Category Archives: Research

New call for researchers (WSUP – Urban Sanitation Research Initiative)

Evaluation of user experience outcomes of Clean Team service use

Focus country: Ghana

This research project is commissioned under the Urban Sanitation Research Initiative, a 2017−2020 research programme core-funded by UK aid from the British people and managed by Water & Sanitation for the Urban Poor (WSUP). This research project will deliver an evaluation of the user experience outcomes of being a customer of Clean Team Ghana.

Clean Team Ghana is a social enterprise providing container-based toilets for a monthly fee covering toilet rental and the container replacement service. Clean Team Ghana currently operates in the city of Kumasi. It has about 1500 customers, and is recruiting new customers at a rate of about 300 per month. This research will aim to generate evidence that is: a) of wide value in Ghana and internationally for understanding the user experience impacts of container-based sanitation service models of this type, and b) of specific value to Clean Team Ghana in further improving their business model.

The research should focus on user experience including i) satisfaction with aspects including for example smell and container replacement service, and ii) subjective wellbeing across a range of dimensions including dignity and security. We anticipate a longitudinal design, with customers interviewed just before service start, soon after service start, and 6 months after service start.

Maximum budget under this Call: GBP 80,000 inclusive of VAT
Bids due: Before UK 1700 hours on 4th March 2019.

For more information visit:

WASH Weekly Research Updates 2019

Dear Colleagues:

The USAID Water CKM team prepares an informal bulletin each week with some of the most recent WASH-related research and these are archived on a Google Document. Please let us know if you find this useful or contact us if you wish to subscribe to the weekly updates.

FEBRUARY 4, 2019


How Humans Get in the Way of Clean Water. Scientific American, Jan 26. There are many cheap and effective ways to provide safe water to the world’s poor regions. But projects often fail due to inadequate planning, maintenance or persuasive power.

Taking Concrete Actions to Leave No One Behind: Government of Ghana Pro-Poor Policies and Sanitation Guidelines for Targeting the Poor and Vulnerable. Global Communities, Jan 8. Global Communities Ghana, with funding from USAID, as part of the WASH for Health project has been collaborating with the Government of Ghana Ministry of Sanitation and Water Resources to develop Guidelines for Targeting the Poor and Vulnerable for Basic Sanitation Services in Ghana, published in 2018, to provide guidance for targeting poor and vulnerable populations.

The economics of antimicrobial resistance and the role of water and sanitation services. WASHeconomics, Jan 21. Seeing a paper published a few weeks ago in Nature Communications (more on that below) reminded me of some reading I did last year on WASH and antimicrobial resistance (AMR), and got me thinking about the economics of this.

Menstrual health programs need a new focus in developing world, critic says. Washington Post, Jan 13. In her new book, “The Managed Body: Developing Girls and Menstrual Health in the Global South,” she contends that programs to provide pads and cups to girls in developing countries — also known collectively as the Global South — miss the mark, well-intentioned though they may be. They overlook higher priorities, such as clean water and comprehensive education efforts, she says, and actually work against eradicating taboos surrounding menstruation.


WASH and Health working together: a ‘how to guide’ for NTD programmes. WHO, January 2019. This toolkit provides step-by-step guidance to NTD programme managers and partners on how to engage and work collaboratively with the WASH community to improve delivery of water, sanitation and hygiene services to underserved population affected by many neglected tropical diseases.

WASH Innovation Catalogue. Elrha, Jan 2019. Our WASH Innovation Catalogue is the first of its kind. It offers a unique overview of some of the most promising new solutions in WASH, and is designed to help practitioners decide which innovations could help them solve their most pressing problems. Taking an innovation from idea to scale can take years, and the innovations featured in this catalogue are all at different stages on that journey, but what this offers the WASH sector now is a look at the exciting work happening around the world to address common challenges.

Continue reading

UNC Water Institute – studies on hygiene behaviors, health risk perceptions, healthcare facilities


Environmental conditions in health care facilities in low-and middle-income countries: coverage and inequalities. Ryan Cronk, Jamie Bartram. 2018. International journal of hygiene and environmental health, Volume 221: 409-422.

A systematic scoping review of hygiene behaviors and environmental health conditions in institutional care settings for orphaned and abandoned children. Moffa, M., Cronk, R., Fejfar, D., Dancausse, S., Acosta Padilla, L., Bartram, J. 2019. Science of the Total Environment. 658:1161-1174.

A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. Moffa, M., Cronk, R., Fejfar, D., Dancausse, S., Acosta Padilla, L., Bartram, J. 2018. International Journal of Hygiene and Environmental Health.

Health risk perceptions and local knowledge of water-related infectious disease exposure among Kenyan wetland communities. 2019. Anthonj, Carmen, Bernd Diekkrüger, Christian Borgemeister, and Thomas Kistemann. International Journal of Hygiene and Environmental Health. 222(1): 34-48.

Health risk perceptions are associated with domestic use of basic water and sanitation services—Evidence from rural Ethiopia. 2018. Anthonj, Carmen, Lisa Fleming, Samuel Godfrey, Argaw Ambelu, Jane Bevan, Ryan Cronk and Jamie Bartram. International Journal of Environmental Research and Public Health. (15)10:

Improving monitoring and water point functionality in rural Ethiopia. 2018. Anthonj, Carmen, Lisa Fleming, Ryan Cronk, Samuel Godfrey, Argaw Ambelu, Jane Bevan, Emanuele Sozzi and Jamie Bartram. Water. 10(11): 1591.


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.

Benefit‐Cost Analysis of Community‐Led Total Sanitation: Incorporating Results from Recent Evaluations

Benefit‐Cost Analysis of Community‐Led Total Sanitation: Incorporating Results from Recent Evaluations. Prepared for the Benefit‐Cost Analysis Reference Case Guidance Project; Funded by the Bill and Melinda Gates Foundation, January 2019.

We analyze the costs and benefits of “Community-Led Total Sanitation” (CLTS), a
sanitation intervention that relies on community-level behavioral change, in a hypothetical rural region in Sub-Saharan Africa with 200 villages and 100,000 people.

The analysis incorporates data on the effectiveness of CLTS from recent randomized control trials (RCTs) and other evaluations. We value reduced mortality benefits by adjusting estimates for the value of statistical life (VSL) from high income countries to reflect incomes in Sub-Saharan Africa.

Reduced morbidity benefits are calculated using a cost of illness (COI) approach based on recent studies quantifying the cost of diarrheal disease in Sub-Saharan Africa. Time savings from owning a latrine are valued using estimates for the shadow value of time based on a proportion of the average local wage. Costs include the cost of intervention implementation and management, households’ time costs for participating in the community behavioral change activities, and the cost of constructing latrines.

We estimate the net benefits of this intervention both with and without the inclusion of a positive health externality, which is the additional reduction in diarrhea for an individual when a sufficient proportion of other individuals in the community construct and use latrines and thereby decrease the overall load of waterborne pathogens and fecal bacteria in the environment.

We examine the sensitivity of the results to changes in the effectiveness of the CLTS intervention. A probabilistic sensitivity analysis using Monte Carlo simulation is used to examine the sensitivity of the results to changes in all of the parameters in the benefit-cost model.

We find that CLTS interventions would pass a benefit-cost test in many situations, but that benefit-cost metrics are not as favorable as many previous studies suggest. The model results are sensitive to baseline conditions, including the income level used to calculate the VSL, the discount rate, and the time spent traveling to defecation sites.

We conclude that many communities will have economic investment opportunities that are more attractive than CLTS, and recommend careful economic analysis of CLTS in specific locations.

Weekly WASH research update – December 3, 2018


Cross-subsidies for improved sanitation in low income settlements: Assessing the willingness to pay of water utility customers in Kenyan cities. World Development, March 2019. Our findings suggest that in a sector that struggles to provide universal access to sanitation services, cross-subsidies may offer a means to support financing of safe sanitation for low-income households.

Moving Up the Ladder: Assessing Sanitation Progress through a Total Service Gap. Water, Nov 2018. This paper examines methodological options for calculating a ‘total service gap’, a measure that would combine data on each rung of the service ladder to quantify how far away each country is from universal safely managed services.

The natural environment: a critical missing link in national action plans on antimicrobial resistance. WHO Bulletin, Dec 2018. The natural environment presents a transmission route and a reservoir for resistant microorganisms and plays a significant role in the development of, and response to, antimicrobial resistance. Antimicrobial use in the livestock industry is driving the selection of resistant bacteria in farm animals, and while the causal link between antimicrobial use in livestock and the selection of resistance in humans is difficult to establish, there is evidence of an association.


Meeting the nutrition and water targets of the Sustainable Development Goals: achieving progress through linked interventions. CGIAR 2018. This paper describes the key water-nutrition linkages reflected in SDG 2 (end hunger, achieve food security and improved nutrition and promote sustainable agriculture) and SDG 6 (ensure availability and sustainable management of water and sanitation for all) as well as the opportunities and challenges to meet both these goals.

Developing a participatory management tool for user-friendly water sanitation and hygiene in healthcare facilities. WaterAid 2018. This report synthesizes key learning on making WASH in healthcare facilities more user-friendly, accessible and inclusive.


Solid waste: the next “Cinderella” of the WASH sector? IRCWASH, November 2018.

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.