Conference report – ISNTD Water

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At the end of November Infectious Diseases Hub attended the International Society for Neglected Tropical Disease’s conference, ISNTD Water, which focused on how water, sanitation and hygiene (WASH) can contribute to better health, particularly with regards to neglected tropical diseases (NTDs).

The conference was opened by Marianne Comparet, Director at the ISNTD, who introduced the society and the key note speaker, Barbara Evans, from the University of Leeds (UK). Barbara then took to the stage, where she emphasized the close relationship between WASH and public health, highlighting the lack of individuals who span the two sectors. She stated that WASH interventions must be carefully considered and disease-causing agents taken into account, specifically factors such as transmission pathways and lifecycles, which will allow us to pinpoint the correct interventions.

The first session of the day focused on WASH and NTDs, beginning with a talk from Anouk Gouvras (Global Schistosomiasis Alliance) on intervention tools for schistosomiasis. With the complex lifecycle of the schistosomiasis parasite, a key point of interruption is in reducing contact with infected water. Anouk gave the example of the the Diama Dam in Senegal and the Manantali Dam in Mali, which increased snail habitats and human water-contact, subsequently increasing cases of schistosomiasis. She stated that water development projects should reach out to the NTD community and consider their implications.

The session continued with Selma Hilgerson from Sightsavers and Simavi, who spoke on developing innovative WASH approaches to eliminate trachoma in Tanzania. Among other work, Selma explained the charities’ activities in primary schools, including school-led sanitation and educating on risks via the school curriculum. She highlighted that a dialogue with the community was essential in developing and implementing interventions, as is careful monitoring and evaluation of interventions via evidence-informed programing.

Looking at another NTD, James Pender from The Leprosy Mission England & Wales gave an insight to WASH with regards to leprosy, emphasizing that often those suffering NTDs face exclusion from essential WASH facilities. He explained the charity’s work in Sri Lanka and Myanmar, stating the importance of not just carrying out mass-drug administration but catering for all of an infected individual’s needs in the long-term, including the provision of WASH facilities for wound care and health.

The final talk of the session came from Alex Dower, from Acting for Health, who concluded by highlighting the many barriers facing behavior change with regards to WASH and suggesting that acting could help break some of these, facilitating the change that is required via an inclusive and informative program.

The session was followed by a quick panel discussion and a morning coffee break, before the focus shifted to technology and innovation in the next section. Michael Templeton from Imperial College London (UK) opened the presentations by giving an overview of his research as part of WISER: Water infrastructure for schistosomiasis-endemic regions. He drew attention to the differences between schistosomiasis and fecal-oral diseases in terms of WASH interventions, and highlighted that safe water must be provided for all needs, not just drinking.

Andrew Wyborn followed, giving the audience an introduction to Greenmash’s Mango platform, which hopes to improve data capture and enable data use – for example, helping in the monitoring and management of mass-drug administration.

Starting discussion more specifically around sanitation, Tineke Hooijmans, from IHE-Delft (the Netherlands), then presented her work on a microwave fecal sludge treatment for sanitization and pathogen inactivation, highlighting its potential benefits in emergency situations where sanitation is one of the strongest determinants of survival.

Continuing this theme with a presentation on container-based sanitation was Luiza Campos from University College London (UK). Luiza highlighted the role that container-based sanitation could play in reaching the sustainable development goals, emphasizing that this strategy takes into account the whole sanitation chain and stating that “the world can’t wait for sewers.”

Concluding the session was Andrew Gibson from Mission Rabies, who gave an introduction to the charity and their partnership with Madzi Alipo Project, which has allowed the rabies community educators to simultaneously gather data on boreholes in regions of Malawi. Andrew emphasized the linking of efficiencies this project has allowed, and the importance of sharing resources and capabilities in WASH and NTDs.

Before lunch there was a second panel discussion and the ISNTD water prizes were presented, representing great achievements in a variety of areas linked to WASH and NTDS. These were as follows:

  • Research award – Eve Mackinnon (University College London)
  • WASH innovation award – John Mullet (Sustainable OneWorld Technologies)
  • Data award – Michael Templeton (Imperial College London)
  • Behavior change award – S-Lab at Providence college (RI, USA)
  • Community engagement award – The Leprosy Mission England & Wales
  • Education award – IHE-Delft (the Netherlands)

Following lunch the delegates split into two parallel workshop sessions, either focusing on schistosomiasis and WASH: what are the gaps? Or looking at accelerating sanitation goals: from data to financing. These gave the opportunity for some quick talks to give participants food for thought, and then an open discussion around the topic area, highlighting some of the priorities.

Then came the final session of the day, which was built around partnerships for global health and WASH. This commenced with a presentation from Adrian Hopkins of AH Consulting, who spoke about mass-drug administration programs and some of the lessons learnt, for example, that health systems in developing countries must be strengthened from the bottom up. He also took the opportunity to highlight that WASH is not just important in transmission of NTDs but also areas such as wound care, stating: “don’t think outside the box, just enlarge the box.”

John Mullet (Butyl Products & Sustainable OneWorld Technologies) followed, presenting an argument calling for a paradigm shift in attitudes towards sanitation in sub-Saharan Africa. He looked closer at the premise of supported local manufacture and the need for new fabrication materials and practices.

Shifting the focus to vector control, Lucy Broom from Oxitec presented on their innovative new solution for controlling harmful insects pests, specifically with regards to mosquito-borne diseases. She outlined the genetically-modified mosquitoes, which contain a self-limiting gene, and presented some results from field trails thus far, highlighting upcoming trials in Brazil, Columbia and India.

In a change of pace, we then heard from Gaia de Battista (Lion’s Head Global Partners) on using innovative finance to support sustainable services in sanitation and water. Gaia highlighted the potential for innovative finance to bridge some of the gaps in funding and emphasized that in most developed countries WASH was historically publically funded, so why do we expect the private sector to step in now?

The conference concluded with a panel discussion, which was joined by Katie Spooner (Business in the Community). This session echoed many of the repeated calls we had heard throughout the day, including involving the community in dialogues about WASH and the importance of behavior change in these at-risk communities.

The day brought together a wide spectrum of individuals to bridge gaps between the WASH and NTD sectors, and attention was brought on the ISNTD as a facilitator for meetings such as this one, which provide a forum for innovative new technologies, informed discussion and most of all a place to learn.

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