Category Archives: Hygiene Promotion

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.

Wash it! WaterAid Cambodia

This hand washing music video is a collaboration between WaterAid Cambodia and Epic Arts and is produced by a group of orginal artists with disability.

This video aims to promote inclusive hygiene and hand washing with soap across Cambodia.

Delivery through online (many channels of social media) and outreach (concert, festival and flashmob); song reached to millions of Cambodian to remind them to wash their hand with soap in a fun and engaging way.

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.

Sanitation experts review Bollywood’s “Toilet: A Love Story”

This is the score CAWST’s sanitation experts gave for the Bollywood film Toilet: Ek Prem Katha or Toilet: A Love Story, which they reviewed for World Toilet Day.  Read the full review by CAWST Communications and Engagement Officer Holly Claeys.

Toilet Design 

Role of Government 

Fecal Sludge Management 

Behaviour Change 

Developing Competencies 



WaterAid – Mass behaviour change campaigns What works and what doesn’t

Mass behaviour change campaigns: What works and what doesn’t. WaterAid, October 2017.

Hygiene promotion campaigns are often piecemeal, insufficiently planned and executed, and a re-tread of unproven or, worse, ineffective approaches. The
lamentable performance of handwashing campaigns in changing behaviours reveals
a lack of coherent thinking in policies, strategies and guidelines.

To promote an effective approach to mass behaviour change campaigning, and
hygiene promotion in particular, WaterAid commissioned an in-depth global and
historical analysis of behaviour change campaigns, analysing both successes and

This paper highlights the main points from that study combined with findings from a previous WaterAid paper on how some countries in East Asia successfully
achieved the widespread adoption of hygienic practices.

It provides policy recommendations as a set of ‘working assumptions’ that can be used by policy makers when it comes to developing mass behaviour change strategies.

Read the complete report.

Global Handwashing Day – Water Currents

Global Handwashing Day – Water Currents, October 13, 2017

Global Handwashing Day is celebrated each year on October 15 to increase awareness and understanding around the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives. USAID recognizes washing hands with soap at critical times as a vital step in curbing the spread of diarrhea and respiratory illness, and promoting healthy growth.

Photo credits: Morgana Wingard/USAID (left) and Be Secure/USAID (right)

Photo credits: Morgana Wingard/USAID (left) and Be Secure/USAID (right)

USAID works with vulnerable populations around the world who lack access to soap and water in the home and are often miles away from a safe and clean facility.

Join your soapy hands together to celebrate this year’s Global Handwashing Day theme, “Our Hands, Our Future.”

USAID handwashing efforts work toward a future where soap and water are accessible to every home and handwashing is a regular habit.

Interventions to Promote Handwashing and Sanitation Webinar. October 24, 2017. This Water Supply and Sanitation Collaborative Council (WSSCC) webinar will discuss the recent WSSCC/3ie systematic review, “Approaches to Promote Handwashing and Sanitation Behavior Change in Low and Middle Income Countries.”

Handwashing ResearchWater Currents, August 2017. This issue highlights recent handwashing studies including research in Bangladesh, Tanzania, and Zimbabwe, as well as studies on handwashing and infectious diseases, among other topics.

Read the complete issue.

WSSCC Webinar: Handwashing and sanitation behaviour change in WASH interventions, 24 October

Water Supply and Sanitation Collaborative Council (WSSCC) would like to invite you to register to the online learning event: Handwashing and sanitation behaviour change in WASH interventions.

A webinar for WASH practitioners.

Learn about the most effective interventions to promote handwashing and sanitation.

Presented by Emmy De Buck, Manager and Lead Researcher, Centre for Evidence-Based Practice, (CEBaP), Belgian Red Cross-Flanders.

Moderated by Chaitali Chattopadhyay, Senior Programme Officer, Monitoring
and Evaluation, WSSCC

To register click here.

Read ahead:

Attention is increasingly focusing on programme design and approaches that promote water, Sanitation, and Hygiene (WASH) behaviour change in efforts to achieve UN Sanitation Goal 6. Several approaches have been developed over the last 2 decades that promote uptake of WASH interventions and sustain WASH behaviour change. While the evidence base for interventions in low and medium-income countries is extensive, there is a gap in behaviour change approaches in WASH interventions.

The International Initiative for Impact Evaluation (3ie), in partnership with the Water Supply and Sanitation Collaborative Council (WSSCC), funded a systematic review to help fill in this evidence gap. It looked at which promotional approaches might change handwashing and sanitation behaviour, and which implementation factors affect the success or failure of such promotional approaches. It synthesises evidence from 42 quantitative studies on the effectiveness of behaviour change approaches and 28 qualitative studies on the implementation of such programme.

Join the webinar on 24th October 2017 for the launch of this recent systematic review “Approaches to promote handwashing and sanitation behaviour change in low- and middle-income countries.”