In our PAASIM matched cohort study, we followed 642 households to evaluate the real-world impact of urban water infrastructure upgrades on water quality, access, and satisfaction. This study is one of the first to comprehensively assess water quality, accessibility, and consumer satisfaction together, giving governments, utilities, and funders a clearer picture of what community-level investments can achieve.

In this scoping review, we synthesized how process evaluations have been designed and applied across 24 published WASH interventions in low- and middle-income countries and brought together practical indicators and approaches to assess implementation, including what was delivered, who was reached, and how participants engaged.

Our new study explores how households in arid and semi-arid lands (ASAL) and non-ASAL regions across five Kenyan counties plan for, cope with, and recover from climate-driven disruptions—specifically droughts and floods—affecting access to energy, water, and nutritious food. It also examines gendered impacts and identifies opportunities for evidence-based interventions.

Our study identified leverage points for system strengthening to deliver the preconditions for hygienic toileting in schools. Three of the nine factors were found to be highly influential and to drive the core system dynamics across both groups of participants: WASH leadership, governance, and partnerships; resource mobilization; and human resource capacity.

We developed and internally validated scales to measure economic and social resilience to environmental disturbances that quantify resilience as a latent construct and are grounded in resilience theory. These scales are suitable for application in urban informal settlements in Indonesia and Fiji. We recommend their use, with re-validation as needed, in the monitoring and evaluation of resilience-building interventions and policies targeting urban households in low-income settings.

We applied a systems thinking approach to for effective and sustained hygienic systems and discussed strategies that could move us beyond behavior-specific approaches and a behavior change approaches focused predominantly on end-users. This focus beyond individual end-user behaviors will require removing silos across sectors and ministries, the generation of relevant evidence for policymakers and the localization of guidance.

Incomplete reporting of WASH interventions is a critical challenge to learning in the sector. This lack of transparent reporting limits our ability to understand what works, how and where. To address this challenge, a multidisciplinary team of researchers and implementers developed a reporting standard that can be used to insure clear communication of implementation activities for both research and practice: TiDIER WASH. This is derived from the broader movement for transparent implementation reporting with TiDIER.

Inconsistent reporting of WASH implementation illustrates a major challenge in the sector. It is difficult to know what interventions are actually being evaluated and how to compare evaluation results.

Our findings support growing literature that water and food insecurity are important to mental well-being, a key aspect of overall health. Further research is needed to confirm causality along these pathways and determine specific mechanisms through which these interactions take place.

We find clear indications that enteric viral pathogens are associated with growth shortfalls, specifically among asymptomatic children. These findings highlight the need for preventive strategies targeting children with enteric viral pathogens, which could address the consequences of growth faltering.

This study aimed to compare the safety and efficacy of VS002A against the standard WHO-ORS in treating non-cholera acute watery diarrhoea in children.

This is the first study to investigate the associations between the detection of enteric protozoan parasites with child growth; we included data from children in multiple countries ranging from birth until 5 years of age with and without diarrhea.

WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns.

Interventions promoting handwashing with soap can reduce acute respiratory infection in low-income and middle-income countries, and could help to prevent the large burden of respiratory disease.

Food hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. This study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene.

Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.

The goal of this study was to quantify Escherichia coli KO11 bacteria, MS2 male-specific (F+) coliphage viruses, and turbidity reductions in seeded natural test water of defined quality when subjected to chitosan coagulation pre-treatment under different coagulation-flocculation stirring conditions, followed by sedimentation and cloth filtration.

Dr. Freeman is part of the Lancet Commission on WASH which aims to reimagine and reconstitute WASH not only as a central pillar of public health, but also as a pathway to gender equality and social and environmental justice.

A new paper from the group explores differences between men and women implementers of rural WASH programs in implementation approaches, challenges, and sources of support for implementation, and success in achieving program quality outcomes.

This paper from Sabrina Haque (PhD Candidate) and Matt describes the value of implementation science for the WASH sector and provides recommendations for its application.