Category Archives: Research

New call for tenders – WSUP

Strengthening public finance for urban sanitation services in Mozambique

It is estimated that poor sanitation costs Maputo’s residents over US$ 7.4 million annually as a result of access time lost, premature deaths, productivity losses due to sickness, and health care costs. The majority of the population relies on on-site sanitation, 28% on septic tanks, and 28% on improved latrines. Many of these systems are emptied by mechanical and manual private operators paid for by households themselves, the total value of which is unknown but thought to be significant. The remainder of the population, over 30%, have access to a non-improved latrine. It is this latter section of population that is most negatively and disproportionally impacted by poor sanitation.

In December 2016, a new sanitation surcharge was approved by CMM (Municipal Council of Maputo), with plans for implementation in 2017. WSUP intends to support CMM in the implementation of the surcharge and introduction of eligible sanitation services. CRA (Conselho de Regulação de Águas, the national water and sanitation regulator) and WSUP intend to undertake a 6 month research project to capture learning from the implementation of previous activities in Maputo, and the replication by CRA in Beira and Quelimane. This includes a documentation of the process, an assessment of the sanitation surcharge, regulatory framework agreement and compliance with the agreement (transfers and investments).

Consultancy objective:
The overall objective of this consultancy is to strengthen CRA’s capacity to more effectively and equitably mobilise public finance into urban sanitation services in Mozambique. More specifically, the objectives are:

1. adapt tools and strengthen capacity to model financial cost of delivering sanitation services in urban centres of Mozambique, and
2. strengthen CRA’s regulatory mechanisms, tools and oversight to ensure more effective and equitable sanitation service delivery in Mozambique.

Bids due: Before 23:59 (GMT +2) on 22nd March 2018
Location: Desk and Mozambique
Start date of consultancy: 30th March 2018
End date of consultancy: 18th September 2018

More information and details of how to apply can be accessed on the WSUP website (‘Current research calls’).

Recent WASH research on sanitation, cholera, MHM and other topics

In addition to the studies and resources below, there are new blog posts, Ethiopian Summit Focuses on Participatory Co-Design to Develop Low-Cost WASH Products, and other resources on the website.


How to reach everyone with safe water and sanitation by 2030. WaterAid, Feb 2018. As the first review of SDG 6 begins, we urge governments and donors to fight WASH inequality with urgent action on finance, integration and sustainability.

WaterAid’s reflections on the results of the WASH Benefits Trials – Kenya and Bangladesh. WaterAid, February 2018. This note has been put together to help WaterAid staff and actors working on nutrition and water, sanitation and hygiene (WASH) to understand the results and implications of these studies, and to interpret the results in light of the full body of evidence on WASH and nutrition.

Clean Hands for All: A toolkit for hygiene advocacy. GHP, Feb 28, 2018. This toolkit includes an overview of why hygiene matters in the context of the Sustainable Development Goals, a short advocacy introduction, and suggestions on audiences, delivery mechanisms, and objectives for hygiene advocacy.

Turning promises into action: Gender equality in the 2030 Agenda for Sustainable Development. UN Women, Feb 2018. The report monitors global and regional trends in achieving the SDGs for women and girls based on available data.

MENSTRUAL HYGIENE MANAGEMENT AND FEMALE GENITAL MUTILATION: CASE STUDIES IN SENEGAL. WSSCC, 2018. The research that is the focus of this paper is a pioneering study: it explores the links between menstrual hygiene management and female genital mutilation, for the first time.


Innovative sanitation approaches could address multiple development challenges. Water Science & Technology, Feb 2018. Nevertheless, a better understanding of driving forces and enabling environments, new organizational models based on more service-oriented sanitation provision, and highlighting potential multiple societal benefits to attract investments from new sectors are identified areas that need further attention.

Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet, March 1. Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.

Preliminary assessment of the computer-based Taenia solium educational program ‘The Vicious Worm’ on knowledge uptake in primary school students in rural areas in eastern Zambia. Trop Med Intl Health, March 1. Preliminary assessment of ‘The Vicious Worm’ indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia.

Impact of the scale-up of piped water on urogenital schistosomiasis infection in rural South Africa. eLife, Feb 20. High coverage of piped water in the community decreased a child’s risk of urogenital schistosomiasis infection eight-fold.

Locally produced hydrogen sulphide detecting water quality test kits increase household level monitoring in rural Tanzania. Journal Water & Health, Feb 22. The H2S test was widely accepted, with 94% of those surveyed willing to buy the test in the future. This will enable households to monitor their own water sources and make informed choices about water safety and treatment.

Effectiveness of a Household Water, Sanitation and Hygiene Package on an Outpatient Program for Severe Acute Malnutrition: A Pragmatic Cluster-Randomized Controlled Trial in Chad. AJTMH, Feb 26. Our results showed that adding a household WASH package did not decrease post-recovery relapse rates but increased the recovery rate among children admitted in OTP.

Enteropathogens and Gut Inflammation in Asymptomatic Infants and Children in Different Environments in Southern India. AJTMH, Feb 2018. Viral and bacterial infections, including enteroviruses, adenoviruses, Campylobacter spp., and diarrhegenic Escherichia coli were more common and fecal biomarkers of inflammation were higher in the poor neighborhood.



Toward a Hygienic Environment for Infants and Young Children: A Review of the Literature – USAID/WASHpals

Toward a Hygienic Environment for Infants and Young Children: A Review of the Literature. USAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS), February 2018.

 For nearly six decades, the routes of pathogen transmission from human excreta to a new host have been reflected in the seminal “F-diagram” via fluids, fingers, flies, fields (floors, earth, dirt), and fomites (surfaces).

The WASHPaLS project conducted a review of the scientific and grey literature, complemented by dozens of key informant interviews with researchers and practitioners, to re-examine the F-diagram, highlighting the underemphasized sources of pathogens and transmission pathways that are of particular relevance to the health of infant and young children (IYC) and not disrupted by the traditional suite of WASH measures.

These are:

  • domestic animal excreta as a source of risk, and
  • direct ingestion of pathogens via eating feces, dirt (geophagy) or through mouthing behaviors as additional pathways.

Research updates from the SHARE project

Below are links to 2017 and 2018 articles from the SHARE project

Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3–9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya – Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3–9 months of age: infant oral contact behavior and caregiver handwashing behavior. The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions.

From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India – Women face greater challenges than men in accessing WASH resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study conducted by Baker et al. assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations.

Estimating the Health Risk Associated with the Use of Ecological Sanitation Toilets in Malawi – Main exposure pathways were through poor storage of sludge, contamination of foods during drying, walking barefoot on the ground contaminated with sludge, pit emptying without protection, and application of sludge in the fields. Estimated annual risk for Ascaris lumbricoides, Taenia, and hookworms was approximately over 5.6 × 10−1 for both Fossa Alternas (FAs) and Urine Diverting Dry Toilet (UDDTs). Risk from E. coli and Salmonella was 8.9 × 10−2 and above. The risks were higher than WHO acceptable risk for use of faecal sludge in crops of 10−4 infections per year. Promoters and users of EcoSan latrines need to consider advocating for strict guidelines to reduce the risk.

Role, ownership and presence of domestic animals in peri-urban households of Kisumu, Kenya – The research demonstrates the high prevalence of animal ownership in a low-income and high-density peri-urban neighbourhood of Kisumu, which may facilitate zoonotic disease transmission. Further research should assess if and to what extent animal ownership in such communities is associated with disease risk.

High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania – Almost a quarter of private and shared latrines in an informal urban settlement in Tanzania are contaminated with ESBL-producing microorganisms, suggesting a high prevalence of human ESBL faecal carriage in the community. Shared latrines may serve as a reservoir for transmission in urban community settings in Tanzania.

Contributing to the debate on categorising shared sanitation facilities as ‘unimproved’: An account based on field researchers’ observations and householders’ opinions in three regions, Tanzania – Having an ‘improved’ latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as ‘improved’. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important.

Immunogenicity of rotavirus vaccine (RotarixTM) in infants with environmental enteric dysfunction – Deployment of rotavirus vaccines has contributed to significant declines in diarrheal morbidity and mortality globally. Unfortunately, vaccine performance in low-middle income countries (LMICs) is generally lower than in developed countries. The cause for this has been associated with several host and maternal factors including poor WASH status, which are predominant in LMICs. More recently, environmental enteric dysfunction (EED) has specifically been hypothesized to contribute to poor vaccine uptake and response. The aim of this study was to examine the association between serological biomarkers of EED and seroconversion to rotavirus vaccine in Zambian infants.

Recent WASH research, presentations from the FSM 2017 conference

In addition to the studies and presentations below a Sustainable WASH Systems (SWS) Learning Partnership webinar on Using Network Analysis to Understand and Strengthen WASH Systems is on the website.

A Longitudinal Study of Household Water, Sanitation, and Hygiene Characteristics and Environmental Enteropathy Markers in Children Less than 24 Months in Iquitos, Peru. AJTMH, ahead of print 2018. These results provide preliminary evidence for the hypothesis that children less than 24 months of age living in unsanitary conditions will have elevated gut inflammation.

Escherichia coli Contamination across Multiple Environmental Compartments (Soil, Hands, Drinking Water, and Handwashing Water) in Urban Harare: Correlations and Risk Factors. AJTMH, ahead of print 2018. This study highlights the complexity of E. coli contamination in household environment within LMICs. More, larger, studies are needed to better identify sources and exposure pathways of E. coli—and enteric pathogens generally—to identify effective interventions.

Effect of Groundwater Iron on Residual Chlorine in Water Treated with Sodium Dichloroisocyanurate Tablets in Rural Bangladesh. AJTMH, ahead of print, 2018. We assessed the ability of sodium dichloroisocyanurate (NaDCC) to provide adequate chlorine residual when used to treat groundwater with variable iron concentration.

Prevalence and Association of Escherichia coli and Diarrheagenic Escherichia coli in Stored Foods for Young Children and Flies Caught in the Same Households in Rural Bangladesh. AJTMH, ahead of print 2018. We investigated the role of flies in contaminating stored food by collecting food and flies from the same households in rural Bangladesh.

Challenges in Assessing Combined Interventions to Promote Linear Growth. AJTMH, ahead of print 2018. We use two common but very different interventions, deworming and multiple micronutrient supplements, to illustrate barriers to recommending an optimal linear growth promotion package based on the currently available literature.

Women in Water Management in El Salvador and Nicaragua. GWP, February 2018. GWP Central America has published two case studies on women in water management, as part of the implementation of GWP´s Gender Strategy. The studies are available in Spanish.


Presentations from the Fecal Sludge Management 2017 Conference in India. (All presentations)

USAID Presentations –

Selected Presentations

Opinion: Want to improve development outcomes? Anticipate the failures. Here’s how

Opinion: Want to improve development outcomes? Anticipate the failures. Here’s how. by Susan Davis, Devex, February 12, 2018.

We’ve all been in this meeting — you know the one — where knowledgeable people have concerns but are reluctant to express reservations about a project. So plans march forward, while those who might have valuable insights keep quiet. The result for the global health and development sector is that far too many projects fail. There is a better way. So if you take away just one message today, let it be this: “Imagining that an event has already occurred increases the ability to correctly identify reasons for future outcomes by 30 percent.

The better way is called a “pre-mortem” — a strategy in which a team imagines that a project has failed, and then works backward to determine what potentially lead to the failure. Like a medical post-mortem, you figure out why the patient died so you save future patients by not repeating the same mistakes. You do it in advance in a way that safely provides space for stakeholders, experts, and dissenters to share concerns, improve chances for success, and not kill the proverbial patient. And unlike a post-mortem, which is often completed and then sent to the morgue so-to-speak, pre-mortems live on.

Pre-mortems have been used for years in the business world, but infrequently in the global health and development sectors where they could make a world of difference, not just to prevent costly mistakes and risks of failure, but also to reduce risks to the communities we serve and the sustained outcomes after a project that we need.

Case in point are water, sanitation and hygiene projects that are filled with good intentions — and broken handles and rusty pumps. Because access to safe water is so fundamental to health and development, WASH projects have typically focused on immediate needs — let’s get that well built quickly — and underemphasized the long-term needs — like who’s going to maintain the well and its pump, who’s going to pay for replacement parts, and are those parts going to be available?

Read the complete article.

Recent WASH research & upcoming webinars


Efficacy of microbial sampling recommendations and practices in sub-Saharan Africa, Water Research, 2018.  This study analyzed microbial water quality sampling practices in 351 piped systems in sub-Saharan Africa and found that many systems detected no indicator bacteria but tested too few samples to be confident in results. We conclude that sampling recommendations should consider definitions, limits, and confidence levels, and the results from this study can be used to improve international guidelines for water quality monitoring.

Water Security Implementation: Toolkit #5. Sustainable Water Partnership, February 2018. The success of a WSI process depends on the implementation of activities or measures defined through collaborative planning and decision-making with the purpose of addressing and mitigating priority water risks now and in the future.

A Longitudinal Study of Household Water, Sanitation, and Hygiene Characteristics and Environmental Enteropathy Markers in Children Less than 24 Months in Iquitos, Peru. American Society of Tropical Medicine and Hygiene, February 12, 2018. We found that less storage of fecal matter near the household along with a reliable water connection were associated with reduced inflammation. These results provide preliminary evidence for the hypothesis that children less than 24 months of age living in unsanitary conditions will have elevated gut inflammation.

Water treatment and handwashing practices in rural Kenyan health care facilities and households six years after the installation of portable water stations and hygiene training. Journal of Water & Health, Feb 2018. This evaluation demonstrated that inexpensive, rapidly installed, portable water stations were in use approximately six years later, providing needed hygiene infrastructure and a plat. form for patient teaching.

Learning from water treatment and hygiene interventions in response to a hepatitis E outbreak in an open setting in Chad. Journal of Water & Health, Feb 2018. In September 2016, Médecins Sans Frontières, responded to a hepatitis E (HEV) outbreak in Chad by implementing water treatment and hygiene interventions. To evaluate the coverage and use of these interventions, we conducted a cross-sectional study in the community.

Community-Led Total Sanitation: A Mixed-Methods Systematic Review of Evidence and Its Quality. EHP, February 2018. The evidence base on CLTS effectiveness available to practitioners, policy makers, and program managers to inform their actions is weak. Our results highlight the need for more rigorous research on CLTS impacts as well as applied research initiatives that bring researchers and practitioners together to address implementation challenges to improve rural sanitation efforts.


February 21, 2018 – Using Network Analysis to Understand and Strengthen WASH Systems – Join the Sustainable WASH Systems (SWS) Learning Partnership for a webinar that provides an introduction to network analysis and early lessons learned from analyses conducted in Ethiopia, Uganda, and Cambodia.

February 23, 2018 – Integrating WASH and Water Resource Management in Kenya – For the WASH sector to become more water secure, governance has to shift towards an approach where people reach out across boundaries and improve governance. This presentation will explore how working with civil society can mobilize communities to claim their water and sanitation rights and empower them to participate in decision-making.

February 27, 2018 – Improving Water and Energy Service Delivery with IoT Solutions – In this webinar, Evan Thomas looks at the findings from a longitudinal cohort study of sensors on handpumps in Rwanda, and data from programs in Rwanda, Kenya, Ethiopia and Somali regions.