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Intersection of Maternal and Child health, and Water and Sanitation

During my Applied Field Experience, I wanted to reduce the knowledge gap between the intersection of Maternal and Child Health and the Water Institute at UNC (WaSH).

1)      Antibiotic Resistant Bacteria: Environmental Pathways and Implications on Human Health.

This project is in collaboration with the World Health Organization and involved working mainly under Professor Mark Sobsey and Lydia Abebe in the Environmental Science & Engineering Department.

Antimicrobial resistance (AMR) is an increasingly serious threat to global public health. AMR develops when a microorganism (bacteria, fungus, virus or parasite) no longer responds to a drug to which it was originally sensitive. This means that standard treatments no longer work; infections are harder or impossible to control, the risk of spreading infection to others is increased and the risk of death is greater. It is well documented that there is considerable overuse, careless use, inappropriate use and unregulated availability and use of many antibiotics in both medicine and veterinary medicine. As well, there is extensive and largely unregulated use in animal agriculture and aquaculture, including for animal and fish growth promotion. These imprudent uses and abuses of antibiotics contribute to the extensive presence of antibiotic residues and their functional genes in human and animal wastes, and focally and otherwise antibiotic-contaminated water and soil. Such contamination could have implications for human health, particularly the health of pregnant women, infants and children.

During this project, I mainly supported the work of systematic literature review and qualitative data analysis to assess evidence for antibiotic resistance effects on increased human health risks.

2) Promoting maternal and child health through household water treatment and hand washing interventions in Cambodia

While working with the WHO in Chapel Hill, I realized I wanted to become more involved with the projects I was learning about during my AFE. I discussed with Professor Mark and Lydia the idea of proposing a project in Cambodia.

The purpose of this project is to promote maternal and child health through water and health education, and point-of-use drinking water and hygiene interventions. The World Health Organization (WHO) estimates 88% of the estimated 4 billion cases of diarrhea are associated with lack of access to safe drinking water, and unsanitary housing conditions. In 2007, mortality rates associated with diarrheal disease were estimated at 1.8 million annually, with children under-five as the most vulnerable. The World Health Organization suggests that 94% of diarrheal diseases are preventable through sanitary modifications and interventions at the household level.

Some countries such as Ethiopia, Cambodia, and Nepal experience the greatest improvements in water and sanitation access. However, the greatest achievements have been made in urban areas, leaving access to drinking water in rural areas behind, especially the rural poor.

This project is to target water and health efforts in rural areas through education, intervention, and adherence monitoring and evaluation. The goal is to increase adherence and sustainability through education pre-intervention and adherence evaluation for post-intervention evaluation. The intended beneficiaries will receive water purification and hand washing interventions in the form of education and technologies.

– Why Cambodia?

With just under 15 million people, Cambodia is a small country in Southeast Asia. It shares borders with Vietnam, Thailand and Laos.While economic growth has increased in recent years, Cambodia remains one of the poorest countries in the world. In 2013, Under-five mortality ranked 138th out of 199 countries assessed in the Human Development Index.  According to the 2012 WHO, Cambodia’s health profile measure of distribution of causes of deaths in children under-five, the sum of HIV/AIDS, measles, and malaria are less than diarrhea.

– Why water purification intervention?

Some 3.9 million of those without access to safe drinking water in Cambodia are poor and live in rural areas. Without safe water and adequate sanitation and hygiene, children (41% of the population) are especially vulnerable to water-borne disease.  The majority of rural villages in Cambodia have no sources of clean drinking water. Without access to clean water, Cambodians are forced to rely on gathering dirty water from ponds, or carrying water in plastic containers from far-away rivers. Drinking microbial contaminated water leads to gastrointestinal infection and disease, of which 10,000 children die each year in Cambodia.

– Why hand washing with soap intervention?

According to the World Bank Water and Sanitation Programmed (WSP) report, hand washing and hygiene has received little attention in terms of policy and interventions in Cambodia. Lack of access to hand washing and proper hygiene education also contributes to high rates of diarrheal disease and mortality. A study funded by the WSP, suggests the impact of hand washing with soap intervention has the potential to reduce deaths associated with diarrheal disease by 1.1 million.

– Solution

As aforementioned, modifications and interventions at the household level have the capacity to significantly enhance health through diarrheal disease prevention. These technologies consist of household level interventions that reduce risk of diarrheal disease. The goal of our project is to focus our intervention on improving drinking-water treatment and provide hand washing stations.

Time to implement and help those in need.

Through this experience, I have gained a strong foundation and interest from which to continue my advocacy work in maternal and child health and water and sanitation. As a Rotary Peace Fellow, once I gain the knowledge and skills, it becomes time to implement and help those in need. With what I have learned through the public health program, I expect this project to be the start of promoting peace through reducing maternal and child health mortality.


  1. WHO Combating waterborne disease at the household level
  2. UNICEF&WHO Progress on drinking water and sanitation JMP2014 Report
  3. WHO Countries, Cambodia
  4. UNDP 2013 Human Development Report
  5. WHO Cambodia: General health statistical profile
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