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Drop-hole covers in Malawi - Menstrual Hygiene in Bhutan: Research Spotlight on Water, Sanitation and Hygiene (WASH)

Operational Research News 
At MSF’s operational research headquarters in Luxembourg, a team of Water, Sanitation and Hygiene (WASH) specialists has kicked off an ambitious research initiative. In eight dedicated studies, they are looking at issues of water quality, sanitary conditions, hygiene standards, and infection control. The findings are geared towards improving health programmes and humanitarian interventions around the globe, and will be published in peer-reviewed scientific journals.

    It has been a busy week for Grace Funsani from Malawi and Tashi Tshomo from Bhutan. They are both attending the WASH course of the Structured Operational Research Training Initiative (SORT-IT) at the MSF office in Luxembourg. “I have been refining my research question, designing a study protocol, conducting a literature review, and asking my colleagues in Malawi for data on sanitation standards – all over the last four days”, said Grace during a short break off her laptop. “But I am now almost ready to present my study protocol in tomorrow’s plenary session”.

    Grace Funsani is looking to analyze a small but important issue observed in latrines across rural Malawi. As the principal environmental health officer working for the Ministry of Health, she is working to improve sanitation coverage and eliminate open defecation all over the country. Visiting a number of communities, Grace and her colleagues found many latrines were not using a drop-hole cover. “This allows insects to enter the latrine’s pit, which in turn pose the risk of spreading fecal diseases”, Grace explained.

    With her research project, she is now setting out to find the roots of the problem. “In some communities, kids seem to leave drop-holes uncovered, but we also found lids that don’t fit properly, and latrines with no cover at all”, she added. By analyzing collected data, Grace is hoping to better educate people on proper latrine construction and maintenance in the near future.

    The SORT-IT courses teach participants to conduct research towards answering operational questions from their daily work. Thanks to close mentoring and a follow-up workshop for writing the scientific paper several months later, almost all studies get published in peer-reviewed journals. The findings then are used to improve their health programmes and provide evidence for advocacy with managers and policy makers.

    The SORT-IT approach was developed by Médecins sans Frontières and The Union Against Tuberculosis and Lung Disease, but has been adapted since by the World Health Organization and held with different thematic priorities all over the world. This is, however, the first time an entire course is focusing on WASH topics.

    To fight malaria, cholera outbreaks or an Ebola epidemic, safe water, adequate sanitation and appropriate hygiene are well known to be key factors. Yet WASH issues remain understudied in other areas such as nutrition, maternal and child health, or HIV/Aids. “With our dedicated training for WASH specialists, we are aiming to mainstream water, sanitation and hygiene further to medical interventions in organizations like MSF”, said Peter Maes, the leader of MSF’s WATSAN working group and faculty member of the course.

    A case in point is Tashi Tshomo’s research project. As programme officer working for the Ministry of Health in Bhutan, she is assessing the knowledge, attitudes and practices around menstrual hygiene management among college-aged women.

    Persisting taboos and misconceptions make menstruation a delicate and rarely discussed topic in low income countries around the world. “In Bhutan, menstruating girls and women often do not haveenough knowledge of how to manage their period safely and of proper disposal of sanitary materials”, Tashi explained. “By evaluating existing infrastructures and hygiene practices in colleges, we are ultimately hoping to better educate women and girls, and to improve sanitary facilities”, she added.

    With the first week of the WASH-course coming to a close, Grace and Tashi, together with their fellow participants, are preparing for a second week of learning about data management. Following this, back at their work places in Africa, Asia, and Latin America, and South Eastern Europe, they will start data collection and analysis. The final week of the course will be the writing workshop in mid-2018  and one month later the manuscripts will be submitted for publication.

    Studies from earlier SORT-IT trainings and all published operational research conducted by MSF are available at http://fieldresearch.msf.org/.

    Main picture: Safe water supply, adequate sanitation and appropriate hygiene are well known to be key success factors of any health interventions. Picture taken at Lake Chilwa in Malawi during the 2016 Cholera Response. © Aurelie Baumel