 Great. Welcome everyone to this first seminar or the webinar of the One Health and Wash Network with a theme, Making Links Between Sonosis, Food, Production and Wash. My name is Kristina Osbiet. I am working as a researcher at the Swedish University of Agricultural Sciences and I will moderate this webinar today that will focus on One Health Perspectives to address Overlook Links Between Sonosis, Food, Production and Wash. And as I mentioned that the webinar is organised by the newly started One Health and Wash Network. The network is under development and you will hear more about it in the first presentation by Saira Dickin. And the network will organise a series of open webinars during 2022. We have quite an intense schedule ahead of us and we have three very knowledgeable speakers and some time for questions as well. Practicalities for you, please keep your microphones muted throughout the webinar. Questions for the presenters are preferred to be posted in the chat. You can write your questions in English or in French since we have some French speakers here today as well. And the posted questions will be read out to the presenters after the presentations. And you are very welcome to post your name, your affiliation and your country in the chat so that we see who is actually joining the webinar today. The webinar is recorded and a link to the webinar will be posted on our network page and we will also post the PDFs of these presentations. We are working on establishing some kind of newsletter for more information sharing on the network events. With that, I would like to invite our first speaker which is Dr Saira Dickin who has a background in health geography and is working as team leader on Sanitation on Health at the Stockholm Environment Institute, SEI. And Dr Saira will provide an introduction to our One Health Wash Network and also to the concept and the linkages between One Health and Wash. Over to you, Saira. Great, thank you. Can you see my presentation? Yes, we see it very well. Okay, great and hopefully the sound's working and getting a message about for network but let me know if there's any issues. So hi everyone and thank you Christina for that introduction. So yeah, I based at SEI. SEI is one of the coordinating organizations for this recently started network on Wash and One Health together with SLU. And I just want to give you a bit of a background today before we get into our two cases that will be presented about the network, what we're planning to do and also about why today's topic is so important. So this network was recently established. It's about a one-year project to build up a network of international and transdisciplinary collaborators working across One Health and Wash issues. So this means it includes people working on veterinarian science, agricultural sciences, gender and development studies, public health wash issues and so on. One of the aims is to develop proposals for work beyond the initial network period. So the network is really aiming to kickstart things and to lead to more collaborative projects among members and also to create a space for science to policy dialogue. So seminars like today, discussions to further collaboration and so on. We have a number of activities that we're planning for this network. So one of those is regular engagement through seminars like today's seminar, which is the first one in the series. We have a few more planned for this year on different topics. We're also planning to do some scoping studies looking at some of these issues, particularly in three countries that are involved with the network, which includes Kenya, Burkina Faso and Mozambique. We're planning some workshops in order to support proposal developments for both research and capacity building initiatives. We'll also be producing some reports that come out of these other activities and also probably some briefs and some materials about sort of our view of how Wash of One Health can be better connected. So this is what you can expect over the coming year from the network. And now I want to provide a bit of a background for today's topic. So one of the challenges with bringing together actors from the One Health sector and Wash is that we often have different starting points, different language in ways of talking about things. So I wanted to lay some things out for everyone to be on the same page. So first of all, when we say Wash, what are we referring to? This refers to a suite of interventions that are often grouped together, which includes drinking water and household water and includes sanitation, which is partly about toilets, but it's also about safe management of human excreta along the entire chain. So that's also collection of waste, management of waste, treatments, potential reuse or disposal in a safe manner, and then also hygiene, which can include hand washing with soap, but also other forms of hygiene like menstrual hygiene, food hygiene, environmental hygiene, and so on. So in the Wash sector, one of the biggest challenges that we're facing today is the lack of safely managed sanitation services. So nearly half the world's population lacks these safely managed services. And almost $2 billion actually lack basic sanitation services. So this is an even lower rung on the so-called sanitation ladder. And then of that, 500 million people still practice open defecation. And so what this presents is a big challenge in terms of widespread exposure to human feces and related health risks related to diarrheal diseases and other types of and other types of enteric infections. Diarrheal diseases is a huge public health threat. It kills around 1.45 million people a year, and it disproportionately impacts children under five. And diarrhea also contributes. It's one of the leading causes of malnutrition as well because of the links between diarrhea and stunting. You can see some progress is being made here on this chart on the right. But progress is still quite slow in terms of improving sanitation access. So what about one health? Some of you might be familiar with one health. But overall, it's an approach which aims to balance the health of people, animals, and ecosystems. It recognizes that these are all interconnected and intrinsically linked. The health of humans, animals, plants, and the wider environment are all interdependent. And one health usually takes an intersectoral approach and also working across different levels, so from local, regional, national, and global levels and so on. And one of the big challenges for a one health approach or a reason to apply a one health approach is to address the burden of zoonotic disease. And these are diseases which threaten both the health and productivity of animals, people's livelihoods, and also cause a range of diseases and burden of disease in humans. So when we look at exposure to animal feces and the health risks here, well, first of all, food animals actually produce four times more fecal matter than humans. So there's actually a much larger challenge here. In high income countries, this leads to exposure through animal food production systems. And in low and middle income countries, exposure can occur in food systems, but also in the domestic environment itself. So in many households, you can find domestic animals, particularly Southeast Asia and Africa. So there's very close interactions between humans and animals. And this is good in one sense that livestock provide an important source of food and health benefits for food security. But then also there are health risks with this close interaction. And so there's there can be zoonotic transmission of enteric diseases as well. And these have been a little bit overlooked, actually. So why are we trying to link wash and one health? What are the connections? Well, wash approaches traditionally just address the human aspect of one health. So they provide sanitation services to protect humans from human excreta and the risks there. But we think that there are there's potential for much broader linkages that wash approaches can actually support one health in all three dimensions. So this includes reducing the burden of pathogens and organic matter entering the environment that can cause ecosystem degradation. And that's both from animal excreta and human excreta. But also wash approaches can help reduce reduce pathogen transmission between animals and humans. So it's not just about human excreta. There's also potential to reduce risks from animal excreta as well. So why is this interconnected approach so important? So one reason, as I've said, is that there's a large burden of real disease, both from human and animal origin and potential to address this together. The global emergence of AMR is another challenge. So AMR is important from both a human health and animal health perspective and washes a kind of upstream intervention that can help to reduce infections in the first place. Another reason from the wash sector is actually that there have been a number of high quality trials that have been done in recent years where the expected decreases of diarrhea and stunting were not actually found. So the expected health outcomes were not observed. And one hypothesis for this among a number of reasons is that these interventions, so they were just addressing household water supply, sanitation and hand washing with soap, was that they didn't address exposure to animal excreta and that this then meant that there were still a number of different transmission pathways leading to risk of diarrhea, particularly among children. So without addressing animals, these interventions were not really doing enough. So what's being done at the moment? Well, we can see in the WHO guidelines on sanitation and health that they do promote an approach with coordination with other interventions. So beyond sanitation, also water supply hygiene and animal feces. So this is included here in these guidelines, but what we see in reality is that one health approaches are rarely applied in the wash sector and animals are not really addressed. So there are many gaps in understanding the complex transmission pathways and behaviors and wash interventions alone are considered complex interventions because of the different interactions between infrastructure, technology, behavior, institutional aspects and so on. So then thinking about how to also bring in animal aspects, management of animals, food production and so on adds another layer of complexity. But some final messages, we need to address this complexity. Animal feces do present a risk, particularly for children, but they haven't been addressed in the wash sector. At the same time, many one health practitioners and researchers don't formally work with wash interventions. So maybe they have some components of that, but it's not formally addressed and there aren't necessarily collaborations between those two groups of actors. So we really do need a one health approach for wash and that can help us with risk prioritization. So to understand where we should put most of our attention when there are limited resources for interventions, for example, to know where, what presents the greatest health risk and also to coordinate interventions to ensure that they're more effective. So what we're proposing with this network is to move from wash. There has been two proposals to include animals as part of wash with the letter A because that doesn't actually stand for anything in the acronym. But we also think that we can go beyond just animals and really take a more integrated one health approach. So one health approach to wash not just thinking about animals but thinking about the environment and all the different interlinkages. So that's a bit of a background for today's presentation. And I'll just end by reminding you that we have a few more webinars that will be coming up on other related topics. So we'll have a webinar coming up focusing more on aspects of AMR specifically and then another one on environmental dimensions of one health and wash. So stay tuned. We'll have more information about the dates of those webinars and the presenters that will be coming up after this one. So thanks for your attention. I'll pass it back over to Christina now. Thanks a lot, Sarah, for providing that introduction both to the network and to the concept of why we need to look more into the linkages between one health and wash. And for those of you that have joined during Sarah's presentation, you have joined the One Health and Wash Network first seminar, meeting with a team making links between synosis food production and wash. Please introduce yourself in the chat and please be encouraged to post questions to our presenters in the chat as well. Our next presenter is Dr. Elizabeth Adikuk, who is a veterinary epidemiologist who is based at the International Life Stock Research Institute in Nairobi, Kenya. And she is also affiliated to the University of Liverpool. Dr. Anne will present to us data on an ongoing research study in Mozambique in Kenya that is looking at urban infant food scapes. And Anne will present some of the data from the dagorette sub-county in Kenya. With that, Anne, I would like to hand over to you and please share your presentation. Thank you very much, Christina. Oh, I'll just make this presentation mode. I hope everybody can see my presentation. Perfect. Okay, hi everybody. My name is Anne Cook. I'm a veterinary epidemiologist at Illry and I'm going to be discussing today an ongoing project, as Christina said. That really fits into everything that Sarah just described. So I might actually skip over some information as we go because you'll see as I describe it how well it kind of covers that one health and wash approach. So I'm based at Illry and this is a collaborative project across two countries. So the collaboration is between the London School of Hygiene and Tropical Medicine and Illry and SISPOP in Mozambique. So we have a study site in Nairobi and a study site in Mozambique. It's funded by the Bill and Melinda Gates Foundation and FCDO in the UK. Oh dear, let me try and advance these slides. Okay, so just a brief overview, a little bit of background on foodborne disease, although Sarah did cover this quite well. And then mostly about the study design of the Urban Infant Foodscapes Project and I'll spend quite a little bit of time on the design because as we said it's an ongoing project and the results are preliminary but interesting from that livestock one health wash aspect as you'll see. So just run through the aims and the study sites where we do the research of what we call the domains at the data collection tools that we use some very preliminary results and what we're planning for next. So as Sarah said foodborne disease it has a very high burden globally with over half a billion cases a year and the burden is predominantly in young children and in low and middle income countries and it's a second most common cause of preventable illness and death among children and we see a relationship with the children, weaning children moving from breastfeeding to solid foods and drinking water because they're losing that passive protection that they gain from breastfeeding. So what are the causes the foodborne disease results from ingestion of foods that are contaminated with other microorganisms and chemical or chemicals and we've got a table below with a list of some of the key ones and many of these are actually zoonoses and the contamination can occur at any stage in that food production process either at the site that the food is grown or sold through to consumption and then the the contamination can be from the environment from water, soil, air or obviously from people handling the food. So we have a I'll explain shortly TacMan array card that will test for all of the pathogens that are listed under bacteria viruses and parasites in the samples that were collected. We're not specifically targeting chemicals but I'll explain that in a little bit. Sorry that they're the ones in the box. So what are the risk factors as Sarah described there are many associated with washing sanitation so poor personal hygiene inadequate sanitation food handling animal contact contaminated water or cross-contamination from other foods particularly chickens and the use of surfaces to like pulp sorry chicken meat we see that quite commonly in all situations. So the urban infant foodscape what is it all about and how did it come about so the aims of this project were to look at the foodborne burden in young children in low income high density urban environments and the aim was to look at a cross sectional study so it wasn't just disease we were also looking at the possibility of enteric carriage of these pathogens in the gut of asymptomatic children so it was a cross sectional study and I'll spend some time describing that so it wasn't targeted at children with diarrhea which many of these studies are so we were to measure the microbial contamination of the food that was consumed by these children and then to understand the risk factors foodborne disease in the children and to look at those risk factors both at the household and these are the domains I'm talking about the household the local market and also from the supply or production chain and finally using all that information from the first three aims and objectives we were our plan is to design and implement a locally appropriate intervention that that will address the exposure to micro microbially contaminate microbially contaminated foods okay so our study sites as I mentioned it's a it's a multi-country study we have a study site here in Kenya which is on the within Nairobi county it's actually in Daggereti south sub county and we selected two wards to work in Uthiru Ruthamita and Buruta we have a sister project in Mozambique I won't speak about that today they are just starting their data collection hopefully very soon so we don't have any results but the design is very similar so we'll concentrate on Nairobi today we selected these sites because they're peri urban on the edge of Nairobi particularly and the households tend to be overcrowded and the living environment there's limited wash infrastructure there's quite a bit of livestock keeping which we'll talk about and and there's challenges within these environments and we believe there was a high risk of foodborne disease or hypothesized that so as I've mentioned previously there are four domains there's the child and we specified the age group of children that we wanted to sample is six to 24 months so these are weaning children there's the household the market and the producers or suppliers so just talking about the child and the household first now as I mentioned to you our study site was Daggereti South sub county and in those two wards so within the wards we worked with the the community health structure so within Kenya we have a structure of a government level public health promoter let's call them called a community health assistant now under them are about one for each of those are about 100 volunteers called community health volunteers and they are responsible for health promotion around vaccination nutrition maternal health within their community so these community health volunteers live within the community and they're active with promoting vaccination and and nutrition we we worked with the sub county government to get a list of those volunteers once we had the list we made a random selection of 100 community health volunteers and each community health volunteer provided a list of the households that they were responsible for now most community health volunteers are responsible for about 100 households so so we ended up with about 88 community health volunteers who who were enrolled in the study so a large number of households but obviously they're responsible for about 100 households but not every household has a child less than two years of age so it range from about 10 to to 40 households that had children in the age group and then from those this we randomly selected seven per household um so a little bit over 600 households to to be involved in the study and we we had we'll speak in a little bit about how successful we were recruiting the households so when we reached the household what were we actually going to do so we had a nurse on the study who went together with the chv to each household was introduced they carried backpack full of materials with them to collect both questionnaire data or survey data using a questionnaire tool on a tablet and then other samples so the first step was the survey that they administered to the caregiver of the child um and that had questions about their age the foods that they ate their food preferences where they bought those foods um where they sourced water whether the child had been on well recently or on any medication and any other risk factors we collected a food sample now this food sample that we collected from each household was a ready prepared ready to eat food so what the child would eat at the next meal or the next time the child needed a snack um and so those samples varied from from yogurt to um you know to uh to vegetables to beans to it was a large variety of food types um then uh we collected a water sample from the household we collected a dried blood spot from each child um we were in the field so we didn't want to do a menous blood sample it was much easier to to collect the blood sample from from a finger prick onto a protein saver card um and we collected a stool sample and this was a voided stool sample so we would leave a packet of diapers with each caregiver and instruct them on how to use them and then they we had a motorbike rider on call and so as soon as the child had passed stool um and there was an hour there was a time limit on that so that the stool reached the the lab in time so it was only if a child passed still between 8 a.m and 2 p.m that we would take the sample and then the rider would pick up this the diaper with the voided stool and and deliver it to the laboratory um right away so unfortunately and the reason for selecting the study site you know actually in some ways was that it's very close to our laboratory so we didn't have long delays in getting those samples to the laboratory and getting them processed we also collected vehicle samples from any livestock who are in the compound I've said compound here because not every caregiver owned livestock but their neighbors often did so we recruited um some of the neighboring households where the the livestock might have been free roaming in the compound and then the children would have been exposed um to those livestock or at least had contact with them we then went on to do observations of the household food preparation this was quite an intensive process where we asked the caregiver to prepare food um and usually took a couple of hours so we did that in about 100 households uh we finally did focus group discussions with 100 caregivers so 10 focus group discussions with 10 caregivers each to um to get ideas about how they prepare food what they thought the risk factors were for contaminating food what their food preferences and where they purchased food and finally um we actually felt and when we did the study design it was pre-COVID-19 uh so we thought that day care centers where children in this age group were dropped off might also be a place that children could be exposed to contaminated food and so um we recruited day care as well but with the COVID-19 outbreak we uh there was a change in in people sending their children to day care and so we weren't as successful at recruiting those day care centers as we'd hoped but we certainly found them just a little it was a little harder than anticipated and then I just the next domain that I talked about was the local market so we would ask the 100 so we um the target sample size was 500 households with 500 children recruited um and we um but then randomly selected 100 households to participate in the food purchasing observations sorry to participate in the household food preparation observations and we asked the same caregivers to go shopping so from our original questionnaire data we identified seven key priority foods I apologize I haven't listed them here but they were milk motoki which is a type of cooked banana rice porridge fruit vegetables and ugali which is a maize meal that's commonly consumed here so we had seven priority food groups when we went to the household and we observed the food preparation we'd asked the caregiver to go shopping um and to buy something that they needed in the house within those seven priority food groups um and then we would actually purchase a sample from the mother after she'd done so we'd observe her purchasing the food and how she carried it and ask her some questions associated with that him or her actually it was a caregiver um but and we'd also collect um a food sample for testing and then finally uh the idea was to follow the value chain of these child foods back to the producers and suppliers it ended up being a lot more difficult than we anticipated because the venus couldn't always tell us where they purchased their foods because obviously it changed seasonally um and we were trying to identify uh producers that were within the study area where we might be able to implement an intervention because obviously if the producer was in a different county it would be hard for us to implement an intervention along that value chain so uh in the end what we did was use our community health volunteers to identify uh producers who were in the study area and were likely to supply to vendors so we didn't have a direct link but these um uh often uh small holder farmers who have a small number of cattle and milk their cattle and sell it at the farm gate um there are also some the toky growers or um vegetable and fruit sellers now we because that didn't cover all our seven priority foods the ones I mentioned particularly for rice porridge and ugali maize flour we then followed up at a local market where um where the vendors said that they purchased their their supplies and so we went to the markets and we identified suppliers of those produce and we sampled from them so that was an observation of how they handle the food from the producers and suppliers and an SSI as well as sorry a semi-structured interview and then a collecting of food sample for processing and then finally this is a very big study as you can see um so there's still a lot of analysis to do we have um the household survey and all the risk factors to analyze um we have the food samples to process and we have some preliminary results from that so in country we culture for salmonella, chigella, any coli and campylobacter and we're also doing PCR for cryptosporidium and norovirus you'll notice that most of these are also zoonoses uh later these samples both the food and the stool will be sent to LSHTM in the UK where attack man array card will be used to test for all those pathogens that were on that third slide that I spoke about the ones that that we haven't tested for so far we also took a house on water sample for E. coli and there was the blood spot that I spoke about and that will be tested for antibodies to infectious diseases and then we had livestock samples and we cultured them the livestock stool samples were cultured for salmonella, E. coli and campylobacter and then all of the SSIs the semi-structured interviews and observational data will be used to understand the risks of foodborne disease okay um oh and my slide's on a bunch there we go so preliminary results um as I said our target was uh 500 households we actually reached 590 um we went a little bit over our target and the reason for that was that we didn't expect people to be particularly compliant with the stool something because of the way we did it leaving a diaper and getting them to call us um and the blood sampling and in fact we did have some issues around blood sampling with particular religious groups um and and one one notable occurrence where we we had to actually destroy a blood sample that had already been collected because um the the one of the the the initial caregiver had consented but then another parent declined so um so it was challenging and we didn't have everyone um consent to every process but I think we our target was 500 and I think considering the limitations we did recently well um so this table's quite busy so in the first round which is the young children and caregivers as I said there were 590 households but then when we moved into the observations we did a random selection of 100 um and actually reached 109 households and then for the post purchasing not every caregiver wanted to go shopping so we have 97 post purchasing um observations and 97 food samples so whilst we were going to do the post purchasing observations and sampling we actually interviewed the vendor at the same time to just kind of we had teams we had seven teams in the field every day so it was easy to try and tie these things in together so if the caregiver was going shopping we'd go with that person do the observations for the purchasing and then do the vendor observations at the same time and so we have but not every vendor consented so we have 84 vendor observations and and and interviews uh now the the producers um as I explained earlier a little bit more challenging but we were able to identify 36 producers and as I said they're mostly fruit vegetables and and milk and then we we filled the gap regarding the dry goods let's call them the rice matoki the maize flower um at the markets so I'm just moving on so preliminary laboratory results and I think this is what might be really interesting um given what Sarah was talking about so remember this is a cross-sectional study so you're not going to expect particularly high premises of these bacterial pathogens in children because most of the children are healthy um and they're not presented to a hospital with diarrhea so and our results um are consistent with what we would have expected so if you look in the first column of children we had 541 stool samples and uh we had a prevalence of campylobacteria 5 percent E. coli a 15 to 73 percent and chigella and salmonella were a lot lower um now I didn't mention we have a study or within a study um to pathotype all the E. coli so we did culture E. coli and you would expect to find E. coli but not necessarily pathogenic E. coli so we haven't done that work yet so when I say here that 86 percent of children were culture positive free coli that's every E. coli but we are still doing the work to pathotype that um food samples interestingly quite a low prevalence of the pathogens that we looked for by culture this is so we this does not include the PCR work that we're going to do for cryptosporidium or norovirus or the tac man array card so at least culture positive results um were were uh were not particularly high um and not surprising because some of the food is cooked so um you wouldn't you may not be able to culture the bacteria so it will be interesting to see how this differs to the to the more molecular based approaches that we're planning for and again we've we found quite a lot of E. coli whether this is pathogenic E. coli um we still need to determine now interestingly in the livestock so livestock is kept by about a third of households in the study area um as I said we didn't just sample the owning the households that were recruited we also sampled the um the the neighbors um and we found quite high prevalence of campalabacta and E. coli 157 but very interestingly low prevalences of salmonella um can you please try to wrap up oh yeah I'm just finishing sorry sorry I would just close up so so I've said this already just about the discussion that low prevalence of non-typhoidal salmonella in Kenya is is consistent with other studies in the high prevalence of campalabacta in chickens and pigs has been previously reported um and as I said the the food sample analysis is ongoing um so we still have quite a bit of work to do on the path of typing we're also doing some AMR work on all these culture bacteria which uh there are two students working on at the moment which will be very interesting to see um the the resistome for these bacteria um and then obviously I've spoken about the other tests we still have to do all of our risk factor analysis and then the intervention design and testing which is planned for this year and will be guided by our results as well as key stock the stakeholder interviews which we're planning for this year so just to thank everyone it was a big team and a lot of work anyway thank you very much thanks a lot Anna you didn't have to rush through it that quickly it was just a warning that you're reaching the end thanks a lot for that very interesting presentation um fascinating to hear that you were actually using motorbike riders on call to collect stool samples whenever it was needed I've never heard about that before um yeah we have a question um from Sarah in in the chat um on what type of interventions that you are type of interventions that you are expecting to use in the study oh that's a very good question and I'm not really sure that I'm in a position to answer that so we we are still processing all of these samples and the data and and we do want to use that together with our stakeholders to guide the interventions um obviously when we proposed the study the idea was to think about interventions all along the value chain um to in and where they might be most appropriate I think we'll still try and do that um and base that on on the on the results that we have so um yes that that's here to be determined so watch this space thanks thanks a lot Anna do we have any more questions I I don't see any more questions in the chat and this is a perfect opportunity to ask any all the questions if there are no more questions from the audience I might ask a question when it comes to the methodology of the study as I noticed that you would both do an interviews and you also did observations um often there's a big discrepancy in when you do interviews that people think they are doing things differently than what they actually do in observations so maybe you could elaborate a bit on the differences and similarities that you observed through your interview studies and your observations so so I can't quantify it because we haven't done that uh that analysis but you're absolutely right which is why we triangulate it I'd like this so we have we have kind of three approaches we have a kind of data collection tool that was quite formal and then we have the observation tool and then we have the um so the first one was quite structured yes no kind of type answers and the second one was observations which the nurse would do just sit and observe did the did the caregiver wash their hands did the did the caregiver wash the instruments where did they prepare the food what kind of surface where the implements wash that kind of what were they washed with so that was the observational data and then there was the SSI the semi-structured interview which asked the the caregiver did they do those things and yes you're absolutely right so often what was observed and what was said um were were quite different and which is why we use the multiple methods approach because we did expect that when you ask someone if they did it they would always say yes um and it wasn't always the case so so we didn't make those observations to try and see exactly what people were practicing rather than what they were reporting thanks a lot and thanks a lot Anu looking forward to see the the results coming out of this project a very interesting one both the Kenya one and the Mozambique one with that thanks a lot for joining us and for presenting and and I would like to introduce our next presenter Mr. Abdullahi Pedi Omka from Burkina Faso who has a background in nutrition and wash and is working as field coordinator at Africa Santé in Burkina Faso Mr. Abdullahi will present data from the Elsevier project um on sorry I lost my my data here so yes on the on the Salivar project in Burkina Faso that is focusing on reducing the exposure to animal excreta as a part of wash initiatives in the community led total sanitation approach. He would use a mix of English and French so those of you who don't know much French this is a perfect opportunity to learn a bit of French and of course questions can be posted both in English and French and with that over to you Abdullahi very happy to have you here okay thank you everybody it's a pleasure for me to to try to share with you our experience in the Salivar wash approach in Burkina Faso next next hello story of the lights it's uh it seems there is a lag um now now it came do you see it okay um yeah okay um Salivar uh mean uh something like uh to stand up to stand up as you know with malnutrition with malnutrition can we can the children and limit their capacity to stand up so we try to to found this acronym to to to give the name of this project in English it's mean supporting family farming to to to launch poultry farming and enhance the rural economy and if prey and afric sunday are responsible to to do the impact evaluation and the implementation is did with uh by uh tenager one year and uh the part of wash is uh lead with local and just we say is uh apis next next yeah um uh Salivar project is a uh an integrated project which combine uh uh agriculture mainly about uh poultry production by the woman with uh the training of them uh to improve the access for credit for the we've for the woman to to to do this uh farming and also encourage them to to do vaccination of poultry and uh the second component is uh behavior behavior change communication in in in in on good nutrition uh which combine um infant and wheelchair and young child uh feeding practice and uh pregnant woman uh yet and uh we hope we've um we hope uh truth the the consumption of eggs and meat by the children will contribute to to to reduce uh malnutrition uh conversely um if the poultry production in an uncontrollable manner risk uh aggravating the already precarious Asian condition in rural alia in Burkina Faso and can then limit the achievement of the project objective as you know in the pathway of malnutrition the rule of uh poor isan can can occur the the malnutrition so isan is considered a key tool to reduce the area and uh uh and teropathy uh and very far also uh malnutrition next indeed uh preview study and affirmative results were we did in uh 2016 uh by if we've if pre uh showed that uh in the in the pre-region we showed that uh children and poultry shared the same space in 91 percent of households in uh 69 percent of households the compound required sweeping at the time of the survey and chicken dropping were visible in uh 70 percent of households uh as you know in this condition uh the the children can be easily uh in fact we've uh we've uh uh we've taken uh a scrota uh if they ingest uh the extractor which is uh mixes in the sand in the in the in the area and only uh 59 percent of households had functional latrines next uh human extractor was visible in six percent of households that is mean that uh children uh uh don't use uh something like box to do the the extractor by do it in the open air um in 58 percent of households livestock add access to the main source of drinking water um we also observe that uh 58 percent of children defected in the open the faces of only uh 30 30 percent of 13 percent of children had been thrown into a lottery we also observe low practice of n washing in at the k moment and a weak drinking water protection or water treatment next uh so uh what approach we try to use to to fight again this condition this poor isian condition the main intervention in the celibate approach project concerned the strangen of local poultry production has we we see it in the previous slide so then we we try to add a a wash component was implemented for our the intervention village we will see it uh at the follow slide in the wash village a cell test approach with an additional livestock component was denied and used uh we contracted with uh local NGO uh wish name is uh rps and which is specialized specialized in cell test for this activity next here we have the our study design uh or to go directly i will say that we we we had at the finally um 60 uh municipality which we we are divided to two group uh the first group is the treatment group which received the uh celibate uh intervention uh 30 municipality and we have the control village uh which are uh 30 municipality uh which constitute the the control community so this is the the first level of randomization to to compare the two group and in about our presentation we will focus on the the the red square where we you can see this is in the second level of randomness and and we add in the the half village or treatment village we we had a wash component which includes cell test and at the end we can compare this group with the sample celibate group and also with the control group next yeah here we have the map of of our study area and you see in the yellow color we have the control group and the green color we have the the treatment group next so as i said in the in the previous slide in addition to the traditional model of cell cell test based on the management of human waste uh that mean uh build and use of light lettering we add the management of poultry manner has been taken into account in the process uh that's mean but we we we add in this process in the traditional process of cell test we add the quantification of animal dropping during the pressuring uh there's this for animal dropping during the environmental work taking animal dropping into account when mapping excreta use of animal dropping in the uh diggers discuss test estimation of health expenses due to the disease linking to poultry dropping next yeah this part is concern the the step of uh of cell test process at the first uh a APS team uh went to the village and visit the condition of uh of uh hygiene and try to meet the leader of the village to explain why what they have to do in the future and we also have a break right during in which in which step we try to collect information uh about uh about uh hygiene uh condition next next yeah here is the main part of uh cell test uh where we do the the pressuring and the first step is to do the village map where the the emphasis on is on defecation area and animal dropping uh very dirty as you can see it in the the the two maps um and uh you see uh at the the left you have the adult uh group and the right right you have the children group uh and you can see in the both uh map that uh the yellow coloration is about uh um human pop in the bushes and the red is uh human pop around compounds and black is uh animal faces uh around this area next um after that we try to do pop estimation this consists of calculating the quantity of pop product produced by the community and the quantity of animal waste per day per week and per year uh we try also to to to visit place of defecation open air defecation latrine and water point we try to encourage uh and ask comprehension question while avoiding guiding the community uh we also visit some compounds in order to appreciate the state of aijen and to see the way in which domestic livestock are managed next yeah here we try to do something like uh a test of uh disgusting uh in the the the left you can see that uh we try to give someone water and he he don't he don't like to to drink it because we will put this water nearby uh the faces and the fly go on the and the face and come back to the water and then if he see it he refused to consume this water uh and the right you can also see uh the see the food nearby the faces human faces and uh animal faces so uh people will also see the fly uh wish go to the to the to the faces and come back in the food uh and then if you invite them to eat it very refuse but we can in this part tell them but you refuse to eat it now but daily every day it's like this you eat because you you you do the defecation in open eye and the the the fly go in this way and come back to your food and you eat it uh every day next we try also to to to estimate uh a medical expenses um and at the end uh we have something like uh children's advocacy after the child advisor two or three children will speak on behalf of all to convict to convey their message to the the parent the parent will in their turn give an answer to to to children who will return to sit down to follow the rest of the activity in the adult next yeah uh here is the commitment and decision making after analyzing the situation the committee uh agree to stop open defecation they raise their end and pledge to build latrine and also early adair are listed and on seat and will be closed monitor it next yeah uh here we can focus this part on uh um poultry wash um here is uh the post-treasuring follow up and uh it's it's concerned to to establish of the establishment of village monitoring community uh those community will do the monitoring of the realization of the population engagement to to to do latrine and and animal space separate with the the men so they can follow up of latrine achievement follow up of achievement of adequate poultry houses separation of animal habits of habitat from compounds monitoring of space equip it for children regular cleaning of yeah um and try to see if population adopt uh the hand hand washing practice next uh this is the the the preliminary view of the data is now uh are now analyzing by if pretty uh they sent us the the the the global view of the result the tendons of the result now and they show that the wash approach used by has contributed to improve knowledge and promoting the adoption of good hygiene practice related to poultry farming some practice related to the separation of poultry and children have have also improved it however it was also sold but no livestock wash practice did not improve in the salivary plus wash group it's mean that uh the the practice like uh hand washing is not uh well is now adopted now the best community what we noted we can tell that is uh this community had very low level of wash to begin with an improving wash in this community will likely require further intervention including infrastructure improvement uh as I tell the I told the analyze of bio the medical and are in progress next yeah lesson learned uh we can say that the wash approach of salivary project is an innovative extension of CLTS that has potential to address the local sanitation and hygiene and contribute to sustainable development uh we we we observe a strong interest of population in solving problem related to hygiene awareness of health risk from a contaminated local environment including cohabitation with animals uh construction of many lateral with local materials wood for the the slabs and straw for the fences uh reinforcing of social equation proof many activity wish bring together several sub-community in the village assembly next testing ways to to spirit livestock from human habitat community monitoring proof village sanitation community and positive influence of uh night boring village of the treasury village dropping and over animal waste that are regularly sweep up of and group it together are sold for market gardening or use a compost as compost in the field next yeah the limit we noted that is a sufficient found or lack found for reinforcing and fairly extensive monitoring absence of subsidies especially for the poorest for infrastructure construction like latrine and chicken cobs the construction of latrine with poor and sustainable materials like wood for the slabs straw or plastic bags for the walls next yeah uh limited adoption of separating animals from domestic area due to the fear of teeth and the mode of poultry uh feeding free uh free ranging as you know in this area uh population is uh poor and to to feed the children they try to let them go uh at around the the household to eat the rest of uh insect or the rest of food um so it's a little difficult to to to to tell them but they have to to contend the poultry and give them every day the food we have also treat of deforestation by the use of tree trunks for manufacture of latrine lab as how you can see in the picture you see that we have to cut all the trees to do this uh latrine next on uh next step for the next step what what we can say it's an ongoing analysis of final data interviews and biomedical samples in control celibate and celibate plus wash village uh wash report will be probably finalizing during this year and after that we can do a journal publication next uh thank for your attention I think you get something in money during my my presentation thank you again