Children's environmental health

Water and sanitation

Hygiene and sanitation

Hygiene graphic

Unhygienic conditions and practices at the household level create a dangerous environment with immediate health risks to children. Also, lack of sanitation facilities in schools helps transmit diseases. Waste dumps sited on the outskirts of almost all major cities provide hazardous environmental conditions to those living nearby, and even more so to those living as scavengers on such wastes. Sanitation interventions, technical and managerial, are badly needed in all areas in houses, schools, and within the community at large. These must be accompanied by the necessary behavioural changes in the child and adult populations, which pose a formidable hygiene education challenge to the health sector.

Trachoma is one of the infectious diseases which are linked to environmental conditions, and is thus amenable to effective environmental interventions. Worldwide there are around 6 million people irreversibly blinded by trachoma and about 500 million people are at risk of the disease. Improved sanitation and hygiene behaviour contribute significantly to the control of trachoma. Through the provision of adequate quantities of water alone, about one quarter of the burden of this disease could be prevented or reduced. Intestinal worms severely affect about 10% of the population of the developing world. Children, due to their direct exposure to soil and other helminth-carrying material are especially at risk, and they are generally more worm-infested than adults. Intestinal parasitic infections in children can lead to malnutrition, anaemia and retarded growth, depending upon the severity of the infection, in addition to their adverse effects on the immune system. Exposure to helminths and hookworms can be effectively controlled through improved sanitation, hygiene and water supply.

Taking action

Further work on the evidence base, specifically targeting children, is required across the spectrum of sanitation, hygiene and behavioural interventions to reduce infectious diseases with an environmental etiology. This entails child-specific research efforts on the impact of alternative sanitation methods on child disease outcome, supported by pilotscale and expanded implementation of highyield health interventions, using feedback from experience to guide future activities. The setting of most significance in the child’s environment is the home and this should be given prime attention. This implies improved household sanitation facilities through affordable interventions, including the development of a sense of responsible ownership and use following the common rules of hygiene. All potential pathways of disease transmission have to be addressed, including drinking-water, safe handling of food, excreta disposal, and personal hygiene. Improved hygiene practices, including both hand and face washing, and safe handling and disposal of children’s faeces should be promoted through educational campaigns in the community and in kindergartens and schools.

Several UN and other organizations in 2000 launched FRESH (Focusing Resources for Effective School Health) to achieve more child-friendly schools. This includes a simple set of core interventions, health-related school policies, provision of safe water and sanitation in all schools, skills-based health and hygiene education, and school-based health and nutrition services.