- Unilever Hygiene-Wired Project

Gaby Judah, a Cambridge University graduate on Natural Sciences, is currently working on the pilot of the Hygiene-Wired project which will be measuring the impact of different interventions on hand washing behaviour in public toilets.

- Handwashing Public-Private partnership profiled in Financial Times

The School’s involvement in a public-private partnership (PPP) aimed at promoting
handwashing in Uganda has been highlighted in the Financial Times.

The School has joined forces with Unilever, USAid, the Bill and Melinda Gates Foundation, and Unicef to form a PPP, coordinated by the World Bank. The Uganda project is one of fifteen projects globally including Kenya, Tanzania, Senegal and Benin, where a total of $4.5 million is set to be spent this financial year.

The article discusses how handwashing, a ‘do-it-yourself vaccination’, is one of the most cost effective ways of saving lives and outlines how the PPP's came about – because of the realisation by groups with an interest in handwashing – soap manufacturers, funding bodies, NGO's and research institutions - that by working more closely together, and pooling their individual strengths and skills, everybody wins – attitudes are changed, children’s lives are saved, and soap sales go up!

It outlines a campaign which Unilever is running, together with the School and other partners, to promote the benefits of handwashing with soap, which can eliminate the bugs that cause diarrhoea and respiratory infections, the two biggest killers of children in Africa after malaria. The campaign includes putting on a show in Muko, Uganda, as a pilot for a government-backed country-wide campaign, in which performers promote handwashing in eleven languages.

Val Curtis, who helped found the PPP initiative said:

“I’m delighted to see soap companies taking up the challenge of promoting handwashing. This could save millions of lives worldwide, and better, because companies can make a profit, their efforts will continue to improve public health long after aid projects have moved on.”

- Liz McDonald from Menzies School of Health Research on Travel Fellowship to Hygiene Central of LSHTM

Liz McDonald is a visiting Post Doctoral Research Fellow from Menzies School of Health Research, Darwin, Nth Territory, Australia. Liz’s visit to the LSHTM is supported by a Travel Fellowship awarded by the Australian Primary Health Care Research Institute, Australian National University, Canberra. The purpose of her visit is to establish a linkage and knowledge exchange network to support her research in trying to improve the growth and development of young indigenous children living in remote communities through improved hygiene and environmental health. Prof Sandy Cairncross is providing supervision and support to Liz during her 3 week stay.

- Jeroen Ensink's article on market handling versus water quality of wastewater irrigated vegetables will appear in the December issue of the Journal of Tropical Medicine and International Health.

- Michael De Barra

Michael De Barra joined the Environmental Health Group in November 2007 where he will be conducting research on hygiene and its relationship with disgust in the public health domain.

- GEO-4

Eileen Chappell attended the launch of the UNEP’s 4th integrated assessment report on the state of the environment. The report, entitled ‘Global Environment Outlook: environment for development’, assesses the current situation over many areas including access to water and sanitation. It discusses the possibility of achieving the MDGs and includes a metadata directory.

- WPRWSHP, China

Adam Biran has recently returned from China where he has been providing technical assistance to help assess training needs and to help with designing and implementing a baseline survey for the Hygiene Promotion component of the project.

Val Curtis, Wolf Schmidt and Adam Biran have been providing technical assistance to the design of an evaluation strategy and associated data collection tools for all components of the project.

- Support to Project Champion, Uganda, October 14th – 20th 2007 by Adam Biran

Purpose:

The purpose of the trip was to train a team of 6 fieldworkers to carry out structured observation of hand-washing practices in homes.

Summary:

The fieldworkers were all women and were mostly recent graduates with some experience of community mobilization work in the hygiene, water and sanitation sector. The fieldworkers grasped the principles of structured observation easily and the supervised observation sessions allowed various minor issues related to the data recording procedure to be uncovered and addressed.

In contrast to recent work in India, the households were much more curious about and suspicious of the study. The use of soap for hand-washing was extremely rare and was only observed in relation to food handling and not latrine use or other faecal contact.

Getting fieldworkers to their allocated houses in time to start data collection was a logistical problem. Fieldworkers had to be escorted to houses in the dark in order to be in position to record the flurry of activity that occurred in some houses as soon as the sun rose. Although it was possible to achieve this for a small study such as this, the problems would be much greater in using structured observation as an evaluation tool for a large intervention.

- Journal Publications by Jeroen Ensink

An article by Jeroen Ensink entitled ‘Simple intervention to reduce mosquito breeding in waste stabilisation ponds’ had been published in ‘Transactions of the Royal Society of Tropical Medicine and Hygiene’ Journal, September 2007

Waste stabilisation ponds (WSP) are the preferred method for treatment of urban wastewater in low-income countries but, especially in arid regions, the pond systems can be important breeding sites for mosquitoes of medical importance. In a WSP system in Faisalabad, Pakistan, we assessed the impact of simple environmental interventions on mosquito occurrence and abundance. Reducing the amount of floating matter in the ponds, eliminating emergent vegetation and repairing cracks in the cement structure reduced the number of mosquito-positive samples in the intervention ponds to almost zero, whereas the control ponds had a significant number of positive samples. This suggests that a combination of simple low-cost interventions is a feasible environmental management strategy for vector control in WSP systems that are located in areas where medically important mosquitoes may breed in the shallow ponds.

A second article by Dr Ensink entitled ‘Waste stabilization pond performance and wastewater use in agriculture in Pakistan’ has been published in Urban Water journal, December 2007

- ESRC Award on design and use of mobile laboratory

Robert Aunger and Val Curtis have won a substantial award from the UK's Economic and Social Research Council to conduct research on the design and use of a naturalistic mobile experimental laboratory for testing hygiene interventions.

- Robert Aunger and Val Curtis’ publication on Biology and Philosophy Journal

Robert Aunger and Val Curtis have had a major paper accepted in which they identify kinds of behaviour that are possible. This is a first step in defining ways of changing behaviour.

- WHO CEA Monograph

The World Health Organization has just published a new monograph by Thomas Clasen, head of the Hygiene Centre water group, and Laurence Haller of the WHO entitled "Water Quality Interventions to Prevent Diarrhoea: Cost and Cost Effectiveness". The CEA follow WHO CHOICE methodology to assess conventional and emerging point-of-use water treatment methods in 11 WHO epidemiological sub regions. It concludes that most such interventions meet internationally-accepted benchmarks for "highly cost effective" interventions. Some of the interventions actually result in net savings to the health sector and individuals when reduced cost for treatment of disease are taken into consideration.

Beth Scott presented a model for understanding household demand for sanitation and participated in a panel discussion in the Sanitation 21 Session at World Water Week in Stockholm.

- BBC – How dirty can I get?

On Monday 10th September Val Curtis appeared on the BBC 3 programme How dirty can I get? The television presenter had given up washing for 60 days. Val said that she was lucky not to have got ill and was probably protected by the good hygiene of those around her.

The show also featured on an item in Woman's Hour on BBC Radio 4. You can Listen Again for 7 days.

- Impact of diarrhoea - Lancet

A paper, entitled: "Impact on diarrhoea of a city-wide sanitation programme in Northeast Brazil" by Barreto et al, on which Sandy Cairncross is a co-author has been accepted for publication by the Lancet. It shows that a $440 million dollar sewerage scheme in the City of Salvador (pop. 2.4 million) reduced diarrhoea by more than 20% overall, and by double that in the areas where diarrhoea incidence was initially highest. It is one of very few studies of environmental health impact on the scale of a population of millions, and one of a tiny number on the impact of sanitation alone. Coming just before the launching of 2008 as the International Year of Sanitation, it is well-timed.

- PPP on Handwashing

Val Curtis will be attending the steering committee meeting of the global Public Private Partnership on handwashing. She will be making a special presentation on the work on China. Val will also be speaking at the University of Handwashing, attended by participants from over 20 countries (13th-14th September) on the results of formative research into handwashing in 12 countries. She will conclude that disgust and social norms are the two most important drivers of handwashing with soap.

- World Water Week

Beth Scott will be giving a presentation on Sanitation Demand at World Water Week in Stockholm later this month. A copy of her presentation will be available on this web site after the conference.

- Wellcome Trust - Cafe Scientifique

Wolf Schmidt gave a talk at the Cafe Scientifique in London on 'Uncertainty in Population Studies'. Cafe Scientifique is a forum supported by the Wellcome Trust where researchers engage with the public to discuss their work

- China

Adam Biran is in China this month working on Water, Sanitatation & Hygiene Promotion projects for the World Bank and DFID.

- Sanitation - Brazil

Working with a Brazilian team led by Mauricio Barreto, Sandy Cairncross has been involved in the health impact evaluation of a $440 million sanitation program in Salvador, Brazil. They have found a reduction of 22% overall in the diarrhoea prevalence and 43% in the high incidence areas. A paper summarizing the results is pending with the LANCET.

-Guinea Worm Eradication Deadline

With Dr Ahmed Tayueh of WHO, Sandy Cairncross has co-authored an editorial questioning the deadline of 2009 for the eradication of Guinea worm disease (dracunculiasis) on the basis of the experience of those countries which have already eliminated it.

- Hygiene Centre Meeting 2007

The Hygiene Centre held its annual retreat on July 2-3 at Highley Manor, Balcombe. Staff members and some external participants flew in from around the world. The past year's achievements in terms of papers, projects and consultancies were reviewed, and plans for the next year, as well as longer term, were debated and prioritised.

The Hygiene Centre’s current management structure, using a core steering committee, was renewed. Participants generally felt that it had been a successful means of renewing our energy and focus as a team.

- Diarrhoea Study

The group has won a £80k research grant from the Wellcome Trust to explore sampling strategies to measure the longitudinal prevalence of diarrhoea and other recurrent infections in epidemiological studies and programme evaluation. This methodological work aims at simplifying and standardising the measurement of diarrhoea and at reducing costs of health studies.

- World Dentistry Conference

Bob Aunger has been invited to attend the World Dentistry Conference in October in Dubai to present his latest work on changing routine behaviour, particularly tooth brushing. His paper from the conference will be published in the International Dental Journal.

- SAFIR Project

Jeroen Ensink has been to Bologona for the EU funded SAFIR project.
The main aim of this visit was to refine the risk assessment model used to quantify risk to consumers and farmers as a result of exposure to treated wastewater.

- New Member of the Administration & Finance Team

We are very pleased to welcome Despoina Xenikaki who joins the Group as its Overseas Projects Coordinator. Despoina studied Social Policy and Social Anthropology at Panteion University of Social and Political Sciences in Athens, Greece and Social Anthropology at Goldsmiths College, University of London. Her main subjects are sociolinguistics and gender. She has previously worked for Imperial College, London as a Research Administrator.

- Behavioural Indicators of Household Decision-Making

Mimi Jenkins and Beth Scott's paper on the social marketing and the demand for sanitation in Ghana has now been published in Social Science & Medicine. A copy is available online at Science Direct.

- Young Environmental Scientist Workshop 2007

Jeroen Ensink attended from 24 to 27 April the 6th World Wide Workshop for Young Environmental Scientists in Paris. The workshop was organised by CEREVE and sponsored amongst others by the International Water Association’s (IWA) young water professional programme and UNESCO. The workshop, which took as its theme: ‘Urban water, resource or risk’ brought together researchers from different research areas and countries. Jeroen presented a paper on the challenges, both risks and benefits, of using wastewater in urban agriculture.

- Deaths from lack of sanitation in the developing world...

Members of the Hygiene Centre provided evidence and technical expertise to the INternational Development Committee for4 the latest report. 'Sanitation and Water' which was published on Thursday 26th April. The full report can be read on the Parliamentary website

- Ethics in Public Health Research

Val Curtis, Nana Garbrah-Aidoo and Beth Scott present an article in the Journal of PUblic Health entitled "Masters of Marketing: Bringing Private SEctor Skills to PUblic Health Partnerships". They explore the contribution that private sector marketing skills can bring to health partnerships.

- Water Quality Association applauds WHO report

The WQA has applauded a recent report by the World Health Organisation that highlights the point-of-use technology as a key weapon in the fight against waterborne disease. It also cites work carried out by Tom Clasen from the Hygiene Centre.

Check out the WHO web site for the full report and the WAQ web site for their review.

- First ROSA project team workshop

The first in-country project team workshop will take place in Arusha, Tanzania from 26th - 28th April. ROSA (Resource-Orientated Sanitation concepts for peri-urban areas in Africa) is a Specific Target Research Project funded within the EU's 6th Framework programme, sub-prioriy "Global Change and Ecosystems" it has academic and municipal collaborators within four East African Counties (Ethiopia, Kenya, Tanzania and Uganda) and links to other Eu funded projects within the region.

- Val Curtis is currently providing technical assistance in China:

For the World Bank who, together with DFID and UNICEF, are providing support to the Governments of Shaanxi and Sichuan in creating a state-of -the-art hygiene promotion component for the proposed Western Province Rural Water Supply, Sanitation and Hygiene Promotion Project.

- Combating waterborne disease at the household level

This WHO/Network document reviews the case for managing water quality in the home, describes the International Network to Promote Household Water Treatment and Safe Storage, gives a brief overview of low-cost technologies, and outlines some of the implementation challenges that lie ahead. Printing is underway and a limited number of hard copies will be made available. Tom Clasen of the Hygiene Centre helped to bring the document together and conduct the final review.

- Bob Aunger has been working for Lifebouy:

On a summary of the key features and evidence for effectiveness of the major theoretical approaches to behavior change with the aim of developing a best possible synthetic approach for use in international hygiene promotion.

- Field Trial in Ethiopia

Sophie Boisson will be joining the Hygiene Centre as the field manager of the Vestergaard-frandsen LifeStraw field trial in Ethiopia.

- Sustainable Sanitation

Jeroen Ensink and Steven Sugden have began planning the research work package for the ROSA (Resource-Oriented Sanitation concepts for peri-urban areas in Africa) http://rosa.boku.ac.at/ Project. A baseline study is being prepared by the partners in the four participating countries and local meetings to support this process have taken place throughout January and February in Ethiopia, Kenya, Tanzania and Uganda.

- Training Programme in Sustainable Water and Sanitation – Integrated Processes

Lund University are inviting suitable candidates in relevant agencies and organisations from the following countries - Angola, Botswana, Burkina Faso, Kenya, Mozambique, Namibia, South Africa, Tanzania, Uganda, Zambia, Bangladesh, Cambodia, China, India, Indonesia, Laos, The Philippines, Sri Lanka, Thailand, Vietnam, Georgia, Albania, Bolivia, Honduras and Iraq, to apply for a place on Sida’s International Training Program on Sustainable Water and Sanitation. Information and application forms may be obtained on-line at www.education.lu.se/sida/water. The closing date is 30th April 2007.

- PPP Handwash Programme

Val Curtis and Bob Aunger gave technical assistance to the Uganda National Handwash Programme in reporting on its formative research, producing what one World Bank official called the best formative research report he had seen.
The study gave detailed insights into handwashing in Uganda, showing that, though 84% of mothers believed that hands should be washed with soap after the toilet, only 14% were actually doing so. Soap was available in 95% of households, and a block of the local laundry soap was affordable, costing the same as one cigarette. Nevertheless, rural mothers felt that handwashing with soap was not for people like them, who live in villages and dig for a living, but was more for sophisticated urbanites. This perception provides one of a number of challenges to the designers of the campaign.

The report, which should soon be available on the PPP handwash website, included the first analysis of school- versus home-based handwashing practice by children, and a detailed examination of handwashing motivations in adults.
Copies of the report may be obtained by emailing hnattabi@worldbank.org

- A Selection of Publications for the New Year - Tom Clasen

Clasen T, Roberts I, Rabie T, Schmidt W-P, Cairncross S (2007). Interventions to improve water quality for preventing diarrhoea: a systematic review and meta-analysis. BMJ (in press)

Clasen T, Haller L, Walker D, Bartram J, Cairncross S (2007). Cost-effectiveness analysis of water quality interventions for preventing diarrhoeal disease in developing countries. J. Water & Health (in press)

Clasen T, Saeed T, Boisson S, Edmondson P, Shipin O (2007). Household-based chlorination of drinking water using sodium dichloroisocyanurate (NaDCC) tablets: a randomized, controlled trial to assess microbiological effectiveness in Bangladesh. Am J. Trop. Med. & Hyg. 76(1) (in press)

Clasen T, Menom S (2007). Microbiological performance of common water treatment devices for household use in India. Int’l J. Environ. Health Research 17(2) (in press)

Clasen T, Roberts I, Rabie T, Schmidt W-P, Cairncross S (2007). Interventions to improve water quality for preventing diarrhoea. Evidence Based Child Health 2(1) (in press)