Little girl collecting water from an open water source - Access to safe water is crucial for disease prevention. Copyright Anouk Gouvras

Currently the majority of Neglected Tropical Disease (NTDs) control programs center around chemotherapy to treat and prevent disease. However two documents from the WHO; the 2012WHOroadmap和more recently thereport关于NTD和水，卫生和卫生（WASH），强调了需要清洗整合以实现可持续的NTD控制和消除。这International Society for NTDshosted a meeting exploring aspects of WASH and NTDs;ISNTD水.

Neglected Tropical Diseases

NTDs is a term given to a diverse group of17 infectious diseasesthat are highly prevalent in tropical and subtropical countries, that thrive in poverty stricken areas with low or no access to sanitation and clean water infrastructure, cause huge damage to public health and socio-economic development and yet still receive little global attention. Together they infect over 1.4 billion people world wide and the majority are caused by protozoan or helminth infections. They are the diseases of neglected people of low income countries and ofpoor communities living in richer countries.

WASH and NTDs

WASH在NTD控制和消除的可持续性中起着至关重要的作用。首先是通过预防传播的；

• increased sanitation availability to reduce contamination of the environment,
• providing safe clean water for drinking and food preparation,
• enabling good hygiene practices such as hand-washing with soap,
• improving water resource management and waste management to control vectors of disease and reducing contact with unsafe and contaminated surface water.

Secondly through care of infected individuals;

• 提供干净的水，以在家中和医疗机构中的受感染者和护理
• 为患有残疾和/或污名化的个人提供可访问的洗涤服务，通常与特定的NTD相关。

ISNTD水

At the conference we heard from diverse groups of charities, researchers, technology developers and industries working on WASH. Highlighted below are some examples of the NTD – WASH aspects that were呈现和discussed at the meeting.

• Buruli溃疡（BU）；由于感染而引起的非常讨厌的溃疡Mycobacertium ulcerans细菌认为to be associated with proximity to water sites but whose transmission is largely unknown. At the meeting we learnt about the role of arsenic on BU development; AstudybyGyasi et al2012found that communities highly endemic to BU in Ghana lived in areas with high levels of arsenic compounds in the water which lead them to look for the possible association of arsenic in water and BU development in mice. They foundstrong evidencethat mice exposed to arsenic through drinking water and exposed toM. ulceranshad a far higher risk of developing BU then those not exposed to arsenic. This has called for further research into the role of arsenic in local water sources and the prevalence of BU as well as WASH interventions to protect high risk communities from this risk factor.

  

• Leprosy and Lymphatic filariasis (LF);Leprosy is a bacterial infection transmitted through cough or fluid contact whilst LF is caused by filarial parasitic worms (Wuchereria bancrofti, Brugia malayi和Brugia timori) living in the lymphatic system of humans and is transmitted by mosquitoes of theCulex和Aedesgenus. Mr James Pender fromLeprosy Mission呈现on the importance of WASH accessibility for发病率管理和疾病预防（MMDP）in leprosy and LF cases. He highlighted how both diseases had similar needs in terms of WASH for MMDP self-care and in terms of disability and stigmatization. Accessibility and inclusion of people with disability has not been considered enough in community WASH programs so Leprosy Mission and水Aid开发了这个briefing note解决此问题并突出显示为两种疾病提供洗涤服务的综合方法的潜力。

  

• Soil-transmitted helminthiasis (STH) and schistosomiasis;STH is caused by infections from parasitic intestinal worms (Ascaris,Nectar Americanus，Trichuris tichuriaETC）;传播直接通过粪便 - 源根，自然突出了卫生和卫生的重要性！另一方面，血吸虫病是具有两个宿主生命周期，哺乳动物和水生蜗牛的血液爆发。传播是通过直接水接触发生的。Suzy Campbell博士使用了两个例子（Timor-Leste和Cameroon) to illustrate the need to evaluate WASH intervention as an integral part ofSTH controlexplaining that it must start with baseline measurements of WASH related infrastructure and behavior including individual, household, and village characteristics. The potential variation in environmental conditions and water-availability should also be considered as this may greatly affect risky behavior. Dr Steffi Knopp updated us on findings from the behavioral intervention arm of theZanzibar Elimination of Schistosomiasis Transmission (ZEST)program highlighting the benefits of a human centered design approach which includes input from community members. However knowledge and willingness alone will not alter risky behavior if the WASH infrastructure is not available and accessible to all. Pumps, wells and taps need to be maintained and easy enough to use so that children as well as adults can collect safe water.