London School of Hygiene & Tropical Medicine

In many parts of the world where people have consistent access to safe water and improved sanitation, typhoid fever is a thing of the past. However, Salmonella Typhi (S. Typhi) still poses a major public health problem in many lower- to middle- income countries, with over 9 million cases and 110,000 deaths estimated in 2019.

The pathogen Shigella is the most common cause of bacterial diarrhoeal deaths globally. It is estimated to have caused 148,000 deaths in 2019, with 63% of these deaths in children under five years old.

Most women have periods for nearly 40 years. Over this time, women should be able to make choices to enable their own positive reproductive health and wellbeing, such as if and when to have children or how to access healthcare and treatment. Unfortunately, many areas of reproductive health, including abortion, miscarriages, infertility and menstrual issues, continue to be taboo topics and many women feel unheard, even when they have sought professional help. 

The first time I visited an environmental surveillance (ES) site was back in 2015. It was hot, the sampled river was black and meandering between backyards of houses (see the photo above). The river had pipes where sewage was deposited, and the area was used to dispose of refuse. Further downstream women were washing clothes and kids were splashing around. But just a month before a river sample yielded poliovirus, related to cases elsewhere in the country. I was in Rawalpindi, Pakistan. At that time, and even now, ES is supplementing clinical surveillance to support polio eradication.