Sustainability of water, sanitation and hygiene interventions in Central America.

The American Red Cross and U.S. Centers for Disease Control and Prevention collaborated on a sustainability evaluation of post-hurricane water, sanitation and hygiene (WASH) interventions in Central America. In 2006 and 2009, we revisited six study areas in rural El Salvador, Guatemala, Honduras and Nicaragua to assess sustainability of WASH interventions finalized in 2002, after 1998's Hurricane Mitch. We used surveys to collect data, calculate indicators and identify factors that influence sustainability. Regional sustainability indicator results showed there was a statistically significant decline in access to water. The presence of sanitation facilities had not changed since the beginning of the project; however, maintenance and use of latrines declined but continued to meet the goal of 75% use after 7 years. The hygiene indicator, hand washing, initially declined and then increased. Declines in water access were due to operational problems related to storm events and population changes. Sanitation facilities were still present and sometimes used even though they reached or surpassed their original design life. Changes in hygiene practices appeared related to ongoing hygiene promotion from outside organizations. These results provide useful input for making WASH programs more sustainable and informing future, more in-depth research into factors influencing sustainability.

Overview of deaths associated with natural events, United States, 1979-2004.

Analysis of the National Center for Health Statistics' Compressed Mortality File showed that between 1979 and 2004, natural events caused 21,491 deaths in the United States. During this 26-year period, there were 10,827 cold-related deaths and 5,279 heat-related deaths. Extreme cold or heat accounted for 75 per cent of the total number of deaths attributed to natural events--more than all of deaths resulting from lightning, storms and foods, and earth movements, such as earthquakes and landslides. Cold-related death rates were highest in the states of Alaska, Montana, New Mexico, and South Dakota, while heat-related deaths were highest in the states of Arizona, Missouri, and Arkansas. These deaths occurred more often among the elderly and black men. Other deaths were attributed to lightning (1,906), storms and foods (2,741), and earth movements (738). Most deaths associated with natural events are preventable and society can take action to decrease the morbidity and mortality connected with them.