Tracy Dawn Morse

• BSc (Hons), PhD
• Professor (Full) at University of Strathclyde

Introduction: While hygiene promotion is frequently included in sanitation programmes, few studies directly evaluate the effect of these interventions on hygiene outcomes. We assessed the effectiveness of a district-level Community-led Total Sanitation (CLTS) intervention with and without locally managed Care Groups (CG) on observed sanitation and...

This study aimed to explore the factors influencing food hygiene behaviours among child caregivers in Chikwawa district, Malawi. This research focused on three specific hygiene behaviours: keeping utensils on an elevated surface, using soap to clean kitchen utensils, and washing hands with soap at critical times. These practises are known to contri...

African communities have a high prevalence of antimicrobial-resistant bacterial carriage, alongside high levels of antibiotic usage and environmental pollution. Limited access to water, sanitation and hygiene infrastructure and wastewater treatment facilities enables the dissemination of resistant bacteria, antimicrobials and antibiotic resistance-...

There is wide recognition of the threats posed by the open dumping of waste in the environment. However, tools to surveil interventions for reducing this practice are poorly developed. This study explores the use of drone imagery for environmental surveillance. Drone images of waste piles were captured in a densely populated residential neighborhoo...

Inadequate waste management and poor sanitation practices in Low- and Middle-Income Countries (LMICs) leads to waste accumulation in urban and peri-urban residential areas. This increases human exposure to hazardous waste, including plastics, which can harbour pathogenic bacteria. Although lab-based studies demonstrate how plastic pollution can inc...

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...

This study aimed to explore factors that influence food hygiene behaviours among child caregivers in Chikwawa district, Malawi. It was done so by exploring factors relating to three hygiene behaviours among child caregivers: keeping utensils on an elevated surface, using soap to clean kitchen utensils, and washing hands with soap at critical times....

Antimicrobial-resistant (AMR) bacteria are prevalent in household and environmental settings in low-income locations. However, there are limited data on individuals’ understanding of AMR bacteria exposure risks in these settings. A cross-sectional study was conducted to identify individual risk perception of AMR bacteria and its associated behavior...

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...

Background Community-based behavior 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 This study reports the baseline characteristics and study design for a trial assessing the effectiveness of a district-le...

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...

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...

Recent data re-affirm antimicrobial resistance (AMR) as a One Health problem, particularly in low- and middle-income countries. Transdisciplinary and intersectoral collaboration are required if we are to improve environmental hygiene, addressing both AMR and a range of aligned development challenges.

The One Health paradigm considers the interdependence of human, animal and environmental health. In high-income countries, limited evidence has been found from recent studies to support the importance of a One Health approach to addressing spread of antimicrobial resistance (AMR). Given AMR is a global threat, and we are all interconnected it would...

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...

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...

Antimicrobial resistance (AMR) poses a severe global health threat, yet the transmission pathways of AMR within communal public environments, where humans and animals interact, remain poorly explored. This study investigated AMR risk pathways, prevalence, and seasonality of extended-spectrum β-lactamase (ESBL) producing E. coli and K. pneumoniae, a...

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 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...

There is wide recognition of the threats posed by open dumping of waste in the environment, however, tools to surveil interventions for reducing this practice are poorly developed. This study explores the use of drone imagery for environment surveillance. Drone images of waste piles were captured in a densely populated residential neighborhood in M...

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to...

Background: Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We ai...

Background: Neonatal sepsis causes morbidity and mortality in sub-Saharan Africa. Antimicrobial resistance exacerbates outcomes. Poor Infection Prevention and Control practices (IPC) by healthcare workers and caregivers drive infection transmission. The Chatinkha Neonatal Unit in Malawi has experienced Klebsiella pneumoniae outbreaks of neonatal se...

Disposable diapers are becoming increasingly popular and present an emerging challenge for global waste management, particularly within LMICs. They offer a cheap and convenient way for caregivers to manage child excreta; however, insufficient understanding of safe disposal methods, combined with limited access to waste management services results i...

Background: Sub-Saharan Africa has the highest estimated death rate attributable to antimicrobial resistance (AMR), especially due to Extended-Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-E). However, the dynamics of human colonisation in the community with ESBL-E are not well described. Inadequate water, sanitation and hygiene (WASH)...

Background: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers of...

Citywide Inclusive Sanitation (CWIS) calls for sustainable urban sanitation services for all, but the definitions of “inclusion” and “sustainability” within the framework leave room for interpretation. This study aims to provide an initial understanding of how these terms are currently interpreted by a range of sanitation actors in six cities of th...

Healthcare associated infections (HAIs) are a burden in many countries especially low-income countries due to poor hand hygiene practices in the healthcare settings. Proper hand hygiene in the healthcare setting is an effective way of preventing and reducing HAIs, and is an integral component of infection prevention and control. The objective of th...

Mental disorders have the potential to affect an individual’s capacity to perform household daily activities such as water, sanitation, and hygiene (food hygiene inclusive) that require effort, time, and strong internal motivation. However, there is limited detailed assessment about the influence of mental health on food hygiene behaviors at househ...

Background Low- and middle-income countries (LMICs) have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. LMICs have varying infrastructure and services in the community to separate people from human and animal waste, creating risks for ESBL-Enterobacterales (ESBL-E) transmissio...

Background Antimicrobial resistance (AMR) represents an important threat to achieving the sustainable development goals in Sub-Saharan Africa (sSA). sSA is reported to have the highest estimated death rate attributable to AMR, with Extended-Spectrum Beta-Lactamase-producing Enterobacterales, such as Klebsiella pneumoniae and Escherichia coli , repr...

Objective Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and...

Process evaluations of environmental health interventions are often under-reported and under-utilized in the development of future programs. The “Hygienic Family” intervention targeted improvements in hygiene behaviors of caregivers with under five-year-old children in rural Malawi. Delivered through a combination of open days, cluster meetings, ho...

Background: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers of...

Diarrhoeal disease remains a leading cause of death in children in sub-Saharan Africa, attributed to environmental health factors such as inadequate water, sanitation and hygiene (WASH) and food hygiene. This formative study in low-income areas of Blantyre focussed on the practices in Early Childhood Development Centre (ECDCs) environments where ch...

Two billion people worldwide consume unsafe drinking water. The problem is particularly pronounced in Sub-Saharan Africa, where more than a quarter of the population relies on unimproved surface water sources. Based on the principles of solar water disinfection (SODIS), a new household water treatment technology, the SODIS bucket, was developed to...

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to...

Climate change is a global health emergency, with impacts felt most acutely by vulnerable populations and communities. This paper explores health risks from climate change in a global context, setting out key risks and actions towards addressing these. In the context of COP27, it draws in a focus on Egypt as a case study throughout to exemplify the...

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of...

Introduction: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers...

A NOVEL ESBL COLILERT SYSTEM FOR ENVIRONMENTAL SURVEILLANCE OF AMR BACTERIA AT MARKETS IN LMICS

Community Exposure Assessment to Anti-microbial Resistance (AMR); case study of Malawi

Research findings and recommendations

We made static and personal PM2.5 measurements with a miniature monitor (RTI MicroPEM) to characterize the exposure of women cooking with wood and charcoal in indoor and outdoor locations in rural Malawi, together with measurements of blood pressure and peak expiratory flow rate (PEFR). Mean PM2.5 concentrations of 1338 and 31 µg/m3 were observed 1...

Social benefits of water, sanitation and hygiene (WASH) interventions are less documented compared to health benefits such as the reduction of diarrheal diseases. Although most decisions in WASH investments are based on potential health outcomes, interventions may also lead to social benefits, such as income generation, increased school enrollment,...

Video of presentation available: https://youtu.be/_0jk3fzuhxI Sanitation projects regularly fail. Sometimes this means that programmes do not achieve their stated aims; other times these failures are setbacks that can be rectified with sufficient reflection and action. In the worst cases, the purported ‘beneficiaries’ of these projects are harmed...

Background A key challenge for menstruating girls and women in low-resource countries is the inadequate and unreliable supply of menstrual products. Although development partners are implementing menstrual product interventions to address this challenge in Malawi, there is a paucity of information on the distribution of menstrual products and the a...

Background A key challenge for menstruating girls and women in low-resource countries is the inadequate and unreliable supply of menstrual products. Although development partners are implementing menstrual product interventions to address this challenge in Malawi, there is a paucity of information on the distribution of menstrual products and the a...

People living in fishing communities have a high burden of preventable water, sanitation, and hygiene (WASH) related diseases but have often been neglected in research and policy. We explored practices and perspectives on WASH among fishing villages around Lake Malombe, Malawi. We employed a mixed methods design, and data were initially collected t...

The multidisciplinary nature of environmental health practitioners (EHP) allows them to understand where different sectors can intersect to maximise severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related interventions. EHPs have the necessary skills to support the transdisciplinary approach required to halt the further spread of SARS...

Few studies have attempted to measure the differences between self-reported and observed food hygiene practices in a household setting. We conducted a study to measure the level of agreement between self-reported and observed food hygiene practices among child caregivers with children under the age of five years in rural Malawi. Fifty-eight child c...

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene...

The study evaluated the effectiveness of an intervention to improve complementary food hygiene behaviors among child caregivers in rural Malawi. Formative research and intervention development was grounded in the risk, attitude, norms, ability, and self-regulation (RANAS) model and targeted washing hands and kitchen utensils with soap, safe utensil...

Despite the increasing volume of evidence demonstrating the efficacy of solar water disinfection (SODIS) as a household water treatment technology, there still appear to be significant barriers to uptake in developing countries. The potential of SODIS is often treated with scepticism in terms of effective treatment, volume, and safety, and is dismi...

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...

Solar water disinfection (SODIS) is an appropriate technology for treating drinking water in developing communities, as it is effective, low-or zero-cost, easy to use. The WHO recognises SODIS as an appropriate intervention to provide drinking water after manmade or natural disasters. Nevertheless, uptake is low due partially to the burden of using...

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...

Diarrhoeal disease remains one of the leading causes of morbidity and mortality in the under-five population, particularly in low income settings such as sub-Saharan Africa. Despite significant progress in sanitation and water access, faecal-oral infections persist in these populations. Therefore, a better understanding of these transmission pathwa...

Background: Solar water disinfection (SODIS) is an appropriate technology for household treatment of drinking water in low-to-middle-income communities, as it is effective, low cost and easy to use. Nevertheless, uptake is low due partially to the burden of using small volume polyethylene terephthalate bottles (1.5–2 L). A major challenge is to dev...

Background: Typhoid fever remains a major cause of morbidity and mortality in low and middle-income settings. In the last 10 years, several reports have described the re-emergence of typhoid fever in southern and eastern Africa, associated with multidrug-resistant H58 Salmonella Typhi. Here, we identify risk factors for pediatric typhoid fever in...

Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of co...

Introduction In Malawi, EcoSan sludge from ecological sanitation (EcoSan) latrines has been found to contain helminths, Salmonella and E. coli above WHO recommended levels making sludge unsuitable for direct handling and use on food crops. This research investigated survival of pathogens in EcoSan sludge with time after sealing the pit. Method An...

Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines...

Draft review report of the National Open Defecation Free (ODF) and Handwashing with Soap (HWWS) strategies. (PDF)

Improving food safety and hygiene is integral to the successful attainment of the Sustainable Development Goals (SDGs). Foodborne diseases continue to impose a high burden on low- and middle-income countries (LMICs), particularly children under five years, and meeting stipulated conditions for both domestic and export markets can be challenging. Th...

Policy Brief highlighting outcomes of community engagement on good research practice

Community poster also available in Chichewa

Short informative guidance for researchers in community health

250 WORDS MAX) In 2017 660 million people remain without sustainable access to safe drinking water [1]. The majority of these are in rural areas with little hope in the foreseeable future of access to distributed treated water systems. Solar water disinfection (SODIS) is a household water treatment using solar energy to inactivate pathogens in wate...

Highlights of the initial formative results from the SHARE II research project in Malawi

Use of Ecological Sanitation (EcoSan) sludge is becoming popular due to increasing price of organic fertilizers in Malawi; however, there is little evidence on the associated risks. Quantitative microbiological risk assessment (QMRA) was done to determine health risks associated with use of EcoSan. Pathogens considered included Escherichia coli (E....

Background Despite Malawi's introduction of a health management information system (HMIS) in 1999, the country's health sector still lacks accurate, reliable, complete, consistent and timely health data to inform effective planning and resource management. Methods A cross-sectional survey was conducted wherein qualitative and quantitative data wer...

Background mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the...

Background: Studies have shown that households using sludge from human excreta for agriculture are at an increased risk of soil transmitted helminths. However, while use of ecological sanitation (EcoSan) latrines is increasing in most African countries including Malawi, few studies have been done to check whether use of such sludge could potential...

This paper examined care-seeking behaviour and its associated risk factors when a family member had diarrhoea. Data was obtained from a survey conducted in Chikwawa, a district in Southern Malawi. Chikwawa is faced with a number of environmental and socioeconomic problems and currently diarrhoea morbidity in the district is estimated at 24.4%, stat...

Fossa Alternas and double vault urine diverting dry (DVUDD) latrines have been extensively promoted as ecological sanitation (EcoSan) latrine options in Malawi, but little is known about whether they are used properly. A qualitative study of EcoSan users was conducted in Blantyre and Chikwawa districts, Malawi. Data were collected using in-depth in...