EHP News January 2004

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Point-of-Use (POU) water treatment is the treatment of water where it is used (household, schools, health facilities) as opposed to treatment of water as part of a community water supply or at a treatment plant. Safe water storage is an important complement to POU water treatment to prevent the re-contamination (by dirty hands and utensils) of water by keeping water in narrow mouth and covered containers or vessels equipped with taps. Both are components of the Safe Water System (SWS). The remaining component of the SWS addresses behavior change to sustain safe treatment and storage practices as well as hygiene promotion such as handwashing.

The primary objective of POU water treatment and safe storage is diarrhea prevention, and the main target populations are children under-five and their care givers. Although the efficacy of POU treatment and safe storage is well documented, program effectiveness has not been equally documented, in particular in households with reduced access to improved water sources and at a higher risk of diarrhea.

EHP is supporting an operations research (OR) activity in Zambia-studying a POU water treatment and safe water storage project implemented by the Society for Family Health, a local affiliate of Population Services International (PSI). The project interventions include POU chlorination using the disinfectant solution “Clorin” and safe water storage in jerry cans. The pilot project was initiated by PSI which successfully social marketed “Clorin” and jerry cans.

The goal of the OR activity in Zambia is to assess the level and use of POU chlorination and safe water storage by low income households with reduced access to improved water sources and higher risk of diarrhea, and higher income households with increased access to improved water sources and lower risk of diarrhea. To date, the study protocol and instruments have been finalized and field work will start around the end of January.

For information on the activity, please contact Fred Rosensweig at [email protected].


The India Urban Child Health Program is a five year effort by USAID to bring about sustained improvement in the health of urban poor children in slum areas of India. USAID through EHP has been working with key governmental and NGO partners in selected cities, and the program has entered its second year of implementation.

The first year of the program focused on situational analysis, vulnerability assessment and other program development efforts in Indore, including a partnership with an NGO-CBO consortium of five organizations for the implementation of child health interventions in 73 slums. One of the crucial components of the Indore urban health program is capacity strengthening of NGO-CBO partners and local-level team members implementing interventions such as neonatal health, improved birth practices and hygiene improvement in the slums.

Over the past year and a half, EHP has emerged as a significant technical resource to the Government of India for informing and influencing its urban health programmatic directions. In a significant move, the Government of India (GOI) requested USAID/India to support the development of sample urban health proposals under the second phase of GOI’s Reproductive and Child Health program. EHP is providing technical assistance to the proposal development. These proposals are expected to provide solid examples of urban poor health care delivery planning in different city settings. Using the Indore program as a model, other sites for urban health programming include Jamshedpur, Delhi, Bally in W. Bengal near Kolkatta, Dehradun, Haridwar, Haldwani and Agra.

For information on the activity, please contact Dr. Siddharth Agarwal at [email protected] or Sarah Fry at [email protected]


An article, “High Seasonal Variation in Entomologic Inoculation Rates in Eritrea, a Semi-arid Region of Unstable Malaria in Africa,” published in the American Journal of Tropical Medicine and Hygiene, 69(6), December 2003, pp. 582-588, discusses findings from malaria studies in Eritrea. The studies were supported by USAID through a mechanism for cooperation with the Ministry of Health, Eritrea, and with technical support from the Environmental Health Project.

The article, based on entomologic studies conducted in eight villages in Eritrea, investigates malaria transmission patterns in different ecologic zones from mosquito collections conducted for 24 months between September 1999 and January 2002. Conclusions from the study demonstrate the need to generate spatial and temporal data on transmission intensity on smaller scales to guide targeted control of malaria operations in semi-arid regions. Furthermore, annual entomologic inoculation rate (EIR) estimates derived in the study provide a means of quantifying levels of exposure to infected mosquitoes in different regions of the country. Since Eritrea has made significant steps in reducing the burden of malaria based on WHO’s Roll Back Malaria initiative, the findings are of importance for evaluating the efficacy of vector control measures.

The article may be viewed at The co-authors include: EHP’s Gene Brantly, EHP consultant Josephat Shilulu, and others.


The West Africa Water Initiative (WAWI), is a global partnership of fourteen international institutions working together to provide potable water supply, sanitation, hygiene and integrated water resources management activities in Ghana, Mali and Niger.

Following a WAWI Partners’ meeting in December 2002, USAID was requested to play a lead/coordinating role to develop a WAWI monitoring and evaluation (M&E) plan. EHP was asked to develop the M&E plan, and in particular to select a core set of indicators to measure progress towards WAWI’s four objectives. The development process was based on research of existing M&E practices, discussions with the partners involved and the WAWI programmatic framework. A draft WAWI M&E plan has been developed, and the final WAWI M&E Plan report is expected to be available in mid-January 2004.

Additionally, based on further discussions with WAWI partners, EHP will also be playing an important role in strengthening hygiene promotion in the WAWI programmatic framework. An EHP consultant will undertake a field assessment in the three WAWI countries from mid-January through mid-February 2004.

For further information on EHP and WAWI, please contact David Fernandes at [email protected].


USAID Asia Near East (ANE) health programming has not kept pace with the region’s rampant urbanization and the health needs of urban slum dwellers, in particular, children living in the vast and growing cities of Asia and the Near East. Recognizing this, the USAID ANE Regional Bureau launched a three-phase Urban Health Initiative in 2001.

A literature review of existing studies on child health in urban slums in select countries of the ANE region was completed by EHP (EHP Activity Report 109: during Phase I. Phase II called for implementation of demonstration urban health programs. EHP is implementing Phase II of the Initiative in Egypt (Cairo Healthy Neighborhood Program) and in India (India Urban Child Health Program). The Cairo program is funded by the USAID ANE regional bureau in collaboration with USAID/EGAT/Urban programs and USAID/Egypt, while the India program is funded by USAID/India.

Phase III of the Initiative focuses on advocacy. The ANE Regional Urban Health Workshop to be held in Agra, India, in February 2004 aims to promote increased health programming in ANE urban slums. The overall workshop objectives are to raise awareness of urban health issues in the ANE region, to present a roadmap for developing urban health programs, and determine next steps for country-level urban health programming. The workshop is designed to increase dialogue among participants on this critical issue. The workshop will provide input to the Urban Health Programming Guidelines being developed by EHP under the ANE Initiative.

For more information, please contact Sarah Fry at [email protected]


Environmental management for vector control frequently aims at introducing changes in the local hydrology or in water-use practices. Environmental management provides a basis on which other methods such as chemical control can build in a complementary fashion, while reducing the environmental costs and resistance risks incurred by excessive use of insecticides.

Recent data indicate that malaria is a growing problem in urban areas in Uganda. A two-year study designed to assess the strengths and weaknesses of a community-based environmental management program for malaria control has been implemented in four study sites in two Ugandan cities: Kampala and Jinja. In Year 1 of the two-year study, entomological and clinical surveys were carried out to determine the level of transmission and intensity of infection in different urban settings. Based on the findings, control options were identified, and community action plans specific to the ecology and social settings in each site were developed using a participatory approach.

The Year 1 Summary Report, “Development of a Community-based Environmental Management Program for Malaria Control in Kampala and Jinja, Uganda” is now available from EHP (see “New EHP Publications” below)


Activity Report 122. First Year Summary Report. Development of a Community-based Environmental Management Program for Malaria Control in Kampala and Jinja, Uganda.

This report describes the activities and findings for the first year of a two-year study designed to assess the strengths and weaknesses of a community-based environmental management program for malaria control in two Ugandan cities: Kampala and Jinja. (Download 786 KB PDF file

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

EHP Brief 20. Community-based Environmental Management for Urban Malaria Control in Uganda-Year . (Download 530 KB PDF file

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


Malaria Epidemic Forecasting and Preparedness Manual. (Download 560 KB PDF file

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

Previous Issues

The main topics or countries discussed are given in parentheses.

November 2003 (Peru and Nepal: Public-Private Partnerships in Handwashing Initiative, Integrating Health, Population and The Environment in Madagascar, Protecting and Improving Water Sources in Jordan, Developing Malaria Risk Maps in Eritrea, Panama: Sanitation in Small Towns Workshop, Cop in Environmental Health)
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”)
May–June 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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