hand washing

{Photo credit: MSH staff, Afghanistan}Photo credit: MSH staff, Afghanistan

In 2013 diarrhea killed 578,000 children under the age of five, 9 percent of all deaths in this age group globally. The tragedy of these deaths is that they are avoidable at many levels. The risk of contracting diarrhea can be drastically decreased through basic hygiene measures, such as consistent and exclusive use of a latrine and washing one’s hands with soap. Once a child becomes ill with diarrhea, most cases can be managed with oral rehydration salts and zinc. But the gap between what is known in the public health community regarding prevention and treatment of diarrhea, and what is practiced in many settings, is wide and deadly.

In Afghanistan, diarrhea killed 13,000 children under the age of five in 2013 and was the third most frequent cause of mortality (after neonatal conditions and pneumonia) in the age group. Many organizations, including Management Sciences for Health (MSH), have worked to improve access to treatment for children with diarrhea, but less attention has been paid to prevention.

A new hand-washing station in Toghak, Afghanistan. {Photo credit: Nikmohammad CLTS Facilitator/MSH.}Photo credit: Nikmohammad CLTS Facilitator/MSH.

In the small Afghan village of Toghak, where open defecation affected the sanitation and health of the community, two women took the initiative to mobilize themselves and others into transforming Toghak.

Ms. Fatima and Ms. Rukhsar attended a community-led total sanitation (CLTS) workshop in the neighboring village of Gheyas Said Abd and learned life-saving lessons they wanted to take back to their village. They learned that flies tend to breed in bacteria infested places, particularly human feces, and then transport the fecal matter to food meant for human consumption.

Knowing that this knowledge would motivate their community to improve their sanitation efforts, the women did not waste any time.

When the women returned from the workshop, they recruited twenty women from Toghak willing to help them improve the latrines. They also requested the assistance of CLTS facilitators to come to Toghak and map the high frequency defecation areas in order to identify the best locations for new latrines.

Within a week the women made improvements to 20 latrines. Within three months 50 new latrines were built.

 {Photo credit: Mahjan CLTS Facilitator.}Washing hands. Itarchi Hakimabad, Badakhshan, Afghanistan.Photo credit: Mahjan CLTS Facilitator.

The USAID-funded Sustainable Water Supply and Sanitation Project, Afghanistan (SWSS) project increases access to potable water and sanitation services in Afghan communities and decreases the prevalence of water borne diseases through household hygiene interventions. Led by the Association for Rural Development, in partnership with Management Sciences for Health, SWSS has led nearly 400 communities in Afghanistan to become Open Defecation Free. The MSH components of the project have succeeded under the astute leadership of Dr. Abdul Hatifie, the team leader for Sustainable Health Outcomes, and Dr. Logarwal, the BCC Material and Media Specialist. Together they have led the successful implementation of innovative approaches in all aspects of the SWSS project. To learn more about SWSS’s accomplishments, please see the cover article in this month’s USAID Global Waters magazine.

Female community health worker teaching mothers to improve hygiene and preventing diarrhea in their homes through regular hand washing.

Many children in Afghanistan die each year of easily preventable diseases; nearly 25% of those deaths are due to diarrhea. However, it is not only the fatal cases of severe diarrhea that are imperative to address. Between a quarter and a half of mothers of children less than five years old report their child had diarrhea in the two weeks prior to questioning. These frequent cases of diarrhea are among the main causes of under nutrition, which delays development and is implicated in over half of all childhood deaths.

One of the most effective ways of preventing diarrhea is to improve hygiene in the home, especially through regular hand washing with soap before preparing and eating food, after using the toilet or handling a child’s feces.

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