Category Archives: Research

UNC Water Institute WASH Research Policy Digests

These useful UNC research digests discuss a key article and include literature reviews on the selected topic:

Issue #1, July 2015: Sanitation Subsidies
Our first Digest deals with the difficult issue of when and how to use subsidies for on-site sanitation.

Issue #2, October 2015: WaSH in Healthcare Facilities
Issue two of the WasH Policy Research Digest digs in to the critical issue of WaSH in health care facilities, including a detailed review of WHO and UNICEF’s 2015 report on the topic and a synthesis of literature and solutions to address its impact on infection, mortality, maternal and neonatal health.

Issue #3, March 2016: Handpump Functionality Monitoring
The third issue of the WaSH Policy Research Digest focuses on handpump functionality monitoring. This issue of the Digest explores recent literature on this topic, focusing on policy implications, recommendations, and a call for standardized functionality measurements.

Issue #4, August 2016: Sanitation and Nutrition
Our fourth digest addresses sanitation and nutrition. This issue explores recent literature and the emerging evidence base on the connection between sanitation, nutritional outcomes, and child stunting.

State Department Notice of Intent To Solicit Comments and Conduct a Public Scoping Meeting on a Global Water Strategy

State Department Notice of Intent To Solicit Comments and Conduct a Public Scoping Meeting on a Global Water Strategy – October 17, 2016.


SUMMARY: The U.S. Department of State (Department) will host a listening session to solicit public comments on the development and content of a strategy to address global water challenges including, but not necessarily limited to: (1) Increasing access to safe drinking water, sanitation, and hygiene; (2) improving water resource management; and (3) promoting cooperation on shared waters. Participants will be asked to provide brief remarks (up to 3 minutes) highlighting specific challenges that should be addressed and opportunities to strengthen U.S. engagement on international water issues.

DATES: This session will take place on Friday, October 28 from 1:00-4:00 p.m. in the George C. Marshall Center at the U.S. Department of State, 2201 C St. NW., (21st Street Entrance), Washington, DC. Attendees must confirm their attendance at A photo identification will be necessary to attend the session. Written comments must be received no later than November 12, 2016.

Written comments may be submitted to by following the prompts.

Comments may also be submitted by mail, addressed to: Global Water Strategy Manager, Office of Conservation and Water, Room 2657, U.S. Department of State, 2201 C Street NW., Washington, DC 20520 and/or by email to Written comments may also be submitted at the public scoping meeting on Friday, October 28, 2016 from 1:00-4:00 p.m.

No evidence that current sanitation interventions stop faecal exposure

A systematic review [1] of 29 studies found “little to no effect from sanitation interventions” on “faecal-oral transmission of enteric and other pathogens”. The transmission pathways reviewed included “faecal pathogens or indicator bacteria in drinking water, hand contamination, sentinel toys, food, household and latrine surfaces and soil, as well as flies and observations of human faeces”.

There was some evidence showing the association of sanitation “with reductions in flies and a small effect on observations of faeces”. There was also evidence showing “an inverse relationship between the distance of a water supply from a latrine and level of faecal contamination of such water supply”.

The authors of the review conclude that current sanitation efforts in low-income countries are ineffective and unable to prevent contamination along well-known pathways. This may be because “interventions often fail to achieve universal coverage or use”, which is the subject of another forthcoming systematic review [2].

As expected from researchers, they are also recommend that more rigorous studies are required to investigate the impact of sanitation interventions on multiple transmission pathways.

Unfortunately this important study is not available as an open access article.

[1] Sclar GD, Penakalapati G, Amato HK, Garn JV, Alexander K, Freeman MC, Clasen T. Assessing the impact of sanitation on indicators of fecal exposure along principal transmission pathways : a systematic review. International Journal of Hygiene and Environmental Health. 2016 Oct 1.DOI:10.1016/j.ijheh.2016.09.021

[2] Garn, J.V., Sclar, G.D., Freeman, M.C., Alexander, K.T., Penakalapati, G., Brooks, P.,Rehfuess, E.A., Clasen, T.F., submitted. The impact of sanitation interventions on latrine coverage and latrine use : a systematic review and meta-analysis.

Recent WASH related research

Exploring Determinants of Handwashing with Soap in Indonesia: A Quantitative AnalysisInternational Journal of Environmental Research and Public Health , September 2016. This study analyzes rural Indonesian households’ hygiene behaviors and attitudes to examine how motivations for handwashing, locations of handwashing space in the household, and handwashing moments are potential determinants of handwashing behavior.

Behaviour Centered Design (BCD): Towards an Applied Science of Behaviour ChangeHealth Psychology Review , August 2016. This paper positions BCD as the foundation of an applied science of behavior change and outlines a sequence of five steps required to design an intervention to change specific behaviors. The BCD approach has been shown to change hygiene, nutrition, and exercise-related behaviors and has the advantages of being applicable to product, service, or institutional design.

The Water Report 2016. Stockholm International Water Institute , August 2016. Published prior to World Water Week, this annual report was meant to inspire discussions at the meeting and bring topical issues to the fore. None is more prominent this year than the issue of migration and its link to water issues. Other topics covered include the 2030 Agenda and sustainable growth.

Asian Water Development Outlook (AWDO) 2016: Strengthening Water Security in Asia and the PacificAsian Development Bank (ADB) , September 2016. The result of rigorous analysis, AWDO 2016 provides a snapshot of the region’s water security status, enabling policymakers, financing institutions, and planners to make informed decisions on how to improve their performance in the water sector. The six-part report describes the water challenges the region is facing, presents the AWDO approach, and provides information on how water security can be increased.

Water and Sanitation Interlinkages Across the 2030 Agenda for Sustainable DevelopmentUnited Nations , August 2016. This brief analyzes the central role of water and sanitation and describes the interlinkages between the targets of Sustainable Development Goal (SDG) 6 and those of other goals. The document emphasizes the mutually reinforcing nature of the interlinkages and the necessity for an integrated implementation approach, and also highlights the importance of mainstreaming water and sanitation in the policies and plans of other sectors.

Measuring Domestic Water Use: A Systematic Review of Methodologies that Measure Unmetered Water Use in Low-Income SettingsTropical Medicine and International Health , August 2016. More than 20 studies were included in this literature review of methods for measuring domestic water use in settings where water meters cannot be used. The review found no standardized methods for measuring unmetered water use and recommended that further research begin with pre-study observations during water collection periods to determine optimal methods for obtaining water use information in a survey.

Herd Protection from Drinking Water, Sanitation, and Hygiene InterventionsAmerican Journal of Tropical Medicine and Hygiene , September 2016. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Through a literature review and modeling, researchers have established that WASH interventions are likely to provide some level of herd protection.

Enteric Pathogens and Factors Associated with Acute Bloody Diarrhoea, KenyaBMC Infectious Diseases , September 2016. This study found that good personal hygiene practices such as washing hands after defecation and storing drinking water separate from water for other uses were key protective factors, while presence of coliform in the main water source was found to be a risk factor for bloody diarrhea. Implementation of WASH interventions is therefore key to prevention and control.

Poor sanitation cost global economy US$ 223 billion in 2015

True cost poor sanitation cover

Lack of access to sanitation cost the global economy US$222.9 billion in 2015, up from US$182.5 billion in 2010, a rise of 22% in just five years, according to a new report released on 25 August 2016 by LIXIL Group Corporation (“LIXIL Group”), a global leader in housing and building materials, products and services.

The true cost of poor sanitation, published in collaboration with WaterAid and Oxford Economics, which conducted economic modeling to develop up-to-date estimations of the global cost of poor sanitation, brings to light the high economic burden in low-income and lower-middle income countries.

More than half (55%) of all costs of poor sanitation are a consequence of premature deaths, rising to 75% in Africa. A further quarter are due to treating related diseases, and other costs are related to lower productivity as a result of illnesses and time lost due to lack of access to a private toilet.

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The Role of Network Science in Analyzing Slums in Rapidly Growing Urban Areas

The Role of Network Science in Analyzing Slums in Rapidly Growing Urban Areas | Source: ETH Zurich, Aug 19 2016 |

As Amy Krakowka Richmond and her colleagues see it, military forces operating in nonlinear urban and urban-fringe environments will increasingly have to deal with volatile, uncertain, complex and ambiguous (VUCA) settings. So, what can these forces do to analyze and anticipate these contexts effectively? Use the latest insights from network theory, argue the authors.

An excerpt: Using Water Resources to Explain Informal Governance Structure

As water is critical for health and wellness of any community, its distribution is absolutely central for maintaining peace and coordination of a region. Urban and peri-urban communities of developing societies offer insights about how both formal government and informal power hierarchy can determine access and control of limited resources. We illustrate the utility of network models by exploring network maps of water availability in urban and peri-urban regions in the developing world. Historically, tension has been fueled when disparate social classes with numerous ethnic affiliations from distinct regions of a state are brought into close proximity and forced to rely on restricted resources. In many cases, political and other influential entities can act as informal gatekeepers, whose role can either aggravate or alleviate such tensions. The complexity of the problem is only made worse by the lack of centralized oversight of the various natural resources, such as water, food, and energy, as well as the physical land upon which these resources are drawn. We suggest that this problem be examined from a systems perspective, by mapping, quantifying and evaluating how well various interdependent systems related to water supply are maintained and balanced. In the figure above we show the various networks that are likely involved in the access and consumption of water.

The water access and consumption network isolates where and how the resources directly impact the population. This network is bi-modal as it is made up two types of nodes: water consumers and water sources. The links indicate which households get water from which source(s). Water is consumed primarily by three sectors: agriculture, households and commercial operations. This network directly reflects constraints to water access—­­how far and how many sources can households access. Households can obtain water from multiple sources. In sub-Saharan Africa for example, a significant portion of the population lacks access to piped water and therefore households rely primarily on springs, communal taps, and open water sources such as lakes and rivers. Analysis of this network can show how water consumption relies on particular types of sources and which suppliers in turn wield the most economic and possibly social and political influence.

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Sewage sludge could make great sustainable fertilizer

Sewage sludge could make great sustainable fertilizer | Source:, Aug 15 2016 |

Ever thought of putting sewage on your plants? Scientists say thermally conditioned sewage sludge serves as an excellent fertilizer to improve soil properties. This was recently published in the open-access journal Frontiers in Nutrition. The major advantage over commercial fertilizers? Sustainable re-use of essential and finite phosphorus resources.

Phosphorus is a key nutrient for all living beings. When deficient in the diet, it severely compromises human health, and when deficient in agriculture, it restricts crop productivity. Without , there can be no food production.

As the source of phosphorus is non-renewable phosphate rocks, there is a strong need for increased recycling to ensure phosphorus security. Efficient use and reduced environmental dissemination of phosphorus throughout the food system is needed to secure the ability to feed a growing global population.

As technological improvements increased the of , it now is a readily available alternative to commercial fertilizers in agriculture. To assess its effectiveness, Andry Andriamananjara from the University of Antananarivo (Madagascar) and his colleagues used a phosphorus radiotracer technique to measure the availability of phosphorus for plants in thermally conditioned sewage sludge.

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