Category Archives: Research

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.

Recent WASH research on handwashing, CLTS, Ascaris infections and more

In addition to the studies below, recent updates to include the blog posts, Webinar Discusses the Use of Monitoring Data in WASH Sector Decision-MakingWater Security in an Uncertain Future: Enhancing Water Resources Management and Planning by Reducing Climate- and Weather-Related Risks and news articles from the African Water Association, Kenya and Nigeria in USAID in the News.


Effects of single and integrated water, sanitation, handwashing, and nutrition interventions on child soil-transmitted helminth and Giardia infections: A cluster-randomized controlled trial in rural Kenya. PLoS Medicine, June 26. Integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies for Ascaris infections, particularly in similar settings with recent or ongoing deworming programs. Combining nutrition with WASH did not provide further benefits, and water treatment alone was similarly effective to integrated WSH. Our findings provide new evidence that drinking water should be given increased attention as a transmission pathway for Ascaris.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi. American Journal of Tropical Medicine and Hygiene, June 24. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers’ technical know-how of local dish rack and tippy tap construction is essential.

Long-term impact of a community-led sanitation campaign in India, 2005‒2016. WHO Bulletin, online first. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes.

Examining time‐dependent effects of water, sanitation, and hygiene (WASH) interventions using an agent‐based model. Trop Med Int Health, June 14. We simulated three intervention strategies, implemented separately in the experiments. The clean drinking water intervention, sanitation intervention, and hand washing intervention had similar success rates in the long‐term. The handwashing intervention had the largest immediate effect. This highlights that proper short‐ and long‐term intervention strategies need to be considered for disease control and the effective management of limited resources.

Comprehensive assessment of handwashing and faecal contamination among elementary school children in an urban slum of Indonesia. Trop Med Int Health, June 13. Proper handwashing technique and HWWS at appropriate times can reduce fecal contamination. Moreover, it is important that both grade‐based and gender‐based handwashing education be considered in elementary school education.

Microbial study of household hygiene conditions and associated Listeria monocytogenes infection risks for Peruvian women. Trop Med Int Health, May 2019. In addition to gaining insights on how human behaviours affect exposure and infection risk, this model addressed uncertainties regarding the influence of household surface contamination levels. Understanding the influence of surface contamination in preventing pathogen transmission in households could help to develop intervention strategies to reduce L. monocytogenes infection and associated health risks.


Three things we have learned by creating shit-flow diagrams. WaterAid, June 24. How do you get a full picture of how a city deals (or doesn’t deal) with its waste? Rémi Kaupp, urban sanitation specialist, swears by shit flow diagrams…

Reducing inequalities through universal access to water, sanitation and hygiene. WaterAid, July 2019. Prioritize reaching the furthest behind first by: 1. Increasing collection and dissemination of disaggregated data (by income, ethnicity, location, gender, disability, etc.), to better understand who lacks access and why.

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.