Filed under sanitation

Hundreds of thousands of Somalians live in crowded, often unsanitary, camps in Mogadishu; they have moved there to escape famine, drought and insecurity. Now in these camps, they face instances of cholera two to three times greater than last year. Health officials fear cholera could now rapidly spread to the camps’ hundreds of thousands of inhabitants.

IRIN reports:

In Mogadishu’s largest health facility, Banadir Hospital, 4,272 cases of acute watery diarrhoea, a symptom of cholera, have been recorded so far this year, causing 181 deaths. (Random laboratory tests showed that 60 percent of the cases also tested positive for malaria, according to WHO.)

Children under five, weakened by malnutrition, make up three-fourths of the cases…
WHO spokesman Tarek Jasarevic said: “This sudden increase had various reasons. First, the numerous informal settlements of internally displaced persons with makeshift shelters, poor sanitation and limited access to safe water. Second, the limited capacity of existing health partners to access those informal settlements and provide essential health services. And third, the high number of malnourished children due to the ongoing famine increased the susceptibility to waterborne diseases such as acute watery diarrhoea.”

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not prompt.

See here for IRIN’s full article.

Margaret Chan, director general of the WHO, has stressed the importance of basic sanitation in her address to the World Health Assembly. Here is an article about sanitation on the Guardian’s “Poverty Matters” blog.

It might seem that sanitation programs would be highly cost effective:

• Approximately 10% of the world’s diseases could be prevented by good sanitation (Chan).
• Hand-washing with soap at critical times can reduce the incidence of diarrhoea by up to 47%. (UN Water). An important finding, given that diarrhoea kills one child every twenty seconds.
• The integrated approach of providing water, sanitation and hygiene reduces the number of deaths caused by diarrhoeal diseases by an average of 65% (WHO)*
• For every $1 invested in water and sanitation, $8 is returned in increased productivity (UNDP)
• Lack of safe water and sanitation costs sub-Saharan Africa around 5% of its Gross Domestic Produce (GDP) each year (UNDP)
• 443 million school days are lost each year due to water-related diseases (UNPP)
• 11% more girls attend school when sanitation is available. (UK DFID)
• 15 pounds can be enough to provide someone access to safe water, improved hygiene and sanitation (WaterAid)

However, Giving What We Can has found that huge and important differences in the cost effectiveness of

a) Construction Programs (the construction of infastructure to improve water supplies)

b) Promotion Programs (the promotion of good sanitation and hygiene practices)

Construction programs are less than a tenth as efficient as some health interventions, and is thus not a top-recommended intervention.

Promoting sanitation practices, and even more so promoting hygiene practices like handwashing, is, however, highly cost-effective. It may be as cost-effective as the treatment of neglected tropical diseases.

We are thus undergoing further research into the cost-effectiveness of hygiene promotion. However, as of yet, we do not know of any charities that focus solely on hygiene promotion, so are not able to make recommendations.

See our short explanation of the cost-effectiveness of water and sanitation interventions here.