Diarrheal Disease

In more than 30 countries across Asia, Africa, and the Caribbean, PSI combats diarrheal disease by educating individuals about purifying drinking water in the home, practicing improved hygiene and sanitation, and offering treatment. PSI’s programs ensure that families have the tools to prevent and treat diarrheal diseases.

PSI is at the forefront of diarrheal disease prevention and treatment programming through its commitment to continuously improving the quality of existing interventions and providing technical assistance with new programs. PSI compiles and distributes best practices and lessons learned and pilots new initiatives, ensuring that country platforms have access to the most current and relevant data and intervention strategies. PSI also fosters and maintains key relationships within the broader international child survival and safe water communities.

As a key partner to both local and donor governments and an advocate for child survival issues and funding, PSI implements technically strong diarrheal disease prevention and treatment programs to improve the health of children around the world.

Our mission is to improve child health by providing PSI country programs evidence-based technical support enabled by an expanding and diversified funding base and an innovative knowledge management system that facilitates the sharing of lessons learned across PSI programs. PSI combines education to motivate healthy behavior with the provision of needed health products and services, which are attractively packaged and marketed in the local context. Local knowledge, attitudes and practices are integrated into the communications messages through ongoing behavioral research. For more than 10 years, PSI has empowered people worldwide to treat more than 93 billion liters of drinking water.

Diarrheal Disease Prevention

Household Water Treatment

Providing safe, reliable, piped-in water to every household in the world is the ideal goal. However, for the majority of people in the developing world the realization of this goal is still very far off. Investments in water supply infrastructure and maintenance are often expensive and implemented over a long time frame.

Household water treatment and safe storage (HWTS) makes an immediate difference on the lives of those who otherwise rely on transporting water daily and storing it in their homes. Simple, safe, and inexpensive techniques have been proven effective for treating drinking water and storing it in the home. In a family utilizing HWTS, a incidence of diarrhea typical reduces by 30-50 percent. HWTS works to address water quality issues while complementing water supply, hygiene, and sanitation interventions. HWTS can be adopted rapidly, at national scale, in both development and emergency situations. In its 2008 publication on the subject, UNICEF touted HWTS as “one of the most effective and cost-effective means of preventing waterborne disease in development and emergency settings.”¹

As a global leader in HWT, PSI empowers millions of people around the world to ensure that that each drop of their water is clean and safe, regardless of its source. PSI’s water treatment products include a sodium hypochlorite-based safe water solution, chlorine-based tablets and a flocculent/disinfectant powder that enable families to purify water at the household level. Each country context is different. PSI takes this into consideration when developing each safe water program. Experience has shown that leveraging different delivery channels can increase access, availability, awareness and use of HWTS.

The availability of these products, along with effective communications, empowers individuals to understand the burden that contaminated drinking water has on their health and allows them take solutions into their own hands PSI launched its first two large-scale safe water programs in Zambia and Madagascar in the midst of public health emergencies and there are now programs in more than 34 countries. The largest household water treatment programs are now found in Zambia, Ethiopia, Madagascar, Kenya, and Uganda.

Hygiene Promotion and Education

Education is a critical component to any water, sanitation and hygiene program. Encouraging uptake of key behaviors can be a major challenge. Therefore it is important to identify the “key determinants” of behavior change and use this culturally specific information as the foundation for development of key messages. Successful behavior change campaigns often leverage multiple communication channels (radio, television, community events, community health workers, etc) and approaches (community mobilization and peer to peer communication) to educate people and promote hand washing, latrine use, safe water storage, and the benefits of household treatment of drinking water. Studies suggest that soap is available in over 95% of households, but that hand washing with soap at key junctures is not a common practice. PSI works to overcome these statistics and seeks to motivate people to wash their hands at critical times, an intervention that has been shown to decrease the incidence of diarrhea in the general population by more than 40 percent.² PSI couples HWTS marketing with education and behavior change communication encouraging proper handwashing and sanitation.

^{1. UNICEF. “Promotion of Household Water Treatment and Safe Storage in UNICEF WASH Programmes.” January 2008.

2. Curtis, V. and Cairncross, S. 2003. Effect of washing hands with soap on diarrhea risk in the community: a systematic review. The Lancet 3:275-281.}

Diarrheal Disease Treatment

For families affected by diarrhea, PSI and its partners work together to provide treatment options to save the lives of children who may otherwise die from diarrhea-related dehydration. These options include oral rehydration salts to counteract the potentially fatal dehydration caused by diarrhea, and zinc supplements to decrease the incidence, severity, duration and recurrence of diarrheal disease in children. PSI’s diarrhea treatments, including diarrhea treatment kits (DTKs) - a prepackaged combination of two ORS sachets and ten zinc tablets - have averted more than 50,000 DALYs in 2010 alone. PSI’s diarrheal disease treatment programs educate caregivers on the use of ORS and zinc and expand the availability of these life-saving products through commercial and other non-traditional channels, including community based outreach and community case management of diarrhea. Globally, PSI socially markets diarrhea treatment in 13 countries: Benin, Burundi, Cameroon, Cote d’Ivoire, Ethiopia, Malawi, Sudan, Madagascar, Zimbabwe, Haiti, Cambodia, India and Myanmar.

How We Work

In order to administer treatment and facilitate diarrheal disease prevention and treatment, PSI leverages several channels of distribution:

Emergency Relief for Cholera Outbreaks or Natural Emergencies

PSI provides targeted water treatment and sanitation efforts in response to cholera outbreaks or other natural disasters. PSI often works in partnership with other aid organizations to distribute water treatment products and provide targeted hygiene education. PSI has responded to cholera epidemics in multiple countries over the last decade.

In 2008, PSI responded to the cholera outbreak in Chitungwiza, Zimbabwe with point-of-use water treatment tablets and hygiene promotion IPC activities. PSI was able to distribute more than 300,000 tablets within a 3 day period while performing a door-to-door hygiene promotion and household water treatment campaign.

PSI is currently responding to the cholera outbreak in Haiti. PSI/Haiti has been able to leverage their existing communications network and media relationships to create a rapid response channel to get consistent messages about cholera prevention and treatment out quickly and efficiently. Messaging has included radio spots, SMS text messages, and a mobile video unit showing a film about prevention and treatment of diarrheal disease which will also be aired on national television. The PSI office in the Dominican Republic has aided relief efforts in Haiti by donating more than 1.8 million sachets of PUR water purifier.