Robert Dreibelbis

• Ph.D
• Professor (Assistant) at London School of Hygiene and Tropical Medicine

Diarrhoeal diseases are a leading cause of mortality in children under 5 in low- and middle-income countries. Within domestic settings, transmission of diarrhoeal pathogens occur through a variety of pathways, including via caregivers’ hands. While handwashing with soap (HWWS) effectively disrupts hand-mediated pathogen spread, barriers such as lim...

Despite significant progress in the provision of water, sanitation, and hygiene (WASH) services, 2.3 billion people still lack access to essential services, and many existing services fail to remain functional, reliable, and safe over time. Strengthening WASH systems is critical to ensure long-term service reliability, equity, and resilience. Howev...

Background: Foodborne diseases are an important cause of morbidity and mortality globally. Most diarrhoeal diseases can be caused by foodborne enteric infections, especially in children. The aim of this review is to synthesise the evidence for the effectiveness of domestic food hygiene interventions on the microbiological quality of child food and...

In benefit-cost analyses of rural sanitation programmes, time savings from stopping open defecation (OD) often comprise 25%-50% of monetised benefits. However, no studies have elicited values directly, and typically assume 50% of the unskilled wage. In this study we estimated the value of travel time for OD, by undertaking a willingness to accept (...

Whilst improving hygiene and sanitation behaviours is key to cost-effective and sustainable water, sanitation and hygiene interventions, measuring behaviour change remains a challenge. This study assessed the validity and reliability of pictorial 24-h recall (P24 hR), a novel method using unprompted recall of past activities through pictures, compa...

Community-Led Total Sanitation (CLTS) seeks to eliminate open defecation by empowering households to adopt improved sanitation and hygiene behaviours through latrine use. Widely integrated into national sanitation strategies in low- and middle-income countries, CLTS is implemented through pre-triggering, triggering, and post-triggering activities....

Background: Climate-related disasters, such as extreme rainfall and flooding, pose a significant threat to progress towards Sustainable Development Goals (SDG) for water, sanitation, and hygiene (WASH). The Water, Sanitation, and Hygiene for Everyone (W4E) programme aims to reach universal WASH coverage in Chiradzulu District by end of 2024. Tradit...

Background Rural communities in low- and middle-income countries, such as The Gambia, often experience water insecurity periodically due to climate drivers such as heavy rainfall and reduced rainfall, as well as non-climate drivers such as infrastructural issues and seasonal workloads. When facing these challenges households use a variety of coping...

BACKGROUND Community-based behaviour change interventions are a common approach to Water, Sanitation, and Hygiene (WASH). Yet, published evaluations of how these interventions work in district-wide approaches are rare. OBJECTIVE The aim of this study is to assess the effectiveness of a district-level Community-led Total Sanitation (CLTS) intervent...

Community-based behaviour change interventions are a common approach to Water, Sanitation, and Hygiene (WASH). Yet, published evaluations of how these interventions work in district-wide approaches are rare. This study reports the baseline characteristics and study design for a trial assessing the effectiveness of a district-level Community-led Tot...

School-age children in low-and middle-income countries (LMICs) face health and educational challenges due to inadequate water, sanitation and hygiene (WASH) in schools (WinS). Evidence for the impact of WinS interventions is limited and inconsistent, and previous systematic reviews have faced challenges in synthesising data due to varied interventi...

Introduction Handwashing facilities (HWFs) are associated with higher rates of handwashing with soap, and the presence of a HWF is the global proxy indicator of household handwashing behaviour. There is limited information on attributes of HWFs important to end-users with few comparative assessments of HWFs from a user-perspective. We aimed to iden...

Background: Patient guardians perform hygiene-related roles during postnatal care but are often overlooked in hygiene Interventions. This study examined perceived facilitators and barriers to handwashing behaviour among Malawian new mothers and their guardians in healthcare facilities and households. Methods: This cross-sectional study was conducte...

Background School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. Methods The WISE cluster-randomised trial, conducted...

Community-led total sanitation (CLTS) is embraced as a key strategy to achieve universal sanitation coverage (Sustainable Development Goal 6.2). Although inclusion is identified as a predictor of CLTS success, people living with disabilities are often excluded from community sanitation programmes and there is limited research exploring CLTS partici...

Objectives This multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The goal of this analysis is to inform future outbreak preparedness and pandemic respons...

Whilst improving hygiene and sanitation behaviours is key to cost-effective and sustainable WASH interventions, measuring behaviour change remains a challenge. This study assessed the validity and reliability of pictorial 24-hour recall (P24hR), a novel method using unprompted recall of past activities through pictures, compared to structured obser...

Improving the water, sanitation, and hygiene (WASH) services in low-resources setting is a challenge. The Department of Education (DepEd) of the Philippines, supported by GIZ and UNICEF, runs the national WASH in schools program which promotes a stepwise approach to reach national WinS Standards and foster the institutionalization of WASH in the ed...

Guardian Waiting Shelters (GWSs) are an essential component of the Malawi’s health care system as they serve as a temporary home for patient guardians while taking care of their relatives admitted to the hospital, and expectant mothers. Although GWSs play a crucial role in Malawi’s healthcare system, past studies have primarily concentrated on mate...

Climate change could pose a threat to water security for many communities, particularly in settings where rainfall patterns are becoming more varied and there is higher frequency of extreme events, such as heavy rainfall and droughts. Understanding how rainfall affects water security—including water access, water quality and water use behaviours—ca...

One in six people worldwide experiences significant disability. Many of these people living in low-and middle-income countries (LMICs) are disproportionately affected by inadequate access to water, sanitation and hygiene (WASH) services, a fundamental necessity for health and well-being. This review aimed to examine the existing evidence on disabil...

Observational evidence suggests that household floors may be an important domain for the transmission of enteric and parasitic infections. However, little work has been done to investigate how household floors can become contaminated with human and animal faeces. This study uses a mixed methods approach to postulate the proximal and distal determin...

Background Water, sanitation and hygiene (WASH) interventions in schools may improve the health and school attendance of schoolchildren, particularly among post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban WASH in schools programme (Project WISE) on child health and attendance. Methods The WISE cluster-random...

Water, sanitation and hygiene (WASH) interventions should provide access to safe water and sanitation, and promote good hygiene practices with dignity, comfort and security. Multiple systematic reviews have noted evidence gaps and is a paucity of good quality evidence related to the effectiveness and implementation of WASH programmes and interventi...

Introduction Environmental hygiene and food safety are important determinants of child stunting. This research aims to explore the relationship between child stunting and household hygiene practices and behaviours, including the availability of water, sanitation and hygiene (WASH) facilities; the use of safe food and good quality drinking water (es...

Community-led total sanitation (CLTS) is embraced as a key strategy to achieve universal sanitation coverage (Sustainable Development Goal 6.2). Although inclusion is identified as a predictor of CLTS success, people living with disabilities are often excluded from community sanitation programmes and there is limited research exploring CLTS partici...

Background 1.5 billion people globally lack access to a basic toilet. Progress on sanitation is primarily measured by types of toilets used. Quality of life (QoL) outcomes are valued by users but rarely rigorously measured. The Sanitation-related Quality of Life (SanQoL-5) index uses five simple questions to measure people’s experiences of sanitati...

Pre-existing health and economic challenges mean residents of low- and middle-income countries (LMICs) are likely to be particularly vulnerable to infectious disease pandemics. Limited access to hygiene facilities, water, soap and masks, and dense living environments impeded effective practice of preventive behaviours – handwashing with soap (HWWS)...

Background Guardian Waiting Shelters (GWSs) are an essential component of the Malawi’s health care system as they serve as a temporary home for patient guardians while taking care of their relatives admitted to the hospital. Despite GWSs valuable role in healthcare settings, there have been few studies on the specific experiences, infrastructure, a...

Background Hand hygiene is an important measure to prevent disease transmission. Objective To summarise current international guideline recommendations for hand hygiene in community settings and to assess to what extent they are consistent and evidence based. Eligibility criteria We included international guidelines with one or more recommendatio...

Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality globally, with 83% of ARI mortality occurring in low-income and middle-income countries (LMICs) before the COVID-19 pandemic. We aimed to estimate the effect of interventions promoting handwashing with soap on ARI in LMICs. Methods: In our systematic revi...

Background: Increasing handwashing with soap (HWWS) among older children (aged 5-14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influence...

Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in...

Objectives Diarrhoea is a leading cause of infant mortality with the main transmission pathways being unsafe water and contaminated food, surfaces and hands. The ‘Safe Start’ trial evaluated a food hygiene intervention implemented in a peri-urban settlement of Kisumu, Kenya, with the aim of reducing diarrhoeagenic enteric infections among infants....

Objectives The aim of this study was to test whether household environmental hygiene and behavioural conditions moderated associations between diarrhoea and enteric pathogen detection in infants 5 months of age in Kenya and pathogen sources, including latrine access, domestic animal co-habitation and public food sources. Design Cross-sectional stu...

Background: Hand hygiene is an important measure to prevent disease transmission in community settings, such as households, public spaces, workplaces, and schools. There exist various international guidelines with recommendations on how to improve hand hygiene in these settings, but no review to date has been conducted to summarise these recommenda...

Background Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions—all of which may also be rapidly evolving. Methods We conducted in-...

Background School-based de-worming is advocated as a strategy for reducing the burden of soil-transmitted helminth (STH) infections among children. However, re-infection tends to occur rapidly, suggesting that comprehensive water, sanitation, and hygiene (WASH) improvements may be needed to prevent this. We qualitatively assessed the influence of p...

Background Handwashing with soap has the potential to curb cholera transmission. This research explores how populations experienced and responded to the 2017 cholera outbreak in the Democratic Republic of the Congo and how this affected their handwashing behaviour. Methods Cholera cases were identified through local cholera treatment centre record...

This research aimed to qualitatively explore whether the determinants of handwashing behaviour change according to the duration of displacement or the type of setting that people are displaced to. We conducted an exploratory qualitative study in three different post-conflict settings in Northern Iraq–a long-term displacement camp, a short-term disp...

Background Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions – all of which may also be rapidly evolving. Methods We conducted i...

Two billion people globally lack access to a basic toilet. While improving sanitation reduces infectious disease, toilet users often identify privacy, safety and dignity as more important. However, these outcomes have not been incorporated in sanitation‐related economic evaluations. This illustrates the general challenge of outcome measurement and...

The prevalence of enteric pathogen detection in children in low-income countries climbs rapidly between birth and 6 months of age. Few studies have tested whether improved household environmental and behavioral hygiene conditions protects infants from exposure to enteric pathogens spread via unhygienic human and animal sanitation conditions, especi...

Background Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of car...

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...

Background Although theory-driven evaluations should have empirical components, few evaluations of public health interventions quantitatively test the causal model made explicit in the theory of change (ToC). In the context of a shared sanitation trial (MapSan) in Maputo, Mozambique, we report findings of a quantitative process evaluation assessing...

Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of...

Background Soil-transmitted helminth (STH) infections are highly prevalent in resource-limited countries. We assessed the effect of a combination intervention aiming to enhance handwashing with soap on STH reinfection following mass drug administration among primary school children in Kagera region, Northwestern Tanzania. Methods We conducted a cl...

Background Promoting good hand hygiene in older children is an important measure to reduce the burden of common diseases such as diarrhoea and acute respiratory infections. The evidence around what works to change this behaviour, however, is unclear. Objectives To aid future intervention design and effective use of resources, this review aims to i...

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both facilities and home environments. Current improvement interventions focus on only one environment and target limited caregivers, primarily birth attendants and mothers. To...

Background: Globally, infections are the third leading cause of neonatal mortality. Predominant risk factors for facility-born newborns are poor hygiene practices that span both the facility and home environments. Current improvement interventions focus on only one environment and tar-get limited caregivers, primarily birth attendants and mothers....

Background Although theory-driven evaluations should have empirical components, few evaluations of public health interventions quantitatively test the causal model made explicit in the theory of change (ToC). In the context of a shared sanitation trial (MapSan) in Maputo, Mozambique, we report findings of a quantitative process evaluation assessing...

Background Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of...

Preventing infectious disease has often been the primary rationale for public investment in sanitation. However, broader aspects of sanitation such as privacy and safety are important to users across settings, and have been linked to mental wellbeing. The aim of this study is to investigate what people most value about sanitation in low-income area...

Introduction Soil transmitted helminths (STH) can affect over 50% of children in some parts of Tanzania. Control measures involve annual deworming campaigns in schools, but re-infection is rapid. This paper presents the design and baseline survey results of an ongoing school-based cluster-randomised controlled trial in Kagera region, NW Tanzania. T...

Objectives: To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children. Methods: In this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or...

Background: Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the w...

While large-scale changes in population behaviour are required to reduce the transmission of the severe acute respiratory syndrome coronavirus 2 virus, the emergency context is not conducive to the sort of careful communications planning that would normally be required to meet such a task. Rapid strategic communications planning in a pandemic by go...

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle-and high-income countries. This paper reviews the role of water, sanitation and hygie...

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygi...

Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wid...

Background: Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wi...

Background Hygiene promotion interventions are likely to be more effective if they target the determinants of handwashing behaviour. Synthesis of the evidence on the determinants of handwashing behaviour is needed to enable practitioners to use evidence in hygiene promotion programming. Purpose To identify, define and categorise the determinants o...

Background: Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare...

Whilst large-scale changes in population behaviour are required to reduce the transmission of the SARS-COV-2 pandemic virus, the emergency context is not conducive to the sort of careful communications planning that would normally be required to meet such a task. Rapid strategic communications planning in a pandemic by governments is, however, poss...

In low‐ and middle‐income countries, food may be a critical transmission route for pathogens causing childhood diarrhoea, but basic food hygiene is often overlooked in public health strategies. Characterising child food contamination and its risk factors could help prioritise interventions to reduce foodborne diarrhoeal disease, especially in low‐i...

Food contamination during weaning and complementary feeding can result in high diarrheal incidence among infants. Caregiver practices are important determinants of exposure to foodborne pathogens, and can therefore play a role in reduction in infant food contamination. Through a qualitative approach, we used the Trials of Improved Practices methodo...

Safe fecal sludge management (FSM)-the hygienic emptying, transport, and treatment for reuse or disposal of fecal sludge-is an essential part of safely managed sanitation, especially in towns and cities in low-and middle-income countries with limited sewer coverage. The need for safe and affordable FSM services has become more acute as cities grow...

Background Children in humanitarian situations are particularly vulnerable to diseases such as diarrhoea. Handwashing with soap can greatly reduce transmission but handwashing rates are often low and traditional interventions ineffective. To aid future intervention design, this study aims to understand the determinants of child handwashing and the...

Background: Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infect...

Background: Access to usable water, sanitation and hygiene provision in schools is included within indicators in the Sustainable Development Goals. Progress towards these indicators is dependent on developing an understanding of which intervention components are most effective to operate and maintain usable services. This study aimed to determine...

Background Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infectio...

Complementary food hygiene is important to reduce infant exposures to enteric pathogens; however, interventions to improve food hygiene in low- and middle-income countries often ignore the larger context in which childcare occurs. In this study, we explore on observational and qualitative information regarding childcare in an informal community in...

Objective To qualitatively assess the effects of a multi-modal school-based water, sanitation and hygiene (WASH) intervention on handwashing behaviour among primary students in North Western (NW) Tanzania. Design The study was a qualitative assessment of barriers and facilitators to handwashing among students attending primary schools participatin...

Sanitary surveys are used in low- and middle-income countries to assess water, sanitation, and hygiene conditions, but have rarely been compared with direct measures of environmental fecal contamination. We conducted a cross-sectional assessment of sanitary conditions and E. coli counts in soils and on surfaces of compounds (household clusters) in...

Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare wo...

Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare wo...

Background Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infectio...

Background: Infections account for 15% of neonatal deaths and one-tenth of maternal mortality globally. Evidence-based practices to prevent and control infection are essential to reduce newborn and maternal mortality. Aim: To identify the barriers and opportunities experienced by staff when implementing infection prevention and control (IPC) gui...