Prevention : environmental health interventions to sustain child survival

Due to their curative nature, however, traditional CS programs miss vital opportunities to treat the child and are expensive. In recent years, the integrated case management (ICM) approach has been introduced to offset these shortcomings. The present paper argues the need to expand ICM by adding environment-based health interventions aimed at preventing the transmission of disease. Specifically, the paper discusses the household- and community-level interventions that can be used to prevent diarrheal disease, malaria, and acute respiratory infection (ARI), citing technical literature on the effectiveness of each intervention. Interventions that can be used to prevent diarrhea disease include excreta containment and treatment, food safety and hygiene, water source protection and handling, and personal and domestic hygiene; those that can be used to prevent malaria include land use and management, residual spraying, surveillance, personal protection, larvicides, source reduction, and malaria health education; and those that would prevent ARI include substitution of biomass fuels, use of fuel-efficient stoves, and improved household ventilation. Virtually all these interventions require changes in health behavior. Development programmers can integrate these types of environmental measures into existing primary health care and CS programs by developing partnerships with non-health sectors. For example, the agriculture sector can be involved in preventing diarrheal disease through food safety, the school sector through education in hygiene, the public works and housing sectors through construction of excreta disposal and treatment systems, and the private sector through manufacturing inexpensive, safe water storage containers. A four-step process for integrating environmental prevention measures into existing CS programs, beginning with trials in a few countries, is presented. Includes references.