Category Archives: Sanitation and Health

The social dynamics around shared sanitation in an informal settlement of Lusaka, Zambia

The social dynamics around shared sanitation in an informal settlement of Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development, March 2019.

This study explored the social dynamics affecting collective management of shared sanitation in the Bauleni compound of Lusaka, Zambia. In-depth interviews were conducted with landlords (n = 33) and tenants (n = 33). Elinor Ostrom’s eight design principles for the management of common-pool resources was used as a framework to analyse the data. jnl

Social capital within plots was also assessed. Pit latrines were predominantly shared by landlords and tenants on residential plots. However, unwelcome non-plot members also used the latrines due to a lack of physical boundaries. Not all plot members fulfilled their cleaning responsibilities equally, thereby compromising the intended benefits for those conforming. Landlords typically decided on latrine improvements independent of tenants.

Latrines were not systematically monitored or maintained, but punishment for non-conformers was proportionate to the level of infraction. There was no system in place for conflict resolution, nor local organizations to regulate the management of sanitation. Lastly, there were few enterprises associated with peri-urban sanitation.

Social capital was moderately high, and tenants were willing to invest money into improving sanitation. The social dynamics illuminated here provide an important basis for the development of a behavioural intervention targeted towards improving urban sanitation.

OPINION: If you’re safe from cholera, thank my dad, a plumber (and thank the ancient Romans)

OPINION: If you’re safe from cholera, thank my dad, a plumber (and thank the ancient Romans). by Lindsay Denny, USA Today, March 11, 2019.

I come from a family of plumbers, and we’ve heard our share of plumber’s crack jokes. But there’s nothing funny about sanitation in public health.

My father once told me that plumbers were the original public health professionals. Growing up, I never gave the sentiment much thought. Mostly, I just heard a lot of plumber’s crack jokes as a kid, and our family’s vacation photos were punctuated with unique toilets my dad came across on our travels. That’s because plumbing is our family business — quite literally.


The author and her father, Scott Denny, in Madrid, Spain, in 2016. (Photo: Family handout)

He and all of his brothers are plumbers, just like their father and uncle. Many of my cousins have worked for the family’s company at some point. Yet, even as I pursued a degree in global health, I never paused to consider the long-standing health impact of their work.

So I will never forget the look on my dad’s face when I told him that I had been hired to bring awareness to a newly recognized, massive gap in health care — the lack of clean water and sanitation, and by extension hygiene, inside tens of thousands of hospitals in developing countries.

Read the complete article.

Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India

Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India. Am Jnl Trop Med Hyg, Feb 18.

Significant predictors for disposing of child feces in an improved latrine were the primary female caregiver reporting using a latrine to defecate, the child’s age, and water observed at place for handwashing.

These findings suggest that child feces interventions should focus on encouraging children to begin using a toilet at a younger age and changing the common behavior of disposing of young child’s feces into open areas.

Environmental enteric dysfunction and child stunting. Nutrition Reviews, Feb 9

Environmental enteric dysfunction and child stunting. Nutrition Reviews, Feb 9. The failure of polarized interventions to reduce stunting may lie in the rationale that the 3 main underlying causes—namely poor quality and quantity of food, poor care practices, and infectious disease—are either directly or indirectly related to inadequate WASH infrastructure and facilities.

The following sections aim to describe this relationship between linear growth failure and WASH and the reasons for the limited success of WASH interventions thus far to prevent stunting worldwide.

Environmental Aspects and Features of Critical Pathogen Groups – GWPP

Environmental Aspects and Features of Critical Pathogen Groups. Global Water Pathogen Project, 2018.

This chapter provides the reader with an overview of various environmental aspects and characteristics of critical pathogen groups (disease-causing microorganisms) associated with fecal wastes, sewage and water-related diseases including viruses, bacteria, protists and helminths. gwpp

The sources of these pathogens are primarily human feces but the reservoirs can be humans, animals or the environment itself. The handling and methods of human or animal waste disposal play a significant role in transmission of infectious diseases globally. The diseases caused by water-related pathogens range from mild gastroenteritis to severe diarrhea, dysentery, typhoid fever and hepatitis.

Some water-related infections have chronic sequelae. The risks of infection are dependent on specific characteristics of the pathogen including potency/infectiousness, concentrations in excreta, their ability to persist in the environment and resistance to sewage treatment.

Pathogen concentrations particularly viruses and bacteria in excreta and sewage is high, typically at concentrations of millions to billions of organisms. For pathogens transmitted via fecal-oral route, persistence in the environment is related to risk of host exposure and potentially disease.

Viruses, protozoan cysts and oocysts and helminths persist longer in the environment than vegetative bacteria. In contrast to other pathogen groups, all helminths have a distinct latency period in the environment and some require intermediate hosts to complete their life cycles.

In general, viruses, protists and helminths pose higher risks of infection (highly potent) than bacteria and resulting disease from ingestion of or contact with very low doses of the pathogen. In addition, the risks of infection by water-related pathogens are influenced by other environmental factors including their potential sources or reservoirs in the environment such as animal (zoonosis) fecal contamination, and their ability to be transported (e.g. vectors) in the environment to reach susceptible hosts.

Majority of the bacteria, protists and helminths are zoonotic pathogens. Vectors such as freshwater snails and rodents play an important role in transmission of infectious diseases caused by some protists (e.g. Leptospirosis) and most of the helminths.

Overall, water-related pathogens are one of the major contributors to the global burden of disease. Understanding how pathogens survive and move in the environment, their sources and transmission routes are crucial to developing effective interventions to reduce water-related diseases.

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