In the first of this series for this year, we recap on Evidence Action’s activities in the last quarter of 2014.
In September, Evidence Action shared a video developed by South Pole Carbon, which provides a snapshot of the benefits reaped from the ‘Dispensers for Safe Water’ program in Uganda.
More than 1500 chlorine dispensers have been set up in Uganda, with plans for thousands more to be installed by Evidence Action in future. The water purification system requires only a few drops of chlorine solution per filling of water in order to eliminate 99% bacteria, and is delivered by motorbike from central storage points. When approximately a quarter of all Ugandan children under 5 years are regularly affected by diarrhoea, and resulting malnutrition, stunting, cognitive impairment and early mortality, such a simple yet effective system is a valuable solution to the health challenges faced by Ugandan families.
A number of people living in rural Ugandan areas described the positive impact such a water system has had on their lives. For example, a mother from the Luwanga village now saves money on the firewood she would have burned to boil three pots of water daily, and she can now use this time to undertake other domestic activities.
Notably, the ‘Dispensers for Safe Water’ program has reduced the inefficient and unsustainable deforestation of firewood, thereby preventing 60,000 tons of carbon entering the atmosphere annually.
A local promoter, assigned to take care of dispensers and educate families on its use, describes his duties. In addition to checking and refilling the dispenser, he is responsible for maintaining the water point (e.g. weeding around the borehole), recording the number of users, encouraging users to be hygienic, and visiting families in their homes to ensure they are drinking safe water. Close collaboration with local authorities and trained local staff means the effective promotion, monitoring and refilling of dispensers.
The success of Evidence Action’s ‘Dispensers for Safe Water’ program lies in its deep understanding and use of the local environment; by recruiting the help of locals, the program stays rooted in communities it serves, leading to the improvements we are seeing in health, education, local forests and climate.
In October, Evidence Action reported on two follow-up studies conducted in Kenya and Uganda, respectively, which built on previous research around improving educational outcomes and weight gain with the ‘Deworm the World’ initiative. These studies demonstrated the long-term positive impacts of deworming children beyond the original experimental timeline.
In Uganda, Kevin Croke followed up on Alderman and colleagues’ 2007 study by tracking children 7 to 8 years after the original deworming period. Dewormed children were found to have higher test scores in literacy and numeracy than the non-treated children in the initial program. We have written about this study here and here.
Similarly, Owen Ozier built upon initial 2004 research in Kenya by assessing the impact of deworming on preschool-age children whose older siblings were dewormed as part of the original study. Ozier found that there is strong evidence of large cognitive improvements among children whose siblings were dewormed; the healthier older children reduced infection rates among their preschool-aged siblings, which improved the latter’s cognitive development.
Despite these evident benefits reaped worldwide, some have argued that the WHO recommendation of mass treatment of everyone in an affected area is not supported by enough evidence. However, such a claim was influenced by studies with methodological weaknesses and the exclusion of other, methodologically strong, evaluations. As described in a paper by Amrita Ahuja, Sarah Baird, Michael Kremer et al., mass deworming treatment does not only benefit individuals, but it is a highly cost-effective educational investment and a high-return economic investment even in the absence of any other health benefits from deworming.
Notably, mass deworming through the school infrastructure is substantially cheaper than undertaking treatment via screened programs. Further, as with vaccines, a ‘herd effect’ of deworming may be observed, meaning that treating individuals will improve outcomes for others by reducing transmission. Finally, significant labour market and income gains will be seen as a result of mass deworming treatment; in an unpublished 2014 study, an annualized internal rate of return of 32-55% (a way to measure the profitability of an investment) was computed for school-based deworming.
As such, Evidence Action believes in supporting the global effort to reduce the threat that soil-transmitted helminths (STH) pose, and have now joined the STH Coalition, a new group of organizations focused on reducing the public health threat of STH worldwide.
Currently, a number of projects are being considered for scale, although not all will progress to subsequent stages of development.
At the end of this year, it remains clear that Evidence Action is an extraordinary charity. Evidence Action’s Deworm the World Initiative was just named a Give Well top-charity .The Life You Can Save calls Evidence Action one of the ‘best charities for 2015’ in its new recommended charity list. Nick Kristoff in the New York Times highlights Evidence Action on his annual holiday list 'Gifts That Inspire’ for ‘spending money in the most cost-effective ways.’
All information and the image taken from the Evidence Action website.
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