Category Archives: Research

UNICEF guides on menstrual hygiene management |WASH Benefits update


Guide to menstrual hygiene materials. UNICEF, May 2019. The guide is meant to familiarize UNICEF staff members with the key characteristics and requirements for the most common menstrual hygiene materials: menstrual cloths, reusable pads, disposable pads, menstrual cups and tampons. For each menstrual material, the environmental, health, and financial aspects are highlighted in individual tables – along with considerations of availability, user experience, and standards and regulations. Technical specifications are provided for each material. The guide concludes with a summary table of these key attributes. mhm

Guidance on Menstrual Health and Hygiene. UNICEF, March 2019. This guidance was developed for UNICEF WASH, Education, Health, and Gender specialists or focal points in country offices who are working with their partners to develop programs related to menstrual health and hygiene (MHH).

Composting and Dry Desiccating Toilets (Latrines). Global Water Pathogen Project, June 2019. Scientists involved with the Global Water Pathogen Project (GWPP) have compiled the most up to date information on Composting and Dry Desiccating Toilets (Latrines) for the purpose of providing a key reference point in the development of quantitative guidance for sanitation practices worldwide.

Mainstreaming Energy Efficiency Investments in Urban Water and Wastewater Utilities. World Bank, June 2019. This guidance note presents an overview of the benefits of improving energy efficiency in urban water and wastewater utilities.


The WASH Benefits and SHINE Trials. Interpretation of Findings on Linear Growth and Diarrhoea and Implications for Policy: Perspective of the Investigative Teams (P10-136-19). Current Developments in Nutrition, June 2019. We recently completed 3 efficacy trials (Bangladesh, Kenya, Zimbabwe) testing the independent and combined effects of improved complementary feeding (CF) and intensive household water quality, sanitation, and hygiene (WASH) on child diarrhea and length-for-age-Z-score (LAZ) at 18 to 24 mo. Intervention uptake was high. In all three trials: CF increased LAZ but WASH had no effect on LAZ. WASH reduced diarrhea in Bangladesh but not in Kenya or Zimbabwe. We present a synthesis of trial findings and their implications.

Design of a parallel cluster-randomized trial assessing the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia: Andilaye study protocol. BMC Public Health, June 21, 2019. The purpose of this protocol is to detail the rationale and design of a cluster-randomized trial evaluating the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia.


Solutions for Resilience and Peace Building Across the World. Engineering for Change, May 30, 2019. About 90 percent of USAID’s water priority countries are conflict-affected or fragile. In 2018, over 60 million people around the world were affected by more than 280 natural disasters. Effective water resource management is complex even in times of peace and prosperity. In a time of crisis, whether war or natural disaster or drought, it means the difference between building resilience or compounding tragedy.

Have you heard of impact bonds? Sustainable Cities, June 2019.  Impact bonds are a form of public-private partnership that rewards investors for successfully delivering impact. Investors are rewarded if providers meet agreed-upon outcomes but lose their investment if the providers underachieve or fail.

WASH weekly research update – June 3, 2019

The USAID Water CKM project sends out an informal bibliography each week via email of some of the latest WASH-related studies, webinars, etc. Please contact us if you would like to be added to the subscription list.


Water as a Tool for Resilience in Times of Crisis – In this webinar, the Environmental Change and Security Program, USAID’s Sustainable Water Partnership, and Winrock International discuss where the challenges lie and what practitioners and policymakers can do to bolster effective water management for the world’s most vulnerable communities.


Lasting results: A qualitative assessment of efforts to make community-led total sanitation more inclusive of the needs of people with disabilities in Rumphi District, Malawi. Disability and Health Journal, 28 May 2019. Implications for future replication show the need to invest in training a wider group of people to assist with implementation and to keep the program simple and focused on more active learning methods to make sustainable behavioral changes.

Water, sanitation and hygiene: measuring gender equality and empowerment. WHO Bulletin, June 2019. Based on a process of expert input and literature review, here we offer a compilation of current water, sanitation and hygiene indicators that measure gender equality and empowerment in four interrelated priority areas.

When the pits fill up: (in)visible flows of waste in urban India. Journal of Water, Sanitation and Hygiene for Development, June 2019. Based on a rich ethnography of cleaning trucks in Bangalore, India, we show that trucking operations dispose of sludge in ways that harm both public health and the environment, and that the caste composition of sanitation work helps to keep it invisible from officials and the public.


WASH reflections series: Water safety planning: What have we learned so far? WHO, May 2019. Water safety plans have been implemented in at least 93 countries, with 46 countries reporting to have policies or regulations in place that promote or require WSPs.

Optimizing Access to Safe Water through Chlorinated Dispensers in Rural Kenya, Uganda and Malawi. Evidence Action, March 2019. Furthermore, community knowledge about the chlorine dispensers and other water treatments methods contributed significantly (p<0.001) to a household using chlorine across the three countries. In Kenya, households that attended Village Community Sensitization forums were 3.2% more likely to treat their water, while in Uganda and Malawi, households who attended Community Education Meetings were 2.5% and 7.0% respectively more likely to chlorinate their water.


 There’s a Better Way to Manage Human Waste by Pallavi Bharadwaj. Engineering for Change, March 2019. Sadly, from India all the way to Kenya, the practice of manual scavenging, as the dirty clean-up work is called, is still fairly common. Despite the practice being banned since 1993 in India, the news of sewer deaths are not rare.

Economist-engineers and public health economists: is WASH economics a “field”? WASHeconomics, May 29, 2019. This post explores ways of breaking down the “field” of WASH economics.

Reflections from a mother on Menstrual Hygiene Day. Water Blog, May 28, 2019. I recently returned to work after six months of maternity leave with my second child. Transitioning back to my ‘original’ role as a Water Supply and Sanitation Specialist at the World Bank, alongside my new role as a Mum, has been a challenging but fun experience!

WASH research on container-based sanitation, water access data and more

Recent updates to include the blog post Finance for the Future: How Fintech Can Help African Governments Leverage Public Resources for More Inclusive WASH. mhm

Also the May 28, 2019 issue of the Global Waters newsletter features articles on menstrual hygiene management, a podcast on Strengthening Water Security in the Sahel and features on USAID projects in the Philippines and Madagascar.


Health Risks for Sanitation Service Workers along a Container-Based Urine Collection System and Resource Recovery Value Chain. Environ. Sci. Technol., May 13, 2019. This study assessed occupational exposure to rotavirus and Shigella spp. during CBS urine collection and subsequent struvite fertilizer production in eThekwini, South Africa.

What If Your Husband Doesn’t Feel the Pressure? An Exploration of Women’s Involvement in WaSH Decision Making in Nyanchwa, Kenya. Int. J. Environ. Res. Public Health, May 2019. From this research, it is evident that economic challenges and cultural factors such as male dominance, greatly inhibit women and girls’ participation in WaSH decision-making and implementation processes. Other factors such as time constraints and low literacy rates also emerged.

Mapping access to domestic water supplies from incomplete data in developing countries: An illustrative assessment for Kenya. PLoS One, May 17, 2019. In developing countries where geospatial datasets concerning drinking-water sources often have necessarily limited resolution or incomplete spatial coverage, the modelled surface can provide an initial indication of the geography of unimproved drinking-water sources to target unserved populations and assess water source vulnerability to contamination and hazards.

Impacts of using the electronic-health education program ‘The Vicious Worm’ for prevention of Taenia solium. Acta Tropica, May 2019. Introduction to ‘The Vicious Worm’ led to changed practices and persistence in knowledge regarding T. solium.

The Impact of Improved Water, Sanitation, and Hygiene on Oral Rotavirus Vaccine Immunogenicity in Zimbabwean Infants: Substudy of a Cluster-randomized Trial. Clinical Infectious Diseases, March 2019. Improvements in household WASH led to modest but significant increases in seroconversion to RVV in rural Zimbabwean infants.

Feasibility of a Comprehensive Targeted Cholera Intervention in The Kathmandu Valley, Nepal. The American Journal of Tropical Medicine and Hygiene, 1 May 2019. Founded on a strengthened surveillance system, the CTI approach combines pointed health behavior messaging with traditional water, sanitation, and hygiene (WASH) interventions and a single-dose OCV campaign (estimated to have a short term effectiveness of 87%) to prevent the spread of cholera once it strikes.


The Sanitation Cityscape Conceptual Framework: understanding urban sanitation systems – Paper for the WASH systems symposium. IRC, 2019. Using the Sanitation Cityscape Framework, 16 indicators describe the sanitation service delivery context under 4 thematic areas.

WHO resolution on Water, sanitation and hygiene in health care facilities. WHO, 2019. The Executive Board, Having considered the report on patient safety: water, sanitation and hygiene in health care facilities, RECOMMENDS to the Seventy-second World Health Assembly the adoption of the following resolution.


Is There a Community of Practice for Handwashing Implementers in Lower-and-Middle-Income Countries? GHP, May 6, 2019. This video presents the landscape of communities of practice for handwashing programming in various contexts. update | WASH research

Check out the new home page design of and a recent update includes the blog post, USAID Releases New Standard Indicators for Water and Sanitation.

Also be sure to check out the USAID Water Team YouTube Channel. The Channel has 14 videos and 13 playlists so far. wateraid


May 14 – Water as a Tool for Resilience in Times of Crisis – Please join the Environmental Change and Security Program, USAID’s Sustainable Water Partnership, and Winrock International for a discussion on where the challenges lie and what practitioners and policymakers can do to bolster effective water management for the world’s most vulnerable communities.


The Role of Desalination in an Increasingly Water-Scarce World. World Bank, March 2019. The cost of desalination has been plummeting over the years. As a result, desalination has become a viable option for certain strategic uses. Today, over 20,000 desalination plants in more than 150 countries supply about 300 million people with freshwater every day.

Fintech for the Water Sector: Advancing Financial Inclusion for More Equitable Access to Water. World Bank, March 2019. The emerging field of financial technology (fintech) can help address barriers to financial inclusion in the water sector while potentially reducing or eliminating the need for subsidy.


Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. Env Sci Technol, May 2019. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.

Addressing how multiple household water sources and uses build water resilience and support sustainable development. NPJ Clean Water, March 2019. ” In this Perspective, we explain the nature and scope of multiple water source use (MWSU) at the household level in developing countries. We also describe the implications of MWSU for human health and water resilience, and identify key knowledge gaps, risks, and opportunities associated with MWSU.


Sanitation: saving lives in developing countries. Institute for Fiscal Studies, May 2. IFS and Royal Holloway researchers, in partnership with WaterAid, provide new evidence on the effectiveness of one of the most popular interventions used by policy-makers and NGOs to improve rural sanitation practices in developing countries. The Nigeria study shows that Community-Led Total Sanitation only works in poorer communities and does not cause everyone in the community to adopt safe sanitation practices.


iDE WASH Markets – Developing Marketplaces for Latrines in the World’s Poorest Locations

Recent research on sanitation systems, water safety plans, enabling environments

The use of qualitative comparative analysis to identify pathways to successful and failed sanitation systems. Science of The Total Environment, 1 May 2019.
Sanitation failure is not systematically understood. Qualitative comparative analysis elucidated pathways for success and failure. Successful systems needed O&M resources, local engagement, and community buy-in. Failed systems lacked municipal engagement, addressed priorities, and O&M support. Systems must be implemented with a holistic view to best use limited resources.

Capacity building and training approaches for water safety plans: A comprehensive literature review. International Journal of Hygiene and Environmental Health, 8 February 2019.
We propose a WSP training taxonomy and discuss it in relation to the stages of learning (introduction, practice, and reinforcement); describe the importance of customizing training to the target group, local language and circumstances; highlight the relevance of auditing for evaluating change over time; and call for robust methods to monitor WSP capacity development.

The Enabling Environment for Participation in Water and Sanitation: A Conceptual Framework. Water, Feb 2019.
This paper explores elements from the theory and practice of participation, applied to the management of water resources and water and sanitation services. Based on an in-depth literature review, we analyze the forms of participation in water and sanitation, their outcomes, as well as the contextual factors and procedural elements of participatory processes that affect their success.

Health and social impacts of open defecation on women: a systematic review. BMC Public Health, 6 February 2019.
The review identified 4 overarching themes; Health Impacts of open defecation, Increased risk of sexual exploitation, Threat to women’s privacy and dignity and Psychosocial stressors linked to open defecation, which clearly present a serious situation of poor sanitation in rural communities of Lower-Middle Income Countries (LMICs). The findings of the review identified that open defecation promotes poor health in women with long-term negative effects on their psychosocial well-being, however it is a poorly researched topic.

Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS One, Feb 6, 2019.
Little evidence was identified on the requirements of disabled people and their carers in managing their menstruation, and only one intervention, but a range of barriers were identified. This gap in evidence is important, as the consequences of failing to meet menstrual hygiene needs of disabled people includes shame, social isolation, and even sterilisation.

Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia? Clinical Infectious Diseases, 15 February 2019.
This article reviews some of the approaches that may help elevate typhoid to a higher level of awareness in public health programs and policy and to ensure that investments in major public health preventive measures are made part of the universal health coverage agenda.

The impact of improved water, sanitation and hygiene on oral rotavirus vaccine immunogenicity in Zimbabwean infants: sub-study of a cluster-randomized trial. Clinical Infectious Diseases, 16 February 2019.
Improvements in household WASH led to modest but significant increases in seroconversion to oral rotavirus vaccine in rural Zimbabwean infants.

Effect of a sanitation intervention on soil-transmitted helminth prevalence and concentration in household soil: A cluster-randomized controlled trial and risk factor analysis. PLoS NTDs, 11 February 2019.
The sanitation intervention did not reduce STH contamination in household soil, suggesting households with access to improved sanitation may still be exposed to STH in the household environment. Risk factors for the presence of STH soil contamination included sharing toilets, an uncovered latrine pit, latrines <2 years old, owning dogs, shade on the sampling location, and high soil moisture content.

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.

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