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EHP News  November 2003











Several studies in different parts of the world have indicated that proper handwashing at proper times results in diarrhea reduction. Collectively, studies over the past decade have reported a 33% to 47% reduction in diarrhea from handwashing alone.

In Peru, the Ministry of Health together with USAID, the World Bank Water and Sanitation Program (WSP), CDC, UNICEF and other public and private partners are working together on the design and implementation of a public-private partnership in handwashing initiative. The initiative is based on the concept that private commercial firms and public entities would find it mutually beneficial to work in partnership to achieve complementary goals of promoting handwashing for public health. USAID, through EHP, has initiated consumer research and baseline field work in Peru as a first step in designing a public-private partnership for handwashing with soap campaign. EHP has subcontracted a local research firm, PRISMA, to conduct the research.

Similarly, in Nepal, USAID, through EHP, and UNICEF/Nepal are collaborating to implement a public-private partnership in handwashing with soap initiative. A local research firm, VARG, subcontracted by EHP, has completed the baseline research. Results from the market research will be used to design an effective media/communications program. The initiative has been able to recruit both large, multi-national and small, regional soap manufacturers to participate. Regional stakeholders' meetings have been held to introduce the initiative and to garner support from various organizations. The initiative's products and approach will be disseminated through UNICEF/Nepal's school sanitation and community programs.

For more on the handwashing initiative, contact Lisa Nichols at [email protected].


Recognizing the nexus between health and environment as a crucial element for achieving sustainable development, USAID is supporting a consortium of NGOs and supporting organizations under Voahary Salama (VS), the NGO umbrella organization that leads the community-centered, integrated health, population and environment program along Madagascar's forest corridors.

EHP helped establish VS as a mechanism to coordinate integrated activities and provided support and assistance in the institutionalization of VS. VS is now a legal association. It is gaining increasing international exposure as a prime example of integrated programming, and EHP and VS received the Population and Environment Pioneers and Leadership award in 2002. VS partners serve 120,000 people in 160 remote rural communities.

In the program, social marketing approaches are implemented through community resources and NGO structures. The approaches are built around an "innovator model" that uses early adopters of positive practices in the community as role models. Two video documentaries produced in 2003 portray the "champion community" approach. The champion community approach is one of the most successful social marketing approaches for engaging communities in setting their own development goals in population, health and the environment.

Preliminary data in Madagascar show substantial improvements of key health indicators: lead NGOs reported a more than twofold increase in contraceptive prevalence rates from less than 10% to over 20%; severe malnutrition rates of children under five dropped from 13% to 5%; and vaccination coverage increased from 41% to 93%.

For more information, contact Eckhard Kleinau at [email protected].



USAID/Jordan is funding an initiative to protect and improve water sources in Jordan and thereby safeguard previous infrastructure investments and protect public health.

The first phase of the initiative, the Jordan Water Quality Management Project, was implemented by Camp Dresser & McKee (CDM), from March 2002 to January 2003, in close partnership with the Ministry of Water (MWI), Water Authority of Jordan (WAJ) and the Ministry of Health. The first phase focused on problem analysis of Jordan's water management system and identified areas for improvement.

EHP (through CDM) is currently implementing the second phase of the initiative. Based on priority problems identified in Phase I, Phase II focuses on three tasks: (1) watershed protection including the implementation of a pilot program; (2) laboratory quality assurance/quality control; and (3) operations and maintenance at selected WAJ treatment facilities.

The watershed protection task is based on findings from Phase I that indicated spring water in five watersheds contained elevated concentrations of coliforms and nitrates and concluded that domestic wastewater is the primary source of groundwater pollution.

For more information on the Jordan watershed/water quality management program, please contact Chitra Parameswar at [email protected].



Eritrea is prone to severe malaria epidemics, and malaria is a leading cause of hospital and health center admissions and in-patient deaths in both children and adults. The decentralized malaria control program in Eritrea is managed by zonal coordinators, who have an established historical practice of using hand-drawn malaria maps.

With technical assistance from EHP, USAID is supporting the development, testing and using of malaria risk maps in Eritrea. Models for the spatial stratification of malaria risk in Eritrea have been developed and tested, and the most robust model has been identified, which employs only three variables: data from the Mapping Malaria Risk in Africa (MARA) model of malaria seasonality; land use; and altitude.

The model was presented by EHP at GeoMed, an international conference showcasing the latest tool developments, research and accomplishments in the application of geo-spatial analysis in public health. The conference was held at the University of Maryland Medical School, October 15-17.

For more information on malaria risk maps in Eritrea, please contact Gene Brantly at [email protected].



Sanitation in small towns is a growing and important problem. Very few small towns in Latin America have managed to provide sustainable sanitation services. This can be attributed to multiple factors including lack of demand for sanitation, an inadequate policy framework, and limited institutional capacity to effectively manage sanitation systems.

Over the past two years, EHP has developed a methodology for designing a sanitation plan for small towns, field tested the methodology in three countries, and actively disseminated the results of this activity in the region. One of the field tests was in La Cabima, a community of 14,000 residents within the Panama Canal Watershed.

With support from USAID, EHP organized a national-level workshop in Panama related to sanitation in small towns. The purpose of the workshop was to discuss and agree upon the framework for a national plan/strategy to improve sanitation in small towns specific to Panama, based on the La Cabima experience. The workshop was attended by 41 participants from national and local governments and NGOs. The workshop resulted in a higher level of awareness about the problem and initial discussions about addressing the problem on the national level. The plan is now being implemented with prospects for funding likely.

For information on workshops or on small town sanitation, contact Fred Rosenswieg at [email protected].


The EHP Information Center has created a trial Environmental Health Blog at

A Blog is a regularly updated, online, information and news journal and includes links to full text articles, study abstracts, news items, questions, opinions, etc. It is also a tool for creating a community of practice (COP)--a community of professionals and experts with a common vision and interest. What sets Blogs apart from other online writing is their dynamic nature (as opposed to static web pages). A Blog thrives on multiple, regular contributors posting information, news, opinions, etc.

The Environmental Health Blog focuses on water, sanitation, hygiene improvement and integrated vector management for malaria prevention and control. Please contact us at [email protected] if you would like to join our Community of Practice in Environmental Health. You will be assigned a username and a password to enable you to contribute information to the Blog. Feedback on the Blog is also welcome.

For information, contact [email protected].



Activity Report 121. Nepal: Analysis of Baseline Survey Data on Japanese Encephalitis, Kala-azar and Malaria

This report analyzes potential risk factors for malaria, kala-azar and Japanese encephalitis across various household/population groups in Nepal. The survey included a socio-behavioral survey, an entomological survey with household and peri-household vector collection, and a clinical survey with blood sample collection. The report analyzes survey findings and identifies interventions for the three vector-borne diseases.(download 542 KB PDF  file)

 For more information or a hard copy, contact [email protected].   


EHP Brief 19. The Nepal Survey on Malaria, Japanese Encephalitis and Kala-azar (download 507 KB PDF

For more information or a hard copy, contact [email protected].  


Highlights from the Sixth Annual Assessment and Mid-term Review Workshop on Malaria Control in Eritrea

This is a mission-funded report, which includes an overview and an annex of the PowerPoint presentations from the Annual Workshop on Malaria Control in Eritrea. (download 1.3 MB PDF

For more information or a hard copy, contact [email protected]


Previous Issues 

The main topics or countries discussed are given in parentheses.

August/September 2003  (Nepal-India Cross Border Collaboration, Nicaragua: Capacity Building of NGOs in Participatory Community Monitoring, Eritrea Village Pilot Program for Mosquito Source Management, PAHO-EHP Partnership for Hygiene Behavior Change, Reducing Urban Malaria Transmission in Uganda)
June/July 2003 Cairo Healthy Neighborhood Program, Strengthening Malaria Surveillance in Eritrea, Democratic Republic of Congo: Integrating Hygiene Improvement into Primary Health Care, Nepal Handwashing with Soap Initiative, Urban Health Conference in India
May 2003
(Global Health Council Conference 2003 Focuses on Health and the Environment, It’s Back: The Return of Vector Control as a Tool Against Malaria, Mainstreaming Prevention of Diarrhea in Child Health" Healthy Families, Healthy Forests: Integrated Programs, Malaria, Dengue, Cholera: Environmental Strategies for Control and Prevention, Improving Maternal and Child Health in Urban Slums and Squatter Settlements, Environmental Issues in Income Generation and Health)
March 2003
EHP Nicaragua Program Receives The Robert C. Marini Clientship Grand Award, Sierra Club Honors AVS Coordinator, Cairo Urban Slum Child Health Program, Aga Khan Workshop, Best Practices For Dengue Prevention And Control In The Americas, Dhanusha-Mahottari Vector-Borne Disease Program: Community-Based Prevention And Control Of Kala-Azar, Sanitation In Small Towns: Summary Report on Sub-Regional Workshops, USAID Knowledge Management Inventory)
January 2003 (The West Africa Water Initiative, Lac Regional Workshop On Community IMCI, Reducing Urban Malaria Transmission in Uganda, Lessons Learned from Community Management of Environmental Health in Benin, Urban Environmental Health Pilot Activities in DR Congo, An Enabling Environment for Rural Water Supply, Sanitation and Hygiene Systems in the Dominican Republic)
October 2002
India: Improving Child Health and Nutrition, Hygiene Promotion in the LAC Region, Malaria Control in Eritrea, Congo: Hygiene Improvement, Madagascar: Integrated Health, Population, World Summit on Sustainable Development)
September 2002
(West Africa Environmental Health Assessment, Dissemination Workshop on Latin America Small Town's Sanitation, Ghana Urban Health Assessment, News from BBIN Network, Honduras)
August 2002 (Improving the Early Warning Report System in Nepal, Assessing Sanitation Policies, Post-Mitch Activities in Nicaragua, African Sanitation and Hygiene Conference)
June 2002 (West Bank Environmental Health Assessment, New Publications)
March 2002 (E-Conference on Hygiene Improvement Framework, Latin America and the Caribbean, Larva Control, Nicaragua, Africa Malaria Day)
January 2002
(New EHP Director; Benin; Monitoring Water, Sanitation, and Hygiene Activities; Malaria and Vector Control)
November 2001 (EHP Handwashing Publication, West Bank, Asia and the Near East, PAHO–EHP Partnership)
October 2001 (Benin, Sustainable Sanitation in Small Towns, DR Congo, Peru Behavior Change)
August 2001
 (India, Eritrea, Democratic Republic of the Congo, BBIN Network, information exchange network)
June 2001
(Mozambique, Madagascar, Nepal, Dominican Republic, indoor air pollution consultation, Nairobi SIMA Conference)
May 2001 (Central America handwashing initiative, Democratic Republic of the Congo, Eritrea, Nepal, Bolivia)
March 2001 (Nicaragua, Madagascar, Africa, DDT cost comparison)
January 2001 (EHP Activities, E-Newsletter, National Malaria Control Programs in 4 African Countries, Congo, Decentralization in Latin America, Peru, WSSCC Forum, Global WS&S Assessment from WHO/UNICEF)
November 2000
(Nicaragua, Dominican Republic, Madagascar, SANICONN)
September 2000 (Nepal/Regional, EHP and E-conferences)
July 2000 (Nicaragua, Malaria Vaccine Development, "Water for the World")
MayJune 2000 (Nicaragua, International Consultation on Indoor Air Pollution)
April 2000 (Nicaragua, Madagascar, Mozambique)
March 2000 (Benin, South Africa, Eritrea, Madagascar)
February 2000 (Nicaragua, Paraguay, Ukraine, Mozambique and Eritrea)
January 2000 (Nicaragua, EHP Lessons Learned)

Previous Issues by Country

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EHP is sponsored by the Office of Health, Infectious Diseases and Nutrition,
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Last modified January 12, 2004