Category Archives: Sanitation and Health

Sanitation research on WASH in schools; latrine use behavior; latrine hygiene

The impact of water consumption on hydration and cognition among schoolchildren: Methods and results from a crossover trial in rural Mali. PLoS One, January 2019. Although there was a trend indicating drinking water may improve cognitive test performance, as has been shown in studies in other settings, results were not statistically significant and were masked by a “practice effect.”

Latent variable modeling to develop a robust proxy for sensitive behaviors: application to latrine use behavior and its association with sanitation access in a middle-income country. BMC Public Health, January 2019.
First and foremost, gender specific indicators, which may be different by life course stage, will likely provide better insight into population-level drivers of behavior and more accurate classification of latrine users. Second, inconsistent latrine use may have a different set of determinants than consistent latrine use, as these behaviors are not strictly opposites. Third, because psychosocial norms, attitudes, and beliefs may change over time, longitudinal analysis are required to determine if these indicators are temporally consistent.

Sand barriers around latrine pits reduce fecal bacterial leaching into shallow groundwater: a randomized controlled trial in coastal Bangladesh. Environ. Sci. Technol., January 2019.
The sand barrier latrine monitoring well samples had 0.38 mean log10MPN fewer E. coli and 0.38 mean log 10MPN fewer thermotolerant, compared to latrines without sand barriers, a reduction of 27% E. coli and 24% thermotolerant coliforms mean counts. A sand barrier can modestly reduce the risk presented by pit leaching.

Bacterial Contamination on Latrine Surfaces in Community and Household Latrines in Kathmandu, Nepal. Int. J. Environ. Res. Public Health, January 2019.
Results found almost no differences between bacterial contamination on latrine surfaces in community and household latrines, with the exception of latrine slabs/seats that were more contaminated in the community latrines under dirty conditions. The study also identified surfaces with higher levels of contamination. Findings demonstrated that well-maintained community latrines may be as clean, or cleaner, than household latrines and support the use of community latrines.

Development and validation protocol for an instrument to measure household water insecurity across cultures and ecologies: The Household Water InSecurity Experiences (HWISE) Scale. BMJ Open, January 2019.
There is no validated tool to measure individual- or household-level water insecurity equivalently across varying cultural and ecological settings. Accordingly, we are developing the Household Water Insecurity Experiences (HWISE) Scale to measure household-level water insecurity in multiple contexts.


The Global Risks Report 2019. World Economic Forum, January 2019.
Environmental risks continue to dominate the results of our annual Global Risks Perception Survey (GRPS).

An Introduction to Community Engagement in WASH. OXFAM, 2018.
The principles and approaches described here are relevant in other programmes and sectors too, but the target audience for this guide is WASH staff in humanitarian programmes – especially those responsible for designing, implementing and monitoring public health promotion activities.

The latest updates to USAID’s & Global Waters on Medium

Below are some of the latest updates to USAID’s website and Global Waters on Medium


Blog Posts 

Global Waters on Medium


Water Currents


USAID OFDA – Social Science in Epidemics: Cholera lessons learned

Social Science in Epidemics: Cholera lessons learned. Social Science in Humanitarian Action, December 2018.

This report is the first installment of the ‘Social Science in Epidemics’ series, commissioned by the USAID Office of U.S. Foreign Direct Assistance (OFDA). In this series, past outbreaks are reviewed in order to identify social science ‘entry points’ for emergency interventions and preparedness activities.

The aim is to determine tangible ways to address the social, political and economic dynamics of epidemics and to ensure that interventions build on the social and cultural resources of the communities they aim to support.

This report focuses on the lessons learned primarily from countries affected by cholera outbreaks in the past four decades, in what is called the 7th Cholera pandemic.

The most important case studies considered are the epidemics in Peru (1991), Haiti (2010), South Sudan (2016), India (endemic outbreaks), Mozambique (2014 and 2017) and Zimbabwe (2008 and ongoing outbreak), yet other countries’ experiences are incorporated.

Lessons are also integrated from literature around cultural responses to Oral Rehydration Therapy in the context of acute diarrheal disease.

Water access and sanitation shape birth outcomes and earning potential

Water access and sanitation shape birth outcomes and earning potential. Mongabay, November 8, 2018. mongabay.png

  • Spending more time per day fetching water increased Indian women’s risk of delivering a low birth weight baby, a study has said.
  • Open defecation and using a shared latrine within a woman’s building or compound were also associated with higher odds of low birth weight and pre-term births, respectively, compared to having a private household toilet.
  • The researchers believe that improving water, sanitation and health access and/or reducing gender-based harassment could reduce these adverse birth outcomes.
  • Another study pointed out that enhanced access to a reliable and proximate water supply reduced the time spent by women in collecting water and the proportion of hard labour performed by women. In addition, the thus freed may be spent on other income generating activities.

Read the complete article.

Association of intestinal pathogens with faecal markers of environmental enteric dysfunction among slum‐dwelling children in the first 2 years of life in Bangladesh

Association of intestinal pathogens with faecal markers of environmental enteric dysfunction among slum‐dwelling children in the first 2 years of life in Bangladesh. Tropical Medicine and International Health, August 2018.

Objective – Environmental Enteric Dysfunction (EED) can be assessed by faecal biomarkers such as Myeloperoxidase (MPO), Neopterin (NEO) and Alpha‐1 anti‐trypsin (AAT). We aimed to test the association of intestinal pathogens with faecal markers of EED among slum‐dwelling children in first 2 years of life.

Methods – The MAL‐ED birth cohort data of Bangladesh site were used to conduct this analysis. Multivariable analyses using Generalized Estimating Equations (GEE) were performed to test the association between intestinal pathogens and faecal markers of EED.

Results – Giardiasis, ascariasis and trichuriasis were the most frequent parasitic infections and Campylobacter spp., Enteroaggregative Escherichia coli (EAEC) and Enterotoxigenic Escherichia coli (ETEC) were the common bacterial pathogens observed in stool samples of the children. Giardiasis was found to be significantly associated with MPO and AAT concentrations. A significant association was found between trichuriasis and NEO. Trichuriasis and giardiasis were significantly associated with EED score. Children with EAEC had significantly higher MPO concentrations.

Conclusion – The study results imply the importance of intestinal pathogens in contributing to intestinal inflammation and increased intestinal permeability in young children.

Surprise (or not)! Toy-in-soap intervention increases handwashing among kids in emergency contexts

Surprise (or not)! Toy-in-soap intervention increases handwashing among kids in emergency contexts. FHI360 Research, October 2018.

There is nothing more satisfying in life, for me, than being able to say: I never thought of it that way. The most game-changing innovations can often have seemingly common sense solutions, and we see these solutions popping up everywhere in peer-reviewed literature. soap.png

One of those published solutions jumped out at me this week as I read a Crowd 360 blog post about innovative hand hygiene interventions to celebrate Global Handwashing Day. Researchers from LSHTM, Save the Children and their partners published new evidence showing toys inside soap can increase handwashing among kids in emergency humanitarian contexts.

Studies have examined handwashing with soap in a variety of ways over the years – with adults, with young kids, and with older kids; with health-based messages, with nudges, and with motivational messages; in school-settings, and in stable, non-emergency settings. The new toy-in-soap study, however, is the first evaluation of its kind. Here I summarize why the study is different, what the authors found and why those findings matter.

Read the complete article.

Unsafe Drinking Water Is Associated with Environmental Enteric Dysfunction and Poor Growth Outcomes in Young Children in Rural Southwestern Uganda

Unsafe Drinking Water Is Associated with Environmental Enteric Dysfunction and Poor Growth Outcomes in Young Children in Rural Southwestern Uganda. American Journal of Tropical Medicine and Hygiene, 22 October 2018. ajtmh-logo

Environmental enteric dysfunction (EED), a subclinical disorder of the small intestine, and poor growth are associated with living in poor water, sanitation, and hygiene (WASH) conditions, but specific risk factors remain unclear.

Nested within a birth cohort study, this study investigates relationships among water quality, EED, and growth in 385 children living in southwestern Uganda. Water quality was assessed using a portable water quality test when children were 6 months, and safe water was defined as lacking Escherichia coli contamination.

Overall, our data suggest that programs seeking to improve nutrition should address poor WASH conditions simultaneously, particularly related to household drinking water quality.