Category Archives: Research

USAID Updates | Aug 2019 WASH research | Blog updates


USAID Participation at Stockholm World Water Week 2019 – USAID sessions this year will cover topics ranging from the role of women in water leadership to promoting self-reliance through financing of water and sanitation services to building resilient water and food systems. armenia


Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Global Health, Sept 2019. Passive chlorination at the point of collection could be an effective and scalable strategy in low-income urban settings for reducing child diarrhea and for achieving global progress towards Sustainable Development Goal 6.1 to attain universal access to safe and affordable drinking water.

Experiences of capacity strengthening in sanitation and hygiene research in Africa and Asia: the SHARE Research Consortium. Health Research Policy and Systems, Aug 2019. Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi. American Journal of Tropical Medicine and Hygiene, 7 Aug. Selected contextual (i.e., presence of handwashing facility, locally made dish rack and ownership of animals) and psychosocial factors which include normative, ability, and self-regulation (remembering) factors have been identified as strong predictors for the success of an intervention that focuses on washing of utensils with soap, keeping of utensils on an elevated place, and hand washing with soap at critical times.

Broad approaches to cholera control in Asia: Water, sanitation and handwashing. Vaccine, Aug 2. Household interventions only marginally reduce cholera risk. Water and sanitation infrastructure provides multiple benefits. New approaches and institutional flexibility needed to address cholera.

The future of groundwater in sub-Saharan Africa. Nature, Aug 7. An analysis of aquifer replenishment in sub-Saharan Africa shows that reduced precipitation does not always deplete groundwater reserves, challenging the idea that these reserves will decrease in response to global warming.


What Proportion Counts? Disaggregating Access to Safely Managed Sanitation in an Emerging Town in Tanzania. Preprints, Aug 6. This study demonstrates the possibility of using simple survey tools to collect reliable data for monitoring progress towards safely managed sanitation in the towns of global south.

Monitoring Menstrual Health and Hygiene: Measuring Progress for Girls related to Menstruation Meeting Report. Columbia University and WSSCC, 2019. Overall, findings highlight the complexity of addressing menstruation in societies around the world that have ongoing menstrual restrictions and taboos that are relevant for the design of interventions.

Running Dry: Tackling the myths about urban water and sanitation. WSUP, July 2019. WSUP has identified five myths which are stopping investors, agencies and policymakers from properly addressing the inadequate access to essential water and sanitation services in cities across Africa and South Asia.


Reflections on a Review of Studies on the Physical and Emotional Toll of Carrying Water. Engineering for Change, Aug 1. UNC’s review includes takeaways for developing strategies to meet the challenge of water provision. The health problems associated with water carriage can only be eliminated if all households have water on premises, which is one of the parameters of ‘safely managed’ water called for under the Sustainable Development Goals. In areas where water fetching must continue, strategies should focus on reducing the distance to water sources, providing alternatives to carrying water on the head, such as wheelbarrows, and eliminating gender-based violence

For street vendors, finding water and toilets isn’t just a nuisance, it’s cutting into earnings. IIED, Aug 7. Guest blogger Carlin Carr argues that providing street vendors access to safe, clean water, sanitation, and hygiene resources benefits not just sellers, but the wider community too.

Rooted in Research, Handwashing Stations Designed to Encourage Kids to Wash Their Hands. WASHfunders, Aug 2019.


World Resources Institute Aqueduct 3.0 Country Rankings – This dataset shows countries and provinces’ average exposure to six of Aqueduct 3.0’s water risk indicators: baseline water stress, riverine flood risk, and drought risk. Scores are also available for all industrial, agricultural, and domestic users’ average exposure to each indicator in each country and province basin.

Recent WASH research | IWMI & UNC Water Institute reports | Global Waters updates

In addition to the studies and reports listed below, be sure to check out the latest Global Waters issue, Global Waters, July 2019. The latest update to includes the blog post, The State of Women and WASH in Textile Manufacturing Communities in India, and there were 15 posts to Sanitation Updates in July 2019.


Assessing longer-term effectiveness of a combined household-level piped water and sanitation intervention on child diarrhoea, acute respiratory infection, soil-transmitted helminth infection and nutritional status: a matched cohort study in rural Odisha, India. International Journal of Epidemiology, July 2019. An intervention where on-premise piped water coverage was contingent on full community sanitation coverage was associated with improvements in infrastructure coverage and use several years after implementation. Although there was no evidence the intervention impacted acute conditions such as diarrheal disease or respiratory infection, it was associated with a reduction in soil-transmitted helminth infection and improvements in height-for-age that may require longer-term reductions in fecal exposure.

Reassessing the projections of the World Water Development Report. NPJ Clean Water, July 2019. The aim of this paper is to highlight the inter-linkage in between population and economic growth and water demand, resources and pollution, that ultimately drive water scarcity, and the relevance of these aspects in local, rather than global, perspective, with a view to stimulating debate.

‘It’s like a burden on the head’: Redefining adequate menstrual hygiene management throughout women’s varied life stages in Odisha, India. PLoS One, August 2019. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM.

Predictors of Enteric Pathogens in the Domestic Environment from Human and Animal Sources in Rural Bangladesh. Environ. Sci. Technol. July 29, 2019. Domestic animals were important contributors to enteric pathogens in these households.

Touch for Health: Use of Pavlovian Processes with Physical Touch as a Means to Improve Menstrual Hygiene Management Initiatives, Measured by Willingness to Pay. PharmacoEconomics, July 23, 2019. Results show a statistically significant difference between the WTP figures of those females allowed interaction with the kits prior to being surveyed and those who did not. This confirms the positive impact of physical presence/touch on motivations to use/acquire hygiene-related tools.

Formative research for the design of a scalable mobile health program water, sanitation, and hygiene: CHoBI7 mobile health program. BMC Public Health, July 2019. This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.


UNC Water Institute WaSH Policy Research Digest, July 2019 – Health Effects of Carrying Water – Fetching water is associated with a variety of negative health outcomes in water carriers, and also with physical, sexual or emotional abuse. In areas where water fetching must continue, strategies should focus on reducing the distance to water sources, providing alternatives to carrying water on the head, such as wheelbarrows, and eliminating gender-based violence.

Determinants of Nutritional Status among Children under Age 5 in Ethiopia: Further Analysis of the 2016 Demographic and Health Survey. DHS Working Paper, July 2019. The study found that child, maternal, and household characteristics were significantly associated with stunting and wasting among children under age 5. The health sector should encourage positive behaviors toward childcare and infant feeding practices. More should be done to help households adopt improved types of toilet facilities and modern types of cooking fuels.

Unpacking the water-energy-environment-food nexus: Working across systems. IWMI, 2019. This paper tries to look at various frameworks and unpacks the concept of nexus in order to develop matrices to help quantify and understand the interlinkages between the nexus systems.

Small Reservoirs in Africa: A Review and Synthesis to Strengthen Future Investment. IWMI, 2019. Small reservoirs are a critical coping mechanism in water-stressed rural areas in Africa, providing immense livelihood benefits that include improved food and water security, entrepreneurial activities and climate resilience.

USAID WASH factsheet |Sanitation Literature Review |WASH Webinars


USAID Afghanistan: Initiative for Hygiene, Sanitation and Nutrition (IHSAN) file fact sheet, July 2019 – In order to improve access to basic sanitation services, IHSAN implements the government Community Led Total Sanitation (CLTS) approach and by end of April the project has verified 1,523 out of 2,264 communities as Open Defecation Free (ODF) which has helped 637,869 (67% of the annual target) people gain access to basic sanitation services. usaidnews


A LITERATURE REVIEW EVALUATING NEW APPROACHES TO RESOLVING THE SANITATION CHALLENGE IN DEVELOPING ASIA. ADBI Working Paper Series, July 2019. This paper establishes the positive impacts on GDP from investment in sanitation and emphasizes how it can regenerate countries. As the backdrop of this idea, this paper combines and analyzes supporting evidence through an extensive literature review to show that a new way of thinking informed by a comprehensive understanding of the historical issues faced must be adopted to address the sanitation challenge.

Designing and delivering research-into-use programmes in the WASH sphere Experience from SHARE, REACH and the Urban Sanitation Research Initiative, June 2019 – This Discussion Paper considers the experience of three ongoing research-into-use programmes: we identify the major challenges we have faced in achieving research uptake, and discuss strategies we are using (or that we might use in future) to overcome those challenges.

Economic Benefits of Market-Based Sanitation. WaterSHED, 2019 – It is hoped that the model will provide those working in the WASH sector with a new tool for assessing market-based sanitation programs, which can be tailored to different contexts and improved over time.

Frontiers 13: Support mechanisms to strengthen equality and non-discrimination (EQND) in rural sanitation (Part 2 of 2). IDS, 2019. In this issue, we use a broad definition of ‘support’ for creating equitable outcomes. Although financial and physical subsidies often quickly come to mind, a broader practical understanding of support needs to encompass both ‘hardware’ mechanisms and ‘software’ approaches.

Water and Economic Development: Correlation between Investment in The Water Sector and Economic Growth of Developing Countries, 2019. T. H. Musouwir, Ministry of Public Works, Republic of indonesia, Directorate General of Water Resources, Jakarta, Indonesia –  However, a statistically significant relationship does exist between national budget on water supply and sanitation and GDP per capita, and also between ODA in all sectors and GDP per capita.


Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review. BMJ Global Health, June 2019. this is the first review to consider the effect of WASH in HCFs on HCAIs. No studies were identified for the effect of water or sanitation interventions in HCF but three studies of hygiene interventions in HCF were identified which all showed protective effects.


August 7 – UNC Water Institute Webinar on Multiple Source Use – The Water Institute will host a webinar to discuss this subject on Wednesday August 7th at 9:00 am EST.

Clean, Fed and Nurtured Webinar: BabyWASH evaluation in Nigeria, July 2019 – On 9 July 2019, the Clean, Fed and Nurtured Coalition hosted a webinar focused on BabyWASH program evaluation results from work in Yobe State, northern Nigeria.


Nine ideas for Gender Transformative WASH programming. IDS, July 2019 – Gender transformative approaches to programming aim to transform the power structures that underlie unequal gender relations and norms.

Keep It Simple, Sanitation – experiences of app development. WASHfunders, July 2019.

Recent WASH reports, blogs and research

In addition to the reports and studies listed below, be sure to check out the latest updates to Globalwaters.orgMeet the Plumber Breaking Gender Norms in Côte D’IvoireWebinar Discusses the Use of Monitoring Data in WASH Sector Decision-Making and articles from Niger, Egypt, the African Water Association and Urban Links in USAID in the News. wateraid


Service delivery models for universal, safe and sustainable water services in Ethiopia. MWA, June 2019.

Planning Differently: Developing long-term, strategic plans for district-wide water, sanitation and hygiene services. MWA, May 2019.

Cost-Effectiveness Analysis of USAID/Nigeria’s Livelihoods Project Final Report, USAID, 2018.

The Next Frontier in Water Supply Service Delivery: An Assessment of the Performance of Water Sector Service Providers in Pourashavas in Bangladesh. World Bank, June 2019.

PRO-WASH Human Centered Design Workshop Tools. PRO-WASH, June 2019.

Ready for the Dry Years: Building resilience to drought in South-East Asia. UN ESCAP, 2019.

Policy Brief: How can Alternative Service Delivery improve water services? SIWI, July 2019.

Implementing the source-to-sea approach: A guide for practitioners. SIWI, July 2019.

Vietnam: Toward a Safe, Clean, and Resilient Water System. World Bank. 2019.


The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi. BMC Psychology, July 2019.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India. BMC Women’s Health, BMC Women’s Health, July 2019.

What motivates open defecation? A qualitative study from a rural setting in Nepal. PLoS One, July 2019.

Effects of single and combined water, sanitation and hygiene (WASH) interventions on nutritional status of children: a systematic review and meta-analysis. Italian Journal of Pediatrics, July 2019.

3D-printed clay-based ceramic water filters for point-of-use water treatment applications. Progress in Additive Manufacturing, July 2019.


Period Poverty Occurs in the United States, Too. Engineering for Change, July 2019.

UN High Level Political Forum 2019: an opportunity to protect the human rights of sanitation workers and manual scavengers. WaterAid, July 2019.

Digital exhibition on Women, Water and Work, curated by Living Waters Museum, a member of the Global Network of Water Museums, 2019.

Bill Frist: Lessons not learned in Congo’s Ebola outbreak. Fox News, July 2019

WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhea

The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrheaLancet Global Health, August 2019.wateraid

Summary: Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household.

We have completed three randomised efficacy trials testing improved household-level WASH with and without improved infant and young child feeding (IYCF) on stunting and diarrhoea in Bangladesh, Kenya, and Zimbabwe. In all trials, improved IYCF had a statistically significant benefit, but WASH had no effect on linear growth.

In observational analyses of data from the control groups of the three trials, baseline sanitation was a strong risk factor for stunting in the study populations, suggesting this frequently reported association might be confounded by unmeasured factors of household wellbeing. WASH interventions reduced diarrhoea in Bangladesh, but not in Kenya or Zimbabwe.

Intervention promoters visited participants six times per month in Bangladesh compared with monthly in Kenya and Zimbabwe; a review of the literature shows that virtually all published studies that have reported an effect on diarrhoea through home-based water treatment and handwashing promotion achieved high adherence by visiting participants at daily to fortnightly intervals.

Despite achieving substantial behavioural change and significant reduction in infection prevalence for some enteric pathogens, detection of enteropathogens among children in the WASH groups of the trials was typically at ten times higher prevalence compared with high-income countries.

Considering these results, we recommend that future research in the WASH sector focus on developing and evaluating interventions that are radically more effective in reducing faecal contamination in the domestic environment than the interventions implemented in these trials.

Water Currents: Handwashing Research, January – June 2019

Water Currents: Handwashing Research, January – June 2019

The January to June 2019 Handwashing Research Index is the result of a collaboration between the Global Handwashing Partnership and the USAID Water Communications and Knowledge Management Project. hw

The index includes 36 peer-reviewed studies from 2019 that explore handwashing in connection with diverse programmatic areas. It also includes several studies from 2018 that were not included in the 2018 Index due to publication timelines.

This issue of Water Currents features selected studies from the index, as well as links to handwashing-related websites.

Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on InequalitiesWHOUNICEF, June 2019. In 2017, 22 percent of the global population (1.6 billion people) had handwashing facilities that lacked water or soap, and 18 percent (1.4 billion people) had no handwashing facility at all.

Handwashing with Soap after Potential Faecal Contact: Global, Regional and Country Estimates for Handwashing with Soap after Potential Faecal ContactInternational Journal of Epidemiology, December 2018. Researchers found that many people lack a designated handwashing facility, but even among those with access, handwashing with soap is poorly practiced. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential fecal contact as people who lack a facility.

Community Settings
Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, IndiaAmerican Journal of Tropical Medicine and Hygiene, April 2019. A study in rural India found that disposal of child feces into a latrine was uncommon, even among households with access to an improved pour-flush latrine that was used by adults in the household.

Read the complete article.

July 2019 WASH Benefits studies | USAID funding for desalination research


USAID/MEDRC Humanitarian Desalination Challenge: Call for Proposals – In partnership with USAID, MEDRC Water Research is launching an international research call for proposals to boost innovation in small scale desalination technologies. The Humanitarian Desalination Challenge Research Call will support pathway research, aimed at the delivery of an innovative family sized desalination unit.


Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials, July 6. Rigorous implementation of interventions deployed at large scale in the context of an efficacy trial achieved high levels of technology and behavioral uptake in individual and combined WASH and nutrition intervention households. Further work should assess how to achieve similar uptake levels under programmatic conditions.

WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. Trials, July 6. Behavioral objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviors. We administered monthly surveys and spot-checks to households from randomly selected clusters for 6 months early in the trial. If any fidelity measures fell below set benchmarks, a rapid response mechanism was triggered.


WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India. BMC Women’s Health, July 5. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls.

Economic cost analysis of low-cost sanitation technology options in informal settlement areas (case study: Soweto, Johannesburg). International Journal of Hygiene and Environmental Health, 3 July 2019. The study revealed that simplified sewerage is the cheapest option for Soweto informal settlement, even when the costs of pumping and treatment are included. Gravity simplified sewerage with treatment is cheaper than the UDDT system and VIP latrine at all population densities above 158 and 172 persons/ha, respectively. The total annual cost per household of simplified sewerage and treatment was US$142 compared to US$156 and US$144 for UDDT and VIP latrine respectively.

Microbial Source Tracking Using 16S rRNA Amplicon Sequencing Identifies Evidence of Widespread Contamination from Young Children’s Feces in an Urban Slum of Nairobi, Kenya. Environ. Sci. Technol., June 21, 2019. Among environmental samples, young children’s feces were almost always identified as the dominant source of human fecal contamination inside households (hands, surfaces) whereas older children/adult feces were often identified as the dominant source outside households (standing water, streams, soil). Markers for young children’s feces were also detected in standing water and streams, and markers for both fecal sources were equally likely to be dominant in open ditches. These results establish motivation for sanitation interventions that directly address child feces management.


Will Sarni: “Cyber security is critical for water utilities.” Smart Water Magazine, July 2019. Digital technologies are providing vastly improved connectivity from source to use.

Gender and water collection responsibilities – A snapshot of Latin America. Water Blog, June 26. In those households where water needs to be collected, 57 % of those collecting water in El Salvador, 55.6 % of those fetching water in Panama, and 57.9 % of those fetching water in Paraguay are women. In Mexico, the burden of fetching water seems more evenly divided: with 50.8 % of women burdened with water-collection responsibilities.

As a major Indian city runs out of water, 9 million people pray for rain. Washington Post, June 28. A severe water shortage is stalking Chennai, whose metropolitan area is home to 9 million people. The city’s reservoirs and lakes are parched and its wells have run dry after two years of scanty rains here.