Category Archives: Research

Interesting innovation with WASH implications

Spinach, Carrots Are Good for You … And for Making Prosthetics, Say UK Scientists | Source: Sustainable Brands, May 9 2016 |

Scientists in the United Kingdom are using spinach leaves and carrots to investigate selective formation of metallic nanoparticles in plastics. The researchers are working to form conductive circuits and create antimicrobial surfaces by accelerating the production of metals already embedded in treated plastic materials using chemicals from the plants. If successful, the practical applications include smart prosthetics, medical devices for hospitals, mobile phones, and other ‘smart’ surfaces.

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Image credit: Heriot-Watt University

Besides devices, the research could also lead to state-of-the-art antimicrobial coatings that could facilitate the creation of cheaper, more reliable ways to improve sanitation in developing countries by creating bacteria-resistant coatings for three dimensional surfaces such as pipes. Such coatings may be able to eliminate micro-organisms that currently cause illnesses and diarrhoeal disease, which kills over 750,000 children each year.

“This method that could be implemented by any country with minimum amount of equipment, is another example of the power of bio-inspired manufacturing.” Desmulliez said.

Read the complete article.

Recent sanitation research

Research Updates

Disease Control Priorities: Diarrheal DiseasesUniversity of Washington, Dept. of Global Health, 2016. Diarrheal diseases remain good indicators of the stage of development of communities in low and middle income families because of the impact of the determinants of diarrheal morbidity and mortality, which include safe drinking water and sanitation.

Should Public Toilets Be Part of Urban Sanitation Solutions for Poor Families Living in Slums? Emory University Center for Global Safe WASH, 2016. This policy note recommends that in order to protect the public health of families living in urban slums, the government of Ghana should reform its current policies regarding public toilets.

Domestic Resource Mobilization in UgandaPublic Finance for WASH, 2016. Efforts to increase domestic resource mobilization for WASH are underway in Uganda, potentially unlocking new sources of revenue that could be channeled into improving WASH services.

The Power of Integration to Multiply Development Impact: A Learning BriefUSAID WASHplus Project, 2016. Under the USAID-funded WASHplus project, integration was a strategic approach to attain desired health and development outcomes and combined WASH with nutrition, education, HIV, and neglected tropical diseases programs.

Village Sanitation and Child Health: Effects and External Validity in a Randomized Field Experiment in Rural IndiaJournal of Health Economics, April 2016. This study of a village sanitation intervention was conducted in rural Maharashtra, India and was designed to identify the effect of village sanitation on average child height.

Topic of the Week – Container-Based Sanitation

Container-Based Sanitation: Assessing Costs and Effectiveness of Excreta Management in Cap Haitien, HaitiEnvironment and Urbanization, April 2015. Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible.

User Perceptions of and Willingness to Pay for Household Container-Based Sanitation (CBS) Services: Experience from Cap Haitien, HaitiEnvironment and Urbanization, October 2015. This study presents the results of a pilot CBS service program in Cap Haitien, Haiti. One hundred and eighteen households were randomly selected to receive toilets and a twice-weekly collection service.

Addressing Sanitation Services in Dense Urban Slums: A Container-Based Model.Stanford University, Stanford Woods Institute for the Environment, 2015. Findings indicate that Container-Based Sanitation can dramatically improve management of waste in otherwise hard-to-serve areas of developing countries while satisfying residents’ desire for safe, convenient, and modern sanitation services.

Webinar: Container-Based Sanitation Solutions. Stanford University, Stanford Woods Institute for the Environment, April 2016. On March 17, 2016 the Water Health and Development Program hosted a webinar discussing Container-Based Sanitation Solutions.

WASH studies in the May 2016 Amer Jnl Trop Med & Hyg

American Journal of Tropical Medicine and Hygiene, 4 May 2016; Vol. 94, No. 5

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study

The current issue of PLoS Medicine has an important review on sanitation and hygiene and also below is an analysis of the review by Jonny Crocker and Jamie Bartram.

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study. PLoS Med, May 2016. Authors: Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L., et al.

Full text: http://goo.gl/z0h9P0

Background – Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child’s risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.

Methods/Findings – The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1–2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India.

Conclusions – This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children’s Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea. PLoS Med, May 2016. Author: Jonny Crocker, Jamie Bartram

Full text: http://goo.gl/6SzZmr

The draft sanitation ladder for measuring SDG progress allows sharing of improved facilities by fewer than five households to count towards ending open defecation [19]. Higher rungs refer to private facilities and safe excreta management. The indicators also interpret access as including use, which was not included in GEMS. Future research should include indicators on use of facilities and excreta management.

Baker and colleagues provide valuable evidence that confirms that private sanitation often provides greater benefits than shared sanitation. Prior evidence suggests health benefits for use of any sanitation facility (including shared) when compared to open defecation [8–10]. This study will inform policy and programming, yet shared facilities may still have a role in addressing open defecation in challenging settings. For reasons beyond just health such as dignity and gender equity [20,21], we should advocate for private access whenever possible.

Baker and colleagues present the best dataset yet on diarrheal disease associated with sanitation and hygiene. They provide compelling evidence on sanitation and hygiene risk factors for MSD and variability in that risk. Importantly, they also demonstrate the feasibility and value of rigorous data collection on health outcomes, something that future studies should develop yet further.

Recent studies on sanitation acess & violence,and others

Below are links to the abstracts or full text of recently published articles:

Access to sanitation and violence against women: evidence from Demographic Health Survey (DHS) data in Kenya. Int J Environ Health Res. 2016 June.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/26593879

This study analyzed 2008 Kenya Demographic Health Survey’s data and found women who primarily practice open defecation (OD), particularly in disorganized communities, had higher odds of experiencing recent non-partner violence

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought. Environ Sci Technol. 2016 Apr 25.
Abstract: http://pubs.acs.org/doi/abs/10.1021/acs.est.5b06186

Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern.

The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched–Control Trial in Mali. Amer Jnl Trop Med Hyg, Current issue
Abstract – http://www.ajtmh.org/content/early/2016/04/21/ajtmh.15-0757.abstract

We found that a school-based WASH intervention can have a positive effect on reducing rates of illness, as well as absence due to diarrhea. However, we did not find evidence that these health impacts led to a reduction in overall absence. Higher absence rates are less likely attributable to the intervention than the result of an imbalance in unobserved confounders between study groups.

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Links to recent sanitation research

Research Updates

Exploring the Potential of Antimicrobial Hand Hygiene Products in Reducing the Infectious Burden in Low-Income Countries: An Integrative ReviewAmerican Journal of Infection Control, April 2016. The study looks at whether adding antimicrobial agents to hand hygiene products increases the health benefits of handwashing with plain soap in low-income settings.

What is Sanitation Success? Improve International, April 2016. This desk review found there was not one widely accepted definition of sanitation success, even for broadly used approaches like community-led total sanitation.

Ruminants Contribute Fecal Contamination to the Urban Household Environment in Dhaka, BangladeshEnvironmental Science & Technology, April 2016. Results suggest that effective household fecal management should account not only for human sources of contamination, but also for animal sources.

Can Behavior Change Approaches Improve the Cleanliness and Functionality of Shared Toilets? Water and Sanitation for the Urban Poor, 2016. A research project in Dhaka looks at whether behavior change strategies help users keep their toilets clean and functional.

Urban Solutions: Metropolitan Approaches, Innovation in Urban Water and Sanitation, and Inclusive Smart Cities: A New Generation of Ideas. Wilson Center, March 2016. The Wilson Center’s Urban Sustainability Laboratory, Cities Alliance, Global Coalition for Inclusive Housing and Sustainable Cities, USAID, and the World Bank are cosponsoring the Reducing Urban Poverty Paper Competition for advanced graduate students. The competition seeks to encourage a new generation of urban policymakers and promote early career research.

Innovation in Scaling Up Access to Water and Sanitation Services in Kenya. Water and Sanitation Program (WSP), 2015. An analysis and summary of the World Bank WSP’s technical assistance to five cities in Kenya. The objective of this technical assistance was to increase access to water and sanitation services by the urban poor in peri-urban areas.

Innovation in the Sanitation Sector: e-Catalogue for Individual Household Toilets.Water for People, 2016. The e-Catalogue, developed in India, is a flash-based software application for desktops and laptops, and an Android application for tablets and smartphones. With the e-Catalogue, a family or customer can design their own toilet based on their individual budget. The e-Catelogue also helps generate demand among households to choose and construct their desired toilet models.

9 WASH open access articles – March 2016

Below are links to the full-text of 9 peer-review WASH studies that were published in March 2016. Click on the titles to go to the abstract and full-text.

Planning for climate change: The need for mechanistic systems-based approaches to study climate change impacts on diarrheal diseases. Authors: Mellor JE, Levy K, et al. Sci Total Environ. 2016 Apr 1.

Indicators for Monitoring Water, Sanitation, and Hygiene: A Systematic Review of Indicator Selection Methods. Authors: Schwemlein S, Cronk R, Bartram J. Int J Environ Res Public Health. 2016 Mar 17.

Association of Safe Disposal of Child Feces and Reported Diarrhea in Indonesia: Need for Stronger Focus on a Neglected Risk. Authors: Cronin AA, Sebayang SK, Torlesse H, Nandy R. Int J Environ Res Public Health. 2016 Mar 11.

Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children’s nutrition and health status in Burkina Faso and Nepal: a study protocol. Authors: Erismann S, Shrestha A, et al. BMC Public Health. 2016 Mar 9.

Effects of Sachet Water Consumption on Exposure to Microbe-Contaminated Drinking Water: Household Survey Evidence from Ghana. Authors: Wright J, Dzodzomenyo M, et al.
Int J Environ Res Public Health. 2016 Mar 9.

Cluster of Ebola Virus Disease Linked to a Single Funeral – Moyamba District, Sierra Leone, 2014. Authors: Curran KG, Gibson JJ; et al. MMWR Morb Mortal Wkly Rep. 2016 Mar 4.

Are studies underestimating the effects of sanitation on child nutrition? Lancet Glob Health. 2016 Mar.

School Water, Sanitation, and Hygiene, Soil-Transmitted Helminths, and Schistosomes: National Mapping in Ethiopia. Authors: Grimes JE, Tadesse G, et al. PLoS Negl Trop Dis. 2016 Mar.

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-Sectional Study. Authors: Fuhrimann S, Winkler MS, et al. PLoS Negl Trop Dis. 2016 Mar.