Category Archives: Research

Recent WASH research

Estimating the Cost and Payment for Sanitation in the Informal Settlements of Kisumu, Kenya: A Cross Sectional Study. International Journal of Environmental Research and Public Health, January 2017. This study aimed to estimate the cost of sanitation and investigated the social and economic dynamics within Kisumu’s informal settlements that hinder provision and uptake of sanitation facilities.

WASH’Nutrition: A Practical Guidebook on Increasing Nutritional Impact through Integration of WASH and Nutrition Programs. ACF International, January 2017. This operational guidebook demonstrates the importance of both supplementing nutrition programs with WASH activities and adapting WASH interventions to include nutritional considerations (i.e., making them more nutrition-sensitive and impactful on nutrition). It has been developed to provide practitioners with usable information and tools so that they can design and implement effective WASH and nutrition programs.

A Mobile Platform Enables Unprecedented Sanitation Uptake in Zambia. PLoS Neglected Tropical Diseases, January 2017. Akros, in partnership with Zambia’s Ministry of Local Government and Housing and UNICEF, has developed an innovative community-led total sanitation (CLTS) monitoring system called CLTS M2W. It uses mobile phones and engagement of traditional leaders to provide communities with the ability to clearly see their progress toward sanitation goals. CLTS M2W paved the way for unprecedented CLTS uptake in Zambia, facilitating the creation of over 1,500,000 new users of sanitation in 18 months.

Measuring Global Water Security towards Sustainable Development GoalsEnvironmental Research Letters, December 2016. In this study, the authors present a spatial multi-criteria analysis framework to provide a global assessment of water security. The selected indicators are based on Goal 6 of the Sustainable Development Goals.

Disposal of Children’s Stools and its Association with Childhood Diarrhea in IndiaBMC Public Health, January 2017. Researchers found significant statistical association between children’s stool disposal and diarrhea. They conclude that gains in the reduction of childhood diarrhea can be achieved in India through the complete elimination of unsafe disposal of children’s stools.

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries. Demography, January 2017. In this study, researchers assessed whether the importance of dense settlement for infant mortality and child height is influenced by exposure to local sanitation behavior.

Towards “Sustainable” Sanitation: Challenges and Opportunities in Urban AreasSustainability, December 2016. This paper reviews challenges associated with providing sanitation systems in urban areas and explores ways to promote sustainable sanitation in cities. It focuses on opportunities to stimulate sustainable sanitation approaches from a resource recovery perspective, generating added value to society while protecting human and ecosystem health.

Publications on Water, Sanitation and Health: 2016. WHO, 2016. This page provides links to WHO 2016 reports on quantitative microbial risk assessment, protecting surface water for health, and household water treatment.

Recent sanitation/WASH studies

UNICEF-WHO-The World Bank Group: Joint Child Malnutrition Estimates – Levels and Trends: Key Findings of the 2016 Edition . UNICEF ; WHO , September 2016. This report gives new estimates of child stunting, overweight, underweight, wasting, and severe wasting. Malnutrition rates remain alarming: stunting is declining too slowly while overweight continues to rise.

Increasing Block Tariffs: WASH Policy Research Digest #5 . UNC Water Institute , December 2016. This is a detailed review of a recent publication : Increasing Block Tariffs Perform Poorly at Targeting Subsidies to the Poor . It includes a literature review on increasing block tariffs and subsidy targeting.

Risk Management for Drinking Water Safety in Low and Middle Income Countries: Cultural Influences on Water Safety Plan (WSP) Implementation in Urban Water Utilities . Science of the Total Environment , January 2017. Few researchers have considered cultural influences on WSP implementation. A thematic analysis of three WSP pilots in India, Uganda, and Jamaica elicited the views of WSP implementers, promoters, and customers. Twelve cultural themes emerged that enable, limit, or are neutral to WSP implementation.

Papua New Guinea (PNG): Rural WASH Sustainability Study . Water and Sanitation Program , 2016. The purpose of this study was to gather evidence about the sustainability of rural WASH activities in PNG. The objectives were to identify and develop practical approaches to improve both the sustainability and equitable delivery of rural water supply and sanitation schemes and make recommendations on the potential for information communication technology (monitoring systems for rural water supply).

Real-Time Learning and Documentation in the Cambodia Rural Sanitation and Hygiene Improvement Program (CRSHIP) . Water Supply and Sanitation Collaborative Council , November 2016. The Cambodia Rural Sanitation and Hygiene Improvement Program aims to increase access to safe sanitation and promote the sustainable practice of key sanitation and hygiene behaviors in rural Cambodia. This video explains how the project’s learning and documentation component helps solve complex project implementation issues.

Review of Self-Supply and its Support Services in African Countries: Synthesis Report . Skat Foundation , April 2016. Supported self-supply of rural water supplies is a very cost-effective service delivery approach, which is complementary to communal supplies and aligned with human rights principles, supports equity and inclusiveness, and achieves several SDGs. This synthesis report summarizes the results of a UNICEF-funded review of supported self-supply in Zambia and Zimbabwe that was conducted in 2015.

Burden of Diarrhea in the Eastern Mediterranean Region, 1990–2013: Findings from the Global Burden of Disease Study 2013 . American Journal of Tropical Medicine and Hygiene , December 2016. The results highlighted a highly inequitable burden of diarrheal diseases, mainly driven by the lack of access to proper resources such as water and sanitation. These findings will guide prevention and treatment interventions that are based on evidence with the ultimate goal of reducing the diarrheal disease burden.

Financing Options for the 2030 Water Agenda . The World Bank , November 2016. A new sector financing paradigm is required based on four broad themes. The sector has to realign itself around actions that: improve sector governance and efficiency (i.e., improving creditworthiness); crowd in or blend private finance (i.e., leveraging capital); allocate sector resources more effectively to deliver the maximum benefit for every dollar invested (i.e., targeting capital); and improve sector capital planning to reduce unit capital costs.

New WHO estimates on stunting; Dec 2016 WASH studies

UNICEF-WHO-The World Bank Group: Joint child malnutrition estimates – levels and trends: Key findings of the 2016 edition. WHO; UNICEF. In September 2016 the inter-agency team released new joint estimates of child stunting, overweight, underweight, wasting and severe wasting.

Trop Med Intl Health – Dec 2016

Is pregnancy a teachable moment to promote handwashing with soap among primiparous women in rural Bangladesh? Follow-up of a randomised controlled trial (Abstract/order)

Potential sources of bias in the use of Escherichia coli to measure waterborne diarrhoea risk in low-income settings(Abstract/order)

Rapid dipstick detection of Vibrio cholerae in household stored and municipal water in Dhaka, Bangladesh: CHoBI7 trial (Abstract/order)

Environmental Health Perspectives – December 2016

Salting the Earth: The Environmental Impact of Oil and Gas Wastewater Spills

Am Jnl Trop Med Hyg – Nov 2016

Effectiveness of Membrane Filtration to Improve Drinking Water: A Quasi-Experimental Study from Rural Southern India (Full text)

Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition(Abstract/order)

Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions (Abstract/order)

Improved Sanitation Facilities are Associated with Higher Body Mass Index and Higher Hemoglobin Concentration Among Rural Cambodian Women in the First Trimester of Pregnancy (Abstract/order)

Int. J. Environ. Res. Public Health 2016, 13(12)

Assessment of Macro-Level Socioeconomic Factors That Impact Waterborne Diseases: The Case of Jordan (Full text)

An Annotated Bibliography on Shared Sanitation – November 28, 2016

An Annotated Bibliography of 2015 and 2016 Studies and Reports on Shared Sanitation – November 28, 2016

 2016 Studies and Reports

1 – Shared sanitation: to include or to exclude? Trans Roy Soc Trop Med & Hygiene, May 2016. Duncan Mara.  (Abstract/order)
Recent research has shown that neighbor-shared toilets perform much better than large communal toilets. The successful development of community-designed, built and managed sanitation-and-water blocks in very poor urban areas in India should be adapted and adopted throughout urban slums in developing countries, with a caretaker employed to keep the facilities clean. Such shared sanitation should be classified as ‘basic’, sometimes as ‘safely-managed’, sanitation, so contributing to the achievement of the sanitation target of the Sustainable Development Goals.

2 – Can behaviour change approaches improve the cleanliness and functionality of shared toilets? A randomised control trial in Dhaka, Bangladesh. WSUP, May 2016.
(Full text)
This project demonstrated that a behavior change communication intervention built upon in-depth qualitative understanding of the perspective and constraints of local residents could improve toilet cleanliness, even in the setting of severe constraints: notably water shortages and the absence of fecal sludge management systems. The most important step towards improving environmental sanitation in Dhaka is to address the absence of any fecal sludge management system. To improve the quality and cleanliness of shared facilities, behavior change strategies targeting the central role that landlords and community managers play can be particularly effective. Future research might explore: 1) how compound managers and/or landlords can make improvements to toilet cleanliness without project-funded hardware; 2) how to leverage mass media approaches to reduce the cost of behavior change communication; 3) how the effectiveness of specific behavior change strategies varies by gender; and 4) further evaluations to assess the sustainability of these efforts to improve toilet cleanliness.

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PLoS journals launch WASH collection

As a contribution to World Toilet Day, PLoS has compiled its 2014-2016 WASH-related articles at: plos.PNG

The 2016 studies include:

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea, PLOS Medicine : 03 May 2016

The Hygiene Hypothesis and Its Inconvenient Truths about Helminth Infections, PLOS Neglected Tropical Diseases : 15 Sep 2016

Scaling up Rural Sanitation in India, PLOS Medicine : 26 Aug 2014

Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands, PLOS Neglected Tropical Diseases : 22 Aug 2016

Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Camb…, PLOS Neglected Tropical Diseases : 22 Aug 2016

Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment, PLOS ONE : 17 Aug 2016

High-Resolution Spatial Distribution and Estimation of Access to Improved Sanitation in Kenya, PLOS ONE : 12 Jul 2016

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter St…, PLOS Medicine : 03 May 2016

A Global Perspective on Drinking-Water and Sanitation Classification: An Evaluation of Census Content, PLOS ONE : 17 Mar 2016

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UC Davis Researchers Streamline Fertilizer Production

UC Davis Researchers Streamline Fertilizer Production. WEF Highlights, November 11, 2016.

University of California, Davis (UCD) researchers are thinking outside of the box, using urine collected in the community to develop a more environmentally friendly fertilizer.

Harold Leverenz, lecturer and project scientist for the civil and environmental engineering program at UCD, works with his research team to create all-natural, locally sourced fertilizers.


While Sudwerk Brewery (Davis, Calif.) also features classic indoor restrooms, patrons who choose to use the Pee Hive receive a $1 discount on their purchases in addition to the knowledge that they are contributing to science. Photo courtesy of George Tchobanoglous, University of California, Davis.

His unique process, which offers significant energy and water savings over traditional fertilizer production methods, collects high amounts of plant nutrients from an unlikely source — the urine from customers of a local brewery.

Through a unique partnership with Sudwerk Brewery (Davis, Calif.) and generous donations from project contributors, Leverenz and his team have secured about 132 L (35 gal) of nitrogen- and phosphorous-rich urine each week since installing a specialized outhouse made from a sawed-off beer keg outside Sudwerk’s tasting room in June. Leverenz is hopeful that the collection rate will increase as UCD students settle into a new school year.

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Recently published sanitation research

Have We Substantially Underestimated the Impact of Improved Sanitation Coverage on Child Health? A Generalized Additive Model Panel Analysis of Global Data on Child Mortality and Malnutrition. PLoS One, October 2016. | Summary in Science Daily | Improving sanitation coverage may be one of the more effective means to reduce childhood mortality, but only if high levels of community coverage are achieved. Studies of the impact of sanitation that focus on the individual’s use of improved sanitation as the predictor variable rather than community coverage is likely to severely underestimate the impact of sanitation.

Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. PLoS Medicine, November 2016.
Efforts to further reduce stunting should be focused on fetal growth restriction and poor sanitation, and this will require refocusing prevention programs on interventions that reach mothers and families and improve their living environment and nutrition.

Costs of Diarrhoea and Acute Respiratory Infection Attributable to Not Handwashing: The Cases of India and China. Tropical Medicine and International Health, November 2016. Results from this study suggest large economic gains relating to decreases in diarrhea and acute respiratory infection for both India and China from behavior change programs to increase handwashing with soap in households.

Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition. American Journal of Tropical Medicine and Hygiene, September 2016. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. It provides evidence that ECD and stunting may have independent effects on children’s intellectual function well into later childhood.

Microwave Treatment of Faecal Sludge from Intensively Used Toilets in the Slums of Nairobi, Kenya. Journal of Environmental Management, December 2016. This study explores the applicability of microwave technology to treat fecal sludge obtained from urine-diverting dry toilets placed in slum settlements in Nairobi, Kenya.

Early Testing of New Sanitation Technology for Urban Slums: The Case of the Blue Diversion Toilet. Science of the Total Environment, January 2017. Inadequate sanitation in urban slums is a threat to the total environment. This study finds that source separation and onsite water recycling is feasible and has market potential.