New Year, new calendar

Just a quick blog from me today. As we approach the New Year I thought it would be a good idea to share with you all the World Banks 2018 water calendar.

Every year the World Bank creates a calendar about the most serious issues facing water worldwide, the 2018 calendar has a specific focus on the provision of adequate water and sanitation. Throughout the 12 cartoon pictures, the World Bank has highlighted the main issues facing water and sanitation. Below I have included my favourite. Each of the months come with a fact about water and sanitation which I have included in the caption of each figure. 

Figure 1: January 

'$114 billion per year in overall global investment is needed to meet SDG targets for water supply and sanitation'
Source: http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

Figure 2: February

2 in 5 people live in parts of the world affected by water stress
Source: http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

Figure 3: March 

2.1 billion people lack access to safe, readily available water at home.

Source: http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

Figure 4: May 

Sub-Saharan Africa loses more than 40 billion potential work hours per year collecting water.

Source: http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

Figure 5: October 

Avoidable diarrheal diseases kill one child every minute

Source: http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

I think this is a great idea by the World Bank to try and highlight the issues of water and sanitation in a 'fun' way. Unfortunately, however, I do not see the calendar being used by the masses, perhaps only those who work for the World Bank and those who are greatly interested in water and sanitation around the world. And so, I urge all of you to make the World Bank water and sanitation your calendar for 2018, you can download it here: 

http://www.worldbank.org/en/news/feature/2017/12/14/water-cartoon-calendar-2018

Great news for Lilongwe!

"Lilongwe City faces considerable water security challenges that must be addressed urgently to serve the growing population and enhance economic activities in the capital"

Greg Toulmin - World Bank Country Manager for Malawi.

Lilongwe's population of one million are currently struggling with inadequate water and sanitation facilities. Rapid urbanisation is leaving the city unable to meet growing demands, resulting in many using unsafe water supplies. 95% of Lilongwe's population is currently not connected to a sewer system, leaving many having their waste collected as illustrated in figure 1.

Figure 1: Waste collection in Lilongwe

Source: https://www.dutchwatersector.com/news-events/news/14840-vei-extends-water-operator-partnership-with-lilongwe-water-board-malawi.html

Scrolling through the news I found a very promising story for Malawi's capital city, Lilongwe. On the 20th December, the World Bank approved a US$100 million investment into the capital city's water and sanitation facilities. The World Bank is investing in a six-year-long scheme called Lilongwe Water and Sanitation Project (LWSP).

Lilongwe's existing water and sanitation systems are under great pressure as a result of rapid urbanisation into the capital city. The LWSP is not only going to improve existing infrastructure but also expand the network, which involves increasing the distribution network by 186km to parts of the city which are currently un-piped. Currently, only 5% of Lilongwe's population is served by a sewer system, consisting of a mix of latrines and septic tanks. The LWSP aims to improve sanitation facilities for 250,000 people in Lilongwe, these are just a few of the key changes being made in Lilongwe:

• Construction of four storage reservoirs with a combined capacity of 2,600m3.
• Reducing the amount of water lost due to leakages.
• Installation of 5000 new sewer connections.
• Construction of 8000 improved sanitation facilities.
• Upgrading the existing Kauma sewage system. 
• Improving sanitation facilities in 10 schools.

This investment into Lilongwe's water and sanitation is great news, however, a report created by the World Bank has highlighted that there are significant risks involved with this investment, some of the most important risks I have listed below:

• Corruption and fraud 
• Limited experience - The Lilongwe Water Board has limited experience in managing complex infrastructural projects, meaning there is a high risk involved with the deliverance of this project.
• Social risks - The project is expected to disturb settlements, however, there has been no mention as to whether these people will be re-housed, and so there are negative social implications of completing this project.
• Climatic risks - Lilongwe in recent years has been experiencing difficulties with unpredictable rainfall and droughts as a result of global warming, which has reduced the amount of water available for extraction. This creates large issues for the future of Lilongwe and Malawi as it appears that water stress conditions are likely to get worse. 

Despite the risks I have mentioned this investment is a great step forward for Lilongwe, and I hope investments like this continue throughout the whole of sub-Saharan Africa, inching the continent ever closer to good quality water and sanitation for all.

If you wish to have a more in-depth knowledge of the Lilongwe Water and Sanitation Project here is the recently published World Bank Report:
http://documents.worldbank.org/curated/en/419171513998119839/pdf/MALAWI-PAD-12012017.pdf 

The Guinea Worm Eradication Programme

Contributing to my previous blog about diseases in sub-Saharan Africa, this blog looks at the Guinea Worm Disease, a disease that can easily be eradicated by providing access to safe and protected drinking water. As the Guinea Worm Disease is mostly found in remote villages, there is often not scope for boreholes or wells, therefore changing behaviour towards water sources is the most appropriate way to provide safe water.

The Guinea Worm Disease, also known as Dracunculiasis, is a water-borne disease caused by the parasite Dracunculus medinensis.  In the 1980s the Carter Centre, a charitable organisation founded by the former US President Carter, alongside other supranational bodies, campaigned to eradicate the Guinea Worm Disease globally by 1995 (Ciantia et al, 2013). Before the eradication programme, Guinea Worm was a largely unreported disease, Nigeria estimated that it annually only had around 3000 cases in the 1980s, however, in 1989 Nigeria carried out a nationwide survey which returned with an actual figure of 650,000 cases annually (Hopkins and Ruiz-Tiben, 2011). The 1995 goal of eradication was not achieved and was therefore extended to 2009, again there were still isolated cases of Guinea Worm and the eradication date was set in line with the Millennium Development Goals (Ciantia et al, 2013).

Causes:

Eradicating the Guinea Worm Disease directly relies on the provision of safe drinking water (Hopkins, 1981). Humans can become infected with the Guinea Worm Disease by drinking stagnant surface water. This water has been infected as a result of copepods eating the young of the parasite, thus infesting the water. Figure 1 below shows an illustration of how a water source can become contaminated.

Figure 1

Source: http://edition.cnn.com/2010/WORLD/africa/10/08/guinea.worm.eradication/index.html 

Once infected the parasite remains in the body for over a year, growing up to 1 metre long. Towards the end of the year, the worm begins to slowly and painfully exit the human body through a ruptured blister on the skin, usually found on the legs or feet. The Guinea Worm Disease is not usually fatal but can have great consequences on villages, due to the painful way the worm exits the body this can result in the infected person being temporarily disabled for around 1 to 2 months, leaving the infected unable to work or attend school (Hopkins and Ruiz-Tiben, 2011). The Guinea Worm Disease commonly has no long-term effects, however, some cases report early onset arthritis, and 0.5% of cases result in permanent disability (Hopkins, 1981). 

Solutions:

There is no medical cure for the Guinea Worm Disease. Providing water from boreholes and wells would be the ideal way of preventing this parasitic disease, however, this is often a very slow and expensive approach, and often not suitable for remote villages (Hopkins and Ruiz-Tiben, 2011), and therefore other approaches are required to tackle the disease.

Through the Guinea Worm Eradication Programme (GWEP), numerous approaches were taken to make the water supply free from Guinea Worm. A vital aspect of the eradication programme involved sending village volunteers to villages impacted by Guinea Worm. The role of the village volunteers was: to educate about disease prevention, record and report cases of Guinea Worm, distribute cloth filters among villagers, and finally administer first aid to those suffering from the disease (Ciantia et al, 2013).

The programme began with educating the villages susceptible to the disease. Many did not understand that the reason behind their illness, was due to water they had drunk a year ago, many blamed bad spirits (Ciantia et al, 2013), the programme was able to change the villager's perception by magnifying a glass of the contaminated water showing the parasites inside, this was met with disgust from many villagers. This education focused on teaching the infected individuals to stay out of the water and taught the villagers how to effectively filter water, with a special emphasis on educating females, as they are the primary water collectors (Hopkins and Ruiz-Tiben, 2011).

Alongside this education, the programme provided finely woven cloths to villages to use as water filters (Hopkins and Ruiz-Tiben, 2011). The programme also provided portable 'pipe filters', a straw that could be hung around one's neck which allowed water to be filtered immediately, this meant that those who were travelling on long journeys were able to filter water effectively (Hopkins and Ruiz-Tiben, 2011).

The success of the Guinea Worm eradication programme:

The Guinea Worm Eradication Programme was an extremely successful way of combating water-borne disease through introducing behavioural changes and low-cost filtering techniques. Figure 2 illustrates the huge success of the Guinea Worm Eradication Programme, the disease which was originally found in 20 countries is now only found in four, Chad, Ethiopia, Mali and South Sudan.

Figure 2 

Source: https://www.cdc.gov/globalhealth/infographics/guinea_worm.htm

The Guinea Worm disease is the perfect example of an illness that does not need to exist, the only way one can get the disease is through drinking contaminated water. By providing the world access to a safe water source, the Guinea Worm disease would be completely eradicated and would help to further eradicate other diseases. 

The burden of disease

In 2002, it had been estimated that the disease burden, caused unnecessarily from water, sanitation and hygiene, accounted for  4% of deaths worldwide, and 5.7% of all diseases worldwide (Prüss et al, 2002). Despite these figures appearing to be low numbers in the grand scheme of things, these are all preventable deaths and diseases if the appropriate water and sanitation requirements are achieved. The World Health Organisation estimates that improvements in sanitation and water provisions could prevent 9.1% of the total burden of disease worldwide, which equates to approximately 6.3% of deaths (Clasen, 2011).

The first half of this blog will look at a few diseases caused by inadequate water and sanitation facilities. The second half will look at why these diseases are such a burden to sub-Saharan Africa.

Common diseases

This section of the blog will briefly highlight a few of the diseases affecting sub-Saharan Africa today as a result of inadequate water and sanitation facilities. Many of these diseases come with very simple interventions, such as frequent hand-washing, however, without the appropriate water and sanitation facilities, these diseases continue to plague countries in sub-Saharan Africa.

Trachoma:

Trachoma is an infectious disease which commonly ends in blindness; figure 1 illustrates the lifecycle of the disease. The incidence of trachoma can be reduced dramatically when access to water is increased. In order to reduce the incidence of trachoma, hygiene needs to be improved. Face washing and access to a latrine have been linked to reducing rates of trachoma. A study of Ethiopian households revealed that having a 'lack of access to a latrine increased the risk of having active trachoma by 4.36-fold but perhaps more important, absence of a clean face...increased the odds of having trachoma by 7.59-fold' (Cook and Mariotti, 2011:181). The International Trachoma Initiative implemented the SAFE initiative (figure 2), highlighting the steps needed to prevent trachoma, two steps involved the use of water.

'lack of access to a latrine increased the risk of having active trachoma by 4.36-fold but perhaps more important, absence of a clean face...increased the odds of having trachoma by 7.59-fold'

Figure 1: The Life Cycle of Trachoma

Source: https://healthfoxx.com/trachoma-definition-symptoms-treatment-pictures/ 

Figure 2: International Trachoma SAFE initiative

Source: http://www.globalcontagions.com/2017/02/ntds-trachoma-blindness-caused-by-chlamydia-bacteria-yes-that-chlamydia/

Hookworm:

Hookworms are the result of open defecation due to a lack of adequate sanitation. There are three ways in which the incidence of hookworm can be greatly reduced, first by providing adequate sanitation facilities to reduce open defecation. Secondly, the provision of a sufficient water source to enable the washing of food. Thirdly, behavioural changes are required, often it is children who practice open defecation, changing behaviour towards open-defecation will reduce the incidence of hookworm (Blackburn and Barry, 2011). Unfortunately, though, it is more cost effective to provide deworming treatment per person than a latrine, as proven by studies in Vietnam (Blackburn and Barry, 2011).

Diarrhoea:

Diarrhoea is a leading cause of death globally. Diarrhoea can be prevented by disposing of waste appropriately, improving water quality, improving personal hygiene and washing food before consumption (Zarocostas, 2008). The World Health Organisation estimates 88% of all diarrhoeal deaths are a result of inadequate water and sanitation facilities (Fitzwater et al, 2011). However, if water is to be treated at the household level, 39% of diarrhoeal cases would be reduced, further reductions would take place with the education of handwashing and appropriate waste disposal (Fitzwater et al, 2011).

The burden of disease on sub-Saharan Africa

The diseases described above and many more can easily be prevented through the provision of adequate water and sanitation, for example, piped water and latrines. However, for many, this is not reality. These diseases can have great impacts on the lives of the infected and are often blamed for restricting development, I have highlighted below the three areas which I think are the most important.

The burden on the extended family:

One perhaps overlooked impact is the strain these diseases place on the extended family. If the parents die, as a result of water-related diseases, this can leave the extended family, such as grandparents, with the role of raising the children. Taking on this role comes with a huge financial burden, with many extended families being often unable to financially assist the orphans, placing the extended family at risk of falling into poverty, or the children being at a high risk of being placed in an orphanage, all of which are poor outcomes for an easily preventable death.

Lost education:

Many children who fall ill due to these preventable diseases face missing days, weeks or even months of school. This can have detrimental impacts on their future. The less education a child receives, the less prosperous their future is likely to be, they are likely to be unable to reach their full potential in the job market and therefore maintain in the vicious cycle of poverty, increasing attendance of school drastically reduces the incidence of poverty within a country (Ayiro, 2012), and with the introduction of adequate water and sanitation facilities the issue of missed school days can be reduced.

Fall in productivity:

This can be at both the local and the national scale.  Locally families are impacted when members of the family have to take time off work due to illness, this can lead to a reduction of income leaving families finding it difficult to make ends meet, it also reduces families financial saving potential (Boutayeb, 2010). Whereas on the national scale the higher the incidence of disease, the lower the rate of development, for example, the more a person works this increases their income (something which would not happen if they are regularly ill). An increase in income leads to an increase in consumer spending, this then drives the economy leading to growth in GDP and development (World Health Organisation, 2009).

Conclusion

The diseases discussed in this blog and more can easily be eradicated, or, casualties greatly reduced if the provision of adequate sanitation and water is implemented across sub-Saharan Africa. Next week’s blog will be looking at how a successful intervention programme has almost completely eradicated the Guinea Worm Disease in sub-Saharan Africa.