Feb/March 2015 selected studies on sanitation, hygiene & handwashing


Household-Level Risk Factors for Influenza among Young Children in Dhaka, Bangladesh: A Case-Control Study(Abstract/order)

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.


Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.


Towards effective and socio-culturally appropriate sanitation and hygiene interventions in the Philippines: a mixed method approach. Full text

Inadequate water, sanitation and hygiene (WASH) represent an important health burden in the Philippines. The non-governmental organisation Fit for School intends to complement its handwashing programme in schools with sanitation interventions. The objectives of this mixed-method study therefore were to describe WASH practices and their impact on childhood diarrhoea in the Philippines, and to examine socio-cultural and environmental factors underlying defecation and anal cleansing practices in Northern Mindanao. When adjusting for non-modifiable factors, susceptibility and socioeconomic factors, WASH factors failed to show a statistically significant effect. Defecation and anal cleansing behaviours were constrained by the physical environment, particularly the lack of clean, safe, comfortable and private facilities. Individual determinants of behaviour were influenced by habit and motivations such as disgust, with some evidence of planned behaviour. Where available, water was the preferred material for anal cleansing. This study combines nationally-representative quantitative data with local in-depth qualitative insights, constituting critical formative research in the development of effective and appropriate interventions.


Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008. (Full text)

Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention’s impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.


Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys – Full text

The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders. Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver’s self-reported practices of washing hands with soap before meals or after defecation were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water. Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.


Assessment of a membrane drinking water filter in an emergency setting – (Abstract/order info)
The performance and acceptability of the NeroxTM membrane drinking water filter was evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6 month period, 230 households were visited and filter performance and use was assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals) together with high temperatures, and large family size were likely to have contributed to poor performance and uptake of the filters.

If you would like to be on the mailing list for these periodic research updates, just email me at: dacampbell@fhi360.org

Dan Campbell, Knowledge Resources Specialist
WASHplus Project

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