SuSanA - Forum Kunena Site Syndication Tue, 21 Feb 2017 03:02:33 +0000 Kunena 1.6 SuSanA - Forum en-gb Re: Benefits of water quality, sanitation, handwashing and nutritional interventions for health and child development (Kenya, Bangladesh) - by: jbr
"The trials are currently conducting their final round of outcome measurement. We anticipate primary results in late 2016 (Bangladesh) and mid 2017 (Kenya)."

Are there any results to share for the Bangladesh study?

Very best
John Brogan
Terre des hommes]]>
Health issues and connections with sanitation Fri, 03 Feb 2017 20:57:22 +0000
Re: studies from WASH benefits project - by: jcolford
The following articles related to WASH Benefits were published in 2016. Please check here: for an up-to-date list of all publications related to the study.


Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya. Williams AM, Chantry CJ, Young SL, Achando BS, Allen LH, Arnold BF, Colford JM Jr, Dentz HN, Hampel D, Kiprotich MC, Lin A, Null CA,Nyambane GM, Shahab-Ferdows S, Stewart CP. J Nutr. 2016 May;146(5):1125-31.

Hand- and Object-Mouthing of Rural Bangladeshi Children 3-18 Months Old. Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Luby SP. Int J Environ Res Public Health. 2016 Jun 4;13(6). #1 (NCBI) #2 (MDPI)

Soil-Transmitted Helminth Eggs Are Present in Soil at Multiple Locations within Households in Rural Kenya. Lauren Steinbaum, Sammy M. Njenga, Jimmy Kihara, Alexandria B. Boehm, Jennifer Davis, Clair Null, Amy J. Pickering. PLOS. Published: June 24, 2016.

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions. Fosiul A. Nizame, Elli Leontsini, Stephen P. Luby, Md. Nuruzzaman, Shahana Parveen, Peter J. Winch, Pavani K. Ram, Leanne Unicomb. Published online June 13, 2016, doi: 10.4269/ajtmh.15-0377. Am J Trop Med Hyg 2016 vol. 95 no. 2 288-297.

Towards a Scalable and Sustainable Intervention for Complementary Food Safety. Rahman MJ, Nizame FA, Nuruzzaman M, Akand F, Islam MA, Parvez SM, Stewart CP, Unicomb L, Luby SP, Winch PJ. - Food and Nutrition Bulletin. 2016 Jun;37(2):186-201.

Occurrence of Host-Associated Fecal Markers on Child Hands, Household Soil, and Drinking Water in Rural Bangladeshi Households. Alexandria B. Boehm, Dan Wang, Ayse Ercumen, Meghan Shea, Angela R. Harris, Orin C. Shanks, Catherine Kelty, Alvee Ahmed, Zahid Hayat Mahmud, Benjamin F. Arnold, Claire Chase, Craig Kullmann, John M. ColfordJr., Stephen P. Luby, and Amy J. Pickering. Publication Date (Web): October 13, 2016. Environ. Sci. Technol. Lett. DOI: 10.1021/acs.estlett.6b00382.

Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting. Marlene K. Wolfe, Holly N. Dentz, Beryl Achando, MaryAnne Mureithi, Tim Wolfe, Clair Null, Amy J. Pickering. Am J Trop Med Hyg 2016 16-0162.

Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. Sania Ashraf, Fosiul A. Nizame, Mahfuza Islam, Notan C. Dutta, Dahlia Yeasmin, Sadika Akhter, Jaynal Abedin, Peter J. Winch, Pavani K. Ram, Leanne Unicomb, Elli Leontsini, Stephen P. Luby. Am J Trop Med Hyg 2016 16-0304.


Jade Benjamin-Chung, PhD
Colford Research Group
Division of Epidemiology
University of California, Berkeley]]>
Health issues and connections with sanitation Thu, 02 Feb 2017 19:33:56 +0000
Re: Squatting vs. Sitting - by: F H Mughal
F H Mughal]]>
Health issues and connections with sanitation Sat, 07 Jan 2017 04:52:11 +0000
Re: Squatting vs. Sitting - by: muench Then again, perhaps women who are used to squatting for using the toilet (or for "sitting" around and waiting, like I have observed vendors to do in Thailand for example), are less impacted even during the later stages of pregnancy. Perhaps you could ask around amongst women that you know in Pakistan where squatting is the norm for toilet use? Could be interesting.

I have read that also the elderly may find it harder, and that grab bars attached to the wall would make a bit difference (also for people with disabilities).
See also posts by Carol and Kris here:]]>
Health issues and connections with sanitation Sat, 07 Jan 2017 00:07:16 +0000
Re: Squatting vs. Sitting - by: F H Mughal
Would the pregnant women still can squat, if she is a bit over-weight?


F H Mughal]]>
Health issues and connections with sanitation Wed, 04 Jan 2017 05:44:13 +0000
Re: squat for money - The Squatty Potty - "healthy colon - healthy life" (product from the US) - by: muench defecation postures ( brought me back to this forum thread. That's because one of the other Wikipedians posted some interesting information on the article's talk page here:

He posted a link to this promotional video for the squatty potty:

Accompanying article:

"Squatty Potty's CEO Ignored Everyone, Made an Insane Video and Boosted Sales 600% Bold marketing helps bring in $15 million"

My fellow Wikipedian also asked:
I can't help but wonder whether it makes a difference whether you squat with a toilet seat supporting your body, as seen in the Squatty Potty video above, or whether you support your weight with your legs/feet, as is done in Japan. --Guy Macon (talk) 17:44, 7 December 2016 (UTC)

He also provided some references for health benefits from squatting although I think none of them stacks up as being good enough for Wikipedia's really high level of references for medical/health content which is explained here
- and which disqualifies primary research and individual small study results.

I guess it is an under-researched topic so not easy to come by the very high quality large studies that would be required to be sure of the possible health benefits from squatting versus sitting ("sure" in the sense of Wikipedia articles' citations, not "sure" in the sense of your own personal experiences).

This is just another example of how Wikipedia work can help us in learning and identifying knowledge gaps and connecting with other interested people.

Health issues and connections with sanitation Tue, 03 Jan 2017 14:31:31 +0000
PLoS journals launch important WASH collection - by: campbelldb Sanitation Updates.

The 2016 studies include:

Interpreting the Global Enteric Multicenter Study (GEMS) Findings on Sanitation, Hygiene, and Diarrhea
Jonny Crocker, Jamie Bartram
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

WASH Research
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

School Water, Sanitation, and Hygiene, Soil-Transmitted Helminths, and Schistosomes: National Mapping in Ethiopia
PLOS Neglected Tropical Diseases : 08 Mar 2016

Have You Heard of Schistosomiasis? Knowledge, Attitudes and Practices in Nampula Province, Mozambique
PLOS Neglected Tropical Diseases : 04 Mar 2016

Risk of Intestinal Parasitic Infections in People with Different Exposures to Wastewater and Fecal Sludge in Kampala, Uganda: A Cross-S…
PLOS Neglected Tropical Diseases : 03 Mar 2016

The Ecological Dynamics of Fecal Contamination and Salmonella Typhi and Salmonella Paratyphi A in Municipal Kathma…
PLOS Neglected Tropical Diseases : 06 Jan 2016

* Added by moderator: What is PLos?
According to Wikipedia:
PLOS (for Public Library of Science) is a nonprofit open access scientific publishing project aimed at creating a library of open access journals and other scientific literature under an open content license.
See for more information.
Health issues and connections with sanitation Mon, 21 Nov 2016 18:07:49 +0000
The Ebola Crisis and Innovative WASH Solutions: Webinar recap - by: BijanFHI360
Sustaining long-term water, sanitation, and hygiene (WASH) practices are essential for strong public health systems which are influential in preventing the resurgence of diseases such as Ebola and preventing future outbreaks. For this reason, the Global Public-Private Partnership for Handwashing hosted a webinar in collaboration with Global Communities, UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC) exploring how innovative WASH and social behavior change (SBC) solutions were critical in halting the West Africa Ebola crisis and how their programs are supporting the recovery process and promoting ongoing community health and wellbeing.

Global Communities Program Development Manager, Alice Urban, and WASH Specialist, Franky Li assessed the impact of community-led total sanitation (CLTS) interventions on helping contain and prevent the spread of Ebola in Liberia. They also described how CLTS engagement in other health-related activities has raised government awareness about the need for more targeted support to the community-level health system and demonstrates a low-cost, sustainable option. CLTS can be more than just a tool for sanitation promotion. Community momentum should be leveraged to promote other community health and development objectives.

Learn more about the CLTS methodology used in Liberia here and a report on the community-led response here.

Gaelle Fohr, a sanitation and hygiene consultant who worked as a specialist between 2014 and 2016 for UNICEF’s West and Central Africa program (WCARO), delivered a presentation on the impact of hygiene kits that were distributed in schools when they reopened in early 2015. Together with handwashing promotion, these kits helped form new norms and improved knowledge of handwashing with soap. Ultimately, hygiene kits became part of the safe school protocol. UNICEF continues to incorporate lessons learned from the Ebola response into their approach towards other infectious disease outbreaks. Programs, such as this, can lead to a stronger evidence base when projects have efficient knowledge management guidelines that work in conjunction with the monitoring and reporting processes.

Read how UNICEF launched global response to the Ebola outbreak in West Africa here and WCARO’s efforts here.

CDC’s Infection Prevention & Control program (IPC) was described by Dr. Nora Chea, Medical Epidemiologist. Dr. Chea demonstrated how improved WASH interventions in healthcare settings drove the success of IPC in Sierra Leone and how key results might be replicated in response to future outbreaks. IPC interventions—which include providing clean water, improving environmental cleaning and environmental waste management practices, and proper disinfection of medical equipment—can have a greater impact when technical guidance and evidence-based knowledge are provided at the regional and global levels and information management systems are supported. Integration is a current hot topic in development, and it is applicable in this context, too. Clearly defining cross-sectoral monitoring between sectors and response clusters can reduce gaps or duplicity between IPC and WASH programs. Dr. Chea concluded his presentation by emphasizing that IPC programs within healthcare structures must integrate improved WASH practices at all levels. WASH is critical in healthcare settings—both for IPC and for promoting public health.

Information about CDC’s ongoing IPC work may be found here. CDC has also produced Ebola outbreak communication resources, available here.

Learn more about key takeaways from these programs by accessing the webinar recording and downloading the presentation slides here. If you’d like to learn more about how handwashing with soap can help prevent Ebola virus transmission, read our one-page summary here.]]>
Health issues and connections with sanitation Wed, 05 Oct 2016 14:57:45 +0000
Webinar Announcement: “The Ebola Crisis and Innovative WASH Solutions” (recording available) - by: BijanFHI360 September 28 at 10:00 am EDT.

In 2015, Sierra Leone, Liberia, and Guinea began to enter periods of Ebola-free recovery. We know that innovative water, sanitation, and hygiene (WASH) interventions, specifically handwashing behavior change programs, played a critical role in halting the crisis and promoting ongoing community health. Now, we must ask ourselves “What’s next?” How can we ensure that the lessons learned from this crisis are incorporated into how the WASH sector promotes sustained behavior change? Can the response to the Ebola crisis frame how the world responds other to infectious disease outbreaks?

Experts from the U.S. Centers for Disease Control and Prevention and Global Communities will share key takeaways on the impact of infection prevention and control programs, community-led total sanitation approaches, and WASH interventions in schools.

Join the Global Public-Private Partnership for Handwashing for this interactive webinar on to discuss these questions and more.

Confirmed Speakers
U.S. Centers for Disease Control and Prevention
Global Communities

Please register here

Health issues and connections with sanitation Wed, 21 Sep 2016 15:25:49 +0000
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment - by: neilpw
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment


Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. These indicators should be measured routinely in order to inform improvements.

Citation: Gon G, Restrepo-M?ndez MC, Campbell OMR, Barros AJD, Woodd S, Benova L, et al. (2016) Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment. PLoS ONE 11(: e0160572. doi:10.1371/journal.pone.0160572

Full text here:]]>
Health issues and connections with sanitation Tue, 30 Aug 2016 18:18:36 +0000
Re: Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: bowenarrow Ross]]> Health issues and connections with sanitation Sun, 26 Jun 2016 00:33:36 +0000 Re: Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: JKMakowka
For example a tube-well can hardly be considered "improved" if Giardia is still found (this is a large protozoa that should be very effectively filtered by the soil, indicating that the tube-well did not have a functioning sanitary seal at the top to prevent surface water intrusion).

The latrine findings are also not that surprising if one looks at the overall coverage, with was only 10% vs 38%, meaning high levels of open-defecation even after the intervention and thus obviously no impact could be found (the summary is a bit misleading in that regard).
However later they mention that there is also evidence of an increase in contamination of ground water due to the pour-flush pit-latrines used, which again is a well known fact that these lead to higher groundwater contamination if installed in areas with high ground-water tables.

So while this study is certainly very interesting, the conclusions made are somewhat misleading as there seems to have been neither really improved tube-wells nor an appropriate sanitation technology used in the area.]]>
Health issues and connections with sanitation Wed, 22 Jun 2016 04:15:11 +0000
Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage - by: campbelldb Sanitation Updates

Human fecal and pathogen exposure pathways in rural Indian villages and the effect of increased latrine coverage. Water Research, Volume 100, 1 September 2016, Pages 232–244.

Authors: Mitsunori Odagiri, Alexander Schriewer, et al.


- Application of Bacteroidales MST to evaluate improved sanitation impacts
- Widespread human and animal fecal contamination detected in homes.
- Pathogens detected in drinking sources associated with subsequent child diarrhea.
- Public ponds used domestically were heavily contaminated with multiple pathogens.
- No decrease in human fecal or pathogen contamination from increased latrine coverage.

In conclusion, the study demonstrates that

(1) improved sanitation alone may be insufficient and further interventions needed in the domestic domain to reduce widespread human and animal fecal contamination observed in homes,
(2) pathogens detected in tubewells indicate these sources are microbiologically unsafe for drinking and were associated with child diarrhea,
(3) domestic use of ponds heavily contaminated with multiple pathogens presents an under-recognized health risk, and
(4) a 27 percentage point increase in improved sanitation access at village-level did not reduce detectable human fecal and pathogen contamination in this setting.]]>
Health issues and connections with sanitation Tue, 21 Jun 2016 15:46:09 +0000
Re: SaniPath - Assessment of Fecal Exposure Pathways in Low-Income Urban Settings (Emory University, USA) - and appeal to SuSanA members for input - by: karobb
Thanks so much for your message and apologies on the delay in getting back to you!
Thanks for bringing up the important point regarding wastewater irrigation and health. One of the key findings from the in-depth SaniPath study in Accra was that the dominant pathway of exposure to fecal contamination for young children was through the food supply. This has important implications for the WASH sector – that typically ignores food safety. As you point out, urban agriculture is a key contributor to the food supply in many cities, and wastewater irrigation is a common practice. Our study demonstrates that this pathway for exposure combines high frequency of exposure and high “doses” of fecal contamination – making it a high-risk pathway that should be a priority for intervention. We’ve recently submitted a manuscript by Wang et al. detailing this finding to the American Journal of Tropical Medicine and Hygiene and we can send you a copy once it’s published. We also conducted a sub-study lead by a PhD student at the London School of Hygiene and Tropical Medicine, Prince Antwi-Agyei. The results of that work can be found in a journal article entitled “A Farm to Fork Risk Assessment for the Use of Wastewater in Agriculture in Accra, Ghana” (

Regarding your question about applying SaniPath in rural or peri-urban areas, we’ve put some thought into this in the past but don’t currently have plans to develop a version of the tool for rural areas. However, we do have plans to apply the tool in peri-urban areas and smaller towns where sanitation investments are planned through a partnership with EAWAG.

We've also recently circulated a policy brief on public toilets based the SaniPath study in Accra, Ghana ( that may be of interest.

We really value you taking the time to contact us and for sharing your insights! Please do keep in touch!


Katharine Robb, MPH
Associate Director, Research Projects
The Center for Global Safe WASH
Emory University
This e-mail address is being protected from spambots. You need JavaScript enabled to view it ]]>
Health issues and connections with sanitation Tue, 07 Jun 2016 17:37:18 +0000
Re: Link between poor sanitation and higher risk of Adverse Pregnancy Outcome - by: jbr
"While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs."

We feel that this study gives a fresh perspective on the link between WASH and Health. Tdh uses WASH to support maternal newborn and child health (MNCH) programming, focusing on girls and women of reproductive age. Although we try to influence delayed pregnancy, among the most significant factors in terms of readiness for motherhood are nutritional status, psycho-social well-being, level of education and status within the family. Since we monitor hundreds of girls and women in our protection/health programmes, this puts a new research angle on our radar.

For example, it would be interesting to explore the relationship between age, open defecation and adverse pregnancy outcome.]]>
Health issues and connections with sanitation Wed, 11 May 2016 19:11:16 +0000