WHO District Level NTD Training Course
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Revised: 30.6.2015(Global version) WHO District Level NTD Training course Learner’s Guide Module 8: Other Preventative Measures and Related Sectors Session 8.1: Introduction to WASH and Vector Control Part 1: Introduction: Session Purpose: The purpose of this session is to introduce the learner to the concept of intersectoral collaboration and the importance of WASH and Vector Control (VC) interventions for the control/elimination of 5 neglected tropical diseases (NTD) targeted for preventive chemotherapy(PC). Prerequisite modules/sessions: Module1 Learning Objectives: By the end of this session, learners will: Understand why Water, Sanitation, and Hygiene (WASH) and Vector Control (VC) are important in control and elimination of Neglected Tropical Diseases (NTDs) Understand how to collaborate with existing WASH and VC sectors in the district Abbreviations and Acronyms LF – Lymphatic filariasis NTD – Neglected Tropical Disease ONCHO - Onchocerciasis PC – Preventive chemotherapy SCH – Schistosomiasis 1 STH – Soil-transmitted helminthiasis WASH – Water, Sanitation, and Hygiene VC – Vector Control Part 2: Key concepts: Concept 1: WASH and NTDs Water, sanitation, and hygiene (WASH) interventions are essential for the long-term control, and even elimination, of four of the PC NTDs: soil-transmitted helminthiasis (STH), trachoma, schistosomiasis (bilharzia), and lymphatic filariasis (LF). Table 1: WASH intervention and disease impacted Intervention Definition Disease impacted Water Access to safe water for: drinking, face washing, hand LF,SCH and body washing and cleaning of foodstuffs and STH, Trachoma clothes to prevent or minimize reinfection. Sanitation Sanitary latrines keep infected human excreta from SCH, STH coming into contact with humans, animals and Trachoma vectors, thereby minimizing the risk of reinfection in treated individuals and preventing new infections. Hygiene Personal and environmental hygiene campaigns in LF, SCH communities to promote positive behaviors to prevent STH, Trachoma infection and morbidity and disabilities. Concept 2: Vector control and NTDs Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans. Many of these vectors are bloodsucking insects, which ingest disease- producing microorganisms during a blood meal from an infected host (human or animal) and later inject it into a new host during their subsequent blood meal. LF, SCH, trachoma 2 and onchocerciasis are diseases transmitted by vectors. Vector control methods should be selected from a list of the available methods. Certain vector control methods are of known efficacy in particular settings. Table 2 lists the vector control methods and their applicability to each vector-borne disease; however, methods must also be assessed locally. Table 2: Methods used to control vector-borne diseases (mosquitoes) Lymphatic Filariasis (black flies) Onchocerciasis (snails) Schistosomiasis (flies) Trachoma (no vector) STH Category Sub-Category Source reduction + Habitat manipulation + + Irrigation management & Environmental + + design Proximity of livestock + Waste management + + Mechanical Polystyrene beads + Natural enemy conservation + Biological Biological larvicides + Fungi + Insecticide-treated bednets + Indoor residual spraying Chemical Insecticidal treatment of habitat + + Chemical repellents + Adapted from Table 4.2 of WHO’s Handbook for integrated vector management Concept 3: Inter sectoral Collaboration In general WASH, VC, and NTD sectors work independently to achieve their complementary goals because of different health and development priorities. Incidence of diarrheal disease has traditionally been the health indicator of most importance to the WASH sector, and crop yield is the indicator of choice for the VC sector. Because WASH and VC break the cycle of transmission of many NTDs, 3 inter sectoral collaboration at the district level is vital for effective NTD control and elimination. Power point slides: Slides: 1-9 of Introduction to WASH and Vector control Part 3: Activities Facilitators will choose sessions depending on the disease endemicity in a country and plan exercise such as (i) Role play–3 groups- WASH, Vector control sector and district NTD unit (ii) Open discussion on how to collaborate with WASH and Vector control (iii) Case studies Part 4: Summary Job aide related to this module( include where applicable) Job aides for the session 8.1(introduction) Key words (maximum 10) Key action points for district level personnel Part 5: References and Additional Resources References 1) Accelerating work to overcome the global impact of NTDs – A Roadmap for Implementation, WHO. 2011. 2) Integrated Vector Management – PAHO/WHO. http://www.paho.org/hq/ integrated- vector-management-IVM and Itemid. (2014) 3) RTI Integrated Vector Management project. http://www.ivmproject.net/about/index.cfm?fuseaction=static&label=vbdzcontrol. (2014) 4) Water, Sanitation, and Hygiene Online Manual Resource. http://www.washntds.org (2014).World Health Organization – NTDS. www.who.org. (2014) 4 Module 8: Other Preventative Measures and Related Sectors Session 8.2: Soil-Transmitted Helminthiasis (Intestinal Parasites) Part 1: Introduction: Session Purpose: The purpose of this session is to introduce WASH interventions that contribute to the control soil-transmitted helminthiasis (STH). Prerequisite modules/sessions Module 1 and Session 8.1 Learning Objectives: By the end of this session, learners will be able to: Explain how WASH interventions control STH Propose strategies for collaborating with water, sanitation, education, and other sectors to effectively control STH. Abbreviations and Acronyms NTD – Neglected Tropical Disease STH – Soil-Transmitted Helminthiasis WASH – Water, Sanitation, and Hygiene Part 2: Key concepts: Concept 1: Transmission of STH infection STH is caused by infection with intestinal parasites. The most common are roundworm, whipworm and hookworm. These parasites thrive in warm and humid climates and in communities with limited access to water and basic sanitation. STH is spread through contact with feces of infected individuals. Infection occurs when: 5 Humans ingest the infective eggs of roundworm and whipworm by eating contaminated food and eating with unwashed hands or utensils; Hookworm larvae penetrate of the skin, usually of the feet. Symptoms of STH include malnutrition, anemia and fatigue. Children with STH experience poor cognitive and physical development. Concept 2: WASH and STH Control Improving access to water and sanitation and good hygiene practice is essential to stop the cycle of STH transmission. Mass drug administration campaigns with a single dose of donated Albendazole or mebendazole (Vermox™) target children at risk of STH. However, reinfection nearly always occurs following treatment when access to improved water and sanitation facilities and knowledge of good hygiene practices (WASH) are limited. Thus, WASH is essential to interrupt the cycle of STH transmission. Water - Access to potable water for hand washing and cleaning of food stuffs minimizes reinfection. Sanitation - Sanitary latrines keep infected human excreta from the areas where people live, work, and play, further minimizing the risk of re-infection in treated individuals and preventing new infections. Hygiene Education - Hygiene education promotes personal and environmental hygiene in communities where STH is endemic. Concept 3: Intersectoral Collaboration and STH Control Many WASH interventions can be undertaken at the district and community levels to control STH. Use the following table to identify partners and organizations from other sectors to implement the following WASH activities. 6 Table 1: Inter sectoral Collaboration to Control STH (Group Planning Activity) Intervention Activities Strategies for Sector/partner including other organization sectors Water Facilitate the provision of sustainable safe water services for hygiene and drinking Promote household treatment and proper storage of water Sanitation Ensure access to household and school latrines to minimize open defecation Ensure that processes are in place for regular cleaning and maintenance of latrines Hygiene Promote wearing shoes when walking outside Education Promote hand-washing before cooking and eating and after defecating Power point slides: Slides 1-9 from WASH (Session 8.2-8.5) and pick up additional slides from Session 8.1: introduction Key message: • Infection occurs when soil or food contaminated with fecal matter harboring eggs is ingested, or when larvae living in soil penetrate bare skin. • Treatment is an important part of control. • Reinfection of intestinal parasites nearly always occurs following treatment when access to WASH is limited. • WASH interventions break the cycle of STH transmission. 7 Part 3: Activities: The course facilitator will distribute the table 1 ( given above) to 3 groups of participants. The participants will complete the exercise and one from each will present. Part 4: Job aides Key words (maximum 10) Key action points for district level personnel Part 5: Reference and Resources: 1. Strunz EC, Addiss DG, Stocks ME, Ogden S, Utzinger J, et al. (2014) Water, Sanitation, Hygiene, and Soil-Transmitted Helminth Infection: A Systematic Review and Meta-Analysis. PLOS Med 11(3): e1001620. (Accessed June 23, 2015 http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pme d.1001620&representation=PDF). 2. Children Without Worms (2014). Controlling STH is an urgent