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Knowledge Systems for Sustainable Development

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    • Sanitary prevention, a question of training
      • When schools and families work together: some exemplary cases, Loïc MONJOUR

When schools and families work together: some exemplary cases, Loïc MONJOUR

Complementary action added to programmes for the supply of water, for increasing awareness on hygiene and the installation of sanitation infrastructure, can lead to a significant reduction of the incidence of infant diarrhoea in developing countries. Combining the two components: prevention, and the development of social and sanitary conditions, is an absolute requisite in order to deliver safe drinking water and therefore improve the health of a population, in particular the health of children.

A very lengthy and costly study of three schools in Ouagadougou (Burkina Faso) was used to evaluate the consequences of poor quality drinking water and mediocre hygiene on the health of children. The first of these schools (1) was very privileged. It was supplied with potable water, sanitation infrastructure (latrines and areas for waste destruction) and it ran a sanitary education programme about the salubrity of water and of the environment The second school (2) only had the benefit of potable water and some education on the protection of water. The third school (3) had neither potable water, nor sanitation, and did not run any health education programme.

A group of children from each school - living at home with their families in conditions of sanitation similar to those of their schools - participated in a comparative study for six months. The study was designed to determine, on a regular basis, the quality of their drinking water, the presence of bacteria and pathogenic parasites in their faeces, and the inter-group incidence rate of diarrhoea. The differences were significant - school 1 (10%), 2 (36%), 3 (53%) - and were even greater for younger children. Children in schools 1 and 2 had a relative risk of diarrhoea 5.2 and 3.5 times lower than that of school 3.

It appears therefore that associated and complementary action: health education, raising awareness about hygiene, and installing sanitation infrastructure - combined with hydraulic programmes - can lead to a very significant reduction in the rates of incidence of infant diarrhoea.

In contrast, deprived of both information and sanitation, the majority of children in developing countries consume, from one end of the year to the other and with no restriction, unclean water, polluted by environmental pathogens and dangerous for their health.

A major step forward as regards health could be achieved by an increase in school attendance. Less than 40% of African children are enrolled, and girls seldom venture to go to school, particularly in rural areas. Furthermore, the words "health education" are almost never heard in suburban areas and the countryside. In the circumstances, deprived of sanitary information, children and adults, village and peri-urban communities, live in unsanitary environments, both in and out of their homes. They are not given any instruction, nor any rules of hygiene or regulations, to improve their behaviour and habits as regards hygiene at home or outside it, on the one hand; nor their comfort and the health of their community, on the other.

When there are no campaigns for the promotion of public hygiene, nor any significant increase in the meagre financial resources of families, sanitation programmes are often more or less ignored. The paradox is that, even now, an obvious truth is neglected: to hear about good hygienic practices, before and after the installation of sanitation infrastructures, leads to an improvement in water quality and curbs the spread of infectious water-borne diseases.

On the basis of these findings, some proposals for action could be made, in order to improve the quality of the potable water supply and of sanitation, and to combat diarrhoeal diseases:

  • Recommend that all sick people should receive health care. Although this is illusory in view of the economic difficulties of developing countries, the lack of available health care facilities and medical personnel, it remains the first condition for public health.
  • Give first priority to strategies for sanitary prevention, omitting neither health and hygiene education, nor sanitation infrastructure, when working on village and urban hydraulic projects.
  • In these concerted programmes associate decision makers, partners, and beneficiaries: representatives of institutions, departments for health and hygiene, hydraulics, education, sociologists, and above all civil society, since they are all essential to further the quest, step by step, for potable water and health.
  • Encourage a demand for potable water and demonstrate its beneficial effect on health; turn this into one of society's major expectations.
  • Finally, in programmes for the supply of water and sanitation, never neglect traditional lore and the potential for innovation of communities, although at a later stage the local authorities may consent to implement government rules of hygiene and official public health documents.

Before there is an increase in the pollution of potable water due to demographic expansion and frenzied urbanisation in developing countries, it is of the utmost urgency for the sake of public health, to apply the above proposals. Most of all, national and international financial sources must be found very soon for that purpose.