Water, Sanitation And Hygiene Programming Research Articles

Prevalence of diarrheal diseases among schools with and without water, sanitation and hygiene programs in rural communities of north-eastern Ethiopia: a comparative cross-sectional study.

Diarrheal diseases are a significant cause of morbidity among school-aged children due to inadequate sanitation, lack of access to potable water and poor hygiene practices. Although the incidence of these illnesses can be reduced through improved water quality and the introduction of sanitation and hygiene programs in schools, there is limited evidence to demonstrate the impact of interventions in schools in Ethiopia. The purpose of this study was to compare the prevalence and associated factors of diarrheal diseases in school-aged children between schools in Habru District, north-eastern Ethiopia that adopted water, sanitation and hygiene (WASH) interventions and those that did not. A comparative cross-sectional study was conducted among 640 randomly selected school children (160 from schools that adopted WASH interventions and 480 from schools that did not). Trained data collectors used a pre-tested structured questionnaire and an observational checklist to collect the data. Descriptive statistics, such as frequencies and percentages, were computed to present the prevalence of diarrheal disease. Bivariate and multivariate logistic regression analyses were used to identify factors associated with diarrheal disease. The overall 2-week prevalence of diarrhea among school children was 30.5%. In WASH-implementing schools, the prevalence was 21.9%, significantly lower than in non-WASH-implementing schools (33.3%). In non-WASH-implementing schools, the odds of diarrheal diseases among students were significantly decreased in those students who used a clean school latrine, self-reported latrine utilization at home and were aware of the causes of diarrhea. Similarly, among students in WASH-implementing schools, self-reported latrine utilization at home, personal hygiene inspection and awareness of the causes of diarrhea were factors associated with decreasing odds of diarrhea occurrence. This study identified a high prevalence of a diarrheal disease among children in schools with no WASH interventions compared with schools that do have WASH interventions. This provides strong evidence for strengthening WASH programs in all rural schools to reduce the burden of diarrheal diseases.

Use of group maturity index to measure growth, performance, and sustainability of community health clubs in urban water, sanitation and hygiene (WASH) program in Zimbabwe

Abstract Zimbabwe experienced an unprecedented cholera outbreak in 2008 and 2009. Reduced access to water, sanitation and hygiene, delayed community health education, and limited knowledge on cholera prevention were the major risk factors of this outbreak which were addressed by urban WASH interventions. Health and hygiene promotion through community health clubs (CHCs) is a cost-effective strategy to reduce the risk of cholera. In 2013, UNICEF Zimbabwe launched the Small Towns WASH Program (STWP) and used the CHC approach for hygiene promotion. To monitor the growth, performance, and sustainability of CHCs, STWP employed the Group Maturity Index, which measures the status of CHCs in five domains: objectives, governance, resources, group systems, and impacts. This study described the maturity status of CHCs as measured by GMI as a new monitoring tool and assessed if CHCs’ performances in GMI's output domains are associated with the impact domain. The results suggested that over 75% of CHCs had reached the managed stage or the mature stage by 2018. Three of the GMI's output domains were independently associated with the overall impact domain after controlling for potential confounders. CHCs and club members may experience overall positive impacts by developing their governance, resource, and group system domains.

WASH and Gender: a critical review of the literature and implications for gender-transformative WASH research

Abstract The connections between gender and water, sanitation, and hygiene (WASH) are profound, and the sector is beginning to explore the integration of gender-transformative principles into WASH programming and research. Gender-transformative approaches challenge inequalities and move beyond an instrumentalist approach to gender in development interventions. Through a critical review of academic empirical studies, this paper explores the last decade of WASH-gender literature (2008–2018). Trends were visualised using an alluvial diagram. The reviewed literature was underpinned by a diversity of disciplines, yet was dominated by women-focused, water-focused studies. Although the studies addressed many important gender considerations, few studies engaged with transformational aspects of gender equality. The majority of the studies were based in rural sub-Saharan Africa and South Asia, indicating opportunity to explore contextual dynamics in other areas of the global south. Lastly, the studies primarily focus on women of productive age; only a few studies touched on gender dynamics relevant for a diversity of women, and men and boys were mostly absent. Insights from this analysis can inform future studies at the intersection of WASH and gender. Researchers and practitioners are encouraged to include a diversity of voices, reflect on the strengths and limitations of research disciplines, and incorporate gender-transformative concepts.

Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster‐randomised controlled trial of the CHoBI7 mobile health program

The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members. A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The 'Standard Message' Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The 'Health Facility Visit+Soapy Water' Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The 'Health Facility Visit+Handwashing Station' Arm received this same intervention plus a small plastic handwashing station. Within 24h of intervention delivery, three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members. Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit+Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14). These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.

A call to action: organizational, professional, and personal change for gender transformative WASH programming

The Sustainable Development Goals (SDGs) and targets aimed at improving access to water, sanitation, and hygiene (WASH) are also an opportunity for the transformation of gender norms. To facilitate this transformation, this paper makes a call to action for global and national efforts for organizational, professional, and personal change. Several NGOs are leading a process towards a more reflective and transformative approach. This paper presents a number of examples – from headquarters, and others from country offices and research institutes – of the changes under way to support a stronger connection between the ‘outer faces’ of WASH professionals in the sector and the individual, personal inner spaces. The paper concludes with a set of recommendations for personal and organizational change.

Sustainable Conflict Resolution through Community Based Water, Sanitation and Hygiene (WASH) Planning in Fragile and Conflict Situations: The Case of Somalia

The study examines the nature of disputes, which are prevalent in water, sanitation and hygiene (WASH) programming and suggests possible conflict management and resolution mechanisms. An online web-based survey, hosted on the popular Survey Monkey platform, was conducted through the Somalia WASH Cluster to 40 ‘active’ member organisations. A response rate of 73% was achieved. Thematic analysis was conducted using NVivo 12. The type of conflicts identified are as follows: visible versus non-visible benefits, emergency versus development focus, the young and the old, insiders versus outsiders, local versus donor priorities and men versus women. The article goes on to suggest possible conflict resolution mechanisms, which include: planning together with communities, continuum programming, setting up early warning systems, harmonisation of institutions managing WASH resources and the development of localised Memorandums of Understanding. It is recommended that the complexities of conflict and fragility require different approaches. The approaches would apply to both relief and developmental WASH programming.

Does payment by results work? Lessons from a multi-country WASH programme

Abstract Payment by results (PbR) for financing public services has attracted increasing interest over recent years in the water, sanitation, and hygiene (WASH) sector. PbR is attractive to funders as a mechanism because it focuses attention on results rather than inputs, and because it transfers a proportion of risk to suppliers. This paper reviews the experience of the UK Department for International Development (DFID) funded WASH Results Programme (WRP), which used PbR, drawing on a process evaluation and the experience of the first author in commissioning the programme, and the second author in evaluating it. The WRP met its targets for people reached with first-time access to water and sanitation and generated high-quality programme data. The PbR mechanism provided strong incentives to the suppliers to improve their monitoring systems. However, the suppliers tended to use tried and tested approaches, with limited innovation. It is critical to consider certain key elements in the design of PbR programmes, including the proportion of funding that uses PbR and the proportions of PbR that focuses on outputs and outcomes.

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention-A Randomised before and after Trial.

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene intervention (food hygiene + handwashing) relative to a food hygiene and water, sanitation and hygiene (WASH) intervention (food hygiene + handwashing + faeces management + water management). The 31-week intervention was delivered by community-based coordinators through community events (n = 2), cluster group meetings (n = 17) and household visits (n = 14). Diarrhoeal disease was self-reported and measured through an end line survey, and daily diaries completed by caregivers. Difference-in-differences results show a 13-percentage point reduction in self-reported diarrhoea compared to the control group. There were also significant increases in the presence of proxy measures in each of the treatment groups (e.g., the presence of soap). We conclude that food hygiene interventions (including hand washing with soap) can significantly reduce diarrhoeal disease prevalence in children under five years in a low-income setting. Therefore, the promotion of food hygiene practices using a behaviour-centred approach should be embedded in nutrition and WASH policies and programming.

UNICEF and the WASH: Analisis Terhadap Peran UNICEF Dalam Mengatasi Masalah Ketersediaan Air Bersih di India

The Sustainable Development Goals (SDGs) are a blueprint for sustainable global development for equitable growth and prosperity between countries. One indicator of equitable growth is the achievement of adequate access to drinking water, sanitation and hygiene and stopping open defecation (BABS) activities. But the difficulty of access to clean water sources and good sanitation facilities is still an urgent problem in India. More than 50% of the water has been polluted and cannot be consumed. The World Health Organization (WHO) estimates that 97 million Indians do not have access to clean water and proper sanitation. This is caused by various factors, among others, first the habits of the people (culture) who conduct BABS activities. Second, lack of education and human awareness of environmental cleanliness. And the third is the lack of public toilet facilities provided by the government. These problems have a major impact on the health of local communities such as diarrhea and pneumonia. Efforts by the Indian government to solve these problems have yet to produce a significant impact. So that the United Nations (UN) opened an open working group to formulate proposals related to global development planning on clean water and sanitation supported by UNICEF through the WASH (Water, Sanitation, and Hygiene) Program. The implementation of this program is aimed at overcoming the impact of problems that give special focus to children. This research will further examine the role of UNICEF in overcoming sanitation problems in India through the WASH Program. The method used in this study uses qualitative methods to explain systematically and factually. This study uses the theory of the Role of International Organizations. This theory is used to explain and emphasize UNICEF in carrying out its roles based on the values ​​set by international organizations.

Development of an e‐learning course to disseminate guidelines for effective promotion of Water, Sanitation and Hygiene (WASH) initiatives in Cambodia

ABSTRACTAn estimated 8 million people in the Kingdom of Cambodia live without access to improved water supply, sanitation, and hygiene (WASH; WHO/UNICEF, Joint monitoring program for water supply and sanitation, 2015). To increase access to WASH in rural areas, Cambodia's Ministry for Rural Development has sought to decentralize the administration of national WASH programs and implement program management at the subnational level. Working at the Center for Sustainable Water in Phnom Penh, the aim of the research was to assess whether an e‐learning platform might be utilized to facilitate the transfer of knowledge of WASH from governmental staff based in the capital to those working in the provinces. A desktop literature review revealed that the success of an e‐learning module is largely predicated on the extent to which the needs and limitations of the target audience are understood. In order to ascertain those needs and limitations in the Cambodian context, technical resource assessments and interviews were carried out at government offices in the provinces of Kampong Cham, Kratié, and Ratanakiri. Those provinces were selected on the basis that each broadly represented a distinct “zone” in terms of current capacity to carry out Rural Water Supply, Sanitation and Hygiene (RWSSH) initiatives, population size, relative poverty indices, and concentration of RWSSH partner organizations at the district level. An analysis of the qualitative data gathered from interviews in the field demonstrated that attitudes to an e‐learning program were overwhelmingly positive, on the proviso that any such program was tailored to the educational and professional background of its intended participants. Moreover, even offices in the most remote and resource‐limited province of Ratanakiri had the necessary infrastructure to support the use of e‐learning, provided that local hardware and software limitations were kept in mind. Results from the literature review, field interviews, and technical resource assessment informed the adaptation of an existing paper‐based National WASH guideline into an e‐learning format. Through a process of consultation with the Ministry of Rural Development, WaterAid Cambodia and the Institute of Technology of Cambodia, and collaboration with project staff at the Center for Sustainable Water, the contents of the ‘National Guidelines on WASH for Persons with Disabilities and Older People’ were synthesized into both an English‐language and Khmer‐language e‐learning course. Center for Sustainable Water has since obtained funding from WaterAid Cambodia to deliver the pilot e‐learning module in the provinces, a process which will undoubtedly pave the way for further improvements.

Using structural equation modelling to untangle sanitation, water and hygiene pathways for intervention improvements in height-for-age in children

BackgroundDespite a strong theoretical rationale for combining water, sanitation and hygiene (WaSH) interventions to improve child health, study findings are heterogeneous with little understanding of the mechanisms for these effects. Our study objective was to demonstrate the utility of structural equation modeling (SEM) to assess intervention effects on height-for-age z score (HAZ) through the complex system of WaSH pathways.MethodsWe used data from a matched cohort effectiveness evaluation of a combined on-premise piped water and improved sanitation intervention in rural Odisha, India. Height/length was measured in children 0–59 months old (n = 1826) from 90 matched villages in February–June 2016. WaSH behaviours and infrastructure were assessed through household surveys and observation, respectively. We used SEM to calculate the standardized path coefficients and the total contributions of WaSH pathways to HAZ.ResultsIntervention improvements on HAZ were through the sanitation pathway (coverage → use β: 0.722; use → HAZ β: 0.116), with piped water coverage indirectly affecting HAZ through improved sanitation use (β: 0.148). Although the intervention had a positive association with handwashing station coverage, there was no evidence of a total hygiene pathway effect on HAZ or further direct effects through the water pathways.ConclusionsThis study demonstrates the utility of SEM to assess the mechanisms through which combined WaSH interventions impact HAZ as a system of pathways, providing a more nuanced assessment than estimation of the total intervention effect. Our finding, that water impacts HAZ through the sanitation pathway, is an important and actionable insight for WaSH programming.

A framework for targeting water, sanitation and hygiene interventions in pastoralist populations in the Afar region of Ethiopia.

Globally, many populations face structural and environmental barriers to access safe water, sanitation and hygiene (WASH) services. Among these populations are many of the 200 million pastoralists whose livelihood patterns and extreme environmental settings challenge conventional WASH programming approaches. In this paper, we studied the Afar pastoralists in Ethiopia to identify WASH interventions that can mostly alleviate public health risks, within the population's structural and environmental living constraints. Surveys were carried out with 148 individuals and observational assessments made in 12 households as part of a Pastoralist Community WASH Risk Assessment. The results show that low levels of access to infrastructure are further compounded by risky behaviours related to water containment, storage and transportation. Additional behavioural risk factors were identified related to sanitation, hygiene and animal husbandry. The Pastoralist Community WASH Risk Assessment visually interprets the seriousness of the risks against the difficulty of addressing the problem. The assessment recommends interventions on household behaviours, environmental cleanliness, water storage, treatment and hand hygiene via small-scale educational interventions. The framework provides an approach for assessing risks in other marginal populations that are poorly understood and served through conventional approaches.

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Design of a parallel cluster-randomized trial assessing the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia: Andilaye study protocol

BackgroundUnimproved water, sanitation, and hygiene (WASH) behaviors are key drivers of infectious disease transmission and influencers of mental well-being. While WASH is seen as a critical enabler of health, important knowledge gaps related to the content and delivery of effective, holistic WASH programming exist. Corresponding impacts of WASH on mental well-being are also underexplored. There is a need for more robust implementation research that yields information regarding whether and how community-based, demand-side interventions facilitate progressive and sustained adoption of improved sanitation and hygiene behaviors and downstream health impacts. The purpose of this protocol is to detail the rationale and design of a cluster-randomized trial evaluating the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia.MethodsTogether with partners, we developed a theoretically-informed, evidence-based behavioral intervention called Andilaye. We randomly selected and assigned 50 sub-districts (kebeles) from three purposively selected districts (woredas); half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). During baseline, midline, and endline, we will collect data on an array of behavioral factors, potential moderators (e.g., water and sanitation insecurity, collective efficacy), and our primary study outcomes: sanitation and hygiene behaviors and mental well-being. We will perform a process evaluation to assess intervention fidelity and related attributes.DiscussionWhile CLTSH has fostered sanitation and hygiene improvements in Ethiopia, evidence of behavioral slippage, or regression to unimproved practices in communities previously declared open defecation free exists. Other limitations of CLTSH, such as its focus on disgust, poor triggering, and over-saturation of Health Extension Workers have been documented. We employed rigorous formative research and practically applied social and behavioral theory to develop Andilaye, a scalable intervention designed to address these issues and complement existing service delivery within Ethiopia’s Health Extension Program. Evidence from this trial may help address knowledge gaps related to scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond.Trial registrationThis trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017.

Water risk perceptions across the life-course of women in Kenya.

Inadequate access to water, sanitation and hygiene (WaSH) exposes many vulnerable populations, especially women and girls, to preventable diseases around the world. This paper reports findings from a photovoice project that explored water-related risk perceptions and health outcomes among women in Nyanchwa, Kenya. Thirteen women in four age categories were recruited for this study in July 2016 using the 'snowball' technique. From the results, inadequate access to WaSH was associated with increased water collection burden on women and children; environmental pollution; poor educational outcomes; loss of time due to water collection and poor sanitation infrastructure. Some barriers to change identified include financial barriers and inadequate government support. The identified risks and barriers are important considerations for the design, evaluation and mainstreaming of WaSH programs in resource constrained settings.

Urban and rural sanitation in the Solomon Islands: How resilient are these to extreme weather events?

The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 (“by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation”). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative cross-sectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders.

Post-disaster recovery in the cyclone Aila affected coastline of Bangladesh: women’s role, challenges and opportunities

The present study deals with the gender aspects of water, sanitation and hygiene (WaSH) situation in post-cyclone Aila period in Bangladesh. Data were collected using participatory approaches like individual interview, key informant interview, focus group discussion and field level observation. Study reveals that after Aila, women had to travel 500 m–2 km per day to fetch water from safe water sources spending 30–90 min. People used pit and hanging latrines, uncovered water framed latrines as well as had open defecation. Considering the impromptu needs, government and other aid-giving agencies focused on immediate WaSH programme. The paper is an outcome of a critical assessment of those arduous efforts made to overcome the WaSH challenges after Aila, particularly women’s role in and challenges faced by them to improving the situation. Also attempt has been made to examine the opportunities and challenges of sustainability of WaSH programme pursued in the post-disaster period. For recovery of the WaSH system, a two-part strategy was followed where one was to make technology (tubewell, pond and filter, saline purification and rainwater harvesting plants) that supporting social arrangement and another was social arrangement (group formation, capacity building on construction, operation and maintenance) that supporting technology. A techno-social contingent model has been followed for addressing the post-disaster WaSH situation following a WasH approach. Women’s these roles in meeting the households’ WaSH requirements might be called WaSH-feminism. The main finding is that although there was a technical challenge to overcome the water and sanitation crises, after the disaster a set of appropriate technologies could remove it considerably, but a corresponding social arrangement was required there to operate it. Many kinds of technical and social limiting factors were there for women that could be removed partly but not totally.

Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact.

Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students’ households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported ‘output’ and/or ‘exposure’ of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.

WASH for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections.

Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.

Target segmentation in WASH policies, programmes and projects: a systematic review

ABSTRACT Despite several years of concentrated efforts to provide safe and improved water, sanitation and hygiene (WASH) facilities, progress towards universal access to WASH has been uneven. The problem is more acute in developing countries. Identification of target segments and proper understanding of barriers faced by these segments would have an important role to play in achieving universal access to WASH facilities. There are multiple ways of segmenting WASH beneficiaries: The conventional approach has been through geographical and social segmentation (such as urban, rural, poor and so on), however there is increasing advocacy for a life-cycle based approach that targets beneficiaries based on their gender, age and so on. This systematic review compares the trends in Life-Cycle Segmentation (LCS) vis-a-vis the Geographic and Social Segmentation (GSS) with the hypothesis that such an understanding would be helpful in achieving universal access to WASH. Drawing on policies, programmes and projects from 11 countries in Southern Asia and sub-Saharan Africa, it was found that in general, GSS has been the dominant approach to targeting population in WASH policy making and programming, though there were variations across regions and sectors. Incorporation of LCS would complement the GSS in improving effectiveness and equity of access to WASH interventions.