WASH Away Neglected Tropical Diseases (NTDs) Guatemala Project

CDC's WASH Away NTDs Activity is beginning its work in Guatemala in partnership with the Universidad del Valle de Guatemala and the Ministerio de Salud Pública y Asistencia Social. A cross-agency team at CDC, comprised of staff from the Waterborne Disease Prevention Branch, the Environmental Global WASH Activity, the Parasitic Diseases Branch, and the International Emerging Infections Program is working with our partners in Guatemala. Collectively, the team is pilot testing a toolkit of questionnaires and protocols during the summer of 2010 that will assess and compare levels of disease in the community with water, sanitation, and hygiene (WASH) status using a variety of epidemiologic, laboratory, and environmental assessment methods. The diseases of interest in this study are intestinal worms (also known as soil-transmitted helminths [STH]), diarrhea, and respiratory illness. This toolkit will then be used in other settings and situations to assess WASH impact and sustainability. It will also form the basic platform on which to add future modules to assess other WASH-related neglected tropical diseases (for example, schistosomiasis, trachoma).

In addition to pilot-testing the WASH toolkit, other outcomes of this study in Guatemala include:

• Evaluating the relationship between WASH status and disease prevalence to:
  • Assess the relative contributions of water, sanitation, and hygiene to the development of STH, diarrhea, and respiratory illness;
  • Develop evidence-based recommendations for the sustainable integration of WASH with STH control programs whereby the disease prevention impacts of WASH will complement existing mass drug administration for STH;
  • Refine a WASH scale that quantifies the impact of WASH and disease risk and can be used to predict risk for disease and monitor changes in WASH status (and changes in WASH-related disease risk) over time.
• Comparing the community-level prevalence of STH, diarrhea, and respiratory disease detected during this study with existing prevalence data for the same diseases collected in healthcare centers as part of the ongoing disease surveillance system in order to evaluate and assess the sensitivity of this surveillance system.
• Describing health seeking behaviors for diarrhea and respiratory illness.
• Providing the Ministerio de Salud Pública y Asistencia Social with information on STH community-level prevalence and STH drug treatments that can help to inform school-based deworming programs using mass drug administration.
• Developing and refining a novel methodology using aerial photographs and geospatial mapping to identify households that can be contacted and interviewed for this study and for future studies in Guatemala.
• Evaluating alternative stool testing methodologies for detecting STH.