Category Archives: Sanitation and Health

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PloS Medicine, July 2015.

Authors: Bijaya K. Padhi, Kelly K. Baker, et al.

Background The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.

Methods and Findings A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72–3.71), preterm birth (OR: 2.36; 95% CI: 1.54–3.62), and low birth weight (OR: 2.00; 95% CI: 1.24–3.23) were found to be significantly associated with open defecation practices. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility of residual confounding should not be ruled out. We did not identify specific exposure pathways that led to the outcomes.

Conclusions This study provides the first evidence, to our knowledge, that poor sanitation is associated with a higher risk of APOs. Additional studies are required to elucidate the socio-behavioural and/or biological basis of this association so that appropriate targeted interventions might be designed to support improved birth outcomes in vulnerable populations. While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs

WASHplus Weekly: Focus on WASH & Nutrition

Issue 197| July 2, 2015 | Focus on WASH Nutrition

This issue on WASH and nutrition integration features a recent USAID webinar and briefs from USAID and WASHplus. Also featured is an upcoming conference organized by Catholic Relief Services and links to a May 2015 seminar by Irish Aid. A chapter from a 2015 report by the International Food Policy Research Institute discusses evidence of the link between sanitation, child height, and well-being. Other reports/articles discuss environmental enteropathy findings and explore water, food security, and nutrition linkages.


USAID WASH and Nutrition Webinar, 2015. Link
Elizabeth Jordan and Katherine Dennison of USAID discuss the connection between undernutrition and lack of access to water, sanitation, and hygiene (WASH) services and highlight opportunities for integrated programming to achieve better health outcomes. Other recent USAID WASH webinars include: | Sanitation | Agricultural Water Management |Sustainability of WASH Services | Drinking Water Quality |

WASH and Nutrition Implementation Brief, 2015. USAID. Link
Positive nutritional outcomes are dependent upon WASH interventions and nutrition actions. Poor WASH conditions create an additional burden of undernutrition. Opportunities for co-programming WASH in nutrition programs exist and are discussed in this brief.

Integrating WASH and Nutrition Learning Brief, 2015. WASHplus. Link
Since 2010, the USAID-funded WASHplus project has been engaged both at the global and country levels in stimulating the discussion and improving the evidence base around integrating WASH into nutrition programming, sharing experiences and approaches to integrating the two sectors. This learning brief describes WASHplus country activities in Bangladesh, Mali, and Uganda; global knowledge sharing efforts; and other WASHplus activities.


September 14–16, 2015 – Catholic Relief Services (CRS) Integrated Nutrition Conference, Nairobi, Kenya. Link
CRS and members of the NGO, research, and donor community will host a two-day conference focusing on integrated solutions relevant to East Africa. Global leaders in the areas of nutrition, water and sanitation, agriculture, health, and early childhood development will come together to: bring knowledge, evidence, and experience on implementing integrated nutrition-sensitive programming; identify best practices in integrated nutrition-sensitive programs; and identify gaps that will lead to the development of a learning agenda for East Africa.

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Raise your hand for hygiene: Sign on to call for a global hygiene indicator in the SDGs!

Join the call for a global-level hygiene indicator in the Sustainable Development Goals! Source: Global Public-Private Partnership for Handwashing

The issue: The Post-2015 Sustainable Development Goals are the successors to the Millennium Development Goals; a draft was published, and the details of the SDGs are being negotiated now. Hygiene is essential for achieving global development, and is therefore included as a target as part of Goal 6. Countries will commit to demonstrating progress on achieving the targets by reporting on indicators. However, in the recent list of global-level indicators being considered by the UN Statistical Commission, hygiene has been deleted. This is likely because the decision makers want a shorter list of indicators. However, demoting hygiene to a huge, secondary list of ‘optional’ indicators will not give hygiene the priority needed for the SDGs to have real impact on both hygiene and the areas that it influences—such as health, education, and equity.

home-learn-photoObjective: The JMP Communications and Advocacy Group is coordinating delivery of a persuasive message about the importance of hygiene to encourage decision makers and stakeholders to act and recommend the reinstatement of a hygiene indicator in the list of global-level indicators for the SDGs.

Audience: This letter will be sent to members of the UN Statistical Commission and others who may have the opportunity to influence discussions and decisions around the SDG Indicators process.

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Estimating the Potential Impact of Sanitary Child Stool Disposal: Policy Brief

Estimating the Potential Impact of Sanitary Child Stool Disposal: Policy Brief, 2015. SHARE. Share_Logo

Authors: Victoria Sykes, Alexandra Chitty, Jeroen Ensink, Joanna EstevesMills, Fiona Majorin

The WASH sector has, thus far, greatly overlooked the enormous potential of hygienic child stool disposal to considerably reduce the prevalence of diarrhoeal diseases. Young children are concurrently more susceptible to faecal-oral disease transmission and an important source of infection because their faeces contain high levels of pathogens.

Based on a literature review and new research, this policy brief describes the potential impact of unsanitary child stool disposal and presents data on child faeces disposal practices in 38 countries in Sub-Saharan Africa and South Asia.

It also highlights how the prevalence of safe disposal of child faeces differs in households with access to different types of sanitation, across rural and urban settings and with the age of the child. Finally, it offers recommendations for the WASH and health sectors on improving child faeces disposal to reduce the presence of child excreta in the household and community environment.

WASHplus Weekly: Focus on Menstrual Hygiene Management

WASHplus Weekly |Issue 193|May 28, 2015|Menstrual Hygiene Management| 

This WASHplus Weekly focuses on issues related to menstrual hygiene management (MHM) and is well-timed, as May 28 is Menstrual Hygiene Day. Menstrual Hygiene Day is meant to serve as a platform to bring together individuals, organizations, social businesses, and the media to create a united and strong voice for women and girls around the world, helping to break the silence around menstrual hygiene management. WASHPlus_HTMLbanner_weekly_600x159

Resources in this issue include a WASHplus MHM toolkit, a listing of upcoming and past MHM conferences, webinars on dealing with the disposal of sanitary pads, a special Waterlines issue on MHM, and recent articles, reports, videos, and key MHM-related websites.


Menstrual Hygiene Management Mini-Toolbox for Teachers and Schools in Zambia, 2015. SPLASH. Link
Menstrual Hygiene Management or MHM is an important component of a “WASH-Friendly School.” Schools Promoting Learning Achievement through Sanitation and Hygiene (SPLASH) designed this toolkit to help classroom teachers, guidance counselors, and other school personnel in Zambian primary schools establish MHM programs or activities in their schools as a way to improve girls’ attendance. With suggestions for incorporating the topic into lessons, the toolkit also includes games, role-plays, and pad-making instructions.

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Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2014

WASH in Schools Empowers Girls’ Education: Proceedings of the Menstrual Hygiene Management in Schools Virtual Conference 2014. United Nations Children’s Fund and Columbia University, New York, 2015.

Authors: Sommer, Marni, Emily Cherenack, Sarah Blake, Murat Sahin and Lizette Burgers.

This publication brings together the key elements of the 16 presentations in a case study format. Each case study outlines the context in which the programme or research is being undertaken, the methods or approaches used, the accomplishments realized and challenges faced. Each case study also provides a number of recommendations to help guide future work.

The virtual conference also provided an opportunity to engage in a visioning exercise during which the participants collectively brainstormed and ranked a list of priority action items to be accomplished by 2024.

The 2015 virtual conference will showcase findings from formative research on MHM in WinS that is underway in a variety of countries.

USAID Sanitation Webinar

USAID Sanitation Webinar, April 28, 2015

More than 2.5 billion people lack access to improved sanitation worldwide. In this webinar, USAID’s Jesse Shapiro discusses and responds to participant questions about the impacts of sanitation; critical challenges to improving sanitation; the sanitation ladder and service chain; and programmatic interventions to improve sanitation.