Impact of Drinking Water, Sanitation and Hand Washing with Soap on Childhood Diarrhoeal Disease

Link to full-text – Impact of Drinking Water, Sanitation and Hand Washing with Soap on Childhood Diarrhoeal Disease: Updated Meta-Analysis and –Regression. Tropical Medicine and International Health, 14 March 2018.

Authors: Jennyfer Wolf, Paul R. Hunter, Matthew C. Freeman, Oliver Cumming, Thomas Clasen, Jamie Bartram, Julian P. T. Higgins, Richard Johnston, Kate Medlicott, Sophie Boisson, Annette Prüss-Us

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/tmi.13051

Objectives – Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease.

Methods – We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression.

Results – A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity.

• Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR=0.39; 95% CI: 0.32, 0.48);
• piped water to premises of higher quality and continuous availability by 75% and 36% (RR=0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water;
• sanitation interventions by 25% (RR=0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR=0.70 (0.64, 0.77)) versus no intervention.
• Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent.

Conclusions – Though evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.

Improving Handwashing in Humanitarian Crises: Methods for Researching Handwashing Practices and Behavior

Improving Handwashing in Humanitarian Crises: Methods for Researching Handwashing Practices and Behavior. by Sian White, Research Fellow, Hygiene and Behaviour Change, The London School of Hygiene and Tropical Medicine. CAWST Blog, October 11, 2017.

This year CAWST has been working with Action Contre Faim (ACF)and The London School of Hygiene and Tropical Medicine (LSHTM) to better understand handwashing practices among internally displaced people.

Working together on this project, this partnership brings together our experience and networks in academic health research, humanitarian operational experience in WASH and Mental Health, and development of educational material.

Left: A participant draws two images of himself, making one intentionally messy to symbolise his life falling apart. Right: The research assistant plots milestones on the timeline as the participant narrates her story.

The general objective of the research is to develop deep understandings of the determinants of hand hygiene in emergency settings so as to contribute to the development of rapid and effective intervention tools; the ultimate goal of the research will be to equip emergency responders with the knowledge and tools to intervene rapidly and effectively on hygiene behaviour. The full findings of this research, including practitioner resources, will be available in 2018.

In this blog post, Sian White, the project’s lead researcher, shares four research methods she has been using and what these have revealed so far.

Read the complete blog post.

WaterAid – Mass behaviour change campaigns What works and what doesn’t

Mass behaviour change campaigns: What works and what doesn’t. WaterAid, October 2017.

Hygiene promotion campaigns are often piecemeal, insufficiently planned and executed, and a re-tread of unproven or, worse, ineffective approaches. The
lamentable performance of handwashing campaigns in changing behaviours reveals
a lack of coherent thinking in policies, strategies and guidelines.

To promote an effective approach to mass behaviour change campaigning, and
hygiene promotion in particular, WaterAid commissioned an in-depth global and
historical analysis of behaviour change campaigns, analysing both successes and
failures.

This paper highlights the main points from that study combined with findings from a previous WaterAid paper on how some countries in East Asia successfully
achieved the widespread adoption of hygienic practices.

It provides policy recommendations as a set of ‘working assumptions’ that can be used by policy makers when it comes to developing mass behaviour change strategies.

Read the complete report.

WSSCC Webinar: Handwashing and sanitation behaviour change in WASH interventions, 24 October

Water Supply and Sanitation Collaborative Council (WSSCC) would like to invite you to register to the online learning event: Handwashing and sanitation behaviour change in WASH interventions.

A webinar for WASH practitioners.

Learn about the most effective interventions to promote handwashing and sanitation.

Presented by Emmy De Buck, Manager and Lead Researcher, Centre for Evidence-Based Practice, (CEBaP), Belgian Red Cross-Flanders.

Moderated by Chaitali Chattopadhyay, Senior Programme Officer, Monitoring
and Evaluation, WSSCC

To register click here.

Read ahead:

• Policy Brief
• Fact Sheet
• Summary
• Report

Attention is increasingly focusing on programme design and approaches that promote water, Sanitation, and Hygiene (WASH) behaviour change in efforts to achieve UN Sanitation Goal 6. Several approaches have been developed over the last 2 decades that promote uptake of WASH interventions and sustain WASH behaviour change. While the evidence base for interventions in low and medium-income countries is extensive, there is a gap in behaviour change approaches in WASH interventions.

The International Initiative for Impact Evaluation (3ie), in partnership with the Water Supply and Sanitation Collaborative Council (WSSCC), funded a systematic review to help fill in this evidence gap. It looked at which promotional approaches might change handwashing and sanitation behaviour, and which implementation factors affect the success or failure of such promotional approaches. It synthesises evidence from 42 quantitative studies on the effectiveness of behaviour change approaches and 28 qualitative studies on the implementation of such programme.

Join the webinar on 24th October 2017 for the launch of this recent systematic review “Approaches to promote handwashing and sanitation behaviour change in low- and middle-income countries.”

Handwashing research – Water Currents

Handwashing research – Water Currents, August 8, 2017.

Highlighting the most recent handwashing research, this issue of Currents includes literature reviews by the Global Handwashing Partnership, the International Initiative for Impact Evaluation, and an interesting report on handwashing and rational addiction. Articles discuss handwashing research in Bangladesh, Tanzania, and Zimbabwe as well as studies on handwashing and infectious diseases, among other topics. 

Reports 
The State of Handwashing in 2016: Annual Review. Global Handwashing Partnership (GHP), March 2017. This GHP review summarizes key themes and findings from 59 peer-reviewed handwashing-related research papers published in 2016.

Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic Review. International Initiative for Impact Evaluation, June 2017. The purpose of this review was to learn which factors might change handwashing and sanitation behavior, finding that a combination of different promotional elements may be the most effective strategy.

Habit Formation and Rational Addiction: A Field Experiment in Handwashing. Yale University, Economic Growth Center, December 2016. The researchers in this study designed and implemented an experiment to test predictions of the rational addiction model in the context of handwashing. The findings are presented in a video from a 2016 conference.

Read the complete issue.

 

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.

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.

July to December 2016 Handwashing Research Summary – GHP

July to December 2016 Handwashing Research Summary, March 2017. Global Handwashing Partnership.

• Full text, pdf

Between July and December 2016, we identified 37 relevant peer-reviewed studies on handwashing.

Learn about key findings during this time period in this handwashing research summary from the second half of 2016.