dbl approach to water & health research and development karsten n. kryger

DBL approach to water & health research and development

Karsten N. Kryger

The DBL approach…

Mandate:To generate and disseminate new knowledge, tools and methods for

disease controlTo build research capacity & institutional capacity for disease control

Focus on Research into practice …and practice into research

Case 1: Study of risk factors for intestinal helminth infections in Western Kenya

Main problem: High prevalence of helminth infections

Objectives: To reveal relationship between sanitation practices and intestinal helminth infections as well as the perceptions of disease.

Approach: Epidemiological and anthropological


Result of the epidemiological study: Lack of latrines (Odds Ratio 1,9)Lack of soap (OR 2,7)no. of inhabitants in household (3,2)presence of children under 5 years (3,8)

Perceptions of risk according to the anthropological study:Latrines perceived to reduce disease by some, not allLack of latrines not perceived as particularly hazardousViolation/transgression of social &cultural norms perceived as cause of disease

Case 2: School based control of bilharzia (urinary schistomiasis) in Eastern Tanzania (1995-2001)

Main problem to be addressed: Very high prevalence of bilharzia infections among school children (morbidity > 50%)

Objectives: To reduce bilharzia infection among school age children


Project activities

Diagnostic survey & Selective treatment– Implemented by school teachers and coordinated by the District

Health Management in collaboration with the District Education Officer

Sanitation– Involvement of parents and communities

Post treatment survey 30 months after the last annual round of treatment, in the year 2001


Findings at the post treatment survey in 2001:

Teachers were still able to perform all of the activites related to the programme, although they had not been trained since 1999

The improved sanitation installed in the schools between 1995 and 1999 had been maintained and extended

Few schools had any latrines in 1995, they each had at least two functional latrines by 2001

Prevalence (% ) of haematuria (micro and/or macro)

0

10

20

30

40

50

60

1995 1996 1997 1998 1999 2001

%


Case 3: Bilharzia Control Programme in Lake Shore Communities of Lake Malawi

Main problem to be addressed: Very high prevalence of bilharzia infections (morbidity in excess of 40%)

Objectives: To reduce bilharzia infection in five health centre cathment areas

• Model for bilharzia control (prevention, treatment, water & sanitation, education & communication)

• Multisector cooperation (health – environment –water & sanitation)• Stakeholder involvement (schools, villages…)

To enhance research capacity• Cross disciplinary (medical, biological & social sciences)• Cross institutional (health centres, district hospital, district environment

authorities, Univerisity of Malawi)

Case 3: Bilharzia Control Model – The Elements

Treatment campaigns• School level and village level• Village based drug revolving funds

Water & sanitation• Safe dringing water reduces human infection• Sanitation reducing contamination of water bodies • Washing slabs with safe water

Environmental management• Removal of vegetation behind shore line

Education and information• Theatre, shows, dances, songs, health in curriculum

Epidiomological monitoring

Linking research to public interventions in health, education, water & sanitation

Some lessons from the cases

Building research capacity in relation to public interventions can- greatly enhance generation of knowledge critical to success - improve effectiveness and cost efficiency of public interventions & investments

Crossdisciplinarity gives high value

Teachers, when trained, can sustain health education… and even treatment campaigns if supplied with required drugs

dbl approach to water & health research and development karsten n. kryger

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