Category Archives: Research

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

Survey on sanitation in flood-prone areas – George Washington University

Dear WASH colleagues,

I am a masters student at the George Washington University (in the U.S.). As part of my thesis, I am collaborating on research that aims to better understand the options for sanitation in flood-prone areas. The aims of the study are to identify best practices, barriers, and technical methods for the implementation of sanitation in flood-prone areas. If you have had experience working on sanitation in flood-prone areas, I would greatly appreciate you sharing your experiences.  If you are willing, I invite you to participate in the following brief online survey: Survey on Sanitation in Flood Prone Areas

In addition to the online surveys, I will be conducting in-depth qualitative interviews with individuals who work on sanitation in flood-prone areas in Cambodia.  If you have implemented a sanitation project in a flood-prone area in Cambodia, and you’re interested in being part of the study, please let me know and I will forward you the informed consent form to enroll you in the study. The interview should take less than 30 minutes and can be conducted over skype, Google hangout, or over the phone, at your convenience.

Finally, if you believe that you know of someone who would be suited for this study, please feel free to forward me his or her contact information.  I appreciate your time and assistance, and please let me know if you have any questions or comments. I look forward to hearing from you!

Jason Lopez, MPH Candidate – Global Environmental Health
The George Washington University
+1 (202) 999-8226
Skype: jas.lop l LinkedIn


How Bangladesh turns toilet waste into high-value compost – in pictures

How Bangladesh turns toilet waste into high-value compost – in pictures |Source: The Guardian, Feb 27 2015 |

Scientists in Bangladesh are working on ways to treat toilet waste in rural areas and use it to develop safe, nutritious compost for food crops. Led by the school of civil engineering at Leeds University, the Value at the End of the Sanitation Value-Chain (VESV) project aims to help reduce reliance on imported inorganic fertilisers and provide potential business opportunities for waste transporters and compost producers in a country where access to sanitation is now widespread but challenges of managing waste remain.

Farmers tend their cabbage crops in Manikganj district. Bangladesh has benefited from major improvements in rural sanitation with the spread of pit toilets – holes dug in the ground. guardian-sanitation

These bypass the problem of installing sewerage infrastructure in densely populated rural areas, but the challenge is what to do with the waste when the pits are full. If treated carefully, this waste could provide a local source of organic matter and plant nutrients such as nitrogen, potassium and phosphorus. All photographs by Neil Palmer/IWMI.

Feb/March 2015 selected studies on sanitation, hygiene & handwashing


Household-Level Risk Factors for Influenza among Young Children in Dhaka, Bangladesh: A Case-Control Study(Abstract/order)

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.


Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.

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Bill Gates – This Ingenious Machine Turns Feces Into Drinking Water

Bill Gates – This Ingenious Machine Turns Feces Into Drinking Water | Source: Gates Notes, January 5, 2015|

An excerpt – I watched the piles of feces go up the conveyer belt and drop into a large bin. They made their way through the machine, getting boiled and treated. A few minutes later I took a long taste of the end result: a glass of delicious drinking water.

The occasion was a tour of a facility that burns human waste and produces water and electricity (plus a little ash). I have visited lots of similar sites, like power plants and paper mills, so when I heard about this one—it’s part of the Gates Foundation’s effort to improve sanitation in poor countries—I was eager to check it out.

Why would anyone want to turn waste into drinking water and electricity?

Because a shocking number of people, at least 2 billion, use latrines that aren’t properly drained. Others simply defecate out in the open. The waste contaminates drinking water for millions of people, with horrific consequences: Diseases caused by poor sanitation kill some 700,000 children every year, and they prevent many more from fully developing mentally and physically.

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Innovation in Urban Sanitation: FaME and U-ACT Research in Sub-Saharan Africa

In Sub-Saharan Africa sanitation needs of the majority of the urban population are met by onsite sanitation technologies such as pit latrines. As part of the SPLASH sanitation research programme the FaME (Faecal Management Enterprises) and U-ACT Project researched innovative solutions to increase access to sustainable sanitation services. Building on this research Sandec/Eawag  has recently started the SEEK Project (Sludge to Energy Enterprises) researching co-processing of faecal sludge and other urban waste streams into fuel pellets and with these electricity through gasification.

Sandec Eawag – Behind the Data: The People Who Make Research Happen

Published on Sep 12, 2014 -“Behind The Data: The People Who Make Research Happen” is a short documentary, highlighting the work that was done in rural communities by the people who were instrumental in collecting and recording data for a sanitation-based research project. We aim to show the fundamental value of each person’s role in achieving the ultimate research objectives.