Improving water, sanitation and hygiene in Bangladesh
Infections of the gut such as typhoid, cholera, and shigella are leading causes of childhood death in the developing world, largely as a result of poor quality water, sanitation and hygiene. These diseases cause diarrhoea, which can lead to significant fluid loss, dehydration and death.
Self-reporting of illness
The effectiveness of water, sanitation and hygiene services is often measured by self-reported incidents of diarrhoea. This can be subject to bias, and is often fraught with inaccuracy, making it difficult to monitor and evaluate.
So what if we could improve how we measure diarrhoea to help tackle some of the biggest causes of childhood death in the world today?
Researchers from the University of Warwick have been examining the accuracy of diarrhoea self-reporting in Bangladesh by evaluating against a ‘gold standard’ technique – the sampling of stools and the measuring of infectious organisms in the lab. This was designed to help understand how well self-reported diarrhoea captures whether or not there are pathogens in the environment.
Exploratory research
The research team, led by Dr Samuel Watson, conducted exploratory research with partner organisation the International Centre for Diarrhoea Disease Research in Bangladesh. The research took place in the Rohyingya refugee camps in Cox’s Bazaar, Bangladesh.
Dr Watson explains: “A total of 400 households were randomly selected and surveyed. We took stool samples from 120 who reported diarrhoea, and 120 who didn’t. Stools were tested for infection, and the results compared with what parents and care-givers were reporting.”
The research provided key evidence to support the monitoring and evaluation of water, sanitation and hygiene interventions, which is crucial in preventing diarrhoeal disease. Bangladesh’s Ministry of Health, as well as international water, sanitation and hygiene organisations, will be able to measure infection levels much better.
“Our research provided data on vulnerable refugee communities, which will help lead to better service planning and enable future research with under-researched populations, such as refugees” explains Dr Watson.
Stool sample containers used to collect specimens for analysis
An upgraded water source in the camps
Measuring the effectiveness of the water, sanitation and hygiene system
The project contributed to determining the best and most cost-effective ways to measure water, sanitation and hygiene system effectiveness, in terms of diarrhoea rates. It has led to further collaboration with local agencies including UNICEF and MSF, where the researchers are developing projects to evaluate water and sanitation using cheap and rapid stool testing methods.
"Bangladesh's Ministry of Health, local partners and UN agencies will benefit from the research through better ability to measure prevalence of infection, and the effectiveness of water, sanitation and hygiene systems" explains Dr Watson.
If the effectiveness of water, sanitation and hygiene issues systems are not properly evaluated, it is unlikely that programme implementers will be able to offer the best services to communities, resulting in more outbreaks of disease.
Upgraded area of the camp with improved sanitation facilities
"We hope that the data created by this exploratory study will be used in displaced and migratory populations in the future" Dr Watson comments.
The project addresses the UN's Sustainable Development Goals of Good Health and Well-Being and Clean Water and Sanitation, and also has potential to extend far beyond Bangladesh.
