERENCES:

Wagner, E. G., and Lanoix, L. N. (1958). Excreta disposal for rural and small communities (PDF). WHO, Geneva, Switzerland. p. 12.

Rosenbaum, J., Ngure, F., Albert, J. and Shapiro, J. (2018). Hygienic Environments for Infants & Young Children. Webinar.

 
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