Category Archives: Research

SaniPath Rapid Assessment Tool

The SaniPath Rapid Assessment Tool is designed to assess risk related to poor sanitation and to help prioritize sanitation investments based on the exposures that have the greatest public health impact.


  • Data from simple environmental microbiology methods and behavioral surveys are combined to assess the relative exposure to fecal contamination. Relevant exposure pathways include open drains, drinking water, surface waters, public latrines, soils, wastewater-irrigated produce, and floodwater.
  • The SaniPath Rapid Assessment Tool automatically generates risk profiles for each pathway using data entered by the user.
  • The risk profiles show users which pathways contribute the greatest risk and where interventions may have the greatest impact on reducing exposure to fecal contamination.

Do donor restrictions affect sustainability of water and sanitation interventions? Results from a Pilot Survey

Do donor restrictions affect sustainability of water and sanitation interventions? Results from a Pilot Survey, 2015. Improve International.

During August-September 2015, Improve International prepared and distributed a survey via Survey Monkey. Out of 14 questions, five allowed open-ended responses, six were multiple-choice and three were yes/no. Three multiple-choice questions allowed for more than one response and seven questions contained comments sections.

The survey was intended for international development organizations (for-profit or not-for profit), civic groups, universities, volunteer groups, or community-based organizations that raise funds from US-based donors to implement or fund water, sanitation, and hygiene interventions.

WHO estimates of the global burden of foodborne diseases

WHO estimates of the global burden of foodborne diseases, 2015. World Health Organization.

Foodborne diseases are an important cause of morbidity and mortality, and a significant impediment to socioeconomic development worldwide, but the full extent and burden of unsafe food, and especially the burden arising from chemical and parasitic contaminants, has been unknown.


Precise information on the burden of foodborne diseases can adequately inform policy-makers and to allocate appropriate resources for food safety control and intervention efforts.

This report, resulting from the WHO Initiative to Estimate the Global Burden of Foodborne Diseases and prepared by the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG), provides the first estimates of global foodborne disease incidence, mortality, and disease burden in terms of Disability Adjusted Life Years (DALYs).

Will better sanitaton and nutrition reduce stunting?

Zimbabwe SHINE trial - Cornell University

Photo: Cornell University

A trial is underway in Zimbabwe to measure the independent and combined effects of improved sanitation and hygiene (WASH) and improved infant diet on stunting and anemia among children 0-18 months old [Cornell University CENTIR Group blog].

The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial is led by the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe in collaboration with the Ministry of Health and Child Care/Government of Zimbabwe. Other contracted experts include Sandy Cairncross, Val Curtis and Peter Morgan.

The SHINE Trial is being undertaken in Chirumanzu and Shurugw, two districts with high HIV prevalence. Besides investigating the effects of sanitation and nutrition, SHINE will also test whether Environmental Enteric Dysfunction (EED)is a major cause of a major cause of child undernutrition. EED, also called environmental enteropathy, is a condition believed to be due to frequent intestinal infections.

SHINE is being being funded by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID). There are additional contributions from Wellcome Trust, National Institutes of Health, and the Swiss Development Cooperation.

A special open access supplement of Clinical Infectious Diseases is devoted to SHINE containing the following articles:

  • The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, doi:10.1093/cid/civ844
  • Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe, doi:10.1093/cid/civ845
  • The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe, doi:10.1093/cid/civ846
  • Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial, doi:10.1093/cid/civ847
  • Assessment of Environmental Enteric Dysfunction in the SHINE Trial: Methods and Challenges, doi:10.1093/cid/civ848
  • The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial, doi:10.1093/cid/civ849
  • Assessing the Intestinal Microbiota in the SHINE Trial, doi:10.1093/cid/civ850
  • Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health, doi:10.1093/cid/civ851
  • Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach, doi:10.1093/cid/civ716

Recent WASH studies on NTDS, shared sanitation, detection of E. coli

The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis. PLoS NTDs, Oct 2015. Authors: Meredith E. Stocks, Matthew C. Freeman, David G. Addiss.

Full text:

For people who already have lymphedema, WHO recommends simple hygiene-based measures that include skin care and limb movement. Yet only a small proportion of those with LF-related lymphedema have been trained in these measures. To determine the effectiveness of hygiene-based lymphedema management, we reviewed the scientific literature. Overall, use of hygiene-based measures was associated with 60% lower odds of inflammatory episodes, known as “acute attacks,” in the affected limb. Hygiene is also effective for managing LF-related lymphedema and reducing suffering caused by acute attacks. Training people with lymphedema in hygiene-based interventions should be a priority for LF programs everywhere.

Evaluation of an Inexpensive Growth Medium for Direct Detection of Escherichia coli in Temperate and Sub-Tropical Waters. PLoS One, Oct 2015. Authors: Robert E. S. Bain , Claire Woodall, John Elliott, Benjamin F. Arnold, Rosalind Tung, Robert Morley, Martella du Preez, Jamie K. Bartram, Anthony P. Davis, Stephen W. Gundry, Stephen Pedley

Full text:

We developed a new low-cost growth medium, aquatest (AT), and validated its use for the direct detection of E. coli in temperate and sub-tropical drinking waters using IDEXX Quanti-Tray®. AT is reliable and accurate for the detection of E. coli in temperate and subtropical drinking water. The composition of the new medium is reported herein and can be used freely.

Continue reading

Oct 2015 WASH studies on toilets and health and other topics

Effect of Poor Access to Water and Sanitation as Risk Factors for Soil-Transmitted Helminth Infection: Selectiveness by the Infective Route. PLoS NTDs, Sept 30, 2015. Authors: Adriana Echazú , Daniela Bonanno, Marisa Juarez, Silvana P. Cajal, Viviana Heredia, Silvia Caropresi, Ruben O. Cimino, Nicolas Caro, Paola A. Vargas, Gladys Paredes, Alejandro J. Krolewiecki

Full text –

The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6–5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3–3.7). The present study reports an association between poor sanitation and water access and STH infections selective to the parasite route of entry. This finding could contribute to the design of specific and rational recommendations to reduce soil-transmitted helminths transmission.

MIT-USAID program releases evaluation of water filters: Study of water filters used in Indian homes assesses suitability, scalability, and sustainability, Oct 2015. | Complete report | Summary |

CITE’s household water filter evaluation allowed us to study innovations with the potential to better the lives of India’s “water poor”—the 76 million people in the country who lack improved drinking water. CITE teams studied over 100 models of householder water filters from nine major brands available on the market in Ahmedabad, India. These models fell into three main categories: conventional particle filtration (cloth/jali mesh), gravity non-electric filters, and reverse osmosis filters.

Toilets Can Work: Short and Medium Run Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation, 2015. Authors: ESTHER DUFLO, MICHAEL GREENSTONE, RAYMOND GUITERAS, AND THOMAS CLASEN

Full text:

This paper estimates the impact of an integrated water and sanitation improvement program in rural India that provided household-level water connections, latrines, and bathing facilities to all households in approximately 100 villages. The estimates suggest that the intervention was effective, reducing treated diarrhea episodes by 30-50%. These results are evident in the short term and persist for 5 years or more. The annual cost is approximately US$60 per household.

Stunting is associated with poor outcomes in childhood pneumonia. Trop Med Intl Health, Oct 2015. Authors: Peter P. Moschovis, et al.


Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials.  Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings.


How can research drive public finance? NEW FINANCE BRIEF by Malaika Cheney-Coker

Finance Brief 7: Evidence into Policy: How Research has Influenced Kenyan Government Budgets for School Wash.

by Malaika Cheney-Coker for PF4WASH

Read it here: Finance Brief 7