Sandy Cairncross

• Doctor of Philosophy
• Professor of Environmental Health at London School of Hygiene and Tropical Medicine

Background In low- and middle-income countries (L&MICs), the biggest contributing factors to the global burden of disease in childhood are deaths due to respiratory illness and diarrhoea, both of which are closely related to use of water, sanitation, and hygiene (WASH) services by households. However, current estimates of the health impacts of WASH...

Background In low- and middle-income countries (L&MICs), the biggest contributing factors to the global burden of disease in childhood are deaths due to respiratory illness and diarrhoea, both of which are closely related to use of water, sanitation and hygiene (WASH) services. However, current estimates of the health impacts of WASH improvements u...

Background Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We descri...

Sub-Sahara African countries face immense challenges in ensuring adequate sanitation and hygiene behaviours to the rapidly growing populations. Attempts to address these challenges require empirical evidence to inform policy and planning. We contribute toward that goal by unveiling findings of formative research conducted in Babati, a rapidly growi...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

Background Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This artic...

Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vuln...

Respiratory tract infections and diarrhoea are the two biggest killers of children in low income contexts. They are closely related to access to, and use of improved water, sanitation and hygiene (WASH). However, there is no high quality systematic review that quantifies the effect of WASH improvements on childhood mortality. Existing systematic re...

Background The Gambia has high rates of under-5 mortality from diarrhoea and pneumonia, peaking during complementary-feeding age. Community-based interventions may reduce complementary-food contamination and disease rates. Methods and findings A public health intervention using critical control points and motivational drivers, delivered February–A...

In this paper we reflect on the contribution, style and legacy of Professor Val Curtis, an important, and sometimes controversial, figure in the water, sanitation and hygiene (WASH) sector who sadly passed away on October 19, 2020. Across numerous scientific articles, and several books, and operational programmes, she established herself as a world...

Formative research findings from the fast-growing Babati town were used to assess the prevalence of sanitation and hygiene practices among individuals and institutions and associated factors. A cross-sectional study involving household surveys, spot-checks, focus group discussions, in-depth interviews, and structured observations of behaviors showe...

Background Trachoma elimination efforts are hampered by limited understanding of Chlamydia trachomatis (Ct) transmission routes. Here we aimed to detect Ct DNA at non-ocular sites and on eye-seeking flies. Methods A population-based household survey was conducted in Oromia Region, Ethiopia. Ocular and non-ocular (faces, hands, clothing, water cont...

Eye-to-eye transmission of Chlamydia trachomatis, the causative agent of trachoma, may be plausibly interrupted if faces are kept free of ocular and nasal discharge. Between April and June 2018, 83 children aged 1-9 years with active trachoma were recruited from 62 households and allocated to a face cleaning protocol: face washing with water, face...

Background: A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting. M...

Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place—one in Zimbabwe implemented by an NGO and the other in Rwanda as part of a Randomized Control Trial. Both interventions achieved high levels of community response, although the Zimbabwe project was more cost-effe...

Abstract The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Programme consortium is a programme funded by the United Kingdom Department for International Development (DFID) that aims to contribute to achieving universal access to effective, sustainable, and equitable sanitation and hygiene worldwide. The capacity development co...

Sustainable Development Goal (SDG) 6.2 sets an ambitious target of leaving no-one without adequate and equitable sanitation by 2030. The key concern is the lack of local human and financial capital to fund the collection of reliable information to monitor progress towards the goal. As a result, national and local records may be telling a different...

Diarrheal disease in under-five children remains high in Sub-Saharan Africa; primarily attributed to environmental pathogen exposure through poorly managed water, sanitation, and hygiene (WASH) pathways, including foods. This formative study in rural Malawi used a theoretical base to determine the personal, social, environmental, and psychosocial f...

Sustainable Development Goal (SDG) 6.2 sets an ambitious target of leaving no one without adequate sanitation by 2030. The key concern is the lack of local human and financial capital to fund the collection of reliable information to monitor progress towards the goal. As a result, national and local records may be telling a different story of the p...

Sustainable Development Goal six sets an ambitious target of leaving no one without adequate sanitation by 2030. The key concern is the lack of local human and financial capital to fund to collect reliable information to monitor progress towards the goal. As a result, national and local records may be telling a different story of the proportion of...

The article Understanding Living Conditions and Deprivation in Informal Settlements of Kisumu, Kenya, written by Sheillah Simiyu, Sandy Cairncross and Mark Swilling, was originally published electronically on the publisher’s internet portal (currently SpringerLink)

Informal settlements are a common occurrence in developing countries. Each settlement, however, has unique living conditions which require improvement efforts that are specifically tailored to the settlement. This study, carried out in Kisumu’s informal settlements, had two aims: to describe living conditions and to propose areas of improvement wit...

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to appr...

Objective Contamination of weaning food leads to diarrhoea in children under 5 years. Public health interventions to improve practices in low-income and middle-income countries are rare and often not evaluated using a randomised method. We describe an intervention implementation and provide baseline data for such a trial. Design Clustered randomis...

Sand-storage dams have proven to be a successful water harvesting method and potential solution to water and food security issues in semi-arid regions such as south east Kenya. This paper examines the microbiological quality of water both contained in the sand dam via test holes and abstracted from it through covered wells and scoop holes. In total...

The health benefits of point-of-use (POU) water treatment can only be realized through high adherence: correct, consistent, and sustained use. We conducted parallel randomized, longitudinal crossover trials measuring short-term adherence to two single-use flocculant-disinfectant sachets in Pakistan and Zambia. In both trials, adherence declined sha...

The hepatitis B virus (HBV) is a liver inflammation due to a viral infection, distributed in virtually every country in the world. Waste collectors are especially vulnerable to this infection because of the high frequency of needlestick accidents. This study aims to verify the immunization status against HBV of waste collectors, including domestic...

A review of the so-called "non-health" benefits of urban sanitation shows them to be important indicators of human wellbeing, and more important to the householder than those which benefit health in the narrower sense of preventing disease. The health benefits are surprisingly difficult to measure, but recent advances suggest that they are greater...

This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The...

As more urban solid waste is generated, managing it becomes ever more challenging and the potential impacts on the environment and human health also become greater. Handling waste – including collection, treatment and final disposal – entails risks of work accidents. This article assesses the perception of waste management workers regarding work-re...

Faecal contamination of groundwater from pit latrines is widely perceived as a major threat to the safety of drinking water for several billion people in rural and peri-urban areas worldwide. On the floodplains of the Ganges-Brahmaputra-Meghna delta in Bangladesh, we constructed latrines and monitored piezometer nests monthly for two years. We dete...

Unlike most quantitative studies that investigate decision-making on investing in sanitation, this study adopted a qualitative approach to investigate decision-making on shared sanitation in the informal settlements of Kisumu city, in Kenya. Using a grounded theory approach, landlords and tenants were interviewed to identify sanitation decisions, i...

Faecal contamination of groundwater from pit latrines is widely perceived as a major threat to the safety of drinking water for several billion people in rural and peri-urban areas worldwide. On the floodplains of the Ganges-Brahmaputra-Meghna delta in Bangladesh, we constructed latrines and monitored piezometer nests monthly for two years. We dete...

Guinea worm disease, dracunculiasis or dracontiasis, is an ancient disease with records going back over 4500 years, but until the beginning of the 20th century, little was known about its life cycle, particularly how humans became infected. In 1905, Robert Thomas Leiper was sent by the British colonial authorities to West Africa to investigate the...

In this study, we report on the results of a trial of an intervention to improve five food hygiene behaviors among mothers of young children in rural Nepal. This novel intervention targeted five behaviors; cleanliness of serving utensils, handwashing with soap before feeding, proper storage of cooked food, and thorough reheating and water treatment...

Background: Shared facilities are not recognised as improved sanitation due to challenges of maintenance as they easily can be avenues for the spread of diseases. Thus there is need to evaluate the quality of shared facilities, especially in informal settlements, where they are commonly used. A shared facility can be equated to a common good whose...

Lack of sanitation facilities is a common occurrence in informal settlements that are common in most developing countries. One challenge with sanitation provision in these settlements is the cost and financing of sanitation. This study aimed at estimating the cost of sanitation, and investigating the social and economic dynamics within Kisumu's inf...

Background Groundwater drawn from shallow tubewells in Bangladesh is often polluted by nearby pit latrines, which are commonly used toilets in rural and sub-urban areas of the country. Methods To determine the minimum safe distance of a tubewell from a pit latrine in different hydrogeological conditions of Bangladesh, 20 monitoring wells were insta...

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV...

Objectives: There are significant gaps in information about the inputs required to effectively extend and sustain hygiene promotion activities to improve people's health outcomes through water, sanitation and hygiene (WASH) interventions. We sought to analyse current country and global trends in the use of key inputs required for effective and sus...

Stunting is a complex and enduring challenge with far-reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygie...

The need to minimise consumer risk, especially for food that can be consumed uncooked, is a continuing public health concern, particularly in places where safe sanitation and hygienic practices are absent. The use of wastewater in agriculture has been associated with disease risks, though its relative significance in disease transmission remains un...

The Brazilian Ministry of Health proposed a research study involving municipal professional staff conducting both epidemiological and water quality surveillance to facilitate the integration of the data which they collected. It aimed to improve the intersectoral collaboration and health promotion activities in the municipalities, especially regardi...

In Cambodia, children's feces are rarely disposed of in an improved sanitation facility. This study examines current practices and the role that enabling products may play in increasing hygienic management of infant and young children's (IYC) feces in households with access to improved sanitation. A survey was conducted with the primary caregiver o...

Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context o...

Background: The eastern provinces of the Democratic Republic of the Congo have been identified as endemic areas for cholera transmission, and despite continuous control efforts, they continue to experience regular cholera outbreaks that occasionally spread to the rest of the country. In a region where access to improved water sources is particular...

Background: Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwate...

Background and methods: Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigat...

In Bangladesh, cholera is endemic and maintains a regular seasonal pattern. The role of phytoplankton in maintaining endemicity and seasonality of cholera was monitored in Matlab, Bangladesh. Phytoplankton and water samples were collected from two ponds bi-weekly for 1 year. The association of Vibrio cholerae O1 with phytoplankton was studied by cu...

Menstrual hygiene management (MHM) practices vary worldwide and depend on the indi-vidual's socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygi...

Access to safe sanitation in low-income, informal settlements of Sub-Saharan Africa has not significantly improved since 1990. The combination of a high faecal-related disease burden and inadequate infrastructure suggests that investment in expanding sanitation access in densely populated urban slums can yield important public health gains. No rigo...

The performance and acceptability of the Nerox TM membrane drinking water filter was evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6 month period, 230 households were visited and filter performance and use was assessed. O...

Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, att...

Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in A...

Yael Velleman and colleagues argue for stronger integration between the water, sanitation, and hygiene (WASH) and maternal and newborn health sectors. Please see later in the article for the Editors' Summary

Progress in rural access to sanitation is far behind agreed targets, especially in Sub-Saharan Africa. As a result, new policies are being defined which shift the role of public investment from infrastructure to sanitation promotion, and give the responsibility of service delivery to local government. This paper analyses the role that local governm...

The institutional arrangements for management of water supply and sanitation in Brazil result from the sector’s long history. Initially, British capital was involved, but by the early twentieth century most of the infrastructure was in public hands. Public health engineering was originally closely allied with public health, but gradually municipal...

This article addresses the tension between subsidies and the sustainability of rural water supply systems based on research carried out in Minas Gerais, Brazil, on the Brazilian rainwater harvesting Programme for One Million Rural Cisterns (P1MC). The fieldwork included a survey of 623 beneficiary households and 47 in-depth interviews, as well as a...

The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease an...

Background: In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program "One Million Cisterns" (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption o...

The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) report is one of the three periodic UN reports dealing with water supply, sanitation and hygiene. This paper analyses the data on hygiene promotion which were collected for the 2012 edition, but not included in the report. Despite the limitations of the information...

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...

This study assessed sanitation access in rapidly expanding informal settlements in Dar es Salaam (Dar) against eight proposed indicators of hygienic safety, sustainability and functionality, and in relation to the Millennium Development Goal (MDG) ‘improved’ sanitation definition. Information was collected on toilet facility designs, management and...

The 2001 and 2011 Census of India returns are used to document the proportion of households with access to a latrine on their premises, in the different regions, states and districts of India. While some states have already achieved coverage of 90% or more, in others the proportion served is as low as 22%. There are also wide disparities between ur...

Moringa oleifera is a plant found in many tropical and subtropical countries. Many different uses and properties have been attributed to this plant, mainly as a nutritional supplement and as a water purifier. Its antibacterial activity against different pathogens has been described in different in vitro settings. However the potential effect of thi...

In this modern age of genomics, it is easy to forget that Mother Nature keeps many surprises for us up her sleeve; hubris is only human, after all. A paper in this issue, describing “The peculiar epidemiology of dracunculiasis in Chad,” 1 provides an example. For more than 20 years now, a dedicated battalion of public health workers has been engage...

In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program "One Million Cisterns" (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water...

Background: Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research...

Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and app...

Tout d'abord, nous sommes en désaccord avec le traitement de la recherche opérationnelle différemment de la recherche “académique” et comme nécessitant des normes et une apologie distinctes. Nous pensons que le débat serait plus clair si, au lieu des termes recherche «académique» et «opérationnelle», on parle plutôt de recherche dans des «tours d'i...

In 2007, readers of the British Medical Journal voted that the introduction of clean water and sewerage- the 'sanitation revolution' of the Victorian era-was the most important medical milestone since the 1840s, over anaesthesia, antibiotics, or vaccines. These improvements led to a dramatic reduction in morbidity and mortality associated with faec...

This book, inclusive of 11 chapters, discusses various non-pesticide-based control strategies against several medically-important disease vector species, including those relevant to the control of malaria, dengue, schistosomiasis, and lymphatic filariasis. Each chapter is dedicated to the discussion of a specific strategy, which includes biological...

L'accès à l'eau potable et fiable et à l'assainissement, Objectif 7 du Millénaire pour le Développement, cible 7c, est essentiel pour la santé et le bien-être et est reconnu comme un droit humain. L'hygiène offre de nombreux avantages pour la santé, liés à l'eau et à l'assainissement et pourtant elle est encore absente des Objectifs du Millénaire p...

Principles of Medicine in Africa combines classical clinical medicine with a rich understanding of the major environmental and cultural influences on health and disease, providing comprehensive guidance for anyone intending to practise medicine in Africa. Disease is presented in the context of family and culture, and the effects of inequality and p...

There is major untapped potential to improve health in low-income communities through improved housing design, fittings, materials and construction. Adverse effects on health from inadequate housing can occur through a range of mechanisms, both direct and indirect, including as a result of extreme weather, household air pollution, injuries or burns...

Objective: This study was conducted to measure the impact of a hygiene intervention on the contamination of weaning food in Bangladesh. Methods: Sixty households were selected: 30 study and 30 control households. Samples of weaning food were collected from all the 60 households at baseline and examined for faecal coliforms (FC), faecal streptoco...

This work presents the stages of an action research applied to assess and improve the practices of the Environmental Monitoring Program related to water quality for human consumption (Vigiagua) in three municipalities of Minas Gerais, Brazil. It aimed to detail the processes triggered during each phase of the action research, exploring methodologic...

The monitoring and evaluation of Vigiagua – Brazil's drinking-water quality surveillance programme (Vigiagua) – are a potentially important source of programme improvements. Published documentation on Vigiagua refers mainly to its quantitative aspects and achievements, but we present here the results of a qualitative evaluation of the programme's f...

A case-control study, aimed at identifying factors associated with rotavirus diarrhoea cases presenting to health facilities, was conducted in children from low-income and middle-low-income families in Brazil. Cases were 390 children with diarrhoea and rotavirus in stools; controls were 1674 children without diarrhoea presenting to the same facilit...

Community health workers (CHWs) are an important element of many health systems and programmes for the promotion and delivery of a wide range of health interventions and disease surveillance. Understanding the motivation and retention of CHWs is recognized as essential but there are few data from sub-Saharan Africa. This qualitative study explored...

The long time needed for global eradication of dracunculiasis (Guinea worm disease) was not anticipated at the outset. The successful eradication of smallpox in 10 years compares with the target date set in 1985 for dracunculiasis eradication - 1995. Seventeen years after that date, transmission continues. Why? Various factors are responsible, main...