Category Archives: Research

Recent WASH research


Global status report on water safety plans: A review of proactive risk assessment and risk management practices to ensure the safety of drinking-water. WHO, June 2017. Based on information gathered from 118 countries representing every region of the globe, this report provides a picture of WSP uptake worldwide.

Incorporating the life cycle approach into WASH policies and programmes: A systematic review. 3ieimpact, 2017. This systematic review assesses the extent to which WASH policies, programmes and projects in eleven priority countries have been inclusive of different population segments during the MDG period.

Journal articles

Effect of community health clubs on child diarrhoea in western Rwanda: cluster-randomised controlled trial. Lancet Global Health, June 2017. Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported diarrhoea among children younger than 5 years.

Is there a difference in prevalence of helminths between households using ecological sanitation and those using traditional pit latrines? A latrine based cross sectional comparative study in Malawi. BMC Research Notes, June 2017. There was no significant difference between overall prevalence of helminths between households using EcoSan and those using traditional pit latrines. However, Ascaris lumbricoides was significantly higher in households using EcoSan latrines.

A methodologic framework for modeling and assessing biomarkers of environmental enteropathy as predictors of growth in infants: an example from a Peruvian birth cohort. AJCN, June 2017. Of the 3 fecal biomarkers studied, 2 that related to intestinal function—AAT and myeloperoxidase—were associatedwith small but highly statistically significant differences in future statural growth trajectories in infants.

Trends of improved water and sanitation coverage around the globe between 1990 and 2010: inequality among countries and performance of official development assistance. Global Health Action, June 12, 2017.

Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review. PLoS NTDs, June 12, 2017.

Estimation of packaged water consumption and associated plastic waste production from household budget surveys.  Environ. Res. Lett., at press

A pilot-scale microwave technology for sludge sanitization and drying. Science of The Total Environment, December 2017.

Behavioral influences on risk of exposure to fecal contamination in low-resource neighborhoods in Accra, Ghana. Journal of Water and Health, June 2017.

The true costs of participatory sanitation

Plan International USA and The Water Institute at UNC have conducted the first study to present comprehensive, accurate, disaggregated costs of a WaSH behaviour-change programme.  The study calculated programme costs, and local investments for four community-led total sanitation (CLTS) interventions in Ghana and Ethiopia.

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Jonny Crocker, Darren Saywell, Katherine F. Shields, Pete Kolsky, Jamie Bartram, The true costs of participatory sanitation : evidence from community-led total sanitation studies in Ghana and Ethiopia. Science of The Total Environment, vol. 601–602, 1 Dec 2017, pp: 1075-1083. DOI: 10.1016/j.scitotenv.2017.05.279 [Open access]


Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behaviour-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34–$81.56 per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and $2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behaviour-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behaviour-change programs.

Recent WASH research


The science behind One Health: at the interface of humans, animals, and the environment. Annals NY Academy of Sciences, May 15, 2017.

According to the One Health Commission, nearly 75% of emerging human infectious diseases in the past three decades originated in animals. Poor environmental health brought on by contamination, pollution, and degradation of air, water, and land creates disturbances that foment cross-species infectious disease transmission, as well as noninfectious disease spread across entire populations of humans and animals.

The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance & Infection Control, May 15, 2017.

Apart from the irrational use of antimicrobials, unique environmental conditions such as crowding and poor sanitation also contribute in the circulation and spread of resistant microorganisms.

Sustainability of community-led total sanitation outcomes: Evidence from Ethiopia and Ghana. International Journal of Hygiene and Environmental Health, May 2017.

This study provides new evidence that CLTS outcomes can be sustained in the presence of training provided to local actors, and strengthens previous recommendations that CLTS is not appropriate in all settings and should be combined with efforts to address barriers households face to building higher quality latrines.

Assessing patterns and determinants of latrine use in rural settings: A longitudinal study in Odisha, India. International Journal of Hygiene and Environmental Health, May 2017.

Results highlight the low and inconsistent use of subsidized latrines built under the TSC in rural Odisha. This study identifies individual and household levels factors that may be used to target behavior change campaigns to drive consistent use of sanitation facilities by all.

Processes and challenges of community mobilisation for latrine promotion under Nirmal Bharat Abhiyan in rural Odisha, India. BMC Public Health, May 16, 2017.

Agencies or organizations implementing sanitation campaigns and conducting sanitation promotions need to enhance their staff’s knowledge and build capacity in order to address important social heterogeneity within villages.


This Brief looks at lessons learned by a local small and medium sized enterprise which operates a new fecal sludge emptying service – SWEEP.


Predictors of drinking water boiling and bottled water consumption in rural China: A hierarchical modeling approach. Environ. Sci. Technol, May 20, 2017.

Our findings show that boiling is not an undifferentiated practice, but one with different methods of varying effectiveness, environmental impact, and adoption across socioeconomic strata.

Environmentally sustainable WASH? Current discourse, planetary boundaries and future directions. Jnl of WASH for Development, March 2017.

This paper reviews recent literature at the intersection of WASH and environmental sustainability to identify current themes and future directions. Findings point to both opportunities and gaps within current sector thinking, which can drive leadership from knowledge and research institutions towards better integration of access and environmental sustainability imperatives.


John Oldfield- Water Is Global (In)Security. Forbes, May 23, 2017.

Agencies Launch Water Monitoring Tools and Processes for SDG 6 Reporting. IISD, May 23, 2017.

Recent WASH research

Open Access

Underreporting of high-risk water and sanitation practices undermines progress on global targets. PLOS One, May 2017. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Mobile surveys offer a cost-effective and innovative platform to rapidly and repeatedly monitor critical development metrics.

Impact of an Intensive Perinatal Handwashing Promotion Intervention on Maternal Handwashing Behavior in the Neonatal Period: Findings from a Randomized Controlled Trial in Rural Bangladesh. BioMed Research International, April 2017. Intensively promoting handwashing with soap resulted in increased availability of soap and water at handwashing places, but only a modest increase in maternal handwashing with soap.

Investing in wastewater in Latin America can pay off. Water Blog, May 10, 2017. But recent advances in the sector present an opportunity to conduct basin-wide planning that promotes investments in wastewater that clearly identifies the downstream benefits of upstream investments, hence maximizing returns.

Drones in Humanitarian Action: A guide to the use of airborne systems in humanitarian crises, 2017. FSD. The most promising uses of drones include: Mapping; Delivering lightweight essential items to remote or hard to-access locations; Supporting damage assessments; Increasing situational awareness; Monitoring changes.


A critical mass analysis of community-based financing of water services in rural Kenya. Water Resources and Rural Development, May 2017. For the first time, this study applies critical mass theory to community waterpoint financial contributions in rural sub-Saharan Africa.

Recent News Items

Recent sanitation/WASH research


Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study. BMC Public Health, May 2017. We argue that handwashing with soap is influenced by broader range of antecedents, many unrelated to fecal contamination, that indicate to people when and where to wash their hands. This exploratory study aimed to identify and characterize this broader range of handwashing antecedents for use in future handwashing promotion efforts.

Provision versus promotion to develop a handwashing station: the effect on desired handwashing behavior. BMC Public Health, May 2017. We conducted a three-month pilot intervention to evaluate two options for setting up handwashing stations: i) provide a handwashing station, or ii) help the family to make their own from available materials. Additionally, we assessed the feasibility of this intervention to be integrated with a child feeding program.


Impact of Community Health Clubs on Diarrhea and Anthropometry in Western Rwanda: Cluster-Randomized Controlled Trial. FASEB Jnl, May 2017. (Abstract/order) – The CHC approach, as implemented in this setting in western Rwanda, had no impact on any main outcomes, but it had a positive impact on household water treatment and type and structure of sanitation facility. Our results raise questions about the value of implementing this intervention at scale.

Diet Quality, Water and Toilets Remain a Lingering Challenge for Undernutrition in India. FASEB Jnl, May 2017. (Abstract/order) – Using data from 2005–06, our regression analyses demonstrate a positive synergistic effect of better complementary feeding and better toilets for all anthropometric indicators, but not for improved drinking water or better ways of disposing child stools.

Evaluation of Student Handwashing Practices During a School-Based Hygiene Program in Rural Western Kenya, 2007. International Quarterly of Community Health Education, May 2017. (Abstract/order) – Teacher training and installation of water stations resulted in observed improvements in pupils’ hygiene, particularly when water stations were located

Consistency of Use and Effectiveness of Household Water Treatment Among Indian Households Claiming to Treat Their Water. Am Jnl Trop Med Hyg, online first. (Abstract/order) – Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Adding a Water, Sanitation and Hygiene Intervention and a Lipid-Based Nutrient Supplement to an Integrated Agriculture and Nutrition Program Improved the Nutritional Status of Young Burkinabé Children. FASEB Jnl, May 2017. (Abstract/order) – Adding WASH to the program in 2014 led to a significantly greater reduction in anemia, and including both WASH and LNS in communities with prior EHFP program exposure led to the largest and most diverse nutritional impacts including significant reductions in anemia, IDA and VAD. These results highlight the importance of addressing the multiple causes of undernutrition simultaneously, through multisectoral programs.

World Bank targets smarter sanitation communication for rural Ethiopia

By Peter McIntyre, IRC Associate

The World Bank in Ethiopia has commissioned a rapid survey of what motivates people to upgrade their latrines, with the aim of delivering behaviour change communication materials with greater impact.

Ethiopia Worldbank_bcc_launch_2_addis_230317

Sanitation rapid survey launch meeting Addis Abeba, 23 March 2017 (Photo: Sirak Wondimu)

The survey is being conducted in four regions, with the main target audiences being adult women, male heads of households, opinion leaders and existing sanitation businesses.

The aim is to pilot and produce materials that emphasise the dignity, prestige and status of having improved sanitation, rather than focusing only on health messages.

The WB decided a new approach was needed after Demographic and Health Survey (DHS) figures for 2016 suggested that only 4% of rural households in Ethiopia have improved toilets facilities while a further 2% have facilities that would be considered improved if they were not shared. This is well below the Joint Monitoring Program figure of 28% for improved latrines (although we understand this may be revised down to around 14%). Indeed, according to DHS, although access to some form of sanitation has risen, access to an improved latrine has declined in percentage terms over the past ten years. Most latrines in rural areas (55%) do not have an effective slab or lid while more than a third of rural households (39%) practise open defecation.

The Government of Ethiopia has a flagship programme to increase use of improved latrines to 82% by 2020.

At a launch meeting in Addis on 23 March 2017, social market consultant, Addis Meleskachew, said that this initiative will develop a memorable brand for marketing materials that will encourage the private sector to provide materials and will attract rural families to buy them.

Dagnew Tadesse,Hygiene and Environmental Health Case Team Leader for Ministry of Health, welcomed the initiative to attract business but emphasised that the GoE approach is based on a comprehensive health education strategy with multiple messages including hygiene awareness, handwashing and safe food, and said that these important messages should not be abandoned.

Jane Bevan, rural WASH Manager at UNICEF Ethiopia offered to share extensive data that UNICEF has collected for its country programme on attitudes to sanitation, which has identified the high cost of concrete slabs as a significant obstacle. She presented examples of low cost options for upgrading sanitation in a pilot project in Tigray region. It was agreed to collate all existing KAP studies and relevant data including research by SNV.

Monte Achenbach from PSI and John Butterworth from IRC spoke about the work being started by USAID Transform WASH to market innovative sanitation models. John Butterworth said there is a need to make people aware of what is available and to get materials to where they are needed.

The World Bank research is being conducted by 251 Communications.

This blog was originally posted on 5 April 2017 on the IRC website.

Recent WASH research

Financing WASH SystemsIRC WASH, March 2017. In this podcast two experts talk about the challenges of financing water and sanitation services and the importance of public finance in reaching the Sustainable Development Goals.

World Water Development Report (WWDR) 2017—Wastewater: An Untapped ResourceUN Water, March 2017. This year’s WWDR report proposes that the vast quantities of domestic, agricultural, and industrial wastewater discharged into the environment be used as a valuable resource.

Turbulent Waters: Pursuing Water Security in Fragile ContextsThe World Bank, March 2017. This report explores the dynamics between water insecurity and fragility. It suggests that water security is more difficult to achieve in fragile contexts because of a range of factors, including weak institutions and information systems, strained human and financial resources, and degraded infrastructure.

Interventions to Improve Facial Cleanliness and Environmental Improvement for Trachoma Prevention and Control: Review of the Grey Literature. International Coalition for Trachoma Control, March 2017. This report reflects a review and synthesis of the F (facial cleanliness) and E (environmental improvement) intervention landscape, as indicated by grey literature produced by the trachoma community.

Effects of Neighbourhood and Household Sanitation Conditions on Diarrhea Morbidity: Systematic Review and Meta-Analysis. PLoS One, March 2017. The findings suggest that, in addition to household sanitation provision, dual emphasis on neighborhood sanitation through public sanitation infrastructure provision and community-wide sanitation adoption is advisable to effectively reduce the diarrheal disease burden.

A Systematic Review: Costing and Financing of Water, Sanitation, and Hygiene (WASH) in SchoolsPreprints, March 2017. The purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements. Data are lacking overall for WASH in school settings compared to community WASH.

Sub-Saharan Africa’s Urban Water Blueprint: Securing Water through Water Funds and Other Investments in Ecological InfrastructureThe Nature Conservancy, 2016. This assessment demonstrates that catchment protection can play an important role in improving the quality and quantity of water for cities across sub-Saharan Africa. These benefits extend beyond the cities themselves to help sustain rural livelihoods and huge areas of critical biodiversity.

A Listing of World Water Day 2017 PublicationsSanitation Updates, March 2017. This post to Sanitation Updates compiles links to World Water Day 2017 reports from WaterAid, UN Water, WHO, and others