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EH Updates - Recent News and Information

Environmental Health Updates

  • Environmental Health Update - July 8, 2010. (pdf) Citations and abstracts of 6 recently published journal articles and links to news updates on water, sanitation, hygiene, indoor air pollution and urban health.

  • June 2010 (pdf) - June 2010 journal articles, new reports and news feed updates.

USAID Hygiene Improvement Project (HIP) -Madagascar French Language MaterialsLady washing dishes

August 2009 Environmental Health Update

Below are citations and abstracts to 12 recently published studies on HIV/AIDS, urban waste management, dengue control and other environmental health topics.

1 - Physics and Chemistry of the Earth, Parts A/B/C, July 2009, ISSN 1474-7065, DOI: 10.1016/j.pce.2009.07.007.

Using water and sanitation as an entry point to fight poverty and respond to HIV/AIDS: The Case of Isulabasha Small Medium Enterprise,

G. Manase, Z. Nkuna, E. Ngorima,

South Africa is faced by a number of challenges that include low water and sanitation coverage in rural and peri-urban areas, high unemployment and increasing inequality between the rich and the poor as indicated by a Gini coefficient of 0.77; the second highest inequality in the world after Brazil. The situation is compounded by high HIV prevalence with South Africa having the largest HIV infection in the world. This case study demonstrates how water and sanitation is used as an entry point to address these major challenges and to empower communities. The project has two main components: the Small Medium Enterprise (SME) that trades in water and sanitation facilities and a community garden that ensure food security and nutrition for people living with HIV/AIDS. Income generated through these activities is ploughed back into the community through construction of sanitation facilities, maintenance of water pipes and paying school fees for orphans. In addition to creating employment, the project has also empowered the community to mobilize and address other challenges such as gender, child abuse and crime.

The case study identifies weaknesses with projects designed solely to provide domestic drinking water and sanitation and calls for an integrated approach that uses water and sanitation as an entry point to unlock opportunities and empower the targeted communities.

2 - Epidemiology and Infection, 2009 forthcoming article, doi:10.1017/S0950268809990422

Recall errors in a weekly survey of diarrhoea in Guatemala: determining the optimal length of recall


We measured the recall error, optimal recall length and factors associated with diarrhoea in a weekly survey. Data was taken from a year-long randomized controlled trial in which characteristics of diarrhoeal episodes were recorded weekly. We labelled the recall period as days 1–6; day 1 being the day before the visit. Recall error was the percentage difference between the number of episodes reported to begin on a particular day and the mean for days 1 and 2. Generalized estimating equations were used to determine associations. Recall error was 37% on day 3 and 51% on day 5. The error was less in younger children (by 10%), severe episodes (by 29%) and when blood was present in the stool (by 18%). Diarrhoea was underreported when the recall period extended beyond 2 days. Surveys that use longer recall periods risk underestimating diarrhoea incidence and selectively capturing more severe episodes.

3 - Curr Opin Infect Dis. 2009 Jul 23.

Viruses causing childhood diarrhoea in the developing world.

Ramani S, Kang G.

Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

PURPOSE OF REVIEW: Acute gastroenteritis is one of the leading causes of morbidity and mortality in children in the developing world. With improvements in hygiene and sanitation, the burden of disease due to bacterial and parasitic infections has decreased and an increasing proportion of diarrhoea hospitalizations are attributed to viruses. This review focuses on enteric viruses and their role in childhood diarrhoea in the developing world.

RECENT FINDINGS: With the use of sensitive molecular techniques, it is evident that a significant proportion of childhood diarrhoea is attributable to enteric viruses, with at least one viral agent in nearly 43% of samples from childhood diarrhoea in developing countries. Rotaviruses remain the most common pathogens in children, followed by noroviruses in almost all countries. There is increasing evidence that both rotaviruses and caliciviruses spread beyond the gut in a large proportion of infections.

SUMMARY: The review highlights the importance of viral agents of gastroenteritis in developing countries. Wider use of molecular techniques is resulting in rapid identification of new or emerging strains and in the detection of extra-intestinal spread. There is a need to better understand susceptibility and immune response to these agents to be able to design suitable interventions.

4 - Journal of Environmental Sciences, Volume 21, Supplement 1, 2009, Pages S40-S43, ISSN 1001-0742, DOI: 10.1016/S1001-0742(09)60033-4.

Finding urban waste management solutions and policies: Waste-to-energy development and livelihood support system in Payatas, Metro Manila, Philippines,

Kevin Roy SERRONA, Jeong-soo YU,

One of the potential solutions in social and environmental sustainability in municipal solid waste management (MSW) in Metro Manila is to combine community-based recycling and sound landfill management strategies. The marriage of the two puts importance on recycling as a source of livelihood while proper landfill management aims to improve the aesthetic and environmental quality of disposal facilities in urban areas. To do this, a social mapping of wastepickers, junkshops and local recycling practices needs to be undertaken and at the same time assess strategies of the national and local governments vis-a-vis existing laws on municipal solid waste. The case of Payatas controlled disposal facility was taken as a pilot study because it represents the general condition of disposal sites in Metro Manila and the social landscape that it currently has. In addition, a waste-to-energy (WTE) project has been established in Payatas to produce electricity from methane gas. Preliminary interviews with wastepickers show that development interventions in disposal sites such as WTE pose no opposition from host communities for as long as alternative livelihood opportunities are provided. Regulating the flow of wastepickers into the landfill has advantages like improved income and security. Felt needs were also articulated like provision of financial support or capital for junkshop operation and skills training. Overall, a smooth relationship between the local government and community associations pays well in a transitioning landfill management scheme such as Payatas.

5 - Journal of Water and Health Vol 07 No 3 pp 497–506 2009 doi:10.2166/wh.2009.071

Turbidity and chlorine demand reduction using locally available physical water clarification mechanisms before household chlorination in developing countries

Nadine Kotlarz, Daniele Lantagne, Kelsey Preston and Kristen Jellison

Over 1.1 billion people in the world lack access to improved drinking water. Diarrhoeal and other waterborne diseases cause an estimated 1.9 million deaths per year. The Safe Water System (SWS) is a proven household water treatment intervention that reduces diarrhoeal disease incidence among users in developing countries. Turbid waters pose a particular challenge to implementation of SWS programmes; although research shows that a 3.75 mg l-1 sodium hypochlorite dose effectively treats turbid waters, users sometimes object to the strong chlorine taste and prefer to drink water that is more aesthetically pleasing. This study investigated the efficacy of three locally available water clarification mechanisms—cloth filtration, settling/decanting and sand filtration—to reduce turbidity and chlorine demand at turbidities of 10, 30, 70, 100 and 300 NTU. All three mechanisms reduced turbidity (cloth filtration -1–60%, settling/decanting 78–88% and sand filtration 57–99%). Sand filtration (P=0.002) and settling/decanting (P=0.004), but not cloth filtration (P=0.30), were effective at reducing chlorine demand compared with controls. Recommendations for implementing organizations based on these results are discussed.

6 - Health Education Research Advance Access published on August 1, 2009, DOI 10.1093/her/cyp004.

The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy

L. Rosen, D. Zucker, D. Brody, D. Engelhard and O. Manor

This paper describes the effect of a preschool hygiene intervention program on psychosocial measures of educators regarding handwashing and communicable pediatric disease. A cluster-randomized trial, with randomization at the level of the preschool, was run in 40 Jerusalem preschool classrooms. Eighty preschool educators participated. The program used a multipronged approach which included elements aimed at staff, children, parents, school nurses and the classroom environment. Frontal lectures by medical, epidemiological and educational experts, along with printed materials and experiential learning, were provided to staff. Responses from a validated survey instrument were used to build four scales for each respondent regarding beliefs, attitudes, self-efficacy and knowledge. The scales were built on a Likert-type 1–7 scale (1 = minimum, 7 = maximum). The effect of the intervention was tested using mixed model analysis of variance. Response was received from 92.5% of educators. Educators believed that handwashing could affect health (mean = 5.5, SD = 1.1), had high levels of self-efficacy (mean = 6.1, SD = 0.9) and had positive attitudes toward handwashing (mean = 5.7, SD = 1.2). Knowledge was affected by the intervention (intervention: mean = 6.2, SD = 0.7; control: mean = 5.8, SD = 0.8). The combination of positive attitudes toward handwashing among educators and the program's effectiveness in imparting knowledge helped to create a sustained social norm of handwashing among many children in disparate locations.

7 - Journal of Water and Health Vol 07 No 3 pp 434–451 2009 doi:10.2166/wh.2009.059

Of taps and toilets: quasi-experimental protocol for evaluating community-demand-driven projects

Subhrendu K. Pattanayak, Christine Poulos, Jui-Chen Yang, Sumeet R. Patil and Kelly J. Wendland

Sustainable and equitable access to safe water and adequate sanitation are widely acknowledged as vital, yet neglected, development goals. Water supply and sanitation (WSS) policies are justified because of the usual efficiency criteria, but also major equity concerns. Yet, to date there are few scientific impact evaluations showing that WSS policies are effective in delivering social welfare outcomes. This lack of an evaluation culture is partly because WSS policies are characterized by diverse mechanisms, broad goals and the increasing importance of decentralized delivery, and partly because programme administrators are unaware of appropriate methods. We describe a protocol for a quasi-experimental evaluation of a community-demand-driven programme for water and sanitation in rural India, which addresses several evaluation challenges. After briefly reviewing policy and implementation issues in the sector, we describe key features of our protocol, including control group identification, pre-post measurement, programme theory, sample sufficiency and robust indicators. At its core, our protocol proposes to combine propensity score matching and difference-in-difference estimation. We conclude by briefly summarizing how quasi-experimental impact evaluations can address key issues in WSS policy design and when such evaluations are needed.

8 - Physics and Chemistry of the Earth, Parts A/B/C, In Press, Corrected Proof, Available online 9 July 2009, ISSN 1474-7065, DOI: 10.1016/j.pce.2009.07.001.

Potential of using plant extracts for purification of shallow well water in Malawi

M. Pritchard, T. Mkandawire, A. Edmondson, J.G. O'Neill, G. Kululanga,

There has been very little scientific research work into the use of plant extracts to purify groundwater. Research studies on the purification of groundwater have mainly been carried out in developed countries and have focused on water purification systems using aluminium sulphate (a coagulant) and chlorine (a disinfectant). Such systems are expensive and not viable for rural communities due to abject poverty. Shallow well water, which is commonly available throughout Africa, is often grossly contaminated and usually consumed untreated. As a result, water-related diseases kill more than 5 million people every year worldwide. This research was aimed at examining natural plant extracts in order to develop inexpensive ways for rural communities to purify their groundwater. The study involved creating an inventory of plant extracts that have been used for water and wastewater purification. A prioritisation system was derived to select the most suitable extracts, which took into account criteria such as availability, purification potential, yield and cost of extraction. Laboratory trials were undertaken on the most promising plant extracts, namely: Moringa oleifera, Jatropha curcas and Guar gum. The extracts were added to water samples obtained from five shallow wells in Malawi. The trials consisted of jar tests to assess the coagulation potential and the resulting effect on physico-chemical and microbiological parameters such as temperature, pH, turbidity and coliforms. The results showed that the addition of M. oleifera, J. curcas and Guar gum can considerably improve the quality of shallow well water. Turbidity reduction was higher for more turbid water. A reduction efficiency exceeding 90% was achieved by all three extracts on shallow well water that had a turbidity of 49 NTU. A reduction in coliforms was about 80% for all extracts. The pH of the water samples increased with dosage, but remained within acceptable levels for drinking water for all the extracts. Overall, M. oleifera powder produced superior results, followed by Guar gum and lastly J. curcas. There is a need to carry out further more detailed tests, which include toxicity to guarantee the safety of using plant extracts as a coagulant in the purification of drinking water for human consumption.

9 - Ocean & Coastal Management, Volume 52, Issue 7, Safer Coasts, Living with Risks: July 2009, Pages 374-377, ISSN 0964-5691, DOI: 10.1016/j.ocecoaman.2009.04.003.

Creative financing solution for water supply and sanitation in the Philippines

Alma D. Porciuncula,

This paper discusses the ongoing initiative to establish a sustainable financing mechanism for water supply and sanitation (WSS) projects, anchored on the principle of public-private partnership. It tackles the magnitude of investment requirements and financing gaps, and the rationale and objectives of the Philippine Water Revolving Fund (PWRF) and its financial structure. PWRF responds to the government's policy to shift financing of WSS projects, starting with existing creditworthy water utilities, from concessional to market-based sources. PWRF is initially designed as a co-financing credit facility combining official development assistance (ODA) with private financing institution funds. However, its ultimate goal is to access the domestic capital market through pooled bond financing.

10 - Water Research, July 2009, ISSN 0043-1354, DOI: 10.1016/j.watres.2009.07.028.

Identifying human and livestock sources of fecal contamination in Kenya with host-specific Bacteroidales assays,

Marion W. Jenkins, Sangam Tiwari, Mario Lorente, Charles Maina Gichaba, Stefan Wuertz,

Microbial source tracking to distinguish between human, livestock and wildlife fecal pollution using molecular techniques is a rapidly evolving approach in many developed countries, but has not previously been applied on the African continent. DNA extracts from cow, donkey, and human fecal specimens and raw domestic sewage samples collected in Kenya were tested against 5 existing quantitative PCR assays designed to detect universal (2), human-specific (2), and cow-specific (1) fecal Bacteroidales genetic markers. Water samples from the River Njoro in Kenya were evaluated using the 5 tested Bacteroidales markers and a multi-species assay for Cryptosporidium in a preliminary exploration of fecal pollution sources and health risks in this watershed. Diagnostic sensitivity on the validation set varied from 18%-100% for the five assays while diagnostic specificity was 100%. Of the two universal assays, Total Bacteroidales (Dick and Field, 2004) showed lower generic fecal diagnostic sensitivity, at 55%, than BacUni-UCD, at 100%, in detecting fecal markers on the 42-sample validation set. Human-specific assay HF183 demonstrated 65% sensitivity overall, and 80% on the human sewage samples, compared to 18% overall and 0% sewage for human-specific assay BacHum-UCD. Cow-specific assay BacCow-UCD had 94% sensitivity. Testing of 18 water samples indicates cows are a likely predominant source of fecal contamination in the Njoro Watershed (78% prevailing rate). Probabilistic assessment of human assay results indicates at most 3 of the river water samples contained human Bacteroidales. Cryptosporidium spp. markers were detected in samples from 9 of the 12 sampling locations. Evidence suggesting widespread contamination by cow feces and Cryptosporidium in the Njoro watershed raises serious concerns for human and animal health.

11: Int J Health Geogr. 2009 Jul 23;8(1):49.

Combining Google Earth and GIS mapping technologies in a dengue surveillance system for developing countries.

Chang AY, Parrales ME, Jimenez J, Sobieszczyk ME, Hammer SM, Copenhaver DJ, Kulkarni RP.

BACKGROUND: Dengue fever is a mosquito-borne illness that places significant burden on tropical developing countries with unplanned urbanization. A surveillance system using Google Earth and GIS mapping technologies was developed in Nicaragua as a management tool.

Methods and Results: Satellite imagery of the town of Bluefields, Nicaragua captured from Google Earth was used to create a base-map in ArcGIS 9. Indices of larval infestation, locations of tire dumps, cemeteries, large areas of standing water, etc. that may act as larval development sites, and locations of the homes of dengue cases collected during routine epidemiologic surveying were overlaid onto this map. Visual imagery of the location of dengue cases, larval infestation, and locations of potential larval development sites were used by dengue control specialists to prioritize specific neighborhoods for targeted control interventions.

CONCLUSIONS: This dengue surveillance program allows public health workers in resource-limited settings to accurately identify areas with high indices of mosquito infestation and interpret the spatial relationship of these areas with potential larval development sites such as garbage piles and large pools of standing water. As a result, it is possible to prioritize control strategies and to target interventions to highest risk areas in order to eliminate the likely origin of the mosquito vector. This program is well-suited for resource-limited settings since it utilizes readily available technologies that do not rely on Internet access for daily use and can easily be implemented in many developing countries for very little cost.

12: Trop Med Int Health. 2009 Jul 14.

Reducing costs and operational constraints of dengue vector control by targeting productive breeding places: a multi-country non-inferiority cluster randomized trial.

Tun-Lin W, Lenhart A, Nam VS, Rebollar-Téllez E, Morrison AC, Barbazan P, Cote M, Midega J, Sanchez F, Manrique-Saide P, Kroeger A, Nathan MB, Meheus F, Petzold M.

Department of Medical Research, Yangon, Myanmar.

Objectives - To test the non-inferiority hypothesis that a vector control approach targeting only the most productive water container types gives the same or greater reduction of the vector population as a non-targeted approach in different ecological settings and to analyse whether the targeted intervention is less costly.

Methods - Cluster randomized trial in eight study sites (Venezuela, Mexico, Peru, Kenya, Thailand, Myanmar, Vietnam, Philippines), with each study area divided into 18-20 clusters (sectors or neighbourhoods) of approximately 50-100 households each. Using a baseline pupal-demographic survey, the most productive container types were identified which produced >/=55% of all Ae. aegypti pupae. Clusters were then paired based on similar pupae per person indices. One cluster from each pair was randomly allocated to receive the targeted vector control intervention; the other received the 'blanket' (non-targeted) intervention attempting to reach all water holding containers.

Results - The pupal-demographic baseline survey showed a large variation of productive container types across all study sites. In four sites the vector control interventions in both study arms were insecticidal and in the other four sites, non-insecticidal (environmental management and/or biological control methods). Both approaches were associated with a reduction of outcome indicators in the targeted and non-targeted intervention arm of the six study sites where the follow up study was conducted (PPI, Pupae per Person Index and BI, Breteau Index). Targeted interventions were as effective as non-targeted ones in terms of PPI. The direct costs per house reached were lower in targeted intervention clusters than in non-targeted intervention clusters with only one exception, where the targeted intervention was delivered through staff-intensive social mobilization.

Conclusions - Targeting only the most productive water container types (roughly half of all water holding container types) was as effective in lowering entomological indices as targeting all water holding containers at lower implementation costs. Further research is required to establish the most efficacious method or combination of methods for targeted dengue vector interventions.

HIV-affected Families and Water/Sanitation Hygiene - Introduction

Access to safe water is considered a basic human need and a basic human right (Kamminga 2006) for all people. Yet this basic right remains unrealized for a large majority of people in developing countries, especially in rural communities. The negative impact of low access to necessary quantities of water, to water of reasonable quality, to basic sanitation and hygiene are magnified for HIV-infected, immuno-compromised individuals. The added burden affects not only the HIV infected, but the entire affected family, increasing risk of diarrheal disease and lost productivity. Girl at a faucet

Therefore, people living with HIV/AIDS (PLWHA) and households affected by HIV and AIDS have a substantially greater need for WaSH services: more water; safe water; access to water and sanitation; proper hygiene. Evidence indicates that HIV affected households require far greater than the 20 liters of water per capita daily (WSP 2007). PLWHA experience periods of illness and relative weakness (Voss 2007) requiring close access to water and sanitation facilities. Studies have shown that those traveling great distances to collect water will reduce intake of water and use less safe water sources and those without easy access to latrines will often resort to open defecation methods (WSP 2007). Increased access to water also assists PLWHA and their families to maintain kitchen gardens or engage in income generating activities that will help ensure food security, improved nutrition, and provide additional income for the household.

In addition, the immuno-compromised status of PLWHA renders them more susceptible to opportunistic infections including those related to water, sanitation and hygiene—diarrhea and skin diseases.

In advanced stages of AIDS, PLWHA often have mouth sores which make eating difficult. Documented evidence has shown that softening food with water helps PLWHA ingest the food needed to maintain good nutrition (Kamminga 2006, WELL Briefing Note 5). Further, when infants are weaned from HIV positive mothers, a safe water source must be used to mix formula or the babies will be at greater risk for dying from diarrheal diseases. In the first two months, a child who receives replacement feeding is six times more likely to die than a breastfed child (UNICEF 2002).

Fourth, people on antiretroviral treatment (ART) require greater amounts of water for drinking (at least 1.5 liters per day). A great irony exists in giving advanced, costly life-saving ART to patients with a glass of water that could infect them with a life-threatening illness. It is important to maximize the effectiveness of these medicines by using safe water for ingesting them, since a side effect of many ARV drugs is diarrhea. Further, diarrheal illness in PLWHA can interfere with and compromise the absorption of these ARV drugs and can even contribute to developing HIV strains that are resistant to antiviral agents (Bushen 2004). Thus safe drinking water becomes that much more compulsory as ART becomes more pervasive in the developing world.

The evidence base: A small but growing body of literature has identified a series of linkages between water, sanitation and hygiene and HIV/AIDS: opportunistic infections negatively impact PLWHA quality of life and can speed the progression to AIDS and infection frequency is tied to water and sanitation services available to households and the hygiene practices of household members (Hillbrunner 2007). Individual studies address the impact of water quantity, quality, sanitation and feces management, handwashing and other aspects of wash can be found through the links below.

Programming experience and guidance: Ensuring proper WaSH practices benefits those infected with HIV and AIDS by keeping them stronger, well nourished, and able to contribute to the household.  In addition, such good practices will also prevent the caregivers and other household members from contracting water-borne diarrheal diseases, which, in turn, helps to keep households economically viable and generally resilient for longer periods of time.

Catholic Relief Services and the USAID Hygiene Improvement Project conducted a Workshop on Integration of Water, Sanitation and Hygiene into HIV/AIDS Home-Based Care Strategies in Lilongwe, Malawi from October 29 - November 1, 2007. Links to the workshop reports are listed below:

Other Publications/Presentations

  • Dignity for All: Sanitation, Hygiene and HIV/AIDS - A presentation at the AfricaSan 2008 Conference by Merri Weinger, USAID. (pdf 380KB) - This presentation:
    • Highlights the linkages between WSH and PLWHA
    • Describes the evidence base for integration
    • Reviews global and country-based based implementation models
    • Recommends key actions for implementers

| Recent Reports | USAID Sponsored Activities, Reports

New Reports/Studies/Links

  • WHO Household Water Treatment and Safe Storage Network Conference Presentations
    • Presentations Home Page, includes conference/meeting presentations from:
      • Istanbul 2009Handwashing at a Tippy Tap
      • Jakarta 2008
      • Accra 2008
      • Addis Ababa 2007
      • Nairobi 2007
      • London 2006
      • Nairobi 2004

  • Household Water Treatment presentations: Disinfection 2009 Conference - The presentations listed below can be viewed or downloaded from the Environmental Health at USAID Household-Water-Treatment Google Group.
    • Baker-Scaling up hwt.pdf, 720.5 KB
    • Brunson-Arsenic and fluoride removal.pdf, 2.4 MB
    • Ceramic filters workshop report.pdf, 392.8 KB
    • Chatterley-UVLEDs for water treatment.pdf, 557.0 KB
    • Duke-Sand Media and Biosand Filter.pdf, 5.5 MB
    • Dyck-Samaritans Purse biosand implementation.pdf, 2.0 MB
    • Eleveld-Water treatment as a business opportunity.pdf, 3.7 MB
    • Elliott-Treatment of waterborne viruses by biosand filter.pdf, 628.8 KB
    • Fisher-Sunlight inactivation of E. coli.pdf, 1.9 MB
    • Hiser-Efficacy of One Drop disinfectant.pdf, 380.2 KB
    • Household Water Treatment Track-DIS2009.pdf, 80 KB
    • Kallman-Evaluation of ceramic filters in Guatemala.pdf, 1.1 MB
    • Kremer-Evaluations of Water Treatment Adoption.pdf, 713.4 KB
    • Kuechler-Alternate source of chlorine.pdf, 1.6 MB
    • Kumpel-Safe water & hygiene in slums.pdf, 6.3 MB
    • Kwak-Social marketing in Madagascar.pdf, 899.2 KB
    • Mburu-Chujio filters in Kenya.pdf, 2.3 MB
    • Miller-Coagulation methods.pdf, 2.8 MB
    • Mosler-SODIS behavior change processs.pdf, 907.1 KB
    • Nelson-Cationic antimicrobial surface coatings.pdf, 848.6 KB
    • Null-Measuring diarrhea.pdf, 902.2 KB
    • Oneil-Safe water systems in Afghanistan.pdf, 283.7 KB
    • Page-Improving the control of viruses.pdf, 906.7 KB
    • Poulos-Perceived water quality and microbial contamination.pdf, 249.9 KB
    • Preston-Turbidity and chlorine demand reduction.pdf, 365.2 KB
    • Ritter-Adoption of chlorination in Haiti.pdf, 4.4 MB
    • Shrestha-Promotion of Point of Use Water Treatment in Nepal.pdf, 2.2 MB
    • Stauber-Performance of biosand filter in Dominican Republic.pdf, 1.4 MB
    • Younger-Point of use water treatment in Peru.pdf, 2.4 MB

  • Boiling: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 538KB). Boiling is arguably the oldest and most commonly practiced household water treatment method, and it has been widely promoted for decades. Organizations recommend boiling both for water treatment in developing countries and to provide safe drinking water in emergency situations throughout the world.

  • Filtration & Chlorination Systems: Household Water Treatment Options in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 150KB). Several household water treatment systems incorporate both a physical filtration step for particle removal and a chlorination step for disinfection. This dual approach leads to high quality treated water.

  • Safe Storage of Drinking Water: Preventing Diarrheal Disease in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 254KB). Safe storage options fall into three general categories: 1) existing water storage containers in the home; 2) water storage containers used in the community and modified by an intervention program; or, 3) commercial safe storage containers purchased by the program and distributed to users.

  • Simple Options to Remove Turbidity: Preventing Diarrheal Disease in Developing Countries. January 2009. CDC Safewater/USAID. (pdf, 173KB). Filtration or flocculation remove particles and reduce turbidity. These pretreatment methods may also increase the efficacy of household water treatment products by removing contaminants that interfere with disinfection and physical filtration processes.

  • Targeting Appropriate Interventions to Minimize Deterioration of Drinking-water Quality in Developing Countries, IN: J HEALTH POPUL NUTR 2008, (pdf, full-text) - This paper proposes a semi-quantified ‘disease risk index’ (DRI) designed to identify communities or households that are ‘most at risk’ from consuming recontaminated drinking-water.

  • A Community-based Bacteriological Study of Quality of Drinking-water and Its Feedback to a Rural Community in Western Maharashtra, India, IN:
    J HEALTH POPUL NUTR 2008 (pdf, full-text) - A longitudinal study of the bacteriological quality of rural water supplies was undertaken for a move­ment towards self-help against diseases, such as diarrhoea, and improved water management through in­creased community participation. Three hundred and thirteen water samples from different sources, such as well, tank, community standpost, handpumps, percolation lakes, and streams, and from households were collected from six villages in Maharashtra, India, over a one-year period.

  • Point of Use Household Drinking Water Filtration: A Practical, Effective Solution for Providing Sustained Access to Safe Drinking Water in the Developing World (pdf, 103KB) IN: Environmental Science & Technology, May 13, 2008 - Web Release Date. by Mark D. Sobsey, Christine E. Stauber, Lisa M. Casanova, Joseph M. Brown, and Mark A. Elliott - The lack of safe water creates a tremendous burden of diarrheal disease and other debilitating, life-threatening illnesses for people in the developing world. Point-of-use (POU) water treatment technology has emerged as an approach that empowers people and communities without access to safe water to improve water quality by treating it in the home. Several POU technologies are available, but, except for boiling, none have achieved sustained, large-scale use. Sustained use is essential if household water treatment technology (HWT) is to provide continued protection, but it is difficult to achieve. The most effective, widely promoted and used POU HWTs are critically examined according to specified criteria for performance and sustainability. Ceramic and biosand household water filters are identified as most effective according to the evaluation criteria applied and as having the greatest potential to become widely used and sustainable for improving household water quality to reduce waterborne disease and death.

  • Water Quality Interventions to Prevent Diarrhoea: Cost and Cost-Effectiveness. 2008. T. Clasen and L. Laurence Haller. Geneva: World Health Organization. (pdf, full-text) - Building on our recent Cochrane review of the effectiveness of water quality interventions to prevent diarrhoea, we collected cost information from 28 country programmes and computed the cost-effectiveness of conventional improvements of water quality at the source (well, borehole, communal stand post) and four interventions to improve water quality at the household level (chlorination, filtration, solar disinfection and combined flocculation/disinfection).

  • Microbiological Effectiveness and Cost of Boiling to Disinfect Drinking Water in Rural Vietnam, by T. Clasen, et. al. IN: Env Sci Tech June 2008. (pdf, full-text) - We assessed the microbiological effectiveness and cost of boiling among a vulnerable population relying on unimproved water sources and commonly practicing boiling as a means of disinfecting water. In a 12 week study among 50 households from a rural community in Vietnam, boiling was associated with a 97% reduction in geometric mean thermotolerant coliforms (TTCs) (p < 0.001). Despite high levels of faecal contamination in source water, 37% of stored water samples from self-reported boilers met the WHO standard for safe drinking water (0 TTC/100 mL), and 38.3% fell within the low risk category (1–10 TTC/100 mL). Nevertheless, 60.5% of stored drinking water samples were positive for TTC, with 22.2% falling into the medium risk category (11–100 TTC/100 mL).

  • Difficulties in Bringing Point-of-Use Water Treatment to Scale in Rural Guatemala. Stephen P. Luby, Carlos Mendoza, Bruce H. Keswick, Tom M. Chiller, AND R. Mike Hoekstra. Am. J. Trop. Med. Hyg., 78(3), March 2008, pp. 382-387. In an earlier study in rural Guatemala, 257 households that received flocculant-disinfectant to treat their drinking water had 39% less diarrhea than 257 control households. Three weeks after completion of the study, national marketing of the flocculant-disinfectant was extended into the study communities. Six months later, we assessed frequency of and characteristics associated with purchase and use of the flocculant-disinfectant by revisiting the original study households and administering a questionnaire. Four hundred sixty-two households (90%) completed the follow-up survey; 22 households (5%) purchased the flocculant-disinfectant within the preceding 2 weeks and used it within the last week. Neither being randomized to the intervention group during the efficacy study nor combined spending on laundry soap, toothpaste, and hand soap in the preceding week was associated with active repeat use. Even after efficacy was demonstrated within their community and an aggressive sophisticated marketing approach, few households purchased flocculant-disinfectant for point-of-use water treatment.

  • Household water treatment and safe storage: a review of current implementation practices. by D. Lantagne, R. Quick and E. Mintz. IN: Water Stories: Expanding Opportunities in Small-Scale Water and Sanitation Projects, a report by the Wilson Center's Navigating Peace Initiative, examines alternatives to large-scale infrastructure projects in the water and sanitation sectors. Woodrow Wilson Center, August 2007.

USAID Sponsored Activities/Reports

IAP Bibliographic Portal

A. New /Studies

  • Int. J. Environ. Res. Public Health 2007, 4(4), 283-288. Effects of Cooking Fuels on Acute Respiratory Infections in Children in Tanzania (pdf, fulltext) James H. Kilabuko. The findings suggest that to achieve meaningful reduction of ARI prevalence in Tanzania, a shift from the use of biomass fuels, charcoal and kerosene for cooking to clean fuels such as gas and electricity may be essential. Further studies, however, are needed for concrete policy recommendation.

  • Environmental Health Perspectives, Articles in Press. Comparison of Particulate Matter from Biomass-Burning Rural and Non-Biomass Burning Urban Households in Northeastern China (pdf, full-text). Ruoting Jiang and Michelle L. Bell. Findings indicate that biomass burning for cooking contributes substantially to indoor particulate levels, and that this exposure is particularly elevated for cooks. Second-by-second personal PM2.5 exposures revealed differences in exposures by population group and strong temporal heterogeneity that would be obscured by aggregate metrics.

  • Environmental Health Perspectives Volume 116, Number 4, April 2008. Prenatal Exposure to Wood Fuel Smoke and Low Birth Weight (pdf, full-text). Amna R. Siddiqui, et al. Conclusion: Cooking with wood fuel during pregnancy, a potentially modifiable exposure, was associated with LBW and marginally lower mean birth weight compared with using NG.

B. Fact Sheets

  • Indoor air pollution and health. WHO, 2005. (html)

C. Bibliographies/Reference

  • WHO - Indoor air pollution and lower respiratory tract infections in children (pdf, 735KB). This publication reports on a symposium and workshop held at the International Society of Environmental Epidemiology, Paris, 4 September 2006. It presents preliminary results of a randomized intervention trial in Guatemala and discusses the implications for policy, advocacy and future research.

  • Improving indoor air quality for poor families: a controlled experiment in Bangladesh. December 2007. by Susmita Dasgupta, Mainul Huq, M Khaliquzzaman, and David Wheeler. (pdf, 1MB)
    This paper reports on an experiment that studied the use of construction materials, space configurations, cooking locations, and household ventilation practices (use of doors and windows) as potentially-important determinants of indoor air pollution. Results from controlled experiments in Bangladesh are analyzed to test whether changes in these determinants can have significant effects on indoor air pollution. Analysis of the data shows, for example, that pollution from the cooking area diffuses into living spaces rapidly and completely.
  • WHO - Indoor air pollution from solid fuels and risk of low birth weight and stillbirth, ( pdf, 657KB). This publication reports on a symposium held at the Annual Conference of the International Society for Environmental Epidemiology (ISEE) in Johannesburg in September 2005. The findings are complemented by a PubMed search of the link between indoor air pollution from solid fuel use and low birth weight and perinatal mortality.

  • Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE).The purpose of study was to better understand the relationship between acute respiratory infections in children and exposure to indoor air pollution.

  • Dasgupta S, Huq M, Khaliquzzaman M, Pandey K, Wheeler D. Indoor air quality for poor families: new evidence from Bangladesh. Indoor Air. 2006 Dec;16(6):426-44. (Abstract)

  • Mishra V, Retherford RD. Does biofuel smoke contribute to anaemia and stunting in early childhood? Int J Epidemiol. 2006 Nov 3 (Abstract)

  • WHO. "Fuel for Life: Household Energy and Health, 2006. The report gives an overview of the health impacts of indoor air pollution from solid fuel use and describes solutions to promote health and development in the context of the household energy challenge.

  • Information on cooking and heating practices - WHO. Increasingly, international household surveys, such as the World Health Survey (WHO), the Multiple Indicator Cluster Survey (UNICEF) and the Demographic and Health Survey (ORCMacro/USAID) collect information on household energy practice.

  • National burden of disease due to indoor air polution - WHO. The national burden of disease due to indoor air pollution from solid fuel use was assessed for the year 2002. In addition to total deaths and disability-adjusted life years (DALYs) due to indoor air pollution, country-by-country estimates are also available for deaths due to acute lower respiratory infections (ALRI) among children as well as chronic obstructive pulmonary disease (COPD) and lung cancer among adults.

  • Kammen, D.; et al. Broad-search annotated bibliography on acute respiratory infections and indoor air pollution (with emphasis on chilren under five in developing countries (pdf, 463KB). Environmental Health Project, December 1998.

  • McCracken, J.; et al. An annotated bibliography on prevention of acute respiratory infections and indoor air pollution (with emphasis on children in developing countries (pdf, 295KB). Environmental Health Project, June 1997.

D. Newsletters

E. Websites

  • Partnership for Clean Indoor Air (PCIA). The mission of PCIA is to improve health, livelihood and quality of life by reducing exposure to air pollution, primarily among women and children, from household energy use.

  • Kirk Smith's Web Site - Kirk R. Smith is Professor of Environmental Health Sciences and holds the Maxwell Endowed Chair in Public Health at the University of California, Berkeley. His research work focuses on environmental and health issues in developing countries, particularly those related to health-damaging and climate-changing air pollution, and includes ongoing field projects in India, China, Nepal, Mexico, and Guatemala.

  • RESPIRE/Guatemala Studies and Information - Professor KIrk Smith's website contains the published journal articles and other information about the RESPIRE projectt.

  • WHO Indoor Air Pollution - WHO's Program on Indoor Air Pollution focuses on: Research and evaluation, Capacity building and Evidence for policy-makers.

  • WHO - Indoor Air Pollution and Household Energy - The directory provides links to web-accessible resources in categories of relevance to policymaking.

USAID Sanitation Consultation, June 19-20, 2008

In response to the challenge of the International Year of Sanitation and the UN’s MillenniumDevelopment Goal for access to sanitation, USAID seeks to develop an agency-wide strategic approach to community and household sanitation in urban and rural settings. Courtest of WEDC, woman standing by latrine i Ghana

As part of this effort, USAID is organizing a Sanitation Consultation to provide a forum where a select group of international public health practitioners, water and sanitation specialists, donor representatives, and USAID decision - makers can help to inform anticipated increases in USAID programming and contributions to international sanitation activities.

This consultation will support USAID in developing consensus and an action plan for stronger, more coherent health-focused programming in sanitation (defined here as handling and disposal of human feces).  

Participation in this event is by invitation only.

Location: Academy for Educational Development, 1825 Connecticut Ave., NW, Washington, DC

USAID/USG Documents Related to Water and Sanitation

USAID Water, Sanitation, Hygiene and Environmental Health Websites

Additional Water and Sanitation Resources

Urban Health Information Resources

Urban Health Contact

  • Contact Anthony Kolb, USAID Urban Health Advisor, if you have questions or information to share on urban health issues.

Urban Health Bulletins - Bimonthly bibliographies of published urban health studies

Urban Health News

USAID Environmental Health Project - Urban Health Reports

USAID Urban Health Links

  • Concern Worldwide/Clinton Global Initiative (CGI)
    Following CGI’s 2006 Annual Meeting, Concern Worldwide created the “Urban Health for the Poor in Bangladesh and Haiti” commitment. Concern: Bangladesh-A Model for Urban Health established priority interventions targeted at the major causes of urban maternal and child mortality -- maternal and newborn care, pneumonia case management, nutrition, and diarrheal disease -- using an integrated approach. Concern Haiti strengthens maternal & child Health in five disadvantaged neighbourhoods of the metropolitan area of Port-au-Prince.

  • Making Cities Work - USAID's Urban Programs Team is dedicated to increasing economic prosperity, democracy and security in the world's rapidly growing cities. The Team works across sectors to advance the Agency's Making Cities Work Strategy in (1) City Management and Services, (2) Local Economic Development, and (3) Municipal Finance.

International Organizations

  • IDRC Urban Poverty and Environment (UPE) Program - UPE funds research and activities in developing countries that apply integrated and participatory approaches to reducing environmental burdens on the urban poor and enhancing the use of natural resources for food, water and income security.

  • IDRC EcoHealth - Ecosystem Approaches to Human Health Program Initiative - EcoHealth's urban focus is currently under development and a more substantial link should be available on their site in the coming months.

  • International Society for Urban Health (ISUH) - ISUH is an association of researchers, scholars, and professionals from various disciplines and areas of the world who study the health effects of urban environments and urbanization.

  • WHO Commission on Social Determinants of Health - The Knowledge Network on Urban Settings (KNUS) is focused on synthesizing global knowledge on social determinants of health and urbanization.

  • WHO Healthy Cities Initiative - Launched in 1986, Healthy Cities is now in its fourth phase (2003–2008). Cities currently involved are working on three core themes: healthy ageing, healthy urban planning and health impact assessment. Links to associated regional WHO efforts include: PAHO Healthy Municipalities/Cities, PAHO Sustainable Development and Environmental Health, WHO Collaborating Centre for Urban Health and Alliance for Healthy Cities.

  • World Bank/Urban Health - The goal of this site is to provide multi-sectoral programs and teams links to resources to design, implement and improve urban interventions that will improve health outcomes.

  • HABITAT Water and Sanitation Program -The highest priority for UN-HABITAT's Water and Sanitation program is improving access to safe water and helping provide adequate sanitation to millions of low-income urban dwellers and measuring that impact.

Non-Governmental Organizations (NGOS)


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