Category Archives: Sanitation and Health

An Annotated Bibliography on Shared Sanitation – November 28, 2016

An Annotated Bibliography of 2015 and 2016 Studies and Reports on Shared Sanitation – November 28, 2016

 2016 Studies and Reports

1 – Shared sanitation: to include or to exclude? Trans Roy Soc Trop Med & Hygiene, May 2016. Duncan Mara.  (Abstract/order)
Recent research has shown that neighbor-shared toilets perform much better than large communal toilets. The successful development of community-designed, built and managed sanitation-and-water blocks in very poor urban areas in India should be adapted and adopted throughout urban slums in developing countries, with a caretaker employed to keep the facilities clean. Such shared sanitation should be classified as ‘basic’, sometimes as ‘safely-managed’, sanitation, so contributing to the achievement of the sanitation target of the Sustainable Development Goals.

2 – Can behaviour change approaches improve the cleanliness and functionality of shared toilets? A randomised control trial in Dhaka, Bangladesh. WSUP, May 2016.
(Full text)
This project demonstrated that a behavior change communication intervention built upon in-depth qualitative understanding of the perspective and constraints of local residents could improve toilet cleanliness, even in the setting of severe constraints: notably water shortages and the absence of fecal sludge management systems. The most important step towards improving environmental sanitation in Dhaka is to address the absence of any fecal sludge management system. To improve the quality and cleanliness of shared facilities, behavior change strategies targeting the central role that landlords and community managers play can be particularly effective. Future research might explore: 1) how compound managers and/or landlords can make improvements to toilet cleanliness without project-funded hardware; 2) how to leverage mass media approaches to reduce the cost of behavior change communication; 3) how the effectiveness of specific behavior change strategies varies by gender; and 4) further evaluations to assess the sustainability of these efforts to improve toilet cleanliness.

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Crappy water and the science of sanitation

Crappy water and the science of sanitation. The Guardian, November 22, 2016. by  by Mary-Ann Ochota, an anthropologist and author of Hidden Histories: a spotter’s guide to the British landscapehe

Stunting, death and malnutrition: why contaminated water has far more serious effects than the odd bout of diarrhoea 


Eight year olds in Monze District, Zambia beneath a chalk line indicating the global average height for their age. 40% of children in Zambia suffer from stunted growth, the 10th highest rate in Africa. Photograph: WaterAid/Chileshe Chanda

At the start of this year, the UN recognised sanitation as a universal human right. The Sustainable Development Goals aim to achieve global sanitation by 2030. But despite these grand ambitions, and a hard-working WASH (Water, Sanitation and Hygiene) development sector, 2.4 billion people around the world still don’t have access to a proper toilet.

When we think of poor sanitation, thoughts usually turn to diarrhoea. If you start off healthy, and have the means to prevent dehydration, it’s not usually life threatening. But more than half a million under fives died from diarrhoea in 2013, with around 314,000 deaths directly attributable to poor WASH. And for people continuously exposed to a faecally-contaminated environment, the lack of a toilet can have far-reaching effects.

Recent research has highlighted an indisputable link between toilets, malnutrition and irreversible stunting.

Malnutrition isn’t simply to do with a lack of food – it’s net nutrition that’s key, with access to nutritious food offset against losses to disease, and impairment in the ability to absorb nutrients.

The World Health Organisation estimates that 50% of cases of malnutrition in the world are due to repeated bouts of diarrhoea or intestinal worm infections caused by inadequate water and sanitation provision. Just five cases of severe diarrhoea in the first two years of a child’s life can result in stunting – short height for age – which is a measure for overall health. Stunting is largely irreversible after the age of two, and results in reduced lifelong immune capacity, retarded cognitive and emotional development, and poor physical health.

Read the complete article.


Water, Sanitation and Hygiene for sustainable Neglected Tropical Disease control

Water, Sanitation and Hygiene for sustainable Neglected Tropical Disease control. by Anouk Gouvras, BugBitten Blog, November 18, 2016.

The International Society for Neglected Tropical Diseases (ISNTD) hosted a meeting exploring aspects of Water, Sanitation and Hygiene (WASH) on NTD control; ISNTD Water. Below I have highlighted some of the NTD and WASH aspects that were presented and discussed at the meeting.

Currently the majority of Neglected Tropical Disease (NTDs) control programs center around chemotherapy to treat and prevent disease. However two documents from the WHO; the 2012 WHO roadmap and more recently the report on NTDs and Water, sanitation and hygiene (WASH),  highlight the need for WASH integration to achieve sustainable NTD control and elimination. The International Society for NTDs hosted a meeting exploring aspects of WASH and NTDs; ISNTD Water.

Neglected Tropical Diseases

NTDs is a term given to a diverse group of 17 infectious diseases that are highly prevalent in tropical and subtropical countries, that thrive in poverty stricken areas with low or no access to sanitation and clean water infrastructure, cause huge damage to public health and socio-economic development and yet still receive little global attention. Together they infect over 1.4 billion people world wide and the majority are caused by protozoan or helminth infections. They are the diseases of neglected people of low income countries and of poor communities living in richer countries.

Read the complete article.


PLoS journals launch WASH collection

As a contribution to World Toilet Day, PLoS has compiled its 2014-2016 WASH-related articles at: plos.PNG

The 2016 studies include:

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea, PLOS Medicine : 03 May 2016

The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections, PLOS Neglected Tropical Diseases : 15 Sep 2016

Scaling up Rural Sanitation in India, PLOS Medicine : 26 Aug 2014

Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands, PLOS Neglected Tropical Diseases : 22 Aug 2016

Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Camb…, PLOS Neglected Tropical Diseases : 22 Aug 2016

Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment, PLOS ONE : 17 Aug 2016

High-Resolution Spatial Distribution and Estimation of Access to Improved Sanitation in Kenya, PLOS ONE : 12 Jul 2016

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter St…, PLOS Medicine : 03 May 2016

A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content, PLOS ONE : 17 Mar 2016

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Diarrhea 101: Time To Talk About Something We Don’t Usually Talk About

Diarrhea 101: Time To Talk About Something We Don’t Usually Talk About. NPR, November 18, 2016.

Diarrhea isn’t something we usually discuss in public. But as the second leading cause of death for children younger than 5, it’s a topic global health advocates want more people to talk openly about.


A mother holds her child at a diarrhea treatment center set up and run by the public health organization Calcutta Kids. Yvan Cohen/LightRocket via Getty Images

Worldwide, there are nearly 1.7 billion cases of diarrhea each year. The disease caused an estimated 1.5 million deaths in 2012, according to the latest data from the World Health Organization. But it’s both preventable and treatable — if more people understood the underlying causes.

What is diarrhea? Three or more loose or watery bowel movements within a day. Some episodes may be triggered by food sensitivities or an intestinal disease. But the most common source is an intestinal infection. In developing countries, the main culprits are any one of four pathogens: E. coli, shigella, cryptosporidium and rotavirus. They all spread through feces-contaminated food and water, and they cause the intestines to secrete excessive fluid. When the body fails to absorb that fluid, it passes right through the guts and gets flushed out along with vital nutrients. Accompanying symptoms can include fever, abdominal pain, vomiting and severe dehydration.

How is it deadly? Mild diarrhea is no more than an inconvenience for many, but moderate to severe symptoms can lead to death from dehydration if lost fluids and nutrients aren’t replaced.

Read the complete article.


Domestic Livestock and Public Health / Animales Domésticos Y Salud Pública

Small-scale livestock production plays an essential role as a source of income and nutrition for households in low-and middle-income countries, yet these practices can also increase risk of zoonotic infectious diseases, especially among young children.

The study upon which the video is based is: Detection of zoonotic enteropathogens in children and domestic animals in a semi-rural community in Ecuador. Appl & Env Microbiol, May 2016. Authors: Karla Vasco, Jay P. Graham and Gabriel Trueba.

Recently published sanitation research

Have We Substantially Underestimated the Impact of Improved Sanitation Coverage on Child Health? A Generalized Additive Model Panel Analysis of Global Data on Child Mortality and Malnutrition. PLoS One, October 2016. | Summary in Science Daily | Improving sanitation coverage may be one of the more effective means to reduce childhood mortality, but only if high levels of community coverage are achieved. Studies of the impact of sanitation that focus on the individual’s use of improved sanitation as the predictor variable rather than community coverage is likely to severely underestimate the impact of sanitation.

Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Medicine, November 2016.
Efforts to further reduce stunting should be focused on fetal growth restriction and poor sanitation, and this will require refocusing prevention programs on interventions that reach mothers and families and improve their living environment and nutrition.

Costs of Diarrhoea and Acute Respiratory Infection Attributable to Not Handwashing: The Cases of India and China. Tropical Medicine and International Health, November 2016. Results from this study suggest large economic gains relating to decreases in diarrhea and acute respiratory infection for both India and China from behavior change programs to increase handwashing with soap in households.

Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition. American Journal of Tropical Medicine and Hygiene, September 2016. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. It provides evidence that ECD and stunting may have independent effects on children’s intellectual function well into later childhood.

Microwave Treatment of Faecal Sludge from Intensively Used Toilets in the Slums of Nairobi, Kenya. Journal of Environmental Management, December 2016. This study explores the applicability of microwave technology to treat fecal sludge obtained from urine-diverting dry toilets placed in slum settlements in Nairobi, Kenya.

Early Testing of New Sanitation Technology for Urban Slums: The Case of the Blue Diversion Toilet. Science of the Total Environment, January 2017. Inadequate sanitation in urban slums is a threat to the total environment. This study finds that source separation and onsite water recycling is feasible and has market potential.