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Publications (71)
Safe drinking water access is a human right, but data on safely managed drinking water services (SMDWS) is lacking for more than half of the global population. We estimate SMDWS use in 135 low- and middle-income countries (LMICs) at subnational levels with a geospatial modeling approach, combining existing household survey data with available globa...
Monitoring access to safely managed drinking water services requires information on water quality. An increasing number of countries have integrated water quality testing in household surveys however it is not anticipated that such tests will be included in all future surveys. Using water testing data from the 2016 Ethiopia Socio-Economic Survey (E...
Background:
Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH s...
Background:
Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-inc...
Background
An alarming number of public health-care facilities in low-income and middle-income countries lack basic water, sanitation, hygiene (WASH), and waste management services. This study estimates the costs of achieving full coverage of basic WASH and waste services in existing public health facilities in the 46 UN designated least-developed...
Introduction
Domestic hand hygiene could prevent over 500 000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility (HWF) with soap and water available at home. We estimated the economic costs of universal access to basic hand hygiene services in household settings in 46 LDCs.
Metho...
Background:
The 2030 Sustainable Development Goals (SDGs) set an ambitious new benchmark for safely managed drinking water services (SMDWs), but many countries lack national data on the availability and quality of drinking water.
Objectives:
We quantified the availability and microbiological quality of drinking water, monitored SMDWs, and examin...
Introduction: Domestic hand hygiene could prevent over 500,000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility with soap and water available at home. We estimated the economic costs of universal access to basic hand hygiene services in household settings in 46 LDCs.
Methods: Ou...
To monitor safely managed drinking water services, an increasing number of countries have integrated water quality testing for Escherichia coli into nationally-representative household surveys such as the Multiple Indicator Cluster Surveys (MICS). However, plastic waste generated during such water quality testing programs, mostly through the use of...
Background. The Sustainable Development Goals set an ambitious new benchmark for safely managed drinking water services (SMDW), but many countries lack data on the availability and quality of drinking water.
Objectives. To quantify the availability and microbiological quality of drinking water, monitor SMDW and examine risk factors for E. coli cont...
Safely managed drinking water services (SMDWS) is the service ladder used for the Sustainable Development Goal (SDG) monitoring of drinking water and expands on the Millennium Development Goal metric (“improved water source”) with three additional criteria, namely: availability when needed, accessibility on premises, and safety (free from faecal an...
Background:
Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bol...
BACKGROUND:To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and mid...
Background:
To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and m...
The assessment of a novel enzyme-based assay showed it to be reliable to detect and quantify E. coli in water.
This is a blog post about the article "Handwashing with soap after potential faecal contact: Global, regional and country estimates" (https://ije-blog.com/2018/12/17/hygiene-gaps-between-access-and-practice-and-from-region-to-region/)
Background
Limited data have been available on the global practice of handwashing with soap (HWWS). To better appreciate global HWWS frequency, which plays a role in disease transmission, our objectives were to: (i) quantify the presence of designated handwashing facilities; (ii) assess the association between handwashing facility presence and obse...
Background: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages.
Objectives: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia.
Methods: Data about...
The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), through the Joint Monitoring Programme (JMP), are responsible for global monitoring of the Sustainable Development Goal (SDG) targets for drinking water, sanitation and hygiene (WASH). The SDGs represent a fundamental shift in household WASH monitoring with a new focus...
Objectives:
The impact on diarrhoea of sanitation interventions has been heterogeneous. We hypothesize that this is due to the level of prevailing faecal environmental contamination and propose a Faecal Contamination Index (FAECI) of selected WASH indicators (objective 1). Additionally, we provide estimates of the proportion of the population livi...
Despite the reported achievement of the Millennium Development Goals (MDGs) with respect to drinking water, lack of access to water remains widespread worldwide. The indicator used there to measure access to water in the MDGs refers to the use of an improved water source. However, the amount of time spent in collecting water is high in countries wh...
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 1...
Background
The Sustainable Development Goals (SDGs) require household survey programmes such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) to enhance data collection to cover new indicators. This study aims to evaluated methods for assessing water quality, water availability, emptying of sanitation facilities, menstrual hygiene...
Water quality data.
(XLSX)
Household and WASH data.
(XLSX)
Behaviour coding data.
(XLSX)
Individual women data.
(XLSX)
Target 6.2 of the Sustainable Development Goals calls for universal access to sanitation by 2030. The associated indicator is the population using ‘safely managed’ sanitation services. Shared sanitation is classified as a ‘limited’ sanitation service and some donors and governments are reluctant to invest in it, as it will not count towards achievi...
Understanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly select...
There remain few nationally representative studies of drinking water quality at the point of consumption in developing countries. This study aimed to examine factors associated with E. coli contamination in Ghana. It drew on a nationally representative household survey, the 2012−2013 Living Standards Survey 6, which incorporated a novel water quali...
We used a prospective, longitudinal cohort enrolled as part of a program evaluation to assess the relationship between drinking water microbiological quality and child diarrhea. We included 50 villages across rural Bangladesh. Within each village field-workers enrolled a systematic random sample of 10 households with a child under the age of 3 year...
Background
Access to safe drinking water has been on the global agenda for decades. The key to safe drinking water is found in household water treatment and safe storage systems.
Objective
In this study, we assessed rural and urban household demand for a new gravity-driven membrane (GDM) drinking-water filter.
Methods
A choice experiment (CE)...
We assessed health risks related to Arsenic (As) in contaminated drinking water in Hanam, applying the Australian Environmental Health Risk Assessment Framework, which promotes stakeholder involvement in risk assessments. As concentrations in 300 tube-well water samples, before and after filtration, were analyzed and the water consumption levels in...
Objective
To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings.Methods
The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on i...
Deaths attributable to inadequate water, sanitation, and hygiene by low- and middle-income countriesa for the year 2012.
Table S2. Deaths attributable to the combined inadequate water and sanitation, and to the combined inadequate water, sanitation and hygiene by low- and middle-income countrya, for the year 2012.
Objective
To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases.Methods
For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exp...
As part of a trans-disciplinary research project, a series of surveys and interventions were conducted in different arsenic-affected regions of rural Bangladesh. Surveys of institutional stakeholders identified deep tubewells and piped water systems as the most preferred options, and the same preferences were found in household surveys of populatio...
Elevated concentrations of naturally-occurring fluoride in groundwater pose a serious health risk to millions of people living in the Ethiopian Rift Valley. In the absence of low-fluoride water resources of sufficient capacity, fluoride removal from drinking water is the accepted mitigation option. To date, five different community-level fluoride-r...
Limited impact of a large scale sanitation and hygiene promotion effort in rural Bangladesh
Amal K Halder1, Stephen P Luby1,2, Jade Benjamin-Chung3,Md. Monirul Alam4, Probir K Ghosh1, Tarique Md. Nurul Huda5, Richard B Johnston6, Leanne Unicomb1
1: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
2:Stan...
Dhaka depends heavily on groundwater for urban water supply. Due to diminished recharge and over abstraction groundwater level has been declining alarmingly over the last two decades. Groundwater elevation contour maps depict a number of cones of depressions at heavy abstraction areas where regional groundwater flows are converging from all sides....
Asia has experienced the highest rates of flood related disasters in the world. Outbreaks of diarrhoea during flood emergencies have been a continued challenge for most of the developing countries. The paper presents studies of the use of point-of-use (POU) methods for ensuring the microbiological safety of drinking water during flood/cyclone emerg...
Arsenic contamination of drinking water is a serious public health threat. In Bangladesh, eight major safe water options provide an alternative to contaminated shallow tubewells: piped water supply, deep tubewells, pond sand filters, community arsenic-removal, household arsenic removal, dug wells, well-sharing, and rainwater harvesting. However, it...
Bone char is a low cost, yet efficient fluoride removal filter material, and regenerating fluoride saturated bone char can increase its lifespan and make it more affordable. This study conducted field tests and laboratory experiments to test how bone char can be effectively and affordably regenerated.
OBJECTIVES: To use a psychological theory of behavioural change to measure and interpret the effectiveness of different promotional strategies for achieving long-term usage of a household water treatment and safe storage (HWTS) system in peri-urban Zimbabwe. STUDY DESIGN: Solar disinfection (SODIS) was introduced into five peri-urban communities ne...
A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 µg/L and the World Health Organization's guideline value of 10 µg/L, respe...
Started in 2007, the Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA-B) project aims to improve the hygiene, sanitation and water supply for 20 million people in Bangladesh, and thus reduce disease among this population. This paper assesses the effectiveness of SHEWA-B on changing behaviors and reducing diarrhea and respiratory i...
Started in 2007, the Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA-B) project aims to improve the hygiene, sanitation and water supply for 20 million people in Bangladesh, and thus reduce disease among this population. This paper assesses the effectiveness of SHEWA-B on changing behaviors and reducing diarrhea and respiratory i...
We assessed which practical handwashing indicators were independently associated with reduced child diarrhea or respiratory disease. Fieldworkers collected 33 indicators of handwashing at baseline in 498 households in 50 villages in rural Bangladesh. Community monitors visited households monthly and asked standard questions about diarrhea and sympt...
Safe drinking water and basic sanitation are key elements of the Millennium Development Goals, a United Nations initiative.
The microbial quality of drinking water is inherently linked to sanitation practices because fecal pathogens are the most
common source of drinking water contamination in developing countries. Filtration of water through soil...
Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyz...
We analyzed data from the baseline assessment of a large intervention project to describe typical handwashing practices in rural Bangladesh, and compare measures of hand cleanliness with household characteristics.
We randomly selected 100 villages from 36 districts in rural Bangladesh. Field workers identified 17 eligible households per village usi...
Nearly an eighth of the population in Bangladesh relies on
arsenic-contaminated drinking water. Arsenic-removal filters could help
to reduce exposure, but their price is high for the poor and their
maintenance is cumbersome.
Handwashing with soap prevents diarrhea and respiratory disease, but it is rarely practiced in high-need settings. Among 100 randomly selected villages in rural Bangladesh, field workers enrolled 10 households per village and observed and recorded household activities for 5 hours. Field workers observed 761 handwashing opportunities among household...
Background: We analyzed data from the baseline assessment of a large intervention project to describe typical handwashing practices in rural Bangladesh, and compare measures of hand cleanliness with household characteristics.
To evaluate the effectiveness of the chulli water purifier, a new household water treatment strategy in Bangladesh that relies on passing water through a stove, we interviewed persons who had this water purifier. From households using it regularly, we tested untreated water, sand-filtered water without heat pasteurization, sand-filtered and heat pa...
To measure enteric bacterial contamination of tubewells in three flood prone areas in Bangladesh and the relationship of bacteriological contamination with tubewell sanitary inspection scores.
Microbiologists selected 207 tubewells in three flood prone districts, assessed physical characteristics of the tubewells and collected a single water sample...
To evaluate the usefulness of the hydrogen sulfide (H(2)S) test for assessing water quality in Bangladesh.
We tested 382 water samples from a variety of sources using locally produced H(2)S test kits and laboratory-based membrane filtration for the detection of Escherichia coli. Compared with membrane filtration, H(2)S tests, when incubated for 24...
Since 2000, nearly 5 million wells in Bangladesh have been tested for arsenic. Results of this survey are presented, and it is estimated that approximately 20% of tube wells nationwide contain arsenic above the drinking water limit of 50 parts per billion, with approximately 20 million people at risk of consuming water above this limit. Three case...
We have examined two redox reactions involving arsenic and iron at near-neutral pH: the reduction of As(V) by Fe(II) under anoxic conditions, and the co-oxidation of As(III) during Fe(II) oxygenation. We also considered the impact of goethite, pH buffers, and radical scavengers on these reactions. In a series of anoxic experiments, Fe(II) was found...
Arsenic in drinking water represents a major public health concern globally, with tens of millions of people thought to be consuming unsafe amounts of As daily. Groundwater is particularly vulnerable to As contamination, and one geochemical environment conducive to natural mobilization of As is found in shallow alluvial Holocene aquifers. Bacterial...
A simple flow-through system has been developed which makes use of wasted heat generated in traditional clay ovens (chullis) to pasteurize surface water. A hollow aluminium coil is built into the clay chulli, and water is passed through the coil during normal cooking events. By adjusting the flow rate, effluent temperature can be maintained at appr...
To evaluate the water quality of recently flooded tube wells in Bangladesh and the effect of spot chlorination on improving bacteriological quality.
The study team identified and tested water samples from 127 tube wells that were flooded within the preceding 4 weeks. Twenty-six of the tube wells with the highest concentration of thermotolerant coli...
Arsenic contamination of drinking water has been reported from many parts of world. In some arsenic affected areas, substitution of drinking water source by a safe and easily available one may not be possible during part or all of the year, or may be very expensive. Arsenic removal may be a more appropriate water supply option in these situations....
Previous chapters have documented the serious health effects that are posed by ingestion of arsenic through drinking water. While some palliative treatment of arsenicosis patients is possible, it is clear that the first step in treating patients, and preventing others from falling sick, is to identify safe sources of water for drinking and cooking...