1. DBL approach to water & health research and development Karsten N. Kryger

2. The DBL approach… Mandate: To generate and disseminate new knowledge, tools and methods for disease control To build research capacity & institutional capacity for disease control Focus on Research into practice …and practice into research

3. Case 1: Study of risk factors for intestinal helminth infections in Western Kenya Main problem: High prevalence of helminth infections Objectives: To reveal relationship between sanitation practices and intestinal helminth infections as well as the perceptions of disease. Approach: Epidemiological and anthropological

4. Case 1: Study of risk factors for intestinal helminth infections in Western Kenya

5. Result of the epidemiological study: Lack of latrines (Odds Ratio 1,9) Lack of soap (OR 2,7) no. of inhabitants in household (3,2) presence of children under 5 years (3,8) Perceptions of risk according to the anthropological study: Latrines perceived to reduce disease by some, not all Lack of latrines not perceived as particularly hazardous Violation/transgression of social &cultural norms perceived as cause of disease

6. Case 2: School based control of bilharzia (urinary schistomiasis) in Eastern Tanzania (1995-2001) Main problem to be addressed: Very high prevalence of bilharzia infections among school children (morbidity > 50%) Objectives: To reduce bilharzia infection among school age children

7. Case 2: School based control of bilharzia (urinary schistomiasis) in Eastern Tanzania (1995-2001) Project activities Diagnostic survey & Selective treatment –Implemented by school teachers and coordinated by the District Health Management in collaboration with the District Education Officer Sanitation –Involvement of parents and communities Post treatment survey 30 months after the last annual round of treatment, in the year 2001

8. Case 2: School based control of bilharzia (urinary schistomiasis) in Eastern Tanzania (1995-2001) Findings at the post treatment survey in 2001: Teachers were still able to perform all of the activites related to the programme, although they had not been trained since 1999 The improved sanitation installed in the schools between 1995 and 1999 had been maintained and extended Few schools had any latrines in 1995, they each had at least two functional latrines by 2001

9. Case 2: School based control of bilharzia (urinary schistomiasis) in Eastern Tanzania (1995-2001)

10. Case 3: Bilharzia Control Programme in Lake Shore Communities of Lake Malawi Main problem to be addressed: Very high prevalence of bilharzia infections (morbidity in excess of 40%) Objectives: To reduce bilharzia infection in five health centre cathment areas Model for bilharzia control (prevention, treatment, water & sanitation, education & communication) Multisector cooperation (health – environment –water & sanitation) Stakeholder involvement (schools, villages…) To enhance research capacity Cross disciplinary (medical, biological & social sciences) Cross institutional (health centres, district hospital, district environment authorities, Univerisity of Malawi)

11. Case 3: Bilharzia Control Model – The Elements Treatment campaigns School level and village level Village based drug revolving funds Water & sanitation Safe dringing water reduces human infection Sanitation reducing contamination of water bodies Washing slabs with safe water Environmental management Removal of vegetation behind shore line Education and information Theatre, shows, dances, songs, health in curriculum Epidiomological monitoring

12. Linking research to public interventions in health, education, water & sanitation Some lessons from the cases Building research capacity in relation to public interventions can - greatly enhance generation of knowledge critical to success - improve effectiveness and cost efficiency of public interventions & investments Crossdisciplinarity gives high value Teachers, when trained, can sustain health education … and even treatment campaigns if supplied with required drugs