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Food hygiene, monitoring handwashing and the HIV/AIDS-sanitation link

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The 36th WEDC International Conference kicked off on the 1st July with the theme ‘Delivering Water, Sanitation and Hygiene Services in an Uncertain Environment’. The opening plenary included a keynote address by Kamal Kar, who presented the current sanitation crisis and the potential of CLTS to tackle it. After that, papers were presented in several parallel sessions which covered different topics. In the ones I attended, dealing with water and sanitation, we had very thought-provoking presentations (the papers will be available soon on the WEDC’s website).

For instance, Om Gautam presented the formative research on food hygiene in Nepal  he did for his PhD. He regards food hygiene promotion as a missed opportunity in the WASH sector.  His thorough study, with in-depth field research and using many innovative research tools, has led him to identify five key behaviours as crucial targets in any food hygiene promotion intervention: i) proper re-heating of leftovers or stored food, ii) cleanliness of utensils used to serve a child’s food, iii) handwashing with soap before touching food, feeding a child or eating, iv) proper storage of cooked food and v) boiling milk and water before serving.

Two papers presented during the day dealt with indicators for handwashing practices and both coincided in the idea that the existence of facilities is not an adequate indicator. Maulit’s observation in Malawi showed that only 49% of the households having a facility washed hands regularly (though self-reporting reached 80%), while 29% of households without facility practiced handwashing (in a basin in the kitchen). Water in the facility was proposed as a more adequate indicator, instead. Craveen’s correlation analysis of data obtained through a random survey in Kenya, in contrast, identified the existence of soap or ash as the best indicator of adequate handwashing practices. However, the use of this indicator could have counterproductive policy implications (distribution of soap to show progress). The disparities between these two studies might be related with context aspects and methodological differences. But they also show how complex and elusive is the measurement of a behaviour such as handwashing.

It was Evelyn Mugamby’s presentation on ‘Promoting healthy hygiene and sanitation practices for people living with HIV and AIDS’ that I enjoyed most. It was an eye-opener for me, probably because the link between HIV-AIDS and sanitation has been my personal blind spot; I had heard about it before, but never got further into it. Diarrhoea is calculated to affect between 50% and 90% of the people living with HIV and to result in high morbidity and mortality rates. In addition, it reduces antiretroviral absorption and increases the burden on caregivers in terms of the amount of water needed for hygiene purposes and of the help required for defecation. In order to address these issues, WASHplus Kenya Program (FHI 360) aims to integrate WASH and HIV/AIDS working with the communities through ‘small doable actions’. The idea is to sequentially target small incremental steps towards the desired WASH behaviours. An example put was the participatory design of sanitation alternatives for lower mobility or bed-ridden people.

As you can see, we had a really exciting first day at the Conference. So don’t miss the posts of the forthcoming days!

Date: 2 July 2013