Toward a Hygienic Environment for Infants and Young Children: A Review of the Literature – USAID/WASHpals

Toward a Hygienic Environment for Infants and Young Children: A Review of the Literature. USAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS), February 2018.

 For nearly six decades, the routes of pathogen transmission from human excreta to a new host have been reflected in the seminal “F-diagram” via fluids, fingers, flies, fields (floors, earth, dirt), and fomites (surfaces).

The WASHPaLS project conducted a review of the scientific and grey literature, complemented by dozens of key informant interviews with researchers and practitioners, to re-examine the F-diagram, highlighting the underemphasized sources of pathogens and transmission pathways that are of particular relevance to the health of infant and young children (IYC) and not disrupted by the traditional suite of WASH measures.

These are:

  • domestic animal excreta as a source of risk, and
  • direct ingestion of pathogens via eating feces, dirt (geophagy) or through mouthing behaviors as additional pathways.

WSSCC and UN Women to host side event on 20 March at the Commission on the Status of Women


WSSCC and UN Women will convene a side event on 20 March in New York during the sixty-second session of the Commission on the Status of Women.

The cross-cutting session, entitled Sanitation: the challenge of rural women and girls in West and Central Africa, will highlight the issue of unlocking multiple benefits for rural women and girls through policy and behaviour change in the WASH sector.

The importance of breaking taboos and fighting stigma through evidence-based approaches on Menstrual Hygiene Management and other topics is key. Participants will discuss approaches and programme implementation in West and Central Africa, including results and recommendations.

This session will bring together experts from the Senegal Government, UNICEF, UN Women and WSSCC to share lessons and successes in policy and practice, with a specific focus on how multi-sectoral partnerships can collaborate to achieve the Sustainable Development Goals. Speakers include:

  • Ms Ndèye Saly Diop Dieng, Ministry of Gender, Government of Senegal
  • Ms Maria-Noël Vaeza, UN Women Director of the Programme Division
  • Ms Virginia Kamowa, WSSCC technical expert, Menstrual Hygiene Management
  • Ms Amanda Marlin, UNICEF Senior Adviser WASH, Partnerships and Global Initiatives (Moderator)

For more information:

An Emergency WASH update – March 15, 2018


March 20 – Solutions for Dirty Water. In this third part of its “Sustainable Water, Resilient Communities” series, co-hosted with Winrock International and the Wilson Center, the USAID-funded Sustainable Water Partnership (SWP) will present “Solutions for Dirty Water” on March 20. Moderated by SWP Director Eric Viala, experts will discuss approaches to meeting the challenges of poor water quality: improving sanitation and hygiene, preventing the spread of waterborne diseases after disasters, addressing agricultural pollution and increasing water supplies through wastewater reuse.

Panelists: Jon Freedman, Global Government Affairs Leader, SUEZ; Daniele Lantagne, Associate Professor, Department of Civil & Environmental Engineering, Tufts University; Lisa Schechtman, Director of Policy and Advocacy, WaterAid America; Jon Winsten, Agricultural and Environmental Economist, Winrock International; Tracy Wise, WASH Sector Advisor, Office of Foreign Disaster Assistance, USAID

April 6 – Water in Humanitarian Emergencies: Water: Systems, Science and Society (WSSS) 9th Annual Symposium: Tufts University. The event will feature discussions and breakout sessions on the role of innovation and diplomacy in addressing water concerns in humanitarian emergencies. The symposium will kick off with a keynote address by Martha Thompson on Puerto Rico’s disaster response, followed by two breakout sessions led by various water experts on the intersection of gender and water, infrastructure and investments, and waterborne disease outbreaks. Finally, the Symposium will conclude with a panel discussion on the water crisis in Cape Town, South Africa.


Taking emergency water, sanitation and hygiene to market. Oxfam Voices, March 2018. Esther Shaylor explains how Oxfam is working with other NGOs to share learning about providing emergency water, sanitation and hygiene using local markets.

Fast-acting antidote in sight for cholera epidemics. Science Daily, March 9, 2018. Groundbreaking discoveries regarding the onset of cholera are paving the way for a future, fast-acting antidote for cholera epidemics.

What You Need to Know About the Future of the Humanitarian Sector. Aid for Aid Workers, March 2018. My guest today, Sean Lowrie is the Director of START Network, has some forward thinking ideas around where the humanitarian sector is headed and what International NGO’s will need to do in order to adapt to these changes

Addressing Water, Sanitation and Disasters in the Context of the Sustainable Development Goals. UN Chronicle, March 2018. The resulting recommendations on key actions include: Raising disaster risk reduction and resilience to a higher level on the political agenda. Special Thematic Sessions on water and disasters should be organized biennially in the United Nations General Assembly.

Why we must engage women and children in disaster risk management. Sustainable Cities, March 2018. At the community level, disaster risk prevention should start with boys and girls. Success stories from Indonesia, the Philippines, Vietnam, Thailand, Cambodia, Nepal, and Bangladesh show the impact of involving children and youth in disaster risk preparedness. Children have successfully participated in mapping hazards, raising awareness through radio and games, and influencing other children, teachers, parents and communities on how to reduce disaster risks.

Monitoring and evaluation framework for WASH market based humanitarian programming: guidance document. Oxfam, 2017. In order to gather evidence about the effectiveness and efficiency of market-based programmatic approaches compared with conventional humanitarian responses, there is a need for a systematic and standardised approach for monitoring and evaluation. To support the development of this standardized approach, Oxfam (with funding from USAID/OFDA) has commissioned the production of a monitoring and evaluation framework and associated IT tools.

Climate Change and Conflict: New Research for Defense, Diplomacy, and Development. This March 7, 2018 event was held at the Wilson Center. “The long-term trends toward a warming climate, more air pollution, biodiversity loss, and water scarcity are likely to fuel economic and social discontent – and possibly upheaval – through 2018,” the U.S. National Intelligence Council warns in its Worldwide Threat Assessment. Panelists discussed how can the state of the research help us understand and address these risks and what are the next steps for translating this expertise into new security practice.


Cholera: Revised cholera kits and calculation tool, World Health Organization. In 2016 WHO introduced the Cholera Kits. These kits replace the Interagency Diarrhoeal Disease Kit (IDDK) which had been used for many years. The Cholera Kit is designed to be flexible and adaptable for preparedness.

Impact of Drinking Water, Sanitation and Hand Washing with Soap on Childhood Diarrhoeal Disease

Link to full-text – Impact of Drinking Water, Sanitation and Hand Washing with Soap on Childhood Diarrhoeal Disease: Updated Meta-Analysis and –RegressionTropical Medicine and International Health, 14 March 2018.

Authors: Jennyfer Wolf, Paul R. Hunter, Matthew C. Freeman, Oliver Cumming, Thomas Clasen, Jamie Bartram, Julian P. T. Higgins, Richard Johnston, Kate Medlicott, Sophie Boisson, Annette Prüss-Us

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/tmi.13051

Objectives – Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease.

Methods – We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression.

Results – A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity.

  • Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR=0.39; 95% CI: 0.32, 0.48);
  • piped water to premises of higher quality and continuous availability by 75% and 36% (RR=0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water;
  • sanitation interventions by 25% (RR=0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR=0.70 (0.64, 0.77)) versus no intervention.
  • Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent.

Conclusions – Though evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.

Is Bollywood’s Pad Man movie too good to be true?

Checking the facts and assumptions about menstrual hygiene in developing countries.

Mensrual hygiene painting-crop

Painting by students of the Dr. M.M. den Hertogschool, The Hague, on the importance of menstrual hygiene management and school WASH. Photo: IRC

March 8th was International Women’s Day. Which approach to menstrual hygiene management fits best with this year’s theme urging everyone to #PressforProgress on gender parity? Is it pressing for access to affordable menstrual products or is there more to it?

A few weeks ago, I joined a group of my female colleagues and family to watch “Pad Man”, the Bollywood film inspired by the life of Arunachalam Muruganantham.  He is an acclaimed Indian social activist and entrepreneur who invented a low-cost sanitary pad-making machine. Muruganantham famously tested sanitary pads on himself, using a bladder with animal blood, while riding his bicycle. “Pad Man” is a feel good, uplifting movie. We left the cinema dancing to the tune of the Pad Man Song.

Too good to be true?

But then, a few days later an IRC colleague from India referred us to a blog that claimed to tell the “real story” about the man, who “shot to fame by selling shame”. The author, Sinu Joseph, is Managing Trustee of the Myrthi Speaks Trust, a Bengaluru-based social activist group working on issues including menstrual health and sanitation. Sinu had initially been involved in distributing Mr. Muruganantham’s sanitary pads until angry mothers complained that she was “trying to get rid of some cheap stuff by dumping it” on their daughters.

Fact check

Sinu counters several of the “facts” mentioned in “Pad Man”, which are also regularly quoted in the media. The first is that Indian women use ash, sand and husks as menstrual absorbents and consequently suffer “from Reproductive Tract Infections for want of a Pad”.  Sinu has found no evidence of this, both from her own experience and the literature. In fact, she says there is no evidence linking the use of menstrual products such as cloth to any menstrual disorder.

Second is the widely quoted statistic that only 12% of Indian women use sanitary napkins. Wrong again, says Sinu: the National Family Health Study of 2015-16 found that the real number is 57.6% , 48.5% in rural, 77.5% in urban areas. Finally, there is no evidence that girls in India drop out of school owing to menstruation and the lack of sanitary napkins. Similar findings emerged from a 2010 study in Nepal, which at the time was not welcomed by the pro-sanitary napkin development lobby.

A developing country problem?

The evidence Sinu refers to, comes from a review of 90 papers, which Myrthi Speaks conducted in 2016. The review not only dispels the “facts” mentioned above but also challenges the assumption that developing countries have a greater prevalence of menstrual disorders than in the West. In fact, the review found that the opposite is true. In developed nations, a higher percentage of adult women and adolescents suffer from heavy bleeding and painful or irregular periods than in developing countries.


So why has the real-life Pad Man attracted so much uncritical support? Is it because this unlikely hero, an uneducated man, took it upon himself to elevate Indian women from their shameful state? Indeed, most of the women in the Pad Man movie are portrayed as ignorant, led by superstition. In Sinu’s words, “shame has been sold to us in a nice package with celebrity endorsements”.

Glorifying traditional practices?

Sinu has been criticised for promoting the traditional practice of seclusion, which she says provides women who are part of joint families “privacy and comfort during menstruation”. A 2015 blog by Eco Femme, an Indian social enterprise producing washable sanitary pads, said that Sinu neglects those women who experience being excluded as degrading. Harrowing stories about the illegal Nepali practice of Chhaupadi, where girls are forced to spend their periods in cattle sheds, come to mind. The Pad Man film similarly condemns the segregation of women during menstruation.

Interestingly, Arunachalam Muruganantham, Sinu Joseph, Eco Femme, along with many development agencies all claim that they understand women’s needs. Whose view do you support? Or have they all got it wrong?

This blog was originally posted on the IRC website.

World Water Day 2018 – Water Currents

World Water Day is observed on March 22 to raise awareness about the vital importance of water and its cross-cutting impact ranging from public health and youth education to economic development and gender equality. This year’s theme, “Nature for Water,” explores nature-based solutions to water challenges.


Laguna Negra, in the upper basin of the Chinchiná River, Colombia, is part of a high-altitude wetland ecosystem that provides much of Colombia’s fresh water. Photo credit: Juliana Narvaez/PARA-Agua

According to UN-Water’s World Water Day fact sheet, nature-based solutions can help to manage both water availability and quality. Examples include restoring forests, grasslands, and natural wetlands; reconnecting rivers to floodplains; and creating vegetation buffers along watercourses. These and other nature-based solutions can reduce erosion, improve water quality, enhance biodiversity, recharge groundwater resources, and mitigate flooding downstream.

This issue contains information on upcoming World Water Day 2018 events and studies on nature-based solutions to water supply issues.

Looking for a back issue of Water Currents? Check out the archive on

March 22: World Water Day 2018. The official World Water Day website advocates for water-related issues, provides resources, and includes a fact sheet as well aspromotional materials for this year’s theme.

March 22: Launch of International Decade for Action: Water for Sustainable Development 2018-2028. The UN General Assembly will launch this initiative to improve cooperation, partnership, and capacity development to address water-related challenges in response to the 2030 Agenda for Sustainable Development.

March 19: 8th World Water Forum. Touted as the world’s biggest water-related event, the annual forum brings together water experts and managers from organizations all over the world. It is organized by the World Water Council.

Read the complete issue.

Recent posts from the WASHeconomics blog

Below are links to posts from the WASHeconomics blog: A blog about the economics and financing of water and sanitation in developing countries:

A systems approach to sanitation – iDE Bangladesh

Bangladesh is a global success story in sanitation, reducing open defecation from 34% in 1990 to less than 1% today. But despite this initial progress, nearly 40% of the country still lacks access to improved sanitation.

To tackle Bangladesh’s sanitation problem iDE takes a comprehensive systems approach to increase improved sanitation coverage.

iDE’s interventions facilitate different actors in the market system, leveraging existing skills and resources, building connections from the local to the national level, and coordinating across public, private, and development sectors to create a complete ecosystem that enables the sustainable, inclusive delivery of improved sanitation products and services.