Key Publications

Let the “A” in WASH Stand for Air: Integrating Research and Interventions to Improve Household Air Pollution (HAP) and Water, Sanitation and Hygiene (WaSH) in Low-Income Settings.


We argue that bringing these two areas together would improve the effectiveness and efficiency of interventions to reduce the massive disease burden associated with HAP and poor WaSH, including pneumonia and diarrhea, the leading killers of young children in low-income countries. Research can advance greater coordination of these areas by demonstrating their interactions and wider impacts on well-being as well as the potential for programmatic synergies. Integrated solutions to clean households and communities can benefit from the contribution in multiple disciplines, including economics and policy analysis; business and finance; engineering and technology; lab sciences, environmental health, and biomedical sciences; and behavioral and implementation sciences.

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Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial


We aimed to assess the effectiveness of a rural sanitation intervention, within the context of the Government of India’s Total Sanitation Campaign, to prevent diarrhoea, soil-transmitted helminth infection, and child malnutrition.


We did a cluster-randomised controlled trial between May 20, 2010, and Dec 22, 2013, in 100 rural villages in Odisha, India. Households within villages were eligible if they had a child younger than 4 years or a pregnant woman. Villages were randomly assigned (1:1), with a computer-generated sequence, to undergo latrine promotion and construction or to receive no intervention (control). Randomisation was stratified by administrative block to ensure an equal number of intervention and control villages in each block. Masking of participants was not possible because of the nature of the intervention. However, households were not told explicitly that the purpose of enrolment was to study the effect of a trial intervention, and the surveillance team was different from the intervention team. The primary endpoint was 7-day prevalence of reported diarrhoea in children younger than 5 years. We did intention-to-treat and per-protocol analyses.

Burden Of Disease From Inadequate Water, Sanitation And Hygiene In Low‐And Middle‐Income Settings: A Retrospective Analysis Of Data From 145 Countries


To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low‐ and middle‐income settings and provide an overview of the impact on other diseases.


For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure‐risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability‐adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.

Recent Publications

WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial

M Rahman, S Ashraf, L Unicomb, AKM Mainuddin, SM Parvez, F Begum, …

Trials 19 (1), 360

Collective efficacy: Development and validation of a measurement scale for use in public health and development programmes

M Delea, G Sclar, M Woreta, R Haardörfer, C Nagel, B Caruso, …

International journal of environmental research and public health 15 (10), 2139

Do Sanitation Improvements Reduce Fecal Contamination of Water, Hands, Food, Soil, and Flies? Evidence from a Cluster-Randomized Controlled Trial in Rural Bangladesh

A Ercumen, AJ Pickering, LH Kwong, A Mertens, BF Arnold, …

Environmental science & technology 52 (21), 12089-12097

Effects of single and combined water, sanitation and handwashing interventions on fecal contamination in the domestic environment: a cluster-randomized controlled trial in …

A Ercumen, A Mertens, BF Arnold, J Benjamin-Chung, AE Hubbard, …

Environmental science & technology 52 (21), 12078-12088

Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis

GD Sclar, G Penakalapati, BA Caruso, EA Rehfuess, JV Garn, …

Social Science & Medicine

Measuring progress towards sanitation and hygiene targets: a critical review of monitoring methodologies and technologies

N Turman-Bryant, TF Clasen, K Fankhauser, EA Thomas

Waterlines 37 (3), 229-247

The association between women’s sanitation experiences and mental health: A cross-sectional study in Rural, Odisha India

BA Caruso, HLF Cooper, R Haardörfer, KM Yount, P Routray, B Torondel, …

SSM-Population Health

Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges

D Anderson, E Thomas, T Clasen

Water 10 (6), 744

Health, livelihood, and environmental impacts of the distribution of a carbon-credit-financed, large-scale water filter and improved cookstove programme in Rwanda

C Barstow, T Clasen, M Kirby, E Thomas

The Lancet Planetary Health 2, S31-S32

Effect of precipitation on clinic-diagnosed enteric infections in children in Rwanda: an observational study

M Kirby, C Nagel, C Uejio, P Okull, JA Nsabimana, J Habyarimana, …

The Lancet Planetary Health 2, S14

Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta‐analysis and meta‐regression

J Wolf, PR Hunter, MC Freeman, O Cumming, T Clasen, J Bartram, …

Tropical medicine & international health 23 (5), 508-525

Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial

SP Luby, M Rahman, BF Arnold, L Unicomb, S Ashraf, PJ Winch, …

The Lancet Global Health 6 (3), e302-e315

Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial

C Null, CP Stewart, AJ Pickering, HN Dentz, BF Arnold, CD Arnold, …

The Lancet Global Health 6 (3), e316-e329

Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention

K Steenland, A Pillarisetti, M Kirby, J Peel, M Clark, W Checkley, …

Environment international 111, 71-79

Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhea and child growth in rural Kenya.”

C Null, CP Stewart, AJ Pickering, HN Dentz, BF Arnold, CD Arnold, …

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