Why water, sanitation and hygiene matter

Water, sanitation and hygiene (WASH) are crucial but often underplayed parts of the prevention and control of a number of neglected tropical diseases (NTDs). Access to safe water and adequate sanitation, together with good hygiene practices, can reduce the transmission of some NTDs, for example trachoma and intestinal worms (page 29). Trachoma is transmitted by flies, fomites (e.g. skin, hair, clothing, or bedding) and direct contact. Preventing transmission of trachoma can be achieved through access to clean water, appropriate hygiene practices that promote face washing, and access to proper sanitation for the disposal of human waste. Intestinal worms, which affect nearly 900 million people worldwide, is most prevalent in communities where people have inadequate access to toilets and/or hand washing facilities. Worms are transmitted through faecal-oral contact or enter through the skin of the feet in areas of open defecation. Access to safe water and adequate sanitation will help communities affected by both trachoma and soil-transmitted helminths (STH) to escape from the perpetual cycle of infection and reinfection. Some global1 and disease specific2 strategies have integrated WASH interventions into their programming guidelines. In the case of trachoma, for example, the inclusion of the ‘F’ (face washing) and ‘E’ (environmental improvement) in the SAFE strategy formally acknowledges the strategic importance of incorporating WASH interventions for disease elimination.