Water, Sanitation and Health

This topic brief documents the approach, outcomes and learning of an integrated sanitation and hygiene programme implemented in Maputo, Mozambique during the period 2013-2017. The programme was funded by the World Bank-managed Japanese Social Development Fund (JSDF) and implemented by WSUP and the Water and Sanitation Program (WSP) of the World Bank.

The USAID Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project conducted a review of the scientific and grey literature, complemented by dozens of key informant interviews with researchers and field implementers, to synthesize the latest understanding of key pathways of fecal microbe ingestion by infants and young children (IYC) and their links to diarrhea, EED, and poor nutrition and development outcomes.

The findings of the literature review will inform the design of research to measure the additive effects of specific measures to reduce IYC exposure to fecal pathogens and other fecal microbes in their home environments when coupled with independent or integrated WASH and nutrition interventions.

This is the introductory article in a four-part PLoS Medicine series on water and sanitation. It highlights the massive disease burden associated with deficient hygiene , sanitation and water supply, which would be largely preventable. The total benefits of improved water, sanitation and hygiene are much greater than merely health benefits. The article calls for making water, sanitation and hygiene development priorities.

This document integrates Water, Sanitation and Hygiene (WASH) practices into HIV care. It draws on experiences from the USAID-funded Hygiene Improvement Project (USAID/HIP) . It contains guidance on implementing priority WASH practices, including WASH in global and national HIV/AIDS policy and guidance, and integrating WASH–HIV programmes.

This is the last article in a four-part PLoS Medicine series on water and sanitation. It considers what needs to be done to make significant progress towards ensuring universal access to hygiene, sanitation, and water in each sector itself, and then discusses which actors need to be involved to achieve an impact. Finally, the importance of the health sector in improving hygiene, sanitation, and water worldwide and propose a detailed Agenda for Action.

This factsheet provides information on the link between sanitation and agriculture as well as related implications on health, economy and environment. It shows examples of treating and using treated excreta and wastewater in a productive way and describes the potential for urban agriculture and resource recovery in rural areas. Institutional and legal aspects, business opportunities and how to manage associated health risks are also discussed

Despite the production of more food and extraction of more water globally, wetlands continue to decline and public health and living standards for many do not improve. Why is this – and what needs to change to improve the situation? If we manage wetlands better, can we improve the health and well-being of people? Indeed, why is this important? This report seeks to address these questions.

This article is part of a four-part PLoS Medicine series on water and sanitation. It summarises the importance of a safe and reliable water supply for h man health, and highlight the negative effects of poor water supply. Furthermore, the article also discusses the reasons for the limited progress towards universal access to adequate aware supply and highlights that strenuous efforts are needed to improve the situation.

A comprehensive book on recycling human excrement without chemicals, high technology or pollution. Well written, practical, and thoroughly researched, this self-published book is built on nearly twenty years of experience by the author, who tells us about every aspect of dealing with excrement on the home-scale level. Only available for free as web book.

The problem with disposing of menstrual waste into pit latrines is that it causes the pits to fill up faster. The excreta in the pit decompose and decrease in volume, while the non-biodegradable components of menstrual waste accumulate and do not break down. Furthermore, once the sludge has been removed from the pit latrine, if it is to be used in agriculture, any waste that has not completely decomposed such as menstrual pads must be removed before the sludge can be composted or applied to farmland. The cost to remove, screen, and dispose of menstrual management products from pit latrine sludge is high and not accounted for.

The article describes some of the key challenges related to water, sanitation and health.

The report highlights that overall benefits from investing in water and sanitation are likely to be large, but that there are wide variations depending on the type of investments made along the water and sanitation services “value chain” and the local conditions.

This is a comprehensive report on why toilets matter. The report is rich in infographics, provides overview of the sanitation crisis and the related burden of disease in developing countries.

This book focuses on the health factors related to pathogenic organisms. The attempt is to assess and review evidences in relation to health impact and to discuss the findings based on epidemiological evidence, risk assessment and behavioural aspects and practices.

This factsheet shows the links between improved sanitation and health in a short overview.

This document sets out WaterAid’s framework for hygiene promotion and behaviour change in the countries where it works. It will also help organisations that work on hygiene in the context of water, sanitation and hygiene (WASH) programmes.

Content in this issue: A Tool For Measuring The Effectiveness Of Handwashing p. 3-7; Five Best Practices Of Hygiene Promotion Interventions In the WASH Sector p. 8-9; Washing Your Hands With Soap: Why Is It Important? p. 10-11; Appropriate Sanitation Infrastructure At Schools Improves Access To Education p. 12-13; Management Of Menstruation For Girls Of School Going Age: Lessons Learnt From Pilot Work In Kwekwe p. 14 -15; WIN-SA Breaks The Silence On Menstrual Hygiene Management p. 16; Joining Hands To Help Keep Girls In Schools p. 17; The Girl-Child And Menstrual Management :The Stories Of Young Zimbabwean Girls. p. 18-19; Toilet Rehabilitation At Nciphizeni JSS And Mtyu JSS Schools p. 20 - 23; Celebratiing 100% sanitation p. 24 - 26.

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports (e.g. from 2004, 2006 and 2008).

This toolkit, intended for practitioners interested in behavior change, is organized into four modules: Behaviour Change, Sustainability, Integration and Results. Each has reports and presentations about the lessons learned from previous projects, as well as mass media, direct consumer contact, and interpersonal communication tools used throughout previous projects.

The benefits of hygiene promotion are generally not prioritised and the costs of hygiene promotion are poorly understood and therefore not adequately budgeted into programming. In this study WASHCost examined hygiene promotion and associated costs in Ghana, Mozambique, and Burkina Faso, looking at interventions that targeted latrine use and faecal containment, hand washing with soap, and the protection of drinking water.

This study estimates the changes in open defecation prevalence between 2005 and 2010 across countries in Sub-Saharan Africa. It also explores the association between national level indices and changes in open defecation prevalence and assesses how many countries can achieve “open defecation free status” by 2015.

This article reviews the evidence linking water, sanitation and health measures to faecal-oral diseases in children. Estimates of the burden of water-, sanitation- and health-related disease are presented, followed by brief overviews of water, sanitation and hygiene-related transmission routes and control measures. It concludes with a summary of current international targets and progress.

In Bangladesh, 20 million people are at the risk of developing arsenicosis because of excessive arsenic intake. Despite increased awareness, many of the implemented arsenic-safe water options are not being sufficiently used by the population. This study investigated the role of social-cognitive factors in explaining the habitual use of arsenic-safe water options.

Water, sanitation and hygiene interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. The objective of this paper is to evaluate the effect of interventions to improve water quality and supply, provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps.

Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. This paper provides the first documentation of a quantitatively important gradient between child height and sanitation that can statistically explain a large fraction of international height differences.

Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in developing countries. While many of the infectious agents associated with diarrhoeal disease are potentially waterborne, the evidence for reducing diarrhoea in settings where it is endemic by improving the microbiological quality of drinking water has been equivocal. The aim of the present study is to assess the effectiveness of interventions to improve water quality for preventing diarrhoea.

In many countries, knowledge about the potential for harm from health-care wastes has now become more prominent to governments, medical practitioners and civil society. The indiscriminate and erratic handling and disposal of waste within health-care facilities is now widely recognized as a source of avoidable infection, and is synonymous with public perception of poor standards of health care. Water pollution and inadequate wastewater treatment pose important risks to health.

Currently, little or no management of healthcare wastes occurs in small-scale facilities in developing countries. Training and infrastructure are minimal. Common practice in urban areas is to dispose of healthcare waste along with the general solid waste or, in peri-urban and rural areas, to bury waste, without treatment. In some cities small hospitals may incinerate waste in dedicated on-site incinerators, but often fail to operate them properly. Unwanted pharmaceuticals and chemicals may be dumped into the local sanitation outlet, be it a sewage system, septic tank or latrine. The contamination of water sources represents serious health risks.

Health-care facilities play a vital role within the community by providing essential medical care at all times including during emergencies. Any incident which causes loss of infrastructure, energy supply, loss of equipment, loss of staff or staff attrition, interruption to supply chains, or patient surge - such as sudden communicable disease epidemics, natural disasters (e.g. floods, earthquakes), or conflict - requires a holistic health response and recovery effort which includes actions to assess and restore basic WASH services.

Sludge Treatment and Disposal is the sixth volume in the series Biological Wastewater Treatment. The book covers in a clear and informative way the sludge characteristics, production, treatment (thickening, dewatering, stabilisation, pathogens removal) and disposal (land application for agricultural purposes, sanitary landfills, landfarming and other methods). Environmental and public health issues are also fully described.

Biological Wastewater Treatment in Warm Climate Regions gives a state-of-the-art presentation of the science and technology of biological wastewater treatment, particularly domestic sewage. The book covers the main treatment processes used worldwide with wastewater treatment in warm climate regions given a particular emphasis where simple, affordable and sustainable solutions are required. The 55 chapters are divided into 7 parts over two volumes: Volume One (also available in the SSWM library): Introduction to wastewater characteristics, treatment and disposal; Basic principles of wastewater treatment; Stabilisation ponds; Anaerobic reactors; Volume Two: Activated sludge; Aerobic biofilm reactors; Sludge treatment and disposal.

This Guide is an abbreviated compilation of the wide range of scientific, engineering, health and operational issues concerned with the control of lead in drinking water in small water supply systems. It explains why lead in drinking water may still be a threat to public health in small communities. It is aimed at Local Health Officials and the operators of drinking water supply systems that serve small communities. Its objectives are to raise awareness, to provide a basis for assessing the extent of problems, and to identify control options.

This study was conducted to measure the impact of a hygiene intervention on the contamination of weaning food in Bangladesh.

This desk review clearly indicates that the international community recognizes that drug administration alone is insufficient to break the cycle of disease transmission. Although past programs have largely left out a WASH component, the current renewed interest in securing WASH to any global Neglected Tropical Diseases (NTD) control or elimination strategy and adding WASH interventions to NTD treatment programs is essential to achieving sustained control and elimination.

There is sufficient evidence that water, sanitation, and hygiene (WASH) may impact maternal and newborn health (MNH) to warrant greater attention from all stakeholders involved in improving MNH and achieving universal WASH access. This article disusses current challenges and monitoring strategies aimed at maximizing healthy lives and increasing access to quality health care'

Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. This report proposes the concept of baby WASH as an additional component of early childhood development programs.

This study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development.

Child stunting and anemia are intractable public health problems in developing countries and have profound short- and long-term consequences. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH).

The resulting WASH intervention comprises material inputs and behavior change communication to promote stool disposal, handwashing with soap, water treatment, protected exploratory play, and hygienic infant feeding. Nurture and disgust were found to be key motivators, and are used as emotional triggers. The concept of a safe play space for young children was particularly novel, and families were eager to implement this after learning about the risks of unprotected exploratory play.