Category Archives: Sanitation and Health

Fecal Sludge Management – Water Currents

Fecal Sludge Management – Water Currents, January 17, 2018.

Worldwide, 2.7 billion people rely on on-site sanitation, but many lack the means to manage fecal sludge—the muddy mix of fecal matter that accumulates over time in septage or pit latrines, which can have significant health and environmental implications. As a result, fecal sludge management (FSM) has become a key component of providing universal sanitation access. fsm.png

This issue of Water Currents contains studies from 2017 that focus on FSM, including research that discusses the health-related aspects, technological aspects, and related economic/financing issues. Also included are links to upcoming courses, announcements, and websites.

We are always looking for ideas and suggestions to make Water Currents more useful and relevant, so we would appreciate your responses to this brief survey.

Introduction to Faecal Sludge Management. This introductory course by the École Polytechnique Fédérale de Lausanne teaches how to apply concepts of sustainable FSM on a citywide scale. It started on January 8, 2018, but enrollment is still open. This course is one of four in the series “Sanitation, Water and Solid Waste for Development.” This is an online course and there is no charge for participating.

Field Test Innovative Sludge Management Tools in Malawi. Mzuzu University Centre of Excellence in Water and Sanitation in Malawi invites self-funded graduate students or experienced researchers to field test their innovative tools and techniques for the emptying, transport, and treatment of pit latrine or septic tank sludge. The site is well suited for conducting field testing on local pit latrines or septic tanks for a period of several weeks to months. Visit the centre’s website or contact Dr. Rochelle Holm for further information.

FSM and Health
Designing a Mixed-Methods Approach for Collaborative Local Water Security: Findings from a Kenyan Case StudyExposure and Health, July 2017. The purpose of this research was to develop and pilot a mixed-methods-coupled systems (human and physical) approach to understand strengths, challenges, and health impacts associated with WASH in a rural Kenyan community. Both quantitative and qualitative data were used for the analysis.

Read the complete article.

Quiet Heroes in the Fight against Ebola – Global Waters

Quiet Heroes in the Fight against Ebola. Global Waters, January 3, 2018.

While the Ebola crisis was at its peak in Liberia, a small group of water, sanitation, and hygiene (WASH) entrepreneurs helped in a significant way by repairing hand pumps in clinics and other health facilities in some of the country’s hardest-hit counties.

By restoring access to water — not only for drinking, but also for infection prevention and control — these WASH entrepreneurs ensured that facilities had the resources they needed to promote handwashing and safe hygiene practices that could help combat the spread of the disease.


Newly graduated WASH entrepreneurs prepare to deploy to their target communities. Photo credit: Global Communities Liberia

Liberia’s Bong, Lofa, and Nimba counties were some of the areas most affected during the Ebola crisis. The communities in these counties are largely rural and hard to reach. Roads and infrastructure are poor and government services are limited.

In these rural communities access to water and sanitation facilities are extreme challenges. According to the latest data from the WHO/UNICEF Joint Monitoring Programme for Water, Sanitation and Hygiene, nearly 80 percent of rural Liberians do not have adequate sanitation facilities. At the same time, 47 percent of rural residents do not have safe drinking water sources.

Read the complete article.

Satellites Predict a Cholera Outbreak Weeks in Advance

Satellites Predict a Cholera Outbreak Weeks in Advance. Scientific American, January 3, 2018.

A test in Yemen showed satellite data could foresee an outbreak four weeks before it exploded 


Vibrio cholerae. Credit: Getty Images

Orbiting satellites can warn us of bad weather and help us navigate to that new taco joint. Scientists are also using data satellites to solve a worldwide problem: predicting cholera outbreaks.

Cholera infects millions of people each year, leading to thousands of deaths. Often communities do not realize an epidemic is underway until infected individuals swarm hospitals. Advanced warning for impending epidemics could help health workers prepare for the onslaught—stockpiling rehydration supplies, medicines and vaccines—which can save lives and quell the disease’s spread.

Back in May 2017 a team of scientists used satellite information to assess whether an outbreak would occur in Yemen, and they ended up predicting an outburst that spread across the country in June.

Read the complete article.

WHO – Achieving quality universal health coverage through better water, sanitation and hygiene services in health care facilities A focus on Cambodia and Ethiopia

Achieving quality universal health coverage through better water, sanitation and hygiene services in health care facilities: A focus on Cambodia and Ethiopia. WHO, December 2017. who-his-sds-2017-17-cover

The WHO/UNICEF Global Action Plan for WASH in HCFs recognises that sustained improvements in WASH in Health Care Facilities require integration between quality of care efforts and WASH. To date, little evidence is available on how such integration occurs at country level.

To address this knowledge gap, WHO has conducted several in-depth situational analysis in countries that are undertaking actions to improve WASH in Health Care Facilities as part of their quality of care improvement efforts.

The purpose of the situation analyses was to capture mechanisms that “jointly support” WASH in HCF and quality of care improvements and also identify barriers and challenges to implementing and sustaining these improvements.

Relationship between water, sanitation, hygiene, and nutrition: what do Link NCA nutrition causal analyses say? – Waterlines, October 2017

Relationship between water, sanitation, hygiene, and nutrition: what do Link NCA nutrition causal analyses say? – Waterlines, October 2017.

Defined by UNICEF as ‘the outcome of insufficient food intake and repeated infectious diseases’, undernutrition is one of the world’s most serious problems, with long-lasting harmful impacts on health and devastating consequences for social and economic development. waterlines

The three main underlying causes of undernutrition, namely unsuitable or insufficient food intake, poor care practices, and infectious diseases, are directly or indirectly related to inadequate access to water, sanitation facilities, and hygiene practices (WASH).

There is a growing base of evidence showing the links between poor WASH conditions, especially exposure to poor sanitation, and stunting (low height for age ratio).

However, the effects of WASH interventions on wasting (low weight for height ratio) and the impact of environmental enteric dysfunction (chronic infection of small intestine caused by extended exposure to faecal pathogens) on undernutrition should be explored further.

Action Against Hunger (Action Contre la Faim) promotes a participatory nutrition causal analysis, the Link NCA methodology, which is used to analyse complex, dynamic, locally specific causes of undernutrition.

This article aims to assess the main findings from 12 most recent Link NCA studies, conducted from the beginning of 2014 until the end of 2016.

Results show that inadequate WASH conditions are often identified as major contributors to undernutrition in the study areas.

The article also provides lessons learned and a set of practical recommendations for better alignment and integration of WASH and nutrition interventions.

Read the complete article.

The “Look it up Club” got me hooked: Sanitation Wikipedia needs you, too.

By Diane Kellogg, Chair Sanitation Wikipedia Project

My father always said:  “Your ticket off the chicken farm is your education.” My parents did their part.  They enrolled us in the “Look it up Club” by buying the World Book Encyclopedia, one book at a time—A through Z.   To any question we asked, our parents’ answer was the same:  “You’re a member of the Look it up Club aren’t you? Look it up.”

Education mattered so much that “I have homework” could get you out of gathering eggs after school.  As a result, all five of “the McKinney Kids” got good grades.   Still, I wanted off that chicken farm badly.  More degrees could get you even farther from the chicken farm, right?

I got so far from my practical roots that I actually ended up warning my students against looking it up.  At least not on Wikipedia.  The “pedia” of today couldn’t possibly be as good as the encyclopedia, right?  Anyone and everyone can add “stuff” to Wikipedia, so how could it be any good?

Was I ever wrong. 

You can’t get anything past the Wikipedia Warriors out there on the planet.  Yes, anyone can add things, but there will be an army of eyes on your work.  The article on cholera, for example.  A total of 244 people have the cholera article on their “watchlist.”  Many of those have probably asked Wikipedia to notify them by e-mail when “changes were made to an article you’re watching.”   If you make an assertion without referencing credible sources or insert your own opinion, you will hear from someone.  Wikipedia specializes in facts.  Objective facts.  Wikipedia’s standards keep going up.  It’s the best kind of crowd-sourcing:  the best version of the article is what sticks.

What bothers me is that some of the articles on sanitation are so unreadable:  Out of 100 points possible on the Flesch Readability Score, the page on “diarrhea” gets a 38.  And get this:  2700 people click on that article every day.  Multiply that by 365 days in a year, and you’ve got to wonder.  I wonder if those clickers are finding what they’re looking for.  Mothers in Mali with a sick baby want to know how much time they have to get fluids into that little body. Shouldn’t that diarrhea article be more easy to read and understand?

I’ve done penance in various ways.  I’ve assigned a few Wikpedia articles so students will know I am no longer snooty about the quality of what can be found there.  I’ve edited a few Wikipedia articles where I thought the experts were making concepts more obscure and complex than they needed to be.  (Thankfully, the Wikipedia Warriors said “Thank you: that makes the point more clear.”)  I’ve even asked colleagues to assign their students to do original research on WASH topics to see if they could find more recent information to add to articles.

Now I’m chairing a SuSanA drive to improve WASH content on Wikipedia ahead of World Toilet Day on 19 November 2017.

It’s that readability thing that has me so motivated.  Our goal is to raise the average readability of all WASH articles to 60-70.  The average is now 37.    (You can check the readability of your own writing at this link.)  In the spirit of  practice what you preach, I just did that for my blog:  65.

On World Toilet Day, we will award $500 Honorariums to especially dedicated Sanitation Wikipedia volunteers.  Click  on this page to join the team or email to offer a few hours of your time.  We make it fun.



The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. International Journal of Hygiene and Environmental Health
Volume 220, Issue 6, August 2017, Pages 928-949.

Authors: Matthew Freeman, Joshua Garn, Gloria Sclar, et al.

Background – Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry.

Methods and findings – We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review’s end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review’s inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high.

Conclusions – This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions.