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WASH Interventions Key to Reaching Africa’s Child Health Milestones

Experts say proper hygiene, especially during the first 1,000 days of a child’s life is critical. Credit: Joyce Chimbi/IPS

Nairobi, Kenya, Feb 15 2022 (IPS) - For two days in a row back in 2018, four-year-old Calvin Otieno suffered from diarrhoea and vomiting, and his mother responded by giving him a salt solution.

Pearl Otieno tells IPS that diarrhoea among children in Kibera, the largest urban informal settlement, is commonplace. A mixture of salt and warm water is often the go-to remedy.

“He did not seem to get worse, but he was not getting better either. He lay on the floor too weak to play,” she says.

It was too late by the time Otieno realized the magnitude of the situation and rushed her son to the nearby Mbagathi Hospital.

Kibera has long been synonymous with ‘flying toilets’, where residents relieve themselves in bags during nighttime and throw them away at dawn because they lack toilets inside their homes and fear using public toilets due to insecurity.

“Open defecation, flying toilets, lack of water and money to buy soap, people dumping household and human waste in open spaces is the life that children in the slums are exposed to,” says Nelson Mutinda, a Community Health Volunteer working hand-in-hand with a local NGO.

But Water, Sanitation, and Hygiene (WASH) challenges are not limited to informal settlements in this East African nation.

Overall, even though Kenyans have access to safe drinking water at 59 percent, according to UNICEF statistics, only 29 percent of the population has access to basic sanitation.

In all, five million Kenyans practise open defecation, a problem that statistics by the World Bank show is similarly prevalent in many low- and middle-income countries.

Open defecation is prevalent in Chad, Benin, Burkina Faso, Eritrea, Madagascar, Niger, Namibia, and Sao Tome and Principal. Only a handful of countries such as South Africa, Rwanda, Uganda, Seychelles, Mauritania, and the Gambia have successfully addressed access to sanitation.

World Health Organization (WHO) data indicates that Africa is not on track to achieve universal access to safe drinking water and proper sanitation in keeping with global Sustainable Development Goals (SDGs).

In the absence of increased investments in WASH interventions, the health body stresses that Africa will remain off track due to the added pressure from climate change and projected growth in population.

Against this backdrop, WHO says children in Sub-Saharan Africa are at least 14 times more likely to die before their fifth birthday than children in developed nations.

According to government statistics, in Kenya, at least 64,500 children die every year before reaching the age of five. Three-quarters of these deaths occur before their first birthday.

Mary Wanjiru, a pediatric nurse at Mbagathi Hospital, tells IPS that, like Otieno, many die from preventable diseases because the primary cause of death is diarrhoea, pneumonia, or neonatal complications.

“It is very important for mothers to understand that proper hygiene, especially during the first 1,000 days of a child’s life, is a very important pillar of child health. Poor hygiene can lead to death or a child failing to reach their full developmental and growth potential,” she says.

“WASH interventions are pillars of maternal, newborn and general child health because they prevent life-threatening infections such as tetanus, diarrhoea, sepsis and helps reduce stunted growth.”

According to USAID research, proper hygiene is a fragile pillar in Africa’s low- and middle-income countries.

In all, 50 percent of health care facilities lack piped water, 33 percent lack improved sanitation, 39 percent lack handwashing soap, 39 percent lack adequate infectious waste disposal, and 73 percent lack sterilization equipment, research shows.

While WASH interventions, such as safe drinking water, proper handwashing practices, and even basic sanitation, could prevent an estimated 297,000 global deaths among children under the age of five every year, this goal is not within reach for many Sub-Saharan African countries.

Hand washing, says the WHO, is the single most cost-effective strategy to prevent pneumonia and diarrhoea in young children successfully.

Still, data from UNICEF and WHO Joint Monitoring Programme released in August 2020 shows that an estimated 818 million of the world’s children lacked basic handwashing facilities within their schools. Of these children, 295 million live in Sub-Saharan Africa.

Overall, seven out of 10 schools lacked basic handwashing facilities in the least developed countries worldwide.

It is within this context that UNICEF paints a dire picture. Over 700 children worldwide under the age of five die daily of diarrheal diseases because of a lack of appropriate WASH services.

Children in conflict situations are especially vulnerable because they are nearly 20 times more likely to die from diarrheal diseases than in conflict.

“For ten years, I have worked in four slums in Nairobi. I find it very shocking that people have not understood how serious diarrhoea in children is. But small children will be given a mixture of water and salt, and sometimes some herbs and people just take the situation very lightly,” Mutinda observes.

Wanjiru agrees. She says that diarrhoea can escalate to a fatality within a matter of hours, “by the time mothers rush to the hospital with children suffering from acute watery diarrhoea, it is sometimes a losing race against time. Any form of illness among children should never be a wait-and-see situation. Seek immediate medical attention.”


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