Saving Lives Through Hygiene
Merri Weinger
Hygiene Improvement Program Manager, USAID
1. What percentage of the 1.5
million annual child deaths caused
by diarrhea are preventable?
a. 0%-30%
b. 31%-60%
c. 61%-80%
d. over 80%
In what regions of the world does
the majority of child mortality from
diarrhea take place?
Where do children < 5
die from diarrhea?
LAC
Middle East
East Asia
South Asia
subSaharan
Africa
countriesaccount
accountfor
forover
over70%
70%ofofthe
theapproximately
annual deaths
1111
countries
globally
from
diarrhea
1.52 million global
deaths
from
diarrhea annually
400,000
300,000
200,000
90% of deaths are in children
100,000
di
N a
ig
e
Pa ria
ki
st
an
D
R
C
Ba Ch
ng ina
la
de
Et sh
hi
op
i
An a
Af
gh gol
an a
is
In tan
do
ne
Ta sia
nz
an
ia
0
In
Deaths from diarrhea
500,000
Source: Safer water, better health (WHO, 2008)
2. Out of the total world population
of over 6.5 billion, how many
people around the globe lack
access to safe water?
a. 50 million
b. 500 million
c. about 1 billion
d. more than 2 billion
WHO/UNICEF, 2010
8
3.How many people in the world
lack access to hygienic sanitation
facilities?
a. 2.6 million
b. 26 million
c. 260 million
d. 2.6 billion
WHO/UNICEF, 2010
10
4. The only sure way to prevent
diarrheal diseases is to ensure that
all households have access to water
and sanitation facilities.
True _________
False_________
False!
5. Which of the following are among the
recognized globally important hygiene
behaviors for diarrhea prevention? (check
all that apply)
__ keeping food safe from contamination
__ bathing daily
__ effective handwashing
__ washing feet before entering the home
__ hygienic disposal of human feces
__ face washing once a day
__ clearing brush near the house
__ safe water handling, transport, and storage
Safe Feces Disposal
Handwashing
Safe Storage
& Treatment of Water
Hygiene Behaviors to Prevent DD
(WHO, 1992)

Keeping drinking water clean

Keeping hands clean


Keeping the environment clean
(sanitation perspective)
Keeping food clean
Primary Prevention
The F-Diagram
Fluids
Fields
Food
Feces
Flies
Fingers
Source: Wagner and Lanois, 1958
New
Host
Primary Prevention
The F-Diagram
Fluids
Water Quality
Fields
Food
Feces
Flies
Fingers
Source: Wagner and Lanois, 1958
New
Host
Primary Prevention
The F-Diagram
Fluids
Water Quality
Fields
Food
Feces
Flies
Fingers
Source: Wagner and Lanois, 1958
Water Quantity
New
Host
Primary Prevention
The F-Diagram
Sanitation
Fluids
Water Quality
Fields
Food
Feces
Flies
Fingers
Source: Wagner and Lanois, 1958
Water Quantity
New
Host
Primary Prevention
The F-Diagram
Sanitation
Fluids
Water Quality
Fields
Food
Feces
Flies
Fingers
Water Quantity
Hand Washing
Source: Wagner and Lanois, 1958
New
Host
6. Key WASH interventions will
reduce diarrheal disease by
a. 0-20%
b. 21-50%
c. 51-80%
d. over 80%

POU water treatment - 30-50%
reduction in child DD prevalence –
twice as effective as interventions at
water source

Safe storage – 21% reduction

Proper handwashing - 43% reduction

Sanitation – basic, low-cost systems can
reduce DD by 30% or more
7. Name three reasons why
household drinking water can often
be unsafe for human consumption.
Transport
Handling, and Storage
8.What are effective methods for
water disinfection at the point-ofuse?
Household Water Treatment Options
 Chlorination
 PuR
 Ceramic Filtration
 Biosand Filtration
 Solar/SODIS
 Boiling
9. What are the critical times for
handwashing with soap (or soap
substitute) for diarrhea
prevention?
Critical Times for
Handwashing with Soap




After defecation
After cleaning a
baby’s bottom
Before preparing
food/cooking
Before
eating/feeding a
baby
10. Which of the following are effective
ways of promoting latrines?
• Public financing and distribution of latrines
to all households
• Public shame
• Demand creation (e.g. Community-Led Total
Sanitation)
• Develop partnerships with private sector
producers of sanitation technologies (e.g.
Sanitation Marketing)
Increasing Demand for Sanitation
MAY NOT DEPEND ON HEALTH MOTIVATIONS…
RESPECT,
PRESTIGE
PERSONAL
COMFORT,
SELF-ESTEEM
WHAT FACTORS BESIDES HEALTH MOTIVATED
SANITATION ADOPTION IN THIS COMMUNITY?
No Toilet, No Bride
The "No Toilet, No Bride” program in the Indian state of
Haryana has been the most successful sanitation
promotion effort there so far. Started about two years ago,
the campaign has resulted in 1.4 million latrines being
built.
"I will have to work hard to afford a toilet. We won't get
any bride if we don't have one now," said 22-year-old
villager Harpal Sirshwa from Nilokheri, who is hoping to
marry soon. "I won't be offended when the woman I like
asks for a toilet."
11. What are the best entry points
for integrating hygiene
improvement into existing health
and development programs?
Child health
HIV/AIDS
Teacher training
Food Security and Nutrition
Avian flu
Education
Antenatal and neonatal care
USAID/GH Supported Partners in
Hygiene Improvement

CDC: Safe Water System
www.cdc.gov/safewater/

International Network to Promote Household
Water Treatment and Safe Storage
www.who.int/household_water/network/en/

Global Public-Private Partnership For
Handwashing with Soap
www.globalhandwashing.org
For further information, contact:
Merri Weinger (Hygiene Improvement)
mweinger@usaid.gov; 202-712-5102