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How do Water and Sanitation Look from a Child Health Perspective?

How do Water and Sanitation Look from a Child Health Perspective?. John Borrazzo U.S. Agency for International Development World Water Forum V Istanbul, Turkey March 20, 2009. The child health problem - targeting Relevant programmatic strategies – focusing

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How do Water and Sanitation Look from a Child Health Perspective?

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  1. How do Water and Sanitation Look from a Child Health Perspective? John Borrazzo U.S. Agency for International Development World Water Forum V Istanbul, Turkey March 20, 2009

  2. The child health problem - targeting • Relevant programmatic strategies – focusing • Outcomes and impact - measuring

  3. 9.2 million child (<5 yrs) deaths annually 90% preventable Undernutrition implicated in 50% of child deaths, and is also associated with diarrhea Source: State of the World’s Children, UNICEF 2008

  4. Source: “Safer Water, Better Health”, WHO 2008

  5. Diarrhea – Real Progress in Reducing Mortality • 1990 World Summit for Children Goal met by 2000 (reduce under-five diarrheal deaths by half) • Almost 3 million child deaths/year averted by 2005 • But - • Estimated 1.5 billion child diarrhea episodes/year (in developing countries) • Still over 1.5 million child deaths/year

  6. Where do child deaths from diarrhea occur?

  7. 11 countries account for over 70% of the annual deaths globally from diarrhea

  8. Deaths from Diarrhea have declined in all regions Source: WHO, 2002; ECA=Europe and Central Asia, LAC=Latin America and the Caribbean, MENA=Middle East and North Africa, SA=South Asia, EAP=East Asia and the Pacific, SSA=sub-Saharan Africa

  9. Under-five mortality rate from diarrhea (deaths per thousand live births) Source: The Lancet Child Survival Series, 2003

  10. Median Age-specific Incidences for Diarrheal Episodes per Child per Year from Three Reviews of Prospective Studies in Developing Areas, 1955-2000 Source: Disease Control Priorities in Developing Countries, Second Edition; 2006

  11. Treatment Prevention • Breastfeeding (13%) • ITM & IPT for malaria (7%) • Zinc (5%) • Complementary feeding (6%) • Water/sanitation/hygiene (3%) • ORT (15%) • Antibiotics for pneumonia/sepsis (6%) • Newborn care (4%) • Antimalarials (5%) • Antibiotics for dysentery (3%) • Zinc (4%) Lancet Child Survival Series… Full coverage with proven interventions could reduce under-five mortality by 66%, equivalent to 6 million child deaths/year.

  12. Behavioral/Social Change • Methods: • Community Mobilization • Social Marketing • School Programs • Community Participation • in Problem Identification • and Solutions • Community Water • Systems • Sanitation Facilities • Household-level • Technologies and • Materials Access to Hardware Hygiene Promotion Hygiene Improvement • Policy Improvement • Community Organization • Financing and Cost • Recovery • Public-Private • Partnerships • Institutional Strengthening Enabling Environments

  13. Focus on the evidence-based interventions with greatest potential for reducing morbidity and mortality • POU water treatment & safe storage – approximately 30-50% reduction in DD prevalence (Cochrane Review, Clasen et al., 2006) • Optimal handwashing (meta-analysis showed 43% reduction in diarrhea prevalence, April 2003, Lancet) • Sanitation – basic, low-cost systems can reduce DD by 30% or more • Increasing quantities of water used – impact on general hygiene and specifically facilitates handwashing

  14. Costs vs. impact of various WSH program strategies (WHO 2007)

  15. Use of Appropriate Technologies: Tippy Tap

  16. Impact of Key Interventions on Diarrhea

  17. Take-home messages • TARGET - Countries with high DD burden (severity, magnitude), children ages 6-24 months, newborns (caregiver handwashing) • FOCUS - On key behavioral outcomes – water use, water quality (at POU), feces disposal, and handwashing • MEASURE - Behaviors, not diarrhea

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