Municipal solid waste (MSW) can pose a threat to public health if it is not safely managed. Despite prior research, uncertainties remain and refurbished evidence is needed along with new approaches. We conducted a systematic review of recently published literature to update and expand the epidemiological evidence on the association between MSW management practices and resident populations’ health risks. Studies published from January 2005 to January 2020 were searched and reviewed following PRISMA guidelines. Eligible MSW treatment or disposal sites were defined as landfills, dumpsites, incinerators, waste open burning, transfer stations, recycling sites, composting plants, and anaerobic digesters. Occupational risks were not assessed. Health effects investigated included mortality, adverse birth and neonatal outcomes, cancer, respiratory conditions, gastroenteritis, vector-borne diseases, mental health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were eligible as well. Twenty-nine studies were identified that met the inclusion criteria of our protocol, assessing health effects only associated with proximity to landfills, incinerators, and dumpsites/open burning sites. There was some evidence of an increased risk of adverse birth and neonatal outcomes for residents near each type of MSW site. There was also some evidence of an increased risk of mortality, respiratory diseases, and negative mental health effects associated with residing near landfills. Additionally, there was some evidence of increased risk of mortality associated with residing near incinerators. However, in many cases, the evidence was inadequate to establish a strong relationship between a specific exposure and outcomes, and the studies rarely assessed new generation technologies. Evidence gaps remain, and recommendations for future research are discussed.

The number of people served by networked systems that supply intermittent and contaminated drinking water is increasing. In these settings, centralized water treatment is ineffective, while household-level water treatment technologies have not been brought to scale. This study compares a novel low-cost technology designed to passively (automatically) dispense chlorine at shared handpumps with a household-level intervention providing water disinfection tablets (Aquatab), safe water storage containers, and behavior promotion. Twenty compounds were enrolled in Dhaka, Bangladesh, and randomly assigned to one of three groups: passive chlorinator, Aquatabs, or control. Over a 10-month intervention period, the mean percentage of households whose stored drinking water had detectable total chlorine was 75% in compounds with access to the passive chlorinator, 72% in compounds receiving Aquatabs, and 6% in control compounds. Both interventions also significantly improved microbial water quality. Aquatabs usage fell by 50% after behavioral promotion visits concluded, suggesting intensive promotion is necessary for sustained uptake. The study findings suggest high potential for an automated decentralized water treatment system to increase consistent access to clean water in low-income urban communities.

Objective: To characterize the relationship between child faeces disposal and child growth in low‐ and middle‐income countries.Methods: We analysed caregiver responses and anthropometric data from Demographic and Health Surveys (2005–2014) for 202 614 children under five and 82 949 children under two to examine the association between child faeces disposal and child growth.Results: Child faeces disposal in an improved toilet was associated with reduced stunting for children under five [adjusted prevalence ratio (aPR) = 0.90, 95% confidence interval (CI) 0.89–0.92] and a 0.12 increase in height‐for‐age z‐score (HAZ; 95% CI: 0.10–0.15) among all households. Among households with improved sanitation access, practicing improved child faeces disposal was still associated with a decrease in stunting (aPR = 0.94, 95% CI: 0.91–0.96) and a 0.09 increase in HAZ (95% CI: 0.06–0.13). Improved child faeces disposal was also associated with reductions in underweight and wasting, and an increase in weight‐for‐age z‐score (WAZ), but not an increase in weight‐for‐height z‐score (WHZ). Community coverage level of improved child faeces disposal was also associated with stunting, with 75–100% coverage associated with the greatest reduction in stunting. Child faeces disposal in an unimproved toilet was associated with reductions in underweight and wasting, but not stunting.Conclusions: Improved child faeces disposal practices could achieve greater reductions in child undernutrition than improving toilet access alone. Additionally, the common classification of child faeces disposal as ‘safe’ regardless of the type of toilet used for disposal may underestimate the benefits of disposal in an improved toilet and overestimate the benefits of disposal in an unimproved toilet.

: Water, sanitation, and hygiene (WASH) practices emerged as a critical component to controlling and preventing the spread of the COVID-19 pandemic. We conducted 131 semistructured phone interviews with households in rural Odisha, India, to understand behavior changes made in WASH practices as a result of the pandemic and challenges that would prevent best practices. Interviews were conducted from May through July 2020 with 73 heads of household, 37 caregivers of children < 5 years old, and 21 members of village water and sanitation committees in villages with community-level piped water and high levels of latrine ownership. The majority of respondents (86%, N = 104) reported a change in their handwashing practice due to COVID-19, typically describing an increase in handwashing frequency, more thorough washing method, and/or use of soap. These improved handwashing practices remained in place a few months after the pandemic began and were often described as a new consistent practice after additional daily actions (such as returning home), suggesting new habit formation. Few participants (13%) reported barriers to handwashing. Some respondents also detailed improvements in other WASH behaviors, including village-level cleaning of water tanks and/or treatment of piped water (48% of villages), household water treatment and storage (17% of respondents), and household cleaning (41% of respondents). However, there was minimal change in latrine use and child feces management practices as a result of the pandemic. We provide detailed thematic summaries of qualitative responses to allow for richer insights into these WASH behavior changes during the pandemic. The results also highlight the importance of ensuring communities have adequate WASH infrastructure to enable the practice of safe behaviors and strengthen resilience during a large-scale health crisis.