Diarrhoeal diseases are a global public health burden, killing 1.8 million people annually. Diarrhoea disproportionately affects children and those in poverty. Most diarrhoeal cases can be prevented through safe drinking water and basic hygiene and sanitation measures, with drinking water interventions having the most impact on reducing diarrhoeal disease. A meta-evaluation of studies assessing a specific household water treatment method, the biosand water filter, was completed. Results from the meta-evaluation illustrated that biosand water filters improve drinking water quality and reduce diarrhoeal disease. However, short follow-up times and inconsistent measures are a concern. Furthermore, there is no generally accepted field method for determining biosand water filter effectiveness that is useable in low-resource communities. This study adds to understanding of biosand water filters.

Aiken, B.A., Stauber, C.E., Ortiz, G.M. and Sobsey, M.D. (2011) ‘An assessment of continued use and health impact of the concrete biosand filter in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 85(2): 309–17 <https://doi.org/10.4269/ajtmh.2011.09-0122>.

Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A. and Bartram, J. (2014) ‘Global assessment of exposure to faecal contamination through drinking water based on a systematic review’, Tropical Medicine & International Health 19: 917–27 <http://dx.doi.org/10.1111/tmi.12334>.

Centre for Affordable Water and Sanitation Technology (CAWST) (2009). Biosand Filter Manual: Design, Construction, Installation, Operation and Maintenance [pdf], Calgary, Canada: CAWST <www.calvin.edu/academic/engineering/senior-design/SeniorDesign09-10/team02/web/Biosand_Manual_English.pdf> [accessed 23 May 2017].

de Aceituno, A.M.F., Stauber, C.E., Walters, A.R., Sanchez, R.E.M. and Sobsey, M.D. (2012) A randomized controlled trial of the plastic-housing biosand filter and its impact on diarrheal disease in Copan, Honduras. The American Journal of Tropical Medicine and Hygiene 86(6): 913–21 <https://doi.org/10.4269/ajtmh.2012.11-0066>.

Duke, W., Nordin, R.N., Baker, D. and Mazumder, A. (2006) ‘The use and performance of Biosand filters in the Artibonite Valley of Haiti: a field study of 107 households’, The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy 6(3): 570.

Earwaker, P. (2006) Evaluation of Household Biosand Filters in Ethiopia, MSc dissertation, Cranfield University, Silsoe Institute of Water and Environment <www.sswm.info/sites/default/files/reference_attachments/EARWAKER%202006%20Evaluation%20of%20Household%20BioSand%20Filters%20in%20Ethiopia.pdf> [accessed 23 May 2017].

Elliot, M.A., Stauber, C.E., Koksal, F., DiGiano, F.A. and Sobsey, M.D. (2008) ‘Reductions of E. coli, echovirus type 12 and bacteriophages in an intermittently operated household-scale slow sand filter’, Water Research 22(10-11): 2662–70 <https://doi.org/10.1016/j.watres.2008.01.016>.

Elliott, M.A., DiGiano, F.A. and Sobsey, M.D. (2011) ‘Virus attenuation by microbial mechanisms during the idle time of a household slow sand filter’, Water Research 45(14): 4092–102 <https://doi.org/10.1016/j.watres.2011.05.008>.

Engell, R.E. and Lim, S.S. (2013) ‘Does clean water matter? An updated meta-analysis of water supply and sanitation interventions and diarrhoeal diseases’, The Lancet 381: S44 <https://doi.org/10.1016/S0140-6736(13)61298-2>.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, The Lancet Infectious Diseases 5(1): 42–52 <https://doi.org/10.1016/S1473-3099(04)01253-8>.

Fiore, M.M., Minnings, K. and Fiore, L.D. (2010) ‘Assessment of biosand filter performance in rural communities in southern coastal Nicaragua: an evaluation of 199 households’, Rural Remote Health 10(1483): 1–8.

Gill, S., Hayes, J. and Coates, S. (2012) Diarrhoea Dialogues: From Policies to Progress. A Call for Urgent Action to Prevent the Biggest Killer of Children in Sub-Saharan Africa [pdf], Teddington, UK: Tearfund; Washington, DC: Path <www.path.org/publications/files/VAC_diarrhoea_dialogues_rpt.pdf> [accessed 23 May 2017].

Guerrant, R.L., Kosek, M., Moore, S., Lorntz, B., Brantley, R. and Lima, A.A. (2002) ‘Magnitude and impact of diarrheal diseases’, Archives of Medical Research 33(4): 351–55 <https://doi.org/10.1016/S0188-4409(02)00379-X>.

Hammond, Cort B. (2015) Low Cost Techniques for Assessing the Quality of Drinking Water from Biosand Filters, Master’s thesis, Washington and Lee University <https://repository.wlu.edu/handle/11021/32174> [accessed 23 May 2017].

Health and Environment Linkages Initiative (HELI) (2014) ‘Vector-borne disease’ [online] <www.who.int/heli/risks/vectors/vector/en/> [accessed 23 May 2017].

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <http://dx.doi.org/10.1021/es9028217>.

Hydraid: A Layman’s Guide to Clean Water (2015) ‘Hydraid biosand household water filters are lightweight and portable’ [online] <www.clean-water-for-laymen.com/household-water-filter.html> [accessed 23 May 2017].

Jenkins, M.W., Tiwari, S.K. and Darby, J. (2011) ‘Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling’, Water Research 45(18): 6227–39 <https://doi.org/10.1016/j.watres.2011.09.022>.

Kanda, A. (2013) ‘Performance of biosand filters in treating source water in post emergency: a case of two rural districts of northern Zimbabwe’, Ozean Journal of Applied Science 6(1): 31–8.

Kennedy, T.J., Anderson, T.A., Hernandez, E.A. and Morse, A.N. (2013) ‘Assessing an intermittently operated household scale slow sand filter paired with household bleach for the removal of endocrine disrupting compounds’, Journal of Environmental Science and Health, Part A 48(7): 753–9 <http://dx.doi.org/10.1080/10934529.2013.744616>.

Klopfenstein, L., Petrasky, L., Winton, V. and Brown, J. (2011) ‘Addressing water quality issues in rural Cameroon with household biosand filters’, International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship 6(1): 64–80 <http://dx.doi.org/10.24908/ijsle.v6i1.3208>.

McKenzie, E.R., Jenkins, M.W., Tiwari, S.S.K., Darby, J., Saenyi, W. and Gichaba, C.M. (2013) ‘In-home performance and variability of biosand filters treating turbid surface and rain water in rural Kenya’, Journal of Water Sanitation and Hygiene for Development 3(2): 189–98 <http://dx.doi.org/10.2166/washdev.2013.050>.

Mangoua-Allali, A.L.C., Coulibaly, L., Ouattara, J.M.P. and Gourene, G. (2012) ‘Implementation of biosand filters in rural area for drinking water production’, African Journal of Food Science 6(24): 574–82 <http://dx.doi.org/10.5897/AJFS12.141>.

Masangwi, S., Ferguson, N., Grimason, A., Morse, T. and Kazembe, L. (2015) ‘The pattern of variation between diarrhea and malaria coexistence with corresponding risk factors in Chikhwawa, Malawi: a bivariate multilevel analysis’, International Journal of Environmental Research and Public Health 12(7): 8526–41 <http://dx.doi.org/10.3390/ijerph120708526>.

O’Reilly, C.E., Jaron, P., Ochieng, B., Nyaguara, A., Tate, J.E., Parsons, M.B., Bopp, C.A., Williams, K.A., Vinjé, J., Blanton, E., Wannemuehler, K.A., Vulule, J., Laserson, K.F., Breiman, R.F., Feikin, D.R., Widdowson, M.A. and Mintz, E. (2012) ‘Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005–2007: a cohort study’, PLoS Medicine 9(7): e1001256 <https://doi.org/10.1371/journal.pmed.1001256>.

Peña, M. and Bacallao, J. (2002) ‘Malnutrition and poverty’, Annual Review of Nutrition 22(1): 241–53 <https://doi.org/10.1146/annurev.nutr.22.120701.141104>.

Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J. and Cairncross, S. (2014) ‘Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries’, Tropical Medicine & International Health 19(8): 894–905 <http://dx.doi.org/10.1111/tmi.12329>.

Samaritan’s Purse (2015) ‘Water, sanitation, and hygiene’ [online] <www.samaritanspurse.org/what-we-do/water/> [accessed 23 May 2017].

Sisson, A.J., Wampler, P.J., Rediske, R.R. and Molla, A.R. (2013) ‘An assessment of long-term biosand filter use and sustainability in the Artibonite Valley near Deschapelles, Haiti’, Journal of Water, Sanitation, and Hygiene for Development 3(1): 51–60 <http://dx.doi.org/10.2166/washdev.2013.092>.

Sobsey, M.D., Stauber, C.E., Casanova, L.M., Brown, J.M. and Elliott, M.A. (2008) ‘Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world’, Environmental Science & Technology 42(12): 4261–7 <http://dx.doi.org/10.1021/es702746n>.

Stauber, C.E., Elliott, M.A., Koksal, F., Ortiz, G.M., DiGiano, F.A. and Sobsey, M.D. (2006) ‘Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions’, Water Science & Technology 54(3): 1–7 <http://dx.doi.org/10.2166/wst.2006.440>.

Stauber, C.E., Ortiz, G.M., Loomis, D.P. and Sobsey, M.D. (2009) ‘A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 80(2): 286–93 <https://doi.org/10.4269/ajtmh.2009.80.286>.

Stauber, C.E., Printy, E.R., McCarty, F.A., Liang, K.R. and Sobsey, M.D. (2011) ‘Cluster randomized controlled trial of the plastic biosand water filter in Cambodia’, Environmental Science & Technology 46(2): 722–8 <http://dx.doi.org/10.1021/es203114q>.

Stauber, C.E., Kominek, B., Liang, K.R., Osman, M.K. and Sobsey, M.D. (2012) ‘Evaluation of the impact of the plastic BioSand filter on health and drinking water quality in rural Tamale, Ghana’, International Journal of Environmental Research and Public Health 9(11): 3806–23 <https://dx.doi.org/10.3390%2Fijerph9113806>.

Tiwari, S.S.K., Schmidt, W.P., Darby, J., Kariuki, Z.G. and Jenkins, M.W. (2009) ‘Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial’, Tropical Medicine & International Health 14(11): 1374–82 <http://dx.doi.org/10.1111/j.1365-3156.2009.02381.x>.

World Health Organization (2011) Disaster Risk Management for Health: Water, Sanitation and Hygiene [pdf] <www.who.int/hac/events/drm_fact_sheet_wash.pdf> [accessed 23 May 2017].

World Health Organization (2013) ‘Diarrhoeal disease’ [online], Fact Sheet <www.who.int/mediacentre/factsheets/fs330/en/> [accessed 23 May 2017].

Aiken, B.A., Stauber, C.E., Ortiz, G.M. and Sobsey, M.D. (2011) ‘An assessment of continued use and health impact of the concrete biosand filter in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 85(2): 309–17 <https://doi.org/10.4269/ajtmh.2011.09-0122>.

Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A. and Bartram, J. (2014) ‘Global assessment of exposure to faecal contamination through drinking water based on a systematic review’, Tropical Medicine & International Health 19: 917–27 <http://dx.doi.org/10.1111/tmi.12334>.

Centre for Affordable Water and Sanitation Technology (CAWST) (2009). Biosand Filter Manual: Design, Construction, Installation, Operation and Maintenance [pdf], Calgary, Canada: CAWST <www.calvin.edu/academic/engineering/senior-design/SeniorDesign09-10/team02/web/Biosand_Manual_English.pdf> [accessed 23 May 2017].

de Aceituno, A.M.F., Stauber, C.E., Walters, A.R., Sanchez, R.E.M. and Sobsey, M.D. (2012) A randomized controlled trial of the plastic-housing biosand filter and its impact on diarrheal disease in Copan, Honduras. The American Journal of Tropical Medicine and Hygiene 86(6): 913–21 <https://doi.org/10.4269/ajtmh.2012.11-0066>.

Duke, W., Nordin, R.N., Baker, D. and Mazumder, A. (2006) ‘The use and performance of Biosand filters in the Artibonite Valley of Haiti: a field study of 107 households’, The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy 6(3): 570.

Earwaker, P. (2006) Evaluation of Household Biosand Filters in Ethiopia, MSc dissertation, Cranfield University, Silsoe Institute of Water and Environment <www.sswm.info/sites/default/files/reference_attachments/EARWAKER%202006%20Evaluation%20of%20Household%20BioSand%20Filters%20in%20Ethiopia.pdf> [accessed 23 May 2017].

Elliot, M.A., Stauber, C.E., Koksal, F., DiGiano, F.A. and Sobsey, M.D. (2008) ‘Reductions of E. coli, echovirus type 12 and bacteriophages in an intermittently operated household-scale slow sand filter’, Water Research 22(10-11): 2662–70 <https://doi.org/10.1016/j.watres.2008.01.016>.

Elliott, M.A., DiGiano, F.A. and Sobsey, M.D. (2011) ‘Virus attenuation by microbial mechanisms during the idle time of a household slow sand filter’, Water Research 45(14): 4092–102 <https://doi.org/10.1016/j.watres.2011.05.008>.

Engell, R.E. and Lim, S.S. (2013) ‘Does clean water matter? An updated meta-analysis of water supply and sanitation interventions and diarrhoeal diseases’, The Lancet 381: S44 <https://doi.org/10.1016/S0140-6736(13)61298-2>.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, The Lancet Infectious Diseases 5(1): 42–52 <https://doi.org/10.1016/S1473-3099(04)01253-8>.

Fiore, M.M., Minnings, K. and Fiore, L.D. (2010) ‘Assessment of biosand filter performance in rural communities in southern coastal Nicaragua: an evaluation of 199 households’, Rural Remote Health 10(1483): 1–8.

Gill, S., Hayes, J. and Coates, S. (2012) Diarrhoea Dialogues: From Policies to Progress. A Call for Urgent Action to Prevent the Biggest Killer of Children in Sub-Saharan Africa [pdf], Teddington, UK: Tearfund; Washington, DC: Path <www.path.org/publications/files/VAC_diarrhoea_dialogues_rpt.pdf> [accessed 23 May 2017].

Guerrant, R.L., Kosek, M., Moore, S., Lorntz, B., Brantley, R. and Lima, A.A. (2002) ‘Magnitude and impact of diarrheal diseases’, Archives of Medical Research 33(4): 351–55 <https://doi.org/10.1016/S0188-4409(02)00379-X>.

Hammond, Cort B. (2015) Low Cost Techniques for Assessing the Quality of Drinking Water from Biosand Filters, Master’s thesis, Washington and Lee University <https://repository.wlu.edu/handle/11021/32174> [accessed 23 May 2017].

Health and Environment Linkages Initiative (HELI) (2014) ‘Vector-borne disease’ [online] <www.who.int/heli/risks/vectors/vector/en/> [accessed 23 May 2017].

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <http://dx.doi.org/10.1021/es9028217>.

Hydraid: A Layman’s Guide to Clean Water (2015) ‘Hydraid biosand household water filters are lightweight and portable’ [online] <www.clean-water-for-laymen.com/household-water-filter.html> [accessed 23 May 2017].

Jenkins, M.W., Tiwari, S.K. and Darby, J. (2011) ‘Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling’, Water Research 45(18): 6227–39 <https://doi.org/10.1016/j.watres.2011.09.022>.

Kanda, A. (2013) ‘Performance of biosand filters in treating source water in post emergency: a case of two rural districts of northern Zimbabwe’, Ozean Journal of Applied Science 6(1): 31–8.

Kennedy, T.J., Anderson, T.A., Hernandez, E.A. and Morse, A.N. (2013) ‘Assessing an intermittently operated household scale slow sand filter paired with household bleach for the removal of endocrine disrupting compounds’, Journal of Environmental Science and Health, Part A 48(7): 753–9 <http://dx.doi.org/10.1080/10934529.2013.744616>.

Klopfenstein, L., Petrasky, L., Winton, V. and Brown, J. (2011) ‘Addressing water quality issues in rural Cameroon with household biosand filters’, International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship 6(1): 64–80 <http://dx.doi.org/10.24908/ijsle.v6i1.3208>.

McKenzie, E.R., Jenkins, M.W., Tiwari, S.S.K., Darby, J., Saenyi, W. and Gichaba, C.M. (2013) ‘In-home performance and variability of biosand filters treating turbid surface and rain water in rural Kenya’, Journal of Water Sanitation and Hygiene for Development 3(2): 189–98 <http://dx.doi.org/10.2166/washdev.2013.050>.

Mangoua-Allali, A.L.C., Coulibaly, L., Ouattara, J.M.P. and Gourene, G. (2012) ‘Implementation of biosand filters in rural area for drinking water production’, African Journal of Food Science 6(24): 574–82 <http://dx.doi.org/10.5897/AJFS12.141>.

Masangwi, S., Ferguson, N., Grimason, A., Morse, T. and Kazembe, L. (2015) ‘The pattern of variation between diarrhea and malaria coexistence with corresponding risk factors in Chikhwawa, Malawi: a bivariate multilevel analysis’, International Journal of Environmental Research and Public Health 12(7): 8526–41 <http://dx.doi.org/10.3390/ijerph120708526>.

O’Reilly, C.E., Jaron, P., Ochieng, B., Nyaguara, A., Tate, J.E., Parsons, M.B., Bopp, C.A., Williams, K.A., Vinjé, J., Blanton, E., Wannemuehler, K.A., Vulule, J., Laserson, K.F., Breiman, R.F., Feikin, D.R., Widdowson, M.A. and Mintz, E. (2012) ‘Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005–2007: a cohort study’, PLoS Medicine 9(7): e1001256 <https://doi.org/10.1371/journal.pmed.1001256>.

Peña, M. and Bacallao, J. (2002) ‘Malnutrition and poverty’, Annual Review of Nutrition 22(1): 241–53 <https://doi.org/10.1146/annurev.nutr.22.120701.141104>.

Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J. and Cairncross, S. (2014) ‘Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries’, Tropical Medicine & International Health 19(8): 894–905 <http://dx.doi.org/10.1111/tmi.12329>.

Samaritan’s Purse (2015) ‘Water, sanitation, and hygiene’ [online] <www.samaritanspurse.org/what-we-do/water/> [accessed 23 May 2017].

Sisson, A.J., Wampler, P.J., Rediske, R.R. and Molla, A.R. (2013) ‘An assessment of long-term biosand filter use and sustainability in the Artibonite Valley near Deschapelles, Haiti’, Journal of Water, Sanitation, and Hygiene for Development 3(1): 51–60 <http://dx.doi.org/10.2166/washdev.2013.092>.

Sobsey, M.D., Stauber, C.E., Casanova, L.M., Brown, J.M. and Elliott, M.A. (2008) ‘Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world’, Environmental Science & Technology 42(12): 4261–7 <http://dx.doi.org/10.1021/es702746n>.

Stauber, C.E., Elliott, M.A., Koksal, F., Ortiz, G.M., DiGiano, F.A. and Sobsey, M.D. (2006) ‘Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions’, Water Science & Technology 54(3): 1–7 <http://dx.doi.org/10.2166/wst.2006.440>.

Stauber, C.E., Ortiz, G.M., Loomis, D.P. and Sobsey, M.D. (2009) ‘A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 80(2): 286–93 <https://doi.org/10.4269/ajtmh.2009.80.286>.

Stauber, C.E., Printy, E.R., McCarty, F.A., Liang, K.R. and Sobsey, M.D. (2011) ‘Cluster randomized controlled trial of the plastic biosand water filter in Cambodia’, Environmental Science & Technology 46(2): 722–8 <http://dx.doi.org/10.1021/es203114q>.

Stauber, C.E., Kominek, B., Liang, K.R., Osman, M.K. and Sobsey, M.D. (2012) ‘Evaluation of the impact of the plastic BioSand filter on health and drinking water quality in rural Tamale, Ghana’, International Journal of Environmental Research and Public Health 9(11): 3806–23 <https://dx.doi.org/10.3390%2Fijerph9113806>.

Tiwari, S.S.K., Schmidt, W.P., Darby, J., Kariuki, Z.G. and Jenkins, M.W. (2009) ‘Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial’, Tropical Medicine & International Health 14(11): 1374–82 <http://dx.doi.org/10.1111/j.1365-3156.2009.02381.x>.

World Health Organization (2011) Disaster Risk Management for Health: Water, Sanitation and Hygiene [pdf] <www.who.int/hac/events/drm_fact_sheet_wash.pdf> [accessed 23 May 2017].

World Health Organization (2013) ‘Diarrhoeal disease’ [online], Fact Sheet <www.who.int/mediacentre/factsheets/fs330/en/> [accessed 23 May 2017].

Aiken, B.A., Stauber, C.E., Ortiz, G.M. and Sobsey, M.D. (2011) ‘An assessment of continued use and health impact of the concrete biosand filter in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 85(2): 309–17 <https://doi.org/10.4269/ajtmh.2011.09-0122>.

Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A. and Bartram, J. (2014) ‘Global assessment of exposure to faecal contamination through drinking water based on a systematic review’, Tropical Medicine & International Health 19: 917–27 <http://dx.doi.org/10.1111/tmi.12334>.

Centre for Affordable Water and Sanitation Technology (CAWST) (2009). Biosand Filter Manual: Design, Construction, Installation, Operation and Maintenance [pdf], Calgary, Canada: CAWST <www.calvin.edu/academic/engineering/senior-design/SeniorDesign09-10/team02/web/Biosand_Manual_English.pdf> [accessed 23 May 2017].

de Aceituno, A.M.F., Stauber, C.E., Walters, A.R., Sanchez, R.E.M. and Sobsey, M.D. (2012) A randomized controlled trial of the plastic-housing biosand filter and its impact on diarrheal disease in Copan, Honduras. The American Journal of Tropical Medicine and Hygiene 86(6): 913–21 <https://doi.org/10.4269/ajtmh.2012.11-0066>.

Duke, W., Nordin, R.N., Baker, D. and Mazumder, A. (2006) ‘The use and performance of Biosand filters in the Artibonite Valley of Haiti: a field study of 107 households’, The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy 6(3): 570.

Earwaker, P. (2006) Evaluation of Household Biosand Filters in Ethiopia, MSc dissertation, Cranfield University, Silsoe Institute of Water and Environment <www.sswm.info/sites/default/files/reference_attachments/EARWAKER%202006%20Evaluation%20of%20Household%20BioSand%20Filters%20in%20Ethiopia.pdf> [accessed 23 May 2017].

Elliot, M.A., Stauber, C.E., Koksal, F., DiGiano, F.A. and Sobsey, M.D. (2008) ‘Reductions of E. coli, echovirus type 12 and bacteriophages in an intermittently operated household-scale slow sand filter’, Water Research 22(10-11): 2662–70 <https://doi.org/10.1016/j.watres.2008.01.016>.

Elliott, M.A., DiGiano, F.A. and Sobsey, M.D. (2011) ‘Virus attenuation by microbial mechanisms during the idle time of a household slow sand filter’, Water Research 45(14): 4092–102 <https://doi.org/10.1016/j.watres.2011.05.008>.

Engell, R.E. and Lim, S.S. (2013) ‘Does clean water matter? An updated meta-analysis of water supply and sanitation interventions and diarrhoeal diseases’, The Lancet 381: S44 <https://doi.org/10.1016/S0140-6736(13)61298-2>.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, The Lancet Infectious Diseases 5(1): 42–52 <https://doi.org/10.1016/S1473-3099(04)01253-8>.

Fiore, M.M., Minnings, K. and Fiore, L.D. (2010) ‘Assessment of biosand filter performance in rural communities in southern coastal Nicaragua: an evaluation of 199 households’, Rural Remote Health 10(1483): 1–8.

Gill, S., Hayes, J. and Coates, S. (2012) Diarrhoea Dialogues: From Policies to Progress. A Call for Urgent Action to Prevent the Biggest Killer of Children in Sub-Saharan Africa [pdf], Teddington, UK: Tearfund; Washington, DC: Path <www.path.org/publications/files/VAC_diarrhoea_dialogues_rpt.pdf> [accessed 23 May 2017].

Guerrant, R.L., Kosek, M., Moore, S., Lorntz, B., Brantley, R. and Lima, A.A. (2002) ‘Magnitude and impact of diarrheal diseases’, Archives of Medical Research 33(4): 351–55 <https://doi.org/10.1016/S0188-4409(02)00379-X>.

Hammond, Cort B. (2015) Low Cost Techniques for Assessing the Quality of Drinking Water from Biosand Filters, Master’s thesis, Washington and Lee University <https://repository.wlu.edu/handle/11021/32174> [accessed 23 May 2017].

Health and Environment Linkages Initiative (HELI) (2014) ‘Vector-borne disease’ [online] <www.who.int/heli/risks/vectors/vector/en/> [accessed 23 May 2017].

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <http://dx.doi.org/10.1021/es9028217>.

Hydraid: A Layman’s Guide to Clean Water (2015) ‘Hydraid biosand household water filters are lightweight and portable’ [online] <www.clean-water-for-laymen.com/household-water-filter.html> [accessed 23 May 2017].

Jenkins, M.W., Tiwari, S.K. and Darby, J. (2011) ‘Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling’, Water Research 45(18): 6227–39 <https://doi.org/10.1016/j.watres.2011.09.022>.

Kanda, A. (2013) ‘Performance of biosand filters in treating source water in post emergency: a case of two rural districts of northern Zimbabwe’, Ozean Journal of Applied Science 6(1): 31–8.

Kennedy, T.J., Anderson, T.A., Hernandez, E.A. and Morse, A.N. (2013) ‘Assessing an intermittently operated household scale slow sand filter paired with household bleach for the removal of endocrine disrupting compounds’, Journal of Environmental Science and Health, Part A 48(7): 753–9 <http://dx.doi.org/10.1080/10934529.2013.744616>.

Klopfenstein, L., Petrasky, L., Winton, V. and Brown, J. (2011) ‘Addressing water quality issues in rural Cameroon with household biosand filters’, International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship 6(1): 64–80 <http://dx.doi.org/10.24908/ijsle.v6i1.3208>.

McKenzie, E.R., Jenkins, M.W., Tiwari, S.S.K., Darby, J., Saenyi, W. and Gichaba, C.M. (2013) ‘In-home performance and variability of biosand filters treating turbid surface and rain water in rural Kenya’, Journal of Water Sanitation and Hygiene for Development 3(2): 189–98 <http://dx.doi.org/10.2166/washdev.2013.050>.

Mangoua-Allali, A.L.C., Coulibaly, L., Ouattara, J.M.P. and Gourene, G. (2012) ‘Implementation of biosand filters in rural area for drinking water production’, African Journal of Food Science 6(24): 574–82 <http://dx.doi.org/10.5897/AJFS12.141>.

Masangwi, S., Ferguson, N., Grimason, A., Morse, T. and Kazembe, L. (2015) ‘The pattern of variation between diarrhea and malaria coexistence with corresponding risk factors in Chikhwawa, Malawi: a bivariate multilevel analysis’, International Journal of Environmental Research and Public Health 12(7): 8526–41 <http://dx.doi.org/10.3390/ijerph120708526>.

O’Reilly, C.E., Jaron, P., Ochieng, B., Nyaguara, A., Tate, J.E., Parsons, M.B., Bopp, C.A., Williams, K.A., Vinjé, J., Blanton, E., Wannemuehler, K.A., Vulule, J., Laserson, K.F., Breiman, R.F., Feikin, D.R., Widdowson, M.A. and Mintz, E. (2012) ‘Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005–2007: a cohort study’, PLoS Medicine 9(7): e1001256 <https://doi.org/10.1371/journal.pmed.1001256>.

Peña, M. and Bacallao, J. (2002) ‘Malnutrition and poverty’, Annual Review of Nutrition 22(1): 241–53 <https://doi.org/10.1146/annurev.nutr.22.120701.141104>.

Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J. and Cairncross, S. (2014) ‘Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries’, Tropical Medicine & International Health 19(8): 894–905 <http://dx.doi.org/10.1111/tmi.12329>.

Samaritan’s Purse (2015) ‘Water, sanitation, and hygiene’ [online] <www.samaritanspurse.org/what-we-do/water/> [accessed 23 May 2017].

Sisson, A.J., Wampler, P.J., Rediske, R.R. and Molla, A.R. (2013) ‘An assessment of long-term biosand filter use and sustainability in the Artibonite Valley near Deschapelles, Haiti’, Journal of Water, Sanitation, and Hygiene for Development 3(1): 51–60 <http://dx.doi.org/10.2166/washdev.2013.092>.

Sobsey, M.D., Stauber, C.E., Casanova, L.M., Brown, J.M. and Elliott, M.A. (2008) ‘Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world’, Environmental Science & Technology 42(12): 4261–7 <http://dx.doi.org/10.1021/es702746n>.

Stauber, C.E., Elliott, M.A., Koksal, F., Ortiz, G.M., DiGiano, F.A. and Sobsey, M.D. (2006) ‘Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions’, Water Science & Technology 54(3): 1–7 <http://dx.doi.org/10.2166/wst.2006.440>.

Stauber, C.E., Ortiz, G.M., Loomis, D.P. and Sobsey, M.D. (2009) ‘A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 80(2): 286–93 <https://doi.org/10.4269/ajtmh.2009.80.286>.

Stauber, C.E., Printy, E.R., McCarty, F.A., Liang, K.R. and Sobsey, M.D. (2011) ‘Cluster randomized controlled trial of the plastic biosand water filter in Cambodia’, Environmental Science & Technology 46(2): 722–8 <http://dx.doi.org/10.1021/es203114q>.

Stauber, C.E., Kominek, B., Liang, K.R., Osman, M.K. and Sobsey, M.D. (2012) ‘Evaluation of the impact of the plastic BioSand filter on health and drinking water quality in rural Tamale, Ghana’, International Journal of Environmental Research and Public Health 9(11): 3806–23 <https://dx.doi.org/10.3390%2Fijerph9113806>.

Tiwari, S.S.K., Schmidt, W.P., Darby, J., Kariuki, Z.G. and Jenkins, M.W. (2009) ‘Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial’, Tropical Medicine & International Health 14(11): 1374–82 <http://dx.doi.org/10.1111/j.1365-3156.2009.02381.x>.

World Health Organization (2011) Disaster Risk Management for Health: Water, Sanitation and Hygiene [pdf] <www.who.int/hac/events/drm_fact_sheet_wash.pdf> [accessed 23 May 2017].

World Health Organization (2013) ‘Diarrhoeal disease’ [online], Fact Sheet <www.who.int/mediacentre/factsheets/fs330/en/> [accessed 23 May 2017].

Aiken, B.A., Stauber, C.E., Ortiz, G.M. and Sobsey, M.D. (2011) ‘An assessment of continued use and health impact of the concrete biosand filter in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 85(2): 309–17 <https://doi.org/10.4269/ajtmh.2011.09-0122>.

Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A. and Bartram, J. (2014) ‘Global assessment of exposure to faecal contamination through drinking water based on a systematic review’, Tropical Medicine & International Health 19: 917–27 <http://dx.doi.org/10.1111/tmi.12334>.

Centre for Affordable Water and Sanitation Technology (CAWST) (2009). Biosand Filter Manual: Design, Construction, Installation, Operation and Maintenance [pdf], Calgary, Canada: CAWST <www.calvin.edu/academic/engineering/senior-design/SeniorDesign09-10/team02/web/Biosand_Manual_English.pdf> [accessed 23 May 2017].

de Aceituno, A.M.F., Stauber, C.E., Walters, A.R., Sanchez, R.E.M. and Sobsey, M.D. (2012) A randomized controlled trial of the plastic-housing biosand filter and its impact on diarrheal disease in Copan, Honduras. The American Journal of Tropical Medicine and Hygiene 86(6): 913–21 <https://doi.org/10.4269/ajtmh.2012.11-0066>.

Duke, W., Nordin, R.N., Baker, D. and Mazumder, A. (2006) ‘The use and performance of Biosand filters in the Artibonite Valley of Haiti: a field study of 107 households’, The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy 6(3): 570.

Earwaker, P. (2006) Evaluation of Household Biosand Filters in Ethiopia, MSc dissertation, Cranfield University, Silsoe Institute of Water and Environment <www.sswm.info/sites/default/files/reference_attachments/EARWAKER%202006%20Evaluation%20of%20Household%20BioSand%20Filters%20in%20Ethiopia.pdf> [accessed 23 May 2017].

Elliot, M.A., Stauber, C.E., Koksal, F., DiGiano, F.A. and Sobsey, M.D. (2008) ‘Reductions of E. coli, echovirus type 12 and bacteriophages in an intermittently operated household-scale slow sand filter’, Water Research 22(10-11): 2662–70 <https://doi.org/10.1016/j.watres.2008.01.016>.

Elliott, M.A., DiGiano, F.A. and Sobsey, M.D. (2011) ‘Virus attenuation by microbial mechanisms during the idle time of a household slow sand filter’, Water Research 45(14): 4092–102 <https://doi.org/10.1016/j.watres.2011.05.008>.

Engell, R.E. and Lim, S.S. (2013) ‘Does clean water matter? An updated meta-analysis of water supply and sanitation interventions and diarrhoeal diseases’, The Lancet 381: S44 <https://doi.org/10.1016/S0140-6736(13)61298-2>.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, The Lancet Infectious Diseases 5(1): 42–52 <https://doi.org/10.1016/S1473-3099(04)01253-8>.

Fiore, M.M., Minnings, K. and Fiore, L.D. (2010) ‘Assessment of biosand filter performance in rural communities in southern coastal Nicaragua: an evaluation of 199 households’, Rural Remote Health 10(1483): 1–8.

Gill, S., Hayes, J. and Coates, S. (2012) Diarrhoea Dialogues: From Policies to Progress. A Call for Urgent Action to Prevent the Biggest Killer of Children in Sub-Saharan Africa [pdf], Teddington, UK: Tearfund; Washington, DC: Path <www.path.org/publications/files/VAC_diarrhoea_dialogues_rpt.pdf> [accessed 23 May 2017].

Guerrant, R.L., Kosek, M., Moore, S., Lorntz, B., Brantley, R. and Lima, A.A. (2002) ‘Magnitude and impact of diarrheal diseases’, Archives of Medical Research 33(4): 351–55 <https://doi.org/10.1016/S0188-4409(02)00379-X>.

Hammond, Cort B. (2015) Low Cost Techniques for Assessing the Quality of Drinking Water from Biosand Filters, Master’s thesis, Washington and Lee University <https://repository.wlu.edu/handle/11021/32174> [accessed 23 May 2017].

Health and Environment Linkages Initiative (HELI) (2014) ‘Vector-borne disease’ [online] <www.who.int/heli/risks/vectors/vector/en/> [accessed 23 May 2017].

Hunter, P.R. (2009) ‘Household water treatment in developing countries: comparing different intervention types using meta-regression’, Environmental Science and Technology 43(23): 8991–7 <http://dx.doi.org/10.1021/es9028217>.

Hydraid: A Layman’s Guide to Clean Water (2015) ‘Hydraid biosand household water filters are lightweight and portable’ [online] <www.clean-water-for-laymen.com/household-water-filter.html> [accessed 23 May 2017].

Jenkins, M.W., Tiwari, S.K. and Darby, J. (2011) ‘Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling’, Water Research 45(18): 6227–39 <https://doi.org/10.1016/j.watres.2011.09.022>.

Kanda, A. (2013) ‘Performance of biosand filters in treating source water in post emergency: a case of two rural districts of northern Zimbabwe’, Ozean Journal of Applied Science 6(1): 31–8.

Kennedy, T.J., Anderson, T.A., Hernandez, E.A. and Morse, A.N. (2013) ‘Assessing an intermittently operated household scale slow sand filter paired with household bleach for the removal of endocrine disrupting compounds’, Journal of Environmental Science and Health, Part A 48(7): 753–9 <http://dx.doi.org/10.1080/10934529.2013.744616>.

Klopfenstein, L., Petrasky, L., Winton, V. and Brown, J. (2011) ‘Addressing water quality issues in rural Cameroon with household biosand filters’, International Journal for Service Learning in Engineering, Humanitarian Engineering and Social Entrepreneurship 6(1): 64–80 <http://dx.doi.org/10.24908/ijsle.v6i1.3208>.

McKenzie, E.R., Jenkins, M.W., Tiwari, S.S.K., Darby, J., Saenyi, W. and Gichaba, C.M. (2013) ‘In-home performance and variability of biosand filters treating turbid surface and rain water in rural Kenya’, Journal of Water Sanitation and Hygiene for Development 3(2): 189–98 <http://dx.doi.org/10.2166/washdev.2013.050>.

Mangoua-Allali, A.L.C., Coulibaly, L., Ouattara, J.M.P. and Gourene, G. (2012) ‘Implementation of biosand filters in rural area for drinking water production’, African Journal of Food Science 6(24): 574–82 <http://dx.doi.org/10.5897/AJFS12.141>.

Masangwi, S., Ferguson, N., Grimason, A., Morse, T. and Kazembe, L. (2015) ‘The pattern of variation between diarrhea and malaria coexistence with corresponding risk factors in Chikhwawa, Malawi: a bivariate multilevel analysis’, International Journal of Environmental Research and Public Health 12(7): 8526–41 <http://dx.doi.org/10.3390/ijerph120708526>.

O’Reilly, C.E., Jaron, P., Ochieng, B., Nyaguara, A., Tate, J.E., Parsons, M.B., Bopp, C.A., Williams, K.A., Vinjé, J., Blanton, E., Wannemuehler, K.A., Vulule, J., Laserson, K.F., Breiman, R.F., Feikin, D.R., Widdowson, M.A. and Mintz, E. (2012) ‘Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005–2007: a cohort study’, PLoS Medicine 9(7): e1001256 <https://doi.org/10.1371/journal.pmed.1001256>.

Peña, M. and Bacallao, J. (2002) ‘Malnutrition and poverty’, Annual Review of Nutrition 22(1): 241–53 <https://doi.org/10.1146/annurev.nutr.22.120701.141104>.

Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J.M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A.D., De France, J., Fewtrell, L., Freeman, M.C., Gordon, B., Hunter, P.R., Johnston, R.B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J. and Cairncross, S. (2014) ‘Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries’, Tropical Medicine & International Health 19(8): 894–905 <http://dx.doi.org/10.1111/tmi.12329>.

Samaritan’s Purse (2015) ‘Water, sanitation, and hygiene’ [online] <www.samaritanspurse.org/what-we-do/water/> [accessed 23 May 2017].

Sisson, A.J., Wampler, P.J., Rediske, R.R. and Molla, A.R. (2013) ‘An assessment of long-term biosand filter use and sustainability in the Artibonite Valley near Deschapelles, Haiti’, Journal of Water, Sanitation, and Hygiene for Development 3(1): 51–60 <http://dx.doi.org/10.2166/washdev.2013.092>.

Sobsey, M.D., Stauber, C.E., Casanova, L.M., Brown, J.M. and Elliott, M.A. (2008) ‘Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world’, Environmental Science & Technology 42(12): 4261–7 <http://dx.doi.org/10.1021/es702746n>.

Stauber, C.E., Elliott, M.A., Koksal, F., Ortiz, G.M., DiGiano, F.A. and Sobsey, M.D. (2006) ‘Characterisation of the biosand filter for E. coli reductions from household drinking water under controlled laboratory and field use conditions’, Water Science & Technology 54(3): 1–7 <http://dx.doi.org/10.2166/wst.2006.440>.

Stauber, C.E., Ortiz, G.M., Loomis, D.P. and Sobsey, M.D. (2009) ‘A randomized controlled trial of the concrete biosand filter and its impact on diarrheal disease in Bonao, Dominican Republic’, The American Journal of Tropical Medicine and Hygiene 80(2): 286–93 <https://doi.org/10.4269/ajtmh.2009.80.286>.

Stauber, C.E., Printy, E.R., McCarty, F.A., Liang, K.R. and Sobsey, M.D. (2011) ‘Cluster randomized controlled trial of the plastic biosand water filter in Cambodia’, Environmental Science & Technology 46(2): 722–8 <http://dx.doi.org/10.1021/es203114q>.

Stauber, C.E., Kominek, B., Liang, K.R., Osman, M.K. and Sobsey, M.D. (2012) ‘Evaluation of the impact of the plastic BioSand filter on health and drinking water quality in rural Tamale, Ghana’, International Journal of Environmental Research and Public Health 9(11): 3806–23 <https://dx.doi.org/10.3390%2Fijerph9113806>.

Tiwari, S.S.K., Schmidt, W.P., Darby, J., Kariuki, Z.G. and Jenkins, M.W. (2009) ‘Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial’, Tropical Medicine & International Health 14(11): 1374–82 <http://dx.doi.org/10.1111/j.1365-3156.2009.02381.x>.

World Health Organization (2011) Disaster Risk Management for Health: Water, Sanitation and Hygiene [pdf] <www.who.int/hac/events/drm_fact_sheet_wash.pdf> [accessed 23 May 2017].

World Health Organization (2013) ‘Diarrhoeal disease’ [online], Fact Sheet <www.who.int/mediacentre/factsheets/fs330/en/> [accessed 23 May 2017].