Tackling neglected tropical diseases with water sanitation and hygiene
Millions of people around the world lack safe drinking water, sanitation and hygiene (WASH). This puts them at-risk from many diseases, including neglected tropical diseases (NTDs). NTDs affect more than 1 billion people in 149 countries. Beyond prevention, WASH services are also critical to care for the people who have many of these diseases.
In August 2015, WHO published “Water, sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases: A Global Strategy 2015-2020". The Strategy aims to increase access to WASH, and to support efforts to combat NTDs.
This fact file looks at the importance of WASH for preventing and caring for neglected tropical diseases.
NTDs and access to water and sanitation are major global challenges
More than 1 billion people in 149 countries suffer from NTDs. These diseases thrive in areas where there is lack of basic sanitation. About 2.4 billion people worldwide do not have adequate sanitation facilities, and 663 million do not have access to improved drinking water sources.
NTDs and poor WASH conditions contribute to poverty
NTDs overload already stretched health systems in developing countries, and some of them can lead to catastrophic expenditures, reduce individual productivity and impact national economies.
Facial cleanliness and environmental improvement are key to eliminating trachoma
Trachoma is a leading cause of preventable blindness. It is caused by a bacterial infection transmitted through contact with eye-seeking flies, fingers and fomites. Facial cleanliness and environmental improvement are primary prevention components of WHO’s SAFE strategy for trachoma elimination. Water is required for face washing to remove eye discharges. Environmental improvement includes safe disposal of excreta to reduce fly populations.
Sanitation prevents soil transmitted helminth infections
Sanitation is a primary prevention strategy for soil-transmitted helminthiases. It prevents faecal pathogens such as intestinal worm eggs from contaminating the environment and infecting people through contaminated food, water, dirty hands and direct skin contact with the soil. Soil-transmitted helminthiases currently affect hundreds of millions of children worldwide, leading to undernutrition, anaemia and poor school performance.
Open sewage running behind the houses in Manilla.
Breeding sites for mosquitoes are reduced through improved sanitation and water management
Improved sanitation and water management can greatly help to reduce proliferation of mosquitoes that transmit diseases to humans, such as lymphatic filariasis, dengue and chikungunya. Poorly constructed latrines facilitate the breeding of the Culex mosquito, which transmits filarial parasites to humans. Safe storage of water can greatly prevent the breeding of the Aedes aegypti and Aedes albopictus mosquitoes which transmit dengue and chikungunya to humans mainly in urban areas.
Protecting freshwater from contamination reduces schistosomiasis
Improved sanitation can prevent faeces and urine which contain worm eggs from contaminating surface water. This can reduce the transmission of schistosomiasis. Since some schistosome species are also transmitted through animal (cow, buffalo) urine or faeces, it is important to protect freshwater from animals and animal waste.
Tran Dinh Luu receives support for limb washing, a critical component of care for those impacted by lympehedema from lymphatic filariasis.
Safe water is essential to treat and care for NTDs
Health-care facilities and households need clean water and hygienic conditions for wound management and surgeries required for the treatment of many NTDs. For guinea worm, Buruli ulcer, or cutaneous leishmaniasis, wound management is needed to speed up healing and reduce disability. People with chronic disabilities from lymphatic filariasis need to maintain rigorous personal hygiene with water and soap to prevent secondary infections.
Bhagwati Thapa (64), an LF patient, chatting with her friend while caring for her leg. Bungmati, Nepal 2015
WASH improves the quality of life for people affected by NTDs
Lymphatic filariasis and leprosy can lead to permanent disability making tasks such as carrying water long distances or accessing toilets difficult. People affected by these diseases need water to manage the symptoms of the disease, but often face stigma and can be excluded from accessing water and sanitation facilities, increasing their risk of poverty and severe illness. Clean water and soap are needed to maintain personal hygiene and dignity for these groups. Efforts to reduce stigma and exclusion are also required.
October 2019 - Kiribati has eliminated lymphatic filariasis as a public health problem. The Pacific island nation joins 11 other countries and areas in the WHO Western Pacific Region to have defeated the disfiguring tropical disease.
Progress on NTDs can be an indicator of access to WASH services
NTDs are most common in rural, vulnerable and marginalised populations where people do not have access to water and sanitation services. Progress or lack of progress on control or elimination of certain NTDs could be an indicator of whether WASH programmes are targeting the right communities and populations.
Collaboration between WASH and NTD
A closer collaboration between WASH and NTD programmes can greatly improve the lives of populations affected by NTDs. Synergies can be created through collaborative planning, delivery and evaluation of programmes, strengthening and sharing of evidence, and using monitoring tools to improve the equity of health services and target the most vulnerable, underserved populations.