# Household Drinking Water Quality Updates

from the WASHplus Project
Updated: 6 min 45 sec ago

### Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality

26 February 2014 11:27 (America/New_York)

Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Intl Health, Feb 2014.

Authors – Lenka Benova, Oliver Cumming and Oona M. R. Campbell

Objective – To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes.

Methods – Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO since 1980.

Results – Fourteen articles were found. Four of ﬁve ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72–5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal
mortality. The only individual-level study looking at the adjusted effect of water showed a signiﬁcant association with maternal mortality (OR = 1.50, 95% CI 1.10–2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality.

Conclusions – There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through
which such associations may operate.

### Evaluation of the Compartment Bag Test for the Detection of Escherichia coli in Water

26 February 2014 8:55 (America/New_York)

Evaluation of the Compartment Bag Test for the Detection of Escherichia coli in Water. J Microbiol Methods. 2014 Feb 21.

Authors: Stauber C, Miller C, Cantrell B, Kroell K

AIMS: Annually, more than 2 million diarrheal disease deaths can be attributed to the lack of access to water, sanitation and hygiene. These deaths occur mostly in developing countries where water quality testing resources are limited. Several tests are currently used to detect and quantify E. coli and other fecal bacteria in drinking water, however they can be expensive, complex, and technically demanding. There is a need for a simple, reliable, low-cost water quality test that can be used in resource limited settings. Therefore, the purpose of this research was to perform a rigorous evaluation of the recently developed compartment bag test for detection and quantification of E. coli against the standard method of membrane filtration.

Methods And Results: A total of 270 water samples were collected from forty-five various naturally contaminated water sources around metro-Atlanta from August 2011 through April 2012. Samples were processed using the compartment bag test and membrane filtration with mI agar. Concentrations of E. coli were significantly correlated with a correlation coefficient of 0.904 (95% CI 0.859 – 0.950). Sensitivity and specificity were 94.9% and 96.6%, respectively.

CONCLUSIONS: These results suggest that the compartment bag test produces results consistent with those produced by membrane filtration on mI agar. Based upon its performance, the compartment bag test has the potential to be used as a reliable, affordable drinking water quality test globally where other microbial water quality testing resources are not readily available, and can be implemented in monitoring activities for microbial water quality to provide reliable and actionable data.

### Impact of Rainfall on Diarrheal Disease Risk Associated with Unimproved Water and Sanitation

26 February 2014 8:41 (America/New_York)

Impact of Rainfall on Diarrheal Disease Risk Associated with Unimproved Water and Sanitation. Am J Trop Med Hyg. 2014 Feb 24.

Bhavnani D, Goldstick JE, Cevallos W, Trueba G, Eisenberg JN.

Diarrheal disease remains a leading cause of morbidity in areas with limited access to safe water and sanitation. As water and sanitation interventions continue to be implemented, it will be important to understand the ecological context in which they can prevent diarrhea. We conducted six serial case control studies in Ecuador to estimate the risk of diarrhea from unimproved water and sanitation and the potential for effect modification by rainfall.

Unimproved water source and unimproved sanitation increased the adjusted odds of diarrhea (odds ratio [OR] = 3.6, 95% confidence interval [95% CI] = 1.7-7.8 and OR = 1.7, 95% CI = 1.2-2.5, respectively). The OR associated with an unimproved water source was highest after maximum rainfall (OR = 6.8, 95% CI = 1.9-24.5), whereas the OR associated with unimproved sanitation was highest after minimal rainfall (OR = 2.9, 95% CI = 1.3-6.6).

Our finding that use of safe water sources and improved sanitation facilities are most protective under opposing rainfall conditions highlights the need for integrated interventions to reduce the burden of diarrheal disease.

### Efficacy of Moringa oleifera leaf powder as a handwashing product

20 February 2014 11:39 (America/New_York)

Efficacy of Moringa oleifera leaf powder as a handwashing product: a crossover controlled study among healthy volunteers. BMC Complementary and Alternative Medicine 2014, 14:57.

Belen Torondel, et al.

Background – 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 this plant leaf as a hand washing product has never been studied. The aim of this study is to test the efficacy of this product using an in vivo design with healthy volunteers.

Methods – The hands of fifteen volunteers were artificially contaminated with Escherichia coli. Moringa oleifera leaf powder was tested as a hand washing product and was compared with reference non-medicated liquid soap using a cross over design following an adaptation of the European Committee for Standardization protocol (EN 1499). In a second part of tests, the efficacy of the established amount of Moringa oleifera leaf powder was compared with an inert powder using the same protocol.

Results – Application of 2 and 3 g of dried Moringa oleifera leaf powder (mean log10-reduction: 2.44 +/- 0.41 and 2.58 +/- 0.34, respectively) was significantly less effective than the reference soap (3.00 +/- 0.27 and 2.99 +/- 0.26, respectively; p < 0.001). Application of the same amounts of Moringa oleifera (2 and 3 g) but using a wet preparation, was also significantly less effective than reference soap (p < 0.003 and p < 0.02, respectively). However there was no significant difference when using 4 g of Moringa oleifera powder in dried or wet preparation (mean log10-reduction: 2.70 +/- 0.27 and 2.91 +/- 0.11, respectively) compared with reference soap (2.91 +/- 0.28). Application of calcium sulphate inert powder was significantly less effective than the 4 g of Moringa oleifera powder (p < 0.01).

Conclusion – Four grams of Moringa oleifera powder in dried and wet application had the same effect as non-medicated soap when used for hand washing. Efficacious and available hand washing products could be useful in developing countries in controlling pathogenic organisms that are transmitted through contaminated hands.

### Household Effectiveness vs. Laboratory Efficacy of Point-of-use Chlorination

20 February 2014 11:34 (America/New_York)

Household Effectiveness vs. Laboratory Efficacy of Point-of-use Chlorination. Water Research, Jan 2014.

Karen Levy, et al.

Highlights

• The effectiveness of chlorine water treatment under household conditions was lower than laboratory efficacy.
• Only 39-51% of stored water was safe for consumption and only 35-53% achieved recommended residual levels of chlorine.
• Chlorine treatment was not protective against diarrhea by WHO standards.
• Point-of-use interventions should take source water conditions such as baseline contamination and turbidity into account.

Treatment of water at the household level offers a promising approach to combat the global burden of diarrheal diseases. In particular, chlorination of drinking water has been a widely promoted strategy due to persistence of residual chlorine after initial treatment. However, the degree to which chlorination can reduce microbial levels in a controlled setting (efficacy) or in a household setting (effectiveness) can vary as a function of chlorine characteristics, source water characteristics, and household conditions. To gain more understanding of these factors, we carried out an observational study within households in rural communities of northern coastal Ecuador. We found that the efficacy of chlorine treatment under controlled conditions was significantly better than its effectiveness when evaluated both by ability to meet microbiological safety standards and by log reductions. Water treated with chlorine achieved levels of microbial contamination considered safe for human consumption after 24 hours of storage in the household only 39 – 51% of the time, depending on chlorine treatment regimen.

Chlorine treatment would not be considered protective against diarrheal disease according to WHO log reduction standards. Factors that explain the observed compromised effectiveness include: source water turbidity, source water baseline contamination levels, and in-home contamination. Water in 38% of the households that had low turbidity source water (< 10 NTU) met the safe water standard as compared with only 17% of the households that had high turbidity source water (> 10 NTU). A 10 MPN/100mL increase in baseline E. coli levels was associated with a 2.2% increase in failure to meet the E. coli standard. Higher mean microbial contamination levels in 54% of household samples in comparison to their matched controls, which is likely the result of in-home contamination during storage. Container characteristics (size of the container mouth) did not influence chlorine effectiveness.

We found no significant differences between chlorine treatment regimens in ability to meet the safe water standards or in overall log reductions, although chlorine dosage did modify the effect of source conditions. These results underscore the importance of measuring both source water and household conditions to determine appropriate chlorine levels, as well as to evaluate the appropriateness of chlorine treatment and other point-of-use water quality improvement interventions.

### Intermittent versus continuous operation of biosand filters

20 February 2014 11:29 (America/New_York)

Intermittent versus continuous operation of biosand filters. Water Research, Feb 2014.

Candice Young-Rojanschi, et al.

Highlights

• Biosand columns were operated either continuously or intermittently.
• Continuous operation of biosand filters is more effective at removing Escherichia coli and MS2.
• E. coli removal occurs during the pause period throughout the filter, up to 20 h.
• Anoxic conditions can occur within the first 10 cm of filter media in intermittenly operated filters.
• Hydraulic conductivity decreased at all media depths over the experimental period.

The biosand filter is a household-scale point-of-use water filtration system based on slow sand filtration, but modified for intermittent operation. Studies on slow sand filters show that intermittent operation reduces filter effectiveness. However, continuous versus intermittent operation of biosand filters has never been compared. Eight 10-cm diameter columns were constructed to represent field biosand filters. Five were operated intermittently with a 24-h residence period, while the remaining three were operated continuously. Continuous operation of the filters resulted in significantly better reduction of Escherichia coli (3.71 log10versus 1.67 log10), bacteriophage MS2 (2.25 log10 versus 0.85 log10), and turbidity (96% versus 87%). Dissolved oxygen levels at 5 and 10 cm of media depth in intermittent filters reached an average of 0 mg/L by 24 h of residence time on day 60 of the experiment. A simple numerical model was developed to describe E. coli removal during ripening from days 0–58 for continuously operated versus intermittent filters. This research confirms that although biosand filters were developed for intermittent operation, the filters perform significantly better when operated continuously. However, both operational modes resulted in a significant reduction of microbial indicators.

### Risk Assessment of the Schmutzdecke of Biosand Filters

20 February 2014 11:26 (America/New_York)

Risk Assessment of the Schmutzdecke of Biosand Filters: Identification of an Opportunistic Pathogen in Schmutzdecke Developed by an Unsafe Water Source. Int. J. Environ. Res. Public Health 2014, 11(2), 2033-2048.

Hyun Gyu Hwang, et al.

The biosand filter (BSF) is widely applied in developing counties as an appropriate technology-based product for supplying “safe” water. Biosand filters exhibit relatively high purifying efficiency because of the schmutzdecke (biofilm) embedded in them. However, schmutzdecke should be cleaned or discarded on a regular basis to maintain the purifying efficiency of the BSF. Due to its role in BSFs, the purifying function of schmutzdecke, rather than its potential risk when not properly discarded, has so far been the primary focus of research. This study aims to provide a risk assessment of schmutzdecke in an attempt to draw attention to a wholly new angle of schmutzdecke usage. We conducted 16S rRNA gene sequencing and phylogenetic analysis to identify opportunistic pathogens in schmutzdecke developed using water from the Hyung-San River. The results reveal that the schmutzdecke derived from this water source contains diverse and relatively high portions of opportunistic pathogen strains; 55% of all isolates collected from schmutzdecke were identified as opportunistic pathogens. Moreover, the diversity of microorganisms is increased in the schmutzdecke compared to its water source in terms of diversity of genus, phylum and opportunistic pathogen strain. As a whole, our study indicates a potential risk associated with schmutzdecke and the necessity of a solid guideline for the after-treatment of discarded schmutzdecke.

### Navigating the WASH sector: a guide for corporate grantmakers

14 February 2014 12:43 (America/New_York)

NAVIGATING THE WATER, SANITATION, AND HYGIENE (WASH) SECTOR: A GUIDE FOR CORPORATE GRANTMAKERS. WASH Advocates, February 2014.

The opportunities for the corporate sector to demonstrate leadership in WASH are widespread and allow for great returns on investment. This guide, developed by WASH Advocates, presents an overview of opportunities for corporations to leverage resources and meet goals effectively.

Key Findings

• WASH programs offer a return of $4 in increased economic productivity and reduced healthcare costs for every$1 invested.
• Tangible benefits for corporations looking to invest in WASH solutions include access to new marketplaces, mitigation of risk, increased brand recognition, and improved employee morale.
• Strategic philanthropy, corporate social responsibility, cause-related marketing, and employee motivation campaigns are among the variety of channels available to corporations for supporting WASH.
• Eleven case studies featured in the guide profile the winning strategies employed by recognized corporate leaders in the sector, including Coca-Cola, Procter & Gamble, and General Electric.
• A number of organizations bring together the public and private sectors to address the WASH challenge, including: WASHfunders.org, WASH Grantmakers Network, CEO Water Mandate, Global Water Challenge, and several water-related trade associations.
• Many corporations are finding success working in partnership with the U.S. Government, particularly the United States Agency for International Development (USAID), which is the largest single donor to WASH programs in the world.

### WASHplus Weekly: Focus on Small Towns

14 February 2014 12:33 (America/New_York)

Issue 134 February 14, 2014 | Focus on WASH and Small Towns

More people now live in urban rather than rural areas. As this traditional balance has changed, a new and significant category of human settlement is emerging—small towns. This issue of the Weekly contains reports and manuals published in 2013 on WASH issues in small towns. Included are a December 2013 report from IRC International Water and Sanitation Center on small town WASH trends and models; country reports from Ghana, Indonesia, and Uganda; and links to a WaterAid website that features a series of videos on WASH issues in small towns.

We welcome your suggestions for future issues of the Weekly; upcoming issues will be on World Water Day 2014, WASH and nutrition, behavior change, CLTS, household water treatment, and menstrual hygiene management.

EVENTS

April 7–9, 2014 Seminar on Monitoring of Decentralised WASH Services in West Africa(Link)
This is a seminar to bring stakeholders from West Africa up to speed with the latest thinking on WASH monitoring, and provide a venue for emphasizing experiences in the field of monitoring WASH services at the municipal level. It will take place in Ouagaoudou, Burkina Faso. IRC International Water and Sanitation Center and PS-Eau organized the event with the political support of ECOWAS and the Government of Burkina Faso.

REVIEWS

Small Town Water Services: Trends, Challenges and Models, 2013. M Adank, IRC.(Link)
This paper presents the main features and explains what constitutes “small towns” to determine the most appropriate water service arrangement for this new phenomenon. Findings of the paper point to challenges in developing a clear typology for small towns and assigning one single model for delivering small town water services. The paper draws examples from different countries and provides compelling evidence that: different models and arrangements have been tested and have worked; there is a growing role for private sector involvement; and there is a need to revisit institutional and regulatory frameworks, as well as funding models, to finance capital maintenance.

Full-Chain Sanitation Services that Last: Non-Sewered Sanitation Services, 2013. J Verhagen. IRC. (Link)
This paper sets out a framework for the delivery of non-sewered sanitation services that last, are accessible to all, and are at scale. The framework identifies four key parameters for sustainable sanitation services: 1) easy and safe access to a sanitary latrine that offers user privacy and operates throughout the year; 2) hygienic use of the latrine (equipped with an accessible hand washing facility) by all, when in and around the house; 3) adequate operation and maintenance and repair and replacement to ensure that the latrine is usable; and 4) safe and final disposal of fecal sludge to ensure environmental protection.

Thinking Beyond the ‘Usual Questions’: Small Towns, 2013. (Video)
Ken Kaplan of Building Partnerships for Development discusses the Small Towns Project with WaterAid and how small towns are different from larger urban and rural areas. One “aha” moment was realizing how far a small town was from a large urban center and how this may force innovation.

Urban Sanitation Review: A Call to Action, 2013. The World Bank. (Link)
This study summarizes the main challenges to scaling up access to sustainable sanitation services in the urban areas of three countries in the East Asia and Pacific region—Indonesia, Philippines, and Vietnam—and proposes the main steps these countries need to take to redress the status quo.

COUNTRY REPORTS

Ghana – Facilitator’s Manual for Small Towns CLTS Field Work, n.d. R Kidd, UNICEF.(Link)
This manual is a guide for field workers who are promoting sanitation improvements at community and household levels, using the community-led total sanitation approach applied to the small towns context.

Ghana – Management Models for the Provision of Small Town and Peri-Urban Water Services in Ghana, 2013. M Adank. (Link)
This document presents a synthesis of the findings of several studies on water services for small towns in Ghana.

Indonesia – Review of Community-Managed Decentralized Wastewater Treatment Systems in Indonesia, 2013. K Eales, Water and Sanitation Program (WSP). (Link)
Community-managed anaerobic decentralized wastewater treatment systems (DEWATS) offer the possibility of relatively swift sanitation improvements in high priority neighborhoods that communities can manage themselves, where local government does not yet provide a full sanitation service. This review explores Indonesia’s experience in implementing community-managed DEWATS on a growing scale.

Kenya – Risk Perception, Choice of Drinking Water, and Water Treatment: Evidence from Kenyan Towns, 2013. J Onjala. (Link)
This study uses household survey data from four Kenyan towns to examine the effect of households’ characteristics and risk perceptions on their decision to treat/filter water as well as their choice of main drinking water source.

Kenya - Water Flows, Energy Demand, and Market Analysis of the Informal Water Sector in Kisumu, Kenya. Ecol EconMar 2013. L Sima. (Link)
This paper presents data gathered from quantitative interviews with informal water business operators in Kisumu, Kenya, collected during the dry season. Sales volume, location, resource use, and cost were analyzed by using material flow accounting and spatial analysis tools. Estimates show that more than 76 percent of the city’s water is consumed by less than 10 percent of the population who have water piped into their dwellings. The remainder of the population relies on a combination of water sources, including water purchased directly from kiosks and delivered by hand-drawn water carts.

Uganda – Private Sector Participation in the Ugandan Water Sector: A Review of 10 Years of Private Management of Small Town Water Systems, 2013. M Hirn, WSP.(Link)
This working paper reviews the first decade (2001-2011) of Uganda’s pioneering private sector participation (PSP) model for small town water supply. The number of towns under the PSP model has steadily risen from only 15 in 2001-2002 to over 90 in 2010-2011 with a combined population of over 1.5 million. In evaluating the impact of this development, this working paper aims to guide further reform within Uganda, and to inform other countries considering similar PSP approaches.

WEBSITES

WaterAid – Small Towns – (Link)
This website contains publications and a series of videos on small town WASH issues.

WASHplus Weeklies will highlight topics such as Urban WASH, Indoor Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at dacampbell@fhi360.org.

### WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers

14 February 2014 12:29 (America/New_York)

WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers, 2013.

Stephanie Ogden, et al.

We intend this manual to serve as a practical guide to WASH practitioners working to implement, support, and sustain WASH interventions at the country level. This manual will equip WASH-implementing organizations with the knowledge they need to target their interventions to NTD-vulnerable communities; to engage in and promote collaborative monitoring for NTD-specific health outcomes; and to communicate the impact of WASH on the NTDs for the purposes of advocacy and policy change.

Why Should WASH Practitioners Care about the Neglected Tropical Diseases?Worldwide, at least one billion people are infected with one or more of the 17 NTDs—and two billion more may be at risk of infection. As diseases of poverty, many NTDs occur in areas with limited access to water and sanitation, and where hygiene practices, household infrastructure and health services are limited.

### The competition for water

14 February 2014 8:07 (America/New_York)

The competition for water | Source/complete article: urb.im for just and inclusive cities

Excerpt: By 2030, the global demand for water will exceed supply by 40 percent. What does this mean for the future of cities and their residents? With ever-increasing competition for clean water among industries, agriculture, and urban populations, cities like Bogotá, Dhaka, Delhi and Rio de Janeiro are implementing much-needed initiatives to improve universal access to water and to protect vital waterways. From a 10,000-person march for river restoration to government subsidies for low-income residents, citizens, NGOs, and government authorities are waking up to the water crisis and taking action. Read on to find out more, and then share your thoughts in the discussion.

### The neglect of hygiene promotion in developing countries

11 February 2014 12:46 (America/New_York)

Journal of Water, Sanitation and Hygiene for Development, In Press, 2014 | doi:10.2166/washdev.2014.119

The neglect of hygiene promotion in developing countries, as shown by the Global Analysis and Assessment of Sanitation and Drinking-Water survey

Authors: Alejandro Jiménez, Sue Cavill and Sandy Cairncross

Technical University of Catalonia (UPC), Barcelona, Spain and Stockholm International Water Institute, Drottninggatan 33. 11151 Stockholm, Sweden E-mail: alejandro.jimenez@siwi.org
GLAAS consultant, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK

Abstract: 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, this is the best picture available of the global status of hygiene promotion in developing countries. Results show the low priority given to hygiene when it comes to implementation. On average, the staff in place meets 40% of the estimated needs to achieve national targets. Countries report that over 60% of their population is reached by hygiene promotion messages, but we estimate that there are barely enough hygiene promoters to reach 10% of the people. Government officials’ greatest concerns are the lack of human resources and funds, but they also point to the absence of strategy, responsible agency and basic coordination and monitoring mechanisms as challenges. This has serious implications for the poor working conditions and low recognition of hundreds of thousands of hygiene promoters, who in most cases are women capable of playing a crucial role for public health. There is an urgent need for further development of capacity for hygiene promotion in developing countries.

### The impact of water and sanitation access on housing values: The case of Dapaong, Togo

11 February 2014 12:40 (America/New_York)

The impact of water and sanitation access on housing values: The case of Dapaong, Togo, 2014,

Johanna CHOUMERT, et al.

The international community has made a commitment that aims to halve, by 2015, the number of people without access to safe drinking water and hygienic sanitation systems. In Togo, the government struggles to provide the population with access to water and sanitation, despite a proactive policy. We argue that a connection to safe water and sanitation increases housing values.

Using collected data from the city of Dapaong, we develop a hedonic price model to capture the relationship between housing values and their characteristics. Our results support the need to accompany any investment in access to water and sanitation with real estate policies, so that the poorest households remain beneficiaries of the pro-poor policies.

### WASH, Environmental Enteropathy, Nutrition, and Early Child Development: Making the Links

11 February 2014 12:35 (America/New_York)

Water, Sanitation, and Hygiene (WASH), Environmental Enteropathy, Nutrition, and Early Child Development: Making the LinksAnnals of the New York Academy of Sciences, Jan 2014.

Authors: Francis M. Ngure, et al.

This study reviews evidence linking WASH, anemia, and child growth, and highlight pathways through which WASH may affect early child development, primarily through inflammation, stunting, and anemia. Environmental enteropathy, a prevalent subclinical condition of the gut, may be a key mediating pathway linking poor hygiene to developmental deficits. Current early child development research and programs lack evidence-based interventions to provide a clean play and infant feeding environment in addition to established priorities of nutrition, stimulation, and child protection. Solutions to this problem will require appropriate behavior change and technologies that are adapted to the social and physical context and conducive to infant play and socialization. The authors propose the concept of baby WASH as an additional component of early childhood development programs.

### Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality

11 February 2014 12:34 (America/New_York)

Trop Med Int Health. 2014 Feb 10. doi: 10.1111/tmi.12275.

Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality.

Authors: Benova L, et al.

OBJECTIVE: To assess whether the lack of water or the lack of sanitation facilities in either the home or in health facilities is associated with an increased risk of maternal mortality and to quantify the effect sizes.

METHODS: Systematic review of published literature in Medline, Embase, Popline and Africa Wide EBSCO 1980.

RESULTS: Fourteen articles were found. Four of five ecological studies that considered sanitation found that poor sanitation was associated with higher maternal mortality. Meta-analysis of adjusted estimates in individual-level studies indicated that women in households with poor sanitation had 3.07 (95% CI 1.72-5.49) higher odds of maternal mortality. Four of six ecological studies assessing water environment found that poor water environment was associated with higher maternal mortality. The only individual-level study looking at the adjusted effect of water showed a significant association with maternal mortality (OR = 1.50, 95% CI 1.10-2.10). Two ecological and one facility-based study found an association between a combined measure of water and sanitation environment and maternal mortality.

CONCLUSIONS: There is evidence of association between sanitation and maternal mortality and between water and maternal mortality. Both associations are of substantial magnitude and are maintained after adjusting for confounders. However, these conclusions are based on a very small number of studies, few of which set out to examine sanitation or water as risk factors, and only some of which adjusted for potential confounders. Nevertheless, there are plausible pathways through which such associations may operate.

### UNICEF – Handwashing Promotion: Monitoring and Evaluation Module

3 February 2014 15:24 (America/New_York)

Handwashing Promotion: Monitoring and Evaluation Module, 2013. UNICEF.

Prepared by Jelena Vujcic, MPH and Pavani K. Ram, MD, University at Buffalo.

This guide will walk you through planning and implementing monitoring and evaluation (M&E) for your handwashing promotion programme. Programmes that promote handwashing are diverse and vary in scope. The content of this module is designed to be adapted to a variety of programmes. In this guide, you will be
introduced to:

• The 7 major steps of monitoring and evaluating handwashing promotion.
• Choosing indicators appropriate to the programme’s objectives.
• Collecting the necessary data, and sample questions for indicators relevant to handwashing advocacy, education and behaviour change.
• Health impact measurement and caveats for the inclusion of health impact assessment as part of an M&E plan.

### The Application of Participatory Research to Optimize a Household Water Treatment Technology

29 January 2014 13:13 (America/New_York)

The Application of Participatory Research to Optimize a Household Water Treatment Technology in a Poor and Marginalized Community of Chennai, India, 2014.

MacDonald, Morgan. University of Guelph.

This research provides an authoritative perspective on the importance of collaborative innovation for the development of sustainable household water treatment and safe storage (HWTS) in Mylai Balaji Nagar, a low-income, peri-urban community in Chennai, India.

The use of HWTS to improve drinking water quality and reduce the burden of diarrhoeal diseases in poor and marginalized communities in the developing world has received considerable attention. However, the technologies proposed by foreign researchers and engineers are often designed without the involvement of local people, and often neglect the cultural heterogeneity of the low income communities they’re intended for. Participatory action research (PAR) encourages a two-way exchange of information that promotes collaborative learning and increases the likelihood of sustainable development. This research employed a PAR framework to promote community control and stimulate local participation in a user-centered approach to HWTS design. Complementary evidence is presented on the importance of appropriate technology that places greater emphasis on the social determinants of user satisfaction.

A twelve month randomized controlled trial of the collaboratively designed HWTS revealed significant reductions of indicator bacteria in intervention household drinking water, with mean log reductions of 1.54 (95\% CI: 1.35 – 1.73) for \emph{E.} coli and 1.92 (95\% CI: 1.76 – 2.08) for total coliforms. Bacterial concentrations in treated water were higher during the monsoon season than the dry season, indicating that water quality may vary according to seasonality in tropical countries with monsoon rains. Additionally, survey data established that households with “high” perceptions of treated water taste, colour, and odour were more than three times more likely to comply with treatment instructions than were households with “very low” perceptions.

### Aquagenx Compartment Bag Test Awarded USAID Pioneers Prize Honorable Mention

29 January 2014 11:11 (America/New_York)

Aquagenx Compartment Bag Test Awarded Prestigious USAID Pioneers Prize Honorable Mention | Source: Aquaenx

The Compartment Bag Test (CBT) is recognized as a major breakthrough in science and technology that delivers an accessible solution that meets the urgent need for ongoing water quality monitoring to help solve the global water crisis.

Chapel Hill, NC, January 22, 2014 – Aquagenx, LLC, a provider of innovative microbial water quality testing products that detect potential health risks, was awarded a USAID Pioneers Prize for its Compartment Bag Test (CBT), a simple, portable water quality test that lets anyone, anywhere quantify fecal bacteria in drinking water without needing electricity, laboratories, refrigeration, technicians or expensive equipment.

USAID selected the Aquagenx CBT for an Honorable Mention award as one of 15 total winners out of nearly 90 entrants in the competition, which is the first-ever USAID Science and Technology Pioneers Prize contest. The purpose of the USAID Pioneers Prize is to seek out new, technologically sophisticated ways of delivering services and achieving development outcomes.

The CBT solves major challenges for bacteriological water quality testing and ongoing monitoring in low resource and disaster settings by enabling onsite testing, eliminating the need to send water samples to a laboratory and wait for lab sample analysis and processing. Testing can be done in the field by anyone with little training, individuals in a household as well as scientists, and is completed in a few steps that generate easy to score, visual, color change results that quantify the amount of E. coli bacteria in a 100 milliliter water sample.

Portable and compact, a CBT Kit is self-contained and includes all supplies needed for 10 tests that fit in a small box, ideal for travel and remote locations. The CBT also includes built-in decontamination.

Dr. Mark D. Sobsey is co-inventor of the CBT and a Keenan Distinguished Professor at the University of North Carolina Gillings School of Global Public Health. He is internationally known for research, teaching and service in environmental health microbiology and virology and in water, sanitation and hygiene, with more than 200 published papers and reports.

“Winning Honorable Mention for the USAID Pioneers Prize is such a great honor and immensely gratifying,” says Sobsey. “My students and I first began researching the need for a better, more convenient to use water quality monitoring product in 2007. One of the most difficult things to test for in terms of water quality is fecal bacteria, and we wanted anyone to be able to open a box and run tests no matter who or where they were. We also knew that we needed to enable anyone to measure the amount of E. coli bacteria in water to know where the biggest health risks are and take action.”

“In its pre-commercial stages,” continues Sobsey, “the CBT was extensively piloted and field tested in Laos, Thailand, Vietnam, Peru and Tanzania, including a Peruvian Demographic and Health Survey in 2011 and the post-disaster recovery response in Haiti in 2012. We launched Aquagenx, LLC in 2012 and the CBT became available commercially in 2013. My colleagues and I want to thank USAID for recognizing our test, which we hope will continue to be used around the world to help provide safe drinking water and eliminate millions of deaths and disease due to water contaminated by fecal bacteria.”

In addition to water quality testing and monitoring in developing countries and disaster settings, the CBT has versatile applications including measuring water quality of private wells, agricultural water and recreational water.

The Aquagenx CBT also received a LAUNCH Water Innovation Prize in 2010. In December 2013, the CBT was approved by the Government of the Philippines Ministry of Health to assist with post-disaster restoration of critical water services following Super Typhoon Haiyan. The test was also featured by USAID on the cover of its 2013 innovations catalog, “The Catalog: Version 1.0.”

Aquagenx provides innovative water quality testing products that detect potential health risks and helps eliminate the millions of annual deaths due to contaminated drinking water. The Compartment Bag Test (CBT) is a portable, simple, microbial water test that addresses the needs of low resource, underserved markets. It has versatile applications for low resource settings and household level testing by individuals, government agencies, NGOs, water utilities and disaster/emergency responders for ongoing water quality monitoring.

Aquagenx and the CBT are the result of groundbreaking research and development led by Dr. Mark D. Sobsey and Dr. Ku McMahan at the University of North Carolina Gillings School of Global Public Health.

### USAID Global Waters, Jan 2014 – Tapping into the Power of Women

29 January 2014 11:07 (America/New_York)

USAID Global Waters, Jan 2014 – Tapping into the Power of Women

Women are half of the world’s population, but their voices too often go unheard. The USAID Water and Development Strategy prioritizes empowering women and promoting gender equality through water programs. We dedicate this edition of Global Waters to these key issues.

Contents

• On the importance of empowering women – The Ripple Effect
• Social entrepreneur Gemma Bulos on the necessity for women’s leadership – Transforming Traditional Roles
• Empowering women to improve their communities – Bridging the Gender Gap
• A stronger role for women in Senegal’s fisheries – Integrating Gender Into Our Work
• A conversation with Gender Equality and Women’s Empowerment Director Vikki Stein
• Currents

### An open faucet

28 January 2014 14:39 (America/New_York)

An open faucet | Source/complete article: Frank Bergh, Contributing Editor, Engineering for Change News, Jan 4, 2014.

Excerpts – High in the mountains of El Salvador in Central America there is a village called Solemán. This outcropping of only 20 houses is small, but it offers a profound example of the technical humanitarian challenges of the future.

….

At night, when electricity is cheapest, Solemán runs the pump until the tank is full. Each morning at 6:00 a.m. someone opens the valves to allow water to flow to each household’s faucet tap. Invariably the tank is empty by 6:30 a.m. At first I was surprised to see that these families consumed thousands of gallons of water in only 30 minutes, but then I was told that most households don’t use their share of the water even over the course of 48 hours. It’s just that no one had ever turned off their faucet.

The author, Frank Bergh (left), surveys for a water distribution system in the Salvadoran village Mariñon, which neighbors Solemán. Photo by Andrea Heugatter

Each family’s faucet pours their morning water supply into a pila. When I asked one woman in Solemán, Mama Hilda, why she never closed her water faucet, she replied that the neighbors would not close theirs, so her family would be the only one without water. Without any assurance of the neighbors’ behavior, no household dared to shut off its faucet. Regardless of the sophistication of their water distribution system, these people had each chosen to forego the benefits of running water simply out of mutual distrust.

I visited Solemán in May 2006 with a team of Engineers Without Borders-USA as we surveyed the land to prepare for the design of an analogous system in the village of Mariñon. This story and the image of an open faucet is so vivid to me, because I believe it is emblematic of the challenges to be faced in the fight against poverty around the world.

The spirit of the village of Solemán, that they rallied together to build the tank and lay the pipe side-by-side with neighbors, gives me so much hope. However, their urge to stockpile the water rather than share it reminds me that collectively, we still have a long way to go. The technical know-how for a brighter and more peaceful future is available today. So much of the injustice and strife in our world is only a matter of inadequate distribution. Whether the problem is wealth versus poverty, surrounded versus lonely, oppressor versus oppressed, obesity versus hunger, farmstead versus slum… all stem from a tendency to accumulate rather than distribute.