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(Journal Article) Are ceramic water filters effective in preventing diarrhoea and acute malnutrition among under-five children in Sudan?
01.07.2020
Access to safe drinking-water at home is essential during the outpatient treatment of children with acute malnutrition due to their increased vulnerability to infections and disease. The study aimed to evaluate the effectiveness of ceramic water filters with safe storage in preventing diarrhoea and acute malnutrition among under-five children in Kassala state, Sudan. It was designed as an open-label randomized controlled trial, comparing two study groups. Data was collected through face-to-face interviews and direct observations, then processed and analysed using Epi Info 7.2.0.1. Use of water filters is a potential predictor of number of diarrhoea episodes per child (P < 0.001). The intervention group had a lower diarrhoea occurrence (P < 0.001), better monthly average weight gain (P = 0.012) and average mid-upper arm circumference increase (P = 0.001), and lower prevalence of acute malnutrition at the end of the study (P = 0.001) compared with the control group. Ceramic water filters with safe storage can be effective in preventing diarrhoea and acute malnutrition, and beneficial to children admitted to Community Management of Acute Malnutrition programmes in Kassala state. More research is needed to understand the pathways to achieving these outcomes. Other WASH interventions may be needed to interrupt the primary vectors of diarrhoea disease transmission in this setting. -
(Journal Article) Fostering smallholder investment and innovation through inclusive financial services
01.03.2020
This article provides a framework, with supporting examples, for addressing finance for smallholder investment for innovation. Smallholder households function in interconnected ‘systems’ radiating outwards from the household unit: livelihoods, agricultural market systems, community and society, and infrastructure and policy. An inclusive livelihoods model analyses what would need to be true for uptake of innovations by women, men, and youth, and what financial and non-financial products are needed. ‘Customer centric’ integrated value chain financing solutions are tailored to smallholder market segments along eight pathways for growth. A roadmap for facilitating innovation and change using priority pathways, yet grounded in proven financial and development principles, is recommended. Tools and approaches include: value chain facilitation and capacity development – aggregation, market linkages, and private–public partnerships; financial tools – transaction-based financing, flexible products, and risk mitigators; and innovations in service delivery – digital and ICT applications. -
(Journal Article) Return to learn: recommendations from revisited rural ecosan projects in Burkina Faso
01.01.2020
Burkina Faso has extensive experience with urine-diverting dry toilets (UDDTs) and the reuse of human excreta in agriculture in line with the ecological sanitation (ecosan) principles of containment, treatment, and reuse. Around 30 such ecosan projects have been implemented over the past 15 years, including installation of approximately 13,500 household UDDTs, accompanied by awareness-building and training on toilet use, emptying, and reuse. Recently, efforts have been made to revisit former and current project sites in the spirit of ‘return to learn’. We identified four such learning initiatives (studies/events), from which we draw recommendations to improve the sustainability of future implementation of ecosan in Burkina Faso and similar contexts. Key recommendations include increased attention to different user needs, handwashing and training on emptying/reuse as well as research and innovation on toilet design, urine collection/handling, menstrual management, and cost reduction/financing. Burkina Faso has set up the ambitious goal of 100 per cent toilet coverage and optimal reuse in the national sanitation programme by 2030, with UDDTs projected to make up 15 per cent of the 2 million toilets needed in rural areas. It is therefore timely to take stock and learn from past interventions. In addition, to enable resource recovery and reuse at scale, it will be important to develop a supportive policy and legal framework with collaboration between the WASH, agriculture, health, and environmental sectors. -
(Journal Article) Dimensions of water insecurity in pastoralist households in Kenya
01.01.2020
Pastoralist communities in Northern Kenya face increasing water security risks attributable to disruptions in their socio-ecological environments. Sedentarized pastoralists, women, and children are most vulnerable to spatial-temporal variations in water availability. This vulnerability is exacerbated by embedded power relations within existing socio-cultural and water governance systems. A preliminary study carried out in 2016 examined pastoralist women’s disempowerment in relation to the domestic water security constraints they face. The research found anecdotal evidence that women with diversified livelihoods and social capital are more resilient to water stress. The follow-on study was carried out in 2018 and aimed to provide empirical evidence on factors behind water security and to identify factors that enhance resilience for vulnerable pastoralist communities. The study covered both urban and rural communities in Samburu County and applied a mixed-methods research methodology incorporating quantitative and qualitative research approaches. The study was also used to test a scale for measuring household water insecurity which could potentially improve the methodology for assessing shock-related stress in these high-risk communities. Results show extreme levels of water insecurity, especially in rural areas, and indicate a close relationship between water security and social capital as indicated in the earlier study. Livelihood diversity does not appear to influence water security but households with higher numbers of livestock tend to be more water insecure than households with smaller herds. This is supported by reports from women that the additional burden of watering homestead-based livestock makes them more vulnerable. -
(Journal Article) Towards demand-driven services? The role of feedback mechanisms in agribusiness-based advisory services for smallholder farmers
01.09.2019
In many developing countries, agribusinesses are highly engaged in providing services to smallholder farmers, including agricultural advisory services or extension. As private service providers depend on farmers’ choice, eliciting farmer feedback and learning from farmers’ demands seem to become more important. However, the phenomenon of agribusiness-based advisory services has received relatively little attention in the study of advisory services. Little is known on whether and how agribusinesses operationalize the idea of demand-driven service provision. This is a critical oversight as agribusinesses are increasingly present as service providers and hence shape the prevailing service landscape for smallholder farmers. Based on a study of 29 agribusinesses providing advisory services to farmers in developing countries, this paper explores the extent to which agribusinesses provide demand-driven services based on farmer feedback and how they integrate and learn from such feedback. -
(Journal Article) Better together: improving food security and nutrition by linking market and food systems
01.09.2019
Market-based approaches to food security often increase agricultural productivity and income yet sometimes fail to enhance nutrition. When food security programming combines market and food systems with a specific focus on women and girls, economic and nutrition outcomes benefit. We identify distinctive and shared elements from market and food systems and highlight how they enhance nutrition outcomes when they are combined. We describe food security programming by CARE and World Vision in Bangladesh, Ethiopia, Madagascar, Zambia, and Zimbabwe, demonstrating nutrition gains in food insecure households. -
(Journal Article) Developing agro-pastoral entrepreneurship: bundling blended finance and technology
01.06.2019
Development of agro-pastoral and pastoral entrepreneurship in arid and semi-arid lands (ASAL) of East Africa is constrained by lack of access to financial services, limited technology, and low capacity to engage in high value crop production. This is exacerbated by high risks associated with providing these services to pastoralist communities in ASAL areas in Kenya. The communities’ preference for ethical financial products and services has exacerbated this exclusion. This article presents a new intervention area that addresses these challenges. It argues that bundling ethical financial services with agricultural technology and capacity building positively affects entrepreneurship and income generation among pastoral communities that are transitioning into crop production. This article is based on the Islamic Relief Kenya (IRK) project implementation experience and participatory action and quantitative research conducted with randomly selected members of 180 Alpha Group Savings and Loans Associations (AGSLAs). -
(Journal Article) Menstrual hygiene management and reproductive tract infections: a comparison between rural and urban India
01.04.2019
The objective of the research was to compare factors associated with menstrual hygiene management (MHM) between urban and rural ever-married women in India, and its effect on reproductive tract infections (RTIs). A cross-sectional study was performed analysing data from the Indian District Level Household and Facility Survey 2007–08 (DLHS-3). The respondents were ever-married women between 15 and 49 years of age (N = 577,768). A quarter of women from urban areas use improved methods compared with only 4.3 per cent in rural areas. Cloth had the highest prevalence of usage in both areas. Socio-demographic factors associated with the usage of improved methods were almost the same between localities. Women using improved methods were less likely to suffer from RTIs across localities, except for urinary tract infections (UTIs) in rural areas; UTIs (adjusted odds ratio (AOR) = 0.95 – 1.03 in rural areas and AOR = 0.80 – 0.88 in urban areas). Findings reiterate the complexity of MHM and the need for immediate attention from the government and other agencies to ensure that girls and women have hygienic practices during their menstrual periods which will help prevent RTIs related to poor MHM. -
(Journal Article) Financing and design innovation in rural domestic rainwater harvesting in Madagascar
01.04.2019
Rural water supply interventions in low-resource settings often suffer from poor functionality. The use of technologies and financing approaches, that are out of step with the communities that they target, are primary drivers of this breakdown in supply. This paper describes a pilot study from south-east Madagascar that provides rural households with access to a water source at the home through the sale of rainwater harvesting systems. Results from the pilot show that households were prepared to pay a significant contribution towards establishing a household water supply despite being located in a low-resource, water-abundant region. Over a payback period of six months, zero households defaulted on loans that covered 57 per cent of the costs for materials and transport. Water quality tests demonstrated that the systems were capable of providing water with low levels of microbial contamination (median CFU/100 ml = 7). High levels of adherence to operation and maintenance schedules suggest that people were capable and motivated to maintain and use their systems. -
(Journal Article) Assessing emotional motivators for handwashing with soap in emergencies: results from three Asian countries
01.01.2019
This paper examines how emotional motivators can be used to promote handwashing with soap (HWWS) among mothers affected by an emergency. The impact of using emotional motivators along with other behaviour determinants for behaviour change in development settings has been well documented; however there is limited evidence for the use of motives for HWWS in emergency contexts. Oxfam, in partnership with Unilever’s Lifebuoy soap and Unilever’s Chief Sustainability Office (CSO), collected data in three countries affected by crises – Nepal (2015), Pakistan (2014), and the Philippines (2015) – to determine motivating factors and barriers around HWWS among mothers. Methods used for the assessment included household survey, structured observation, key informant interview, focus group discussion, and behavioural trials. Post-emergency handwashing knowledge and practice was also measured along with the most effective communication channels to reach the target group. The findings reveal that all mothers were motivated by affiliation and nurture; additionally, in Nepal and Pakistan mothers were motivated by purity and mothers in the Philippines were motivated by handwashing drivers related to shame. Barriers to HWWS in emergencies relate to socio-cultural beliefs and the absence of handwashing hardware. -
(Journal Article) Process learning on partnerships: building functioning research and practice organizational relationships
01.01.2019
Implementers and researchers are responding to increasingly strong incentives to work together closely. Donors are placing a higher value on data, rigour, and evidence of impact from development assistance projects. This is seen in policy debates emphasizing value for money, and funding contingent on results and performance. In response, implementing organizations are increasingly collaborating with researchers. Such arrangements incur costs (financial and other), but the return on investment is high. Investments in relationship building, open and frequent communications, a clear understanding of partners’ objectives and non-negotiable requirements, and a mind-set of problem solving are important priorities in setting productive implementation science partnerships. We document process learning from developing a partnership between an implementing organization, Plan International, and a research institute, the Water Institute at the University of North Carolina. We make the case that: effective partnerships have preconditions for success; building institutional respect takes time and incremental changes to business as usual; establishing a partnership early with a long start-up period is advisable; accountability and research relevancy increase through shared roles during project design and results interpretation; and research message development requires regular review meetings with increasing frequency toward the end of a project. -
(Journal Article) Strengthening market systems that provide water and hygiene items for cholera mitigation and emergency preparedness in Haiti
01.10.2018
In the context of the cholera epidemics in Haiti, a pre-crisis market analysis (PCMA) was conducted in Artibonite to study the supply of and demand for various water- and hygiene-related items. The objective was to inform current and future assistance modalities, whilst avoiding a negative impact on local markets and supporting local businesses. The market analysis found that the majority of households already purchase soap from local traders, but very few have handwashing facilities in their home. A good uptake of chlorine-based disinfection products was observed, including specific products to treat water for drinking. In addition, an extensive local supply of calcium hypochlorite (HTH), traditionally used by water services operators, was found to be available to individuals on Haitian markets. The market for water containers was also found to be strong, with the recycling of buckets and jerry cans used to import vegetable oil and other products. However, buckets with a tap, which are recommended for safer water handling and distributed during emergencies, were not available in the market. The findings from the PCMA are being used to strengthen market systems and supply chains to enable households to access water and hygiene commodities in Artibonite rather than to provide in-kind commodities directly as part of humanitarian responses. A marketing scheme was successfully piloted to encourage the purchase of water treatment products while promoting the installation of taps on households’ buckets. But another initiative to link water committees, national authorities and the wholesaler of HTH stalled due to disagreements about the role of authorities in supplying the product. -
(Journal Article) Efficiency of additives and internal physical chemical factors for pit latrine lifetime extension
01.07.2018
Pit latrines are the most common form of on-site sanitation, but are blighted by the problem of pit fill-up. Little is known about what factors and conditions affect decomposition of pit content and thus govern pit filling, but the liquid–mass balance is the key factor. Under laboratory conditions the effect of inorganic and biological additives and the effect of physical chemical factors on solids hydrolysis of black water and human faeces were investigated to establish the potential of these to extend pit latrine lifetime. Additives did little or nothing to enhance net solids hydrolysis in batch tests or to reduce pit fill height in miniature simulated pit latrines. Physical chemical factors such as redox condition and initial pH increased solids hydrolysis, whereas temperature and substrate moisture did little. Since additives need contact with the substrate to act, measurements on faeces crust formation speed and strength were performed and showed that crusts formed within three hours and persisted after covering with fresh faeces or water. -
(Journal Article) Incontinence in Zambia: initial investigation into the coping strategies of sufferers and carers
01.07.2018
There is little information on the management of incontinence in low-income settings. This article provides some initial insights, of particular relevance to water, sanitation, and hygiene (WASH) and health practitioners, into the coping strategies used by sufferers and carers in Zambia. Incontinence is rarely reported to medical professionals in Zambia, possibly due to a reluctance to disclose as a result of the stigma associated with the condition. Management and treatment of incontinence is subsequently limited, and both coping strategies and treatment received are determined by affordability and accessibility. If the global community is to achieve the Sustainable Development Goals of universal sanitation (Goal 6) and well-being (Goal 3), future studies and programmes on incontinence in Zambia will need to involve collaborations between WASH and health practitioners that investigate how to reduce the stigma associated with the condition and increase awareness, and how to improve the availability and affordability of management and treatment, considering the potential preference for traditional medicine in rural communities. -
(Journal Article) Transgender-inclusive sanitation: insights from South Asia
01.04.2018
This paper provides insights from initiatives to include transgender people in sanitation programming in South Asia. Three case studies of recent actions to make sanitation inclusive for transgender people (in India and Nepal) are presented, accompanied by reflections and recommendations to guide future practice. Practitioners are recommended to: engage with transgender people as partners at all stages of an initiative; recognize that the language of gender identity is not fixed, varying across cultures and between generations; and acknowledge that transgender people are not a single homogeneous group but rather have diverse identities, histories, and priorities. The case studies aim to raise awareness of the diversity of transgender identities, exploring the needs and aspirations of transgender women, transgender men, and third gender people in South Asia. -
(Journal Article) The handpump choice is yours: a pilot study in Rumphi District, Malawi
01.10.2017
In sub-Saharan Africa, moving towards the Sustainable Development Goals will require an approach to water and sanitation service delivery for many rural communities where handpumps still dominate infrastructure. This paper reviews a case study of allowing users (local government and communities) in Rumphi District, Malawi, to choose a handpump model based on information about the life-cycle costs. The results indicate that there is some awareness within communities and within the local government of several handpump options for the rural water supply in the study area. Given a choice of different handpump models in the treatment communities, each community chose the rope pump. Allowing communities to choose the type of handpump model, with input from both local government and donors on low cost borehole drilling, should be considered as an innovative approach to rural water service delivery. -
(Journal Article) Relationship between water, sanitation, hygiene, and nutrition: what do Link NCA nutrition causal analyses say?
01.10.2017
Defined by UNICEF as ‘the outcome of insufficient food intake and repeated infectious diseases’, undernutrition is one of the world’s most serious problems, with long-lasting harmful impacts on health and devastating consequences for social and economic development. The three main underlying causes of undernutrition, namely unsuitable or insufficient food intake, poor care practices, and infectious diseases, are directly or indirectly related to inadequate access to water, sanitation facilities, and hygiene practices (WASH). There is a growing base of evidence showing the links between poor WASH conditions, especially exposure to poor sanitation, and stunting (low height for age ratio). However, the effects of WASH interventions on wasting (low weight for height ratio) and the impact of environmental enteric dysfunction (chronic infection of small intestine caused by extended exposure to faecal pathogens) on undernutrition should be explored further. Action Against Hunger (Action Contre la Faim) promotes a participatory nutrition causal analysis, the Link NCA methodology, which is used to analyse complex, dynamic, locally specific causes of undernutrition. This article aims to assess the main findings from 12 most recent Link NCA studies, conducted from the beginning of 2014 until the end of 2016. Results show that inadequate WASH conditions are often identified as major contributors to undernutrition in the study areas. The article also provides lessons learned and a set of practical recommendations for better alignment and integration of WASH and nutrition interventions. -
(Journal Article) From new evidence to better practice: finding the sanitation sweet spot
01.10.2017
A growing body of evidence shows that there is a strong causal link between exposure to poor sanitation and detrimental health, human capital, and economic outcomes. At the same time a number of recent impact evaluations of specific sanitation interventions show mixed results. This heterogeneity in findings raises the questions of whether and how the demonstrated benefits of improved sanitation can be consistently achieved through regular project implementation. This paper attempts to show that the benefits of improved sanitation can be consistently achieved through investing in interventions that address the drivers of latrine use and by divesting from interventions that do not address the drivers of latrine use. -
(Journal Article) What is cocoa sustainability? Mapping stakeholders’ socio-economic, environmental, and commercial constellations of priorities
01.09.2017
Given growing concerns regarding the chocolate sector’s long-term future, more private-sector, public-sector, and civil-society stakeholders have become involved in initiatives seeking to make cocoa more ‘sustainable’. However, the commercial, socio-economic, and environmental priorities they associate with the omnipresent, yet polysemic term diverge considerably: while transforming the crop into a more viable livelihood for growers is essential for some, others prioritize the crop’s links to global environmental challenges through agroforestry. A third dimension encompasses commercial concerns related to securing supply. The article explores how tensions and synergies manifest in these divergent understandings of what cocoa sustainability is and is to entail, which diverse civil-society, public-sector, and private-sector stakeholders bring to the table. It argues that priorities associated with ‘cocoa sustainability’ diverge, yielding synergies, tensions, and trade-offs. This article draws on the author’s in-depth doctoral fieldwork in cocoa sustainability initiatives incorporating environmental measures, which encompassed semi-structured interviews, focus-group discussions, documentary analysis, and participant observation in Latin America and Europe. It proposes the ‘constellations of priorities’ model as an instrument to capture how the priorities driving cocoa stakeholders variously dovetail, intersect, and collide. Particularly against the backdrop of the sector’s brewing crisis, the paper suggests that stakeholders systematically assess their and other actors’ socio-economic, environmental, and commercial priorities as part of the equitable engagement required to transform the sector and attain genuine cocoa sustainability. -
(Journal Article) Youth savings groups in Africa: they’re a family affair
01.09.2017
Based on fieldwork in Tanzania, Zambia, Uganda, and Ghana, in the paper we provide new evidence that young people’s engagement with savings groups in Africa is deeply embedded in networks of family and social relations. Savings group members rely on money that is given to them by partners and family members to make savings contributions to the groups, while they also transfer some of their share-outs and loans to family members and friends. This is particularly true for younger members. As such we argue that the socially embedded nature of young people's engagement with savings group needs to be taken into account. The tension between the primary focus on the individual within youth saving programming, and the socially embedded nature of their engagement, has important implications for programme design, implementation and evaluation.