The Long-Term Impact of Water and Sanitation on Childhood Cognition. The FASEB Journal, April 2015.

Authors: Nisaa’ Wulan, Emily Smith, et al.

Unsafe water and poor sanitation may negatively affect brain development, however few studies have examined the long-term impact on children’s cognitive function. Our objective was to assess the relationship between household access to safe water and toilet facilities during the prenatal period with childhood cognition 9-12 years later. The Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), conducted in 2001-2004 In Indonesia, compared the health effects of a prenatal multiple micronutrient supplement to an iron and folic acid supplement.

Children of mothers who had access to safe toilet facilities during pregnancy had higher scores in Digit Span Forward (95%CI 0.008-0.17, P<0.03), Information (95%CI 0.08-0.2, P<0.001), Block Design (95%CI 0.01-0.1, P<0.02), and Word List Memory (95%CI 0.006-0.17, P<0.03) tests after adjusting for cluster randomization, data collector, maternal education, socio-economic status and home environment score.

Children of mothers with access to safe water during pregnancy had higher Word List Memory scores (95%CI 0.01-0.19, P<0.02). The finding that safe water and toilet facilities were associated with child cognition even after adjustment for socio-economic status and maternal education suggests that interventions to improve water and sanitation in early life may have long-term benefits on child cognitive abilities.

Water, sanitation, and diarrheal incidence among children: evidence from Guatemala. Water Policy, In Press, Uncorrected Proof, Mar 2015.

Authors: William F. Vásquez and Anna-Maria Aksan

Using household survey data for Guatemala, this paper investigates the role of water and sanitation infrastructure on diarrheal incidence in children. Hierarchical logit models of diarrhea incidence are estimated to account for potential regional heterogeneity of water and sanitation effects. Results indicate that the incidence probability of diarrhea is on average 20% lower in homes connected to a sewage system. The effect of in-home access to tap water is weaker at 11% and subject to regional heterogeneity. Findings also indicate that consumption of bottled water reduces the incidence probability of diarrhea by 20–22%. In-home water treatments have no effect on incidence of diarrhea. Policy implications are discussed.

Piped water flows but sachet consumption grows: The paradoxical drinking water landscape of an urban slum in Ashaiman, Ghana. Habitat International, June 2015.

Authors: Justin Stoler, et al.


  • This research explores drinking water perceptions in Old Tulaku, an urban slum in Ashaiman, Ghana.
  • The study synthesizes results from 4 focus groups and survey data from 95 households.
  • Sachet water consumption is associated with socioeconomic and knowledge factors.
  • Drivers of water-seeking behaviour are complex and can inform water provision policy.

Empowerment in action: savings groups improving community water, sanitation, and hygiene services. Enterprise Development and Microfinance, March 2015.

Kaelyn DeVries, Alejandro Rizo, Project Concern International, Guatemala.

Savings groups (SGs) combined with social empowerment strategies can be used to engage communities meaningfully in addressing development challenges such as access to clean water and a functioning latrine. As participants in PCI’s SG initiative entitled Women Empowered (WE), women have independently identified WASH needs in their communities and have organized and carried out collective actions to improve their situation. This paper highlights results from a qualitative study in which PCI looked at SGs within two international development programmes in urban and rural Guatemala.

Do Decentralized Community Treatment Plants Provide Better Water? Evidence from Andhra Pradesh, 2015.

Authors: Marc Jeuland, et al.

Highly advanced, community-level drinking water treatment facilities are increasingly seen as water supply solutions in locations where piped in-house water systems are nonexistent or unreliable. These systems utilize combined technologies, such as advanced filtration plus ultraviolet disinfection or reverse osmosis, which are known to be highly effective for the removal of pathogens and other water contaminants. Yet there is a paucity of rigorous evidence on whether the community-level treatment model delivers water quality, health, or other benefits to households that source water from them.

We find low rates of sourcing water from the facilities (~10%), and little evidence of benefits among households living in villages receiving a community water system (CWS). Particularly among users of the CWS, we also observe short-term increases in the number of drinking water sources used and in monthly expenses on drinking water combined with decreases in in-house water treatment, and higher reported rates of diarrheal diseases among children. These findings suggest that caution and additional scrutiny is warranted before concluding that such systems provide safer water to households in communities facing drinking water quality problems.

A Review of Heterogeneous Photocatalysis for Water and Surface DisinfectionMolecules 2015, 20, 5574-5615.

Authors: John Anthony Byrne, et al.

Photo-excitation of certain semiconductors can lead to the production of reactive oxygen species that can inactivate microorganisms. The mechanisms involved are reviewed, along with two important applications. The first is the use of photocatalysis to enhance the solar disinfection of water. It is estimated that 750 million people do not have accessed to an improved source for drinking and many more rely on sources that are not safe. If one can utilize photocatalysis to enhance the solar disinfection of water and provide an inexpensive, simple method of water disinfection, then it could help reduce the risk of waterborne disease.

Chlorine dispensers in Kenya: scaling for results, 3ie Grantee Final Report, 2015.

Authors: Amrita Ahuja, et al.

We conducted three studies: one survey experiment and two large-scale randomized evaluations, to investigate how a particular community-level water treatment device, the chlorine dispenser, is valued and allocated by local government officials, and how best it can be financed and managed.

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Effectiveness of Chlorine Dispensers in Emergencies: Case Study Results from Haiti, Sierra Leone, DRC, and Senegal. Environ. Sci. Technol., March 2015.

Authors: Travis Yates , Elise Armitage , Lilian V. Lehmann , Ariel J. Branz , and Daniele S. Lantagne

Dispensers are a source-based water quality intervention with promising uptake results in development contexts. Dispenser programs include a tank of chlorine with a dosing valve that is installed next to a water source, a local Promoter who conducts community education and refills the Dispenser, and chlorine refills. In collaboration with response organizations, we assessed the effectiveness of Dispensers in four emergency situations.

In the three initial and four sustained response phase evaluations, 70 Dispenser sites were visited, 2,057 household surveys were conducted, and 1,676 water samples were analyzed. Across the evaluations, reported Dispenser use ranged from 9-97%, confirmed Dispenser use (as measured by free chlorine residual) ranged from 5-87%, and effective use (as measured by improvement in household water quality to meet international standards) ranged from 0-81%.

More effective Dispenser interventions installed Dispensers at point-sources, maintained a high-quality chlorine solution manufacturing and distribution chain, maintained Dispenser hardware, integrated Dispensers projects within larger water programs, remunerated Promoters, had experienced project staff, worked with local partners to implement the project, conducted ongoing monitoring, and had a project sustainability plan. Our results indicate that Dispensers can be, but are not always, an appropriate strategy to reduce the risk of waterborne diseases in emergencies.

Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial. PLoS One, March 2015

Authors: Ayse Ercumen , Abu Mohd. Naser , Leanne Unicomb, Benjamin F. Arnold, John M. Colford Jr., Stephen P. Luby

Background - Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.

Methods - We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants’ source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.

Findings - Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.

Conclusions - Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.


Sustainability and scale-up of household water treatment and safe storage practices: Enablers and barriers to effective implementation. International Journal of Hygiene and Environmental Health, March 2015.

Authors: Edema Ojomo, Mark Elliott, Lorelei Goodyear, Michael Forson, Jamie Bartram

Household water treatment and safe storage (HWTS) options provide a solution, when employed correctly and consistently, for managing water safety at home. However, despite years of promotion by non-governmental organizations (NGOs), governments and others, boiling is the only method to achieve scale. Many HWTS programs have reported strong initial uptake and use that then decreases over time. This study maps out enablers and barriers to HWTS sustainability and scale-up.

Interviews were carried out with 72 HWTS practitioners who had direct experience with HWTS programs in over 25 countries. A total of 47 enablers and barriers important to sustaining and scaling up HWTS practices were identified. These were grouped into six domains: (1) user guidance on HWTS products; (2) resource availability; (3) standards, certification and regulations; (4) integration and collaboration; (5) user preferences; and (6) market strategies.

Collectively, the six domains cover the major aspects of moving products from development to the consumers. It is important that each domain is considered in all programs that aim to sustain and scale-up HWTS practices. The findings described in this paper can aid governments, NGOs, and other organizations involved in HWTS to approach programs more effectively and efficiently.