WASH weekly research updates – November 12, 2019

In additional to the studies and resources listed below, recent updates to Globalwaters.org include:

Many thanks to Sheela Sinharoy, sheela.sinharoy@emory.edu, for sharing the 2 studies below on structural equation modelling and sanitation policies and to John Sauer, jsauer@psi.org, for the blog post, 3 ways India can tackle its human-waste problem. The Weekly WASH Research Updates are also posted on Sanitation Updates.


Using structural equation modelling to untangle sanitation, water and hygiene pathways for intervention improvements in height-for-age in children <5 years old. International Journal of Epidemiology, October 2019. Authors: Heather Reese, Sheela S Sinharoy, Thomas Clasen – Our finding, that water impacts HAZ through the sanitation pathway, is an important and actionable insight for WaSH programming.

Review of drivers and barriers of water and sanitation policies for urban informal settlements in low-income and middle-income countries. Utilities Policy, October 2019. Authors: Sheela S.Sinharoy, Rachel Pittluck, Thomas Clasen – Ensuring responsive water and sanitation policies for informal settlements will require inter-disciplinary collaboration and both top-down and bottom-up approaches.

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Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection

Interventions to improve disposal of child faeces for preventing diarrhoea and soil‐transmitted helminth infection. Cochrane Database Syst Rev. 2019 Sep; 2019(9): CD011055. cochrane

Authors: Fiona Majorin, Belen Torondel, Gabrielle Ka Seen Chan, and Thomas Clasen

Evidence suggests that the safe disposal of child feces may be effective in preventing diarrhea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very‐low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.

While child feces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of feces of children of different age groups.

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017. Lancet Infectious Diseases, October 30, 2019.

Authors – GBD 2017 Diarrhoeal Disease Collaborators: Collaborators listed at the end of the Article lancet

An excerpt – Diarrhea was responsible for an estimated 533 768 deaths among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhea mortality per 100 000 globally decreased by 69·6% between 1990 and 2017.

Among the risk factors considered in this study, those responsible for the largest declines in the diarrhea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4).

Diarrhea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhea mortality.

Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhea that have already reduced diarrhea mortality could further avert many thousands of deaths due to this illness.

WASH weekly research update – October 8, 2019

Many thanks to Ian Ross, Ian.Ross@lshtm.ac.uk, for sharing the blog post, Funders shouldn’t misinterpret WASH-B and SHINE results as “WASH doesn’t work”

It is easy to misinterpret the WASH-B and SHINE findings as “WASH doesn’t work”. If funders make this misinterpretation, people will miss out on life-changing WASH services. In this post, I discuss the incremental changes the interventions delivered, how epidemiologists have interpreted the results, and how funders should interpret them.

Thanks also to Val Curtis, Val.Curtis@lshtm.ac.uk, for sharing her article, Explaining the outcomes of the ‘Clean India’ campaign: institutional behavior and sanitation transformation in India. BMJ Global Health, Sept 2019. mhm

The experience of the Clean India program suggests that countries can almost eliminate open defecation. The success of the program was due to the following factors: setting of ambitious targets; use of modern communications strategies and monitoring technology; and provision of visible reward and recognition for employees. What do the new findings imply? Disruptive leadership is needed to create working environments where, sometimes jaded, civil servants are given an opportunity to make a difference. Politicians who embrace the cause of sanitation may find that there are votes in toilets.

Other recently published studies:

Underrepresented groups in WaSH – the overlooked role of chemical toxicants in water and health. Journal of Water, Sanitation and Hygiene for Development, Sept 2019. The review enumerated studies that focused on water quality and treatment from a chemical perspective, highlighting in particular organic contaminants of emerging concern. Organic chemicals were addressed in only 2% of journal articles and fewer than 0.7% of conference presentations.

The Household Water InSecurity Experiences (HWISE) Scale: development and validation of a household water insecurity measure for low-income and middle-income countries. BMJ Global Health, August 2019. The HWISE Scale can be used to monitor and evaluate water insecurity, identify vulnerable subpopulations for maximally effective resource allocation and measure the effectiveness of water-related policies and interventions.

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries. BMJ Open, August 2019. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from −0.18 to −0.10 SDs.

Measuring open defecation in India using survey questions: evidence from a randomised survey experiment. BMJ Open, Sept 2019. We provide the first evidence that individual-level questions find more open defecation than household-level questions.

Testing the socioeconomic and environmental determinants of better child-health outcomes in Africa: a cross-sectional study among nations. BMJ Open, Sept 2019. Across nations, child health was lowest when water quality, improved sanitation, air quality and environmental performance were 

WASH weekly research update – October 28, 2019

The latest updates to Globalwaters.org include:


Leaving no one behind? Analysis of trends in access to water and sanitation services in the slum areas of Nairobi, 2003–2015. Journal of Water, Sanitation and Hygiene for Development (2019) 9 (3): 549-558.

The struggle for water in Indonesia: the role of women and children as household water fetcher. Journal of Water, Sanitation and Hygiene for Development (2019) 9 (3): 540-548.

Diurnal water use patterns for low-cost houses with indigent water allocation: a South African case study. Journal of Water, Sanitation and Hygiene for Development (2019) 9 (3): 513-521.

Household drinking water safety among the population of Gaza Strip, Palestine: knowledge, attitudes, practices, and satisfaction. Journal of Water, Sanitation and Hygiene for Development (2019) 9 (3): 500-512.

The role of social identification for achieving an open-defecation free environment: A cluster-randomized, controlled trial of Community-Led Total Sanitation in Ghana. Journal of Environmental Psychology, October 2019.

Dracunculiasis—a case study for infection eradication. Lancet Infectious Diseases, November 2019. This strategy of educational interventions, behavioral changes, sanitation improvement, and vector control has been largely successful: cases of guinea worm disease decreased from 3·5 million in 1986 to 28 in 2018.

Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis. Wellcome Open Research, 2019.


Celebrating the Sanitation Learning Hub’s new lease of life. IDS, October 2019.

Using Location Intelligence to Solve the Urban Sanitation Crisis. Chapter 2 in Ideas for Action 2019 Financing and Implementing Sustainable Development. World Bank, 2019. Gather uses location data intelligence to get toilets to people who need them. We use geospatial analysis to inform investment in sanitation infrastructure and services to prevent fecal contamination of water supplies in highrisk areas.


The Guts of the Matter: A Global History of Human Waste and Infectious Intestinal Disease. By James L. A. Webb, Jr. Cambridge University Press, November 2019.


NC State WaSH Cluster – The NC State WaSH Cluster catalyzes & conducts transformational research and education to serve the water, sanitation, and hygiene needs of marginalized people. A recent news item – CCEE Researcher Awarded Half a Million Dollars to bring the Flexcrevator to a more Inclusive Market – NC State developed the Flexcrevator, the only all-in-one machine that simultaneously removes fecal sludge in the presence of trash.

WASH weekly research update – November 4, 2019


Water, sanitation and hygiene (WASH) behaviour change research: why an analysis of contingencies of reinforcement is needed. International Journal of Environmental Health Research, Oct 28. Currently, there is an emphasis on addressing cognitive processes to bring about changes in behavior. In this review, a case is made for the benefits of a contingency-based perspective, focusing on the contextual antecedents and consequences of behavior. armenia

Stool-Based Pathogen Detection Offers Advantages as an Outcome Measure for Water, Sanitation, and Hygiene Trials. American Journal of Tropical Medicine and Hygiene, November 2019.

Effectiveness of a Behavior Change Intervention with Hand Sanitizer Use and Respiratory Hygiene in Reducing Laboratory-Confirmed Influenza among Schoolchildren in Bangladesh: A Cluster Randomized Controlled Trial. American Journal of Tropical Medicine and Hygiene, November 2019.

Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980-2015. J Glob Health. 2019 Dec. Universal coverage of direct diarrhea, nutrition and WASH interventions has the potential reduce the diarrhea-specific mortality rate by 90%.

Integrating Face Washing into a School-Based, Handwashing Behavior Change Program to Prevent Trachoma in Turkana, Kenya. American Journal of Tropical Medicine and Hygiene, Oct 2019.

Unavoidable Risks: Local Perspectives on Water Contact Behavior and Implications for Schistosomiasis Control in an Agricultural Region of Northern Senegal. American Journal of Tropical Medicine and Hygiene, Oct 2019.


THE STATE OF WASH FINANCING IN EASTERN AND SOUTHERN AFRICA: Regional Level Assessment. UNICEF, October 2019. This report focuses on WASH financing for the entire ESAR and follows the development of four country reports (Burundi, Eswatini, Uganda and Zimbabwe).

Water Strategy: Water Sector Analysis. Asian Infrastructure Investment Bank, October 2019. Key Water Sector Issues in Asia.

FEATURED RESOURCE – Sanitation and Hygiene Applied Research for Equity (SHARE) PROJECT

SHARE website – SHARE contributes to achieving universal access to effective, sustainable and equitable sanitation and hygiene by generating evidence to improve policy and practice worldwide.

New reports, journal articles include:

What Proportion Counts? Disaggregating Access to Safely Managed Sanitation in an Emerging Town in Tanzania.

Developing a Contextually Appropriate Integrated Hygiene Intervention to Achieve Sustained Reductions in Diarrheal Diseases.

Experiences of capacity strengthening in sanitation and hygiene research in Africa and Asia: the SHARE Research Consortium.

Additional studies and reports

3 ways India can tackle its human-waste problem

3 ways India can tackle its human-waste problem. World Economic Forum, October 2019.

On 2 October, the government of India declared the country open defecation-free (ODF). This is a significant milestone, which has addressed mindset, behavioural change and infrastructure gaps “Before the Flush”. But what happens “After the Flush”?

It is estimated that poor sanitation costs India 5.2% of its gross domestic product (GDP) annually. While much is being done to create access to toilets, the fact remains more than 57% of human waste globally is not contained, transported, or treated in a way that safely contains harmful pathogens. wef

A staggering 78% of sewage generated in India remains untreated and is unsafely disposed of in rivers, groundwater or lakes, contaminating 90% of all surface water.

India must find ways to manage its faecal sludge to secure clean water sources to meet the needs of its burgeoning population of 1.37 billion, and facilitate their healthy, productive participation in the economy.

Read the complete article.