Jessica Costello

Evidence Action in the last quarter of 2014

In the first of this series for this year, we recap on Evidence Action’s activities in the last quarter of 2014.

September: ‘Dispensers for Safe Water’ delivers the goods

 developed by South Pole Carbon, which provides a snapshot of the benefits reaped from the ‘Dispensers for Safe Water’ program in Uganda.

More than 1500 chlorine dispensers have been set up in Uganda, with plans for thousands more to be installed by Evidence Action in future. The water purification system requires only a few drops of chlorine solution per filling of water in order to eliminate 99% bacteria, and is delivered by motorbike from central storage points. When approximately a quarter of all Ugandan children under 5 years are regularly affected by diarrhoea, and resulting malnutrition, stunting, cognitive impairment and early mortality, such a simple yet effective system is a valuable solution to the health challenges faced by Ugandan families.

A number of people living in rural Ugandan areas described the positive impact such a water system has had on their lives. For example, a mother from the Luwanga village now saves money on the firewood she would have burned to boil three pots of water daily, and she can now use this time to undertake other domestic activities.

Notably, the ‘Dispensers for Safe Water’ program has reduced the inefficient and unsustainable deforestation of firewood, thereby preventing 60,000 tons of carbon entering the atmosphere annually.

A local promoter, assigned to take care of dispensers and educate families on its use, describes his duties. In addition to checking and refilling the dispenser, he is responsible for maintaining the water point (e.g. weeding around the borehole), recording the number of users, encouraging users to be hygienic, and visiting families in their homes to ensure they are drinking safe water. Close collaboration with local authorities and trained local staff means the effective promotion, monitoring and refilling of dispensers.

The success of Evidence Action’s ‘Dispensers for Safe Water’ program lies in its deep understanding and use of the local environment; by recruiting the help of locals, the program stays rooted in communities it serves, leading to the improvements we are seeing in health, education, local forests and climate.

October: The importance of long-term data

In October, Evidence Action reported on two follow-up studies conducted in Kenya and Uganda, respectively, which built on previous research around improving educational outcomes and weight gain with the ‘Deworm the World’ initiative. These studies demonstrated the long-term positive impacts of deworming children beyond the original experimental timeline.

In Uganda, Kevin Croke followed up on Alderman and colleagues’ 2007 study by tracking children 7 to 8 years after the original deworming period. Dewormed children were found to have higher test scores in literacy and numeracy than the non-treated children in the initial program. We have written about this study 

Similarly, Owen Ozier built upon initial 2004 research in Kenya by 

 of deworming on preschool-age children whose older siblings were dewormed as part of the original study. Ozier found that there is strong evidence of large cognitive improvements among children whose siblings were dewormed; the healthier older children reduced infection rates among their preschool-aged siblings, which improved the latter’s cognitive development.

November: How much evidence is ‘enough’?

Despite these evident benefits reaped worldwide, 

 have argued that the WHO recommendation of mass treatment of everyone in an affected area is not supported by enough evidence. However, such a claim was influenced by studies with methodological weaknesses and the exclusion of other, methodologically strong, evaluations. As described in a 

 by Amrita Ahuja, Sarah Baird, Michael Kremer et al., mass deworming treatment does not only benefit individuals, but it is a highly cost-effective educational investment and a high-return economic investment even in the absence of any other health benefits from deworming.

Notably, mass deworming through the school infrastructure is substantially cheaper than undertaking treatment via screened programs. Further, as with vaccines, a ‘herd effect’ of deworming may be observed, meaning that treating individuals will improve outcomes for others by reducing transmission. Finally, significant labour market and income gains will be seen as a result of mass deworming treatment; in an unpublished 2014 study, an annualized internal rate of return of 32-55% (a way to measure the profitability of an investment) was computed for school-based deworming.

As such, Evidence Action believes in supporting the global effort to reduce the threat that soil-transmitted helminths (STH) pose, and have now joined the 

, a new group of organizations focused on reducing the public health threat of STH worldwide.

Currently, a number of projects are being considered for scale, although not all will progress to subsequent stages of development.

, a non-profit based in Botswana, to implement an advocacy program aimed at reducing the spread of HIV/AIDS among youth.

Testing the hypothesis that alternative strategies to food aid may be effective. This will include investigating cost-effective means of providing seasonal income support in Bangladesh and elsewhere, allocating people to different destinations, local price effects of worker inflow to migration destinations; impacts on household well-being, and welfare impacts of the program on non-participating households.

Potentially using Dispensers for Safe Water's existing rural delivery system to deliver nutrition information to targeted groups at a low marginal cost in order to reduce the impact of undernutrition and malnutrition on child health.

Working with the Government of Kenya on G-United, a pilot program for post-university volunteers that aims to increase social cohesion, improve student literacy outcomes, and provide unemployed college graduates with professional skills.

Understanding how to effectively target water treatment products to low-income households at scale, in order to expand our reach and impact beyond the current/planned catchment area of the Dispensers for Safe Water program.

December: Evidence Action, one of the ‘best charities for 2015’

At the end of this year, it remains clear that Evidence Action is an extraordinary charity. Evidence Action’s Deworm the World Initiative was just named 

 .The Life You Can Save calls Evidence Action one of the ‘best charities for 2015’ in its 

. Nick Kristoff in the New York Times highlights Evidence Action on his annual holiday list 

 for ‘spending money in the most cost-effective ways.’

All information and the image taken from the Evidence Action website.

Evidence Action - August Update

This post is part of a monthly series of updates on Evidence Action. The one about progress in July can be found 

. You can find this and more information in their 

Last month, Evidence Action’s Deworm the World Initiative and the Government of Kenya announced the results of the second Kenya National School-Based Deworming Programme. This was the largest deworming exercise ever conducted in the country, targeting soil-transmitted helminthes (STH, common worms) and schistosomes (which cause bilharzia).

The programme was highly successful, and national targets were surpassed!

Notably, more than 6.4 million children were successfully dewormed, exceeding the target of 5.7 million children by 12%. After two successful rounds of treatment, the prevalence of STH dropped from 33% in 2012 to 6% in 2014 in 20 observed sub-counties.

More than 890,000 children were also treated for schistosomiasis, exceeding the national target of 600,000 children by 33%.

Deworming took place in nearly 16,000 schools in 28 counties that are endemic for parasitic worms, again exceeding the target of 11,000 schools. Further to this, 143 Sub-Counties successfully implemented deworming, out of 144 Sub-Counties planned for; 28,248 teachers were trained to administer deworming tablets to children, and 3,534 Sub-County and Ward personnel from the Health and Education ministries were trained in successfully implementing deworming.

This is great news, because school-based deworming is proven to be an effective intervention with tangible health, education, labour productivity and earnings benefits, and is one of the most cost-effective methods of increasing overall school attendance and participation.

The success of Evidence Action’s Deworm the World Initiative in achieving its goals was recognized by Ezra Klein from Vox Media, who donated to Deworm the World as part of the 

EvidenceAction thanked him for his support by 

Overall, it's well worth celebrating the success of Evidence Action’s Deworm the World Initiative across Kenya, which surpassed its initial goals. It is also good to see the enthusiastic public support it has garnered!

Jessica is based in Manchester, and studied Pharmacology and Genetics at King's College London.

Jessica Costello

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Evidence Action in the last quarter of 2014

Evidence Action - August Update