In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.

Community management is the accepted management model for rural water supplies in many low and middle-income countries. However, endemic problems in the sustainability and scalability of this model are leading many to conclude we have reached the limits of an approach that is too reliant on voluntarism and informality. Accepting this criticism but recognising that many cases of success have been reported over the past 30 years, this study systematically reviews and analyses the development pattern of 174 successful community management case studies. The synthesis confirms the premise that for community management to be sustained at scale, community institutions need a ‘plus’ that includes long-term external support, with the majority of high performing cases involving financial support, technical advice and managerial advice. Internal community characteristics were also found to be influential in terms of success, including collective initiative, strong leadership and institutional transparency. Through a meta-analysis of success in different regions, the paper also indicates an important finding on the direct relationship between success and the prevailing socio-economic wealth in a society. This holds implications for policy and programme design with a need to consider how broad structural conditions may dictate the relative success of different forms of community management.

Addressing the lack of sanitation globally is a major global challenge with 700 million people still practicing open defecation. Circular Economy (CE) in the context of sanitation focuses on the whole sanitation chain which includes the provision of toilets, the collection of waste, treatment and transformation into sanitation-derived products including fertiliser, fuel and clean water. After a qualitative study from five case studies across India, covering different treatment technologies, waste-derived products, markets and contexts; this research identifies the main barriers and enablers for circular sanitation business models to succeed. A framework assessing the technical and social system changes required to enable circular sanitation models was derived from the case studies. Some of these changes can be achieved with increased enforcement, policies and subsidies for fertilisers, and integration of sanitation with other waste streams to increase its viability. Major changes such as the cultural norms around re-use, demographic shifts and soil depletion would be outside the scope of a single project, policy or planning initiative. The move to CE sanitation may still be desirable from a policy perspective but we argue that shifting to CE models should not be seen as a panacea that can solve the global sanitation crisis. Delivering the public good of safe sanitation services for all, whether circular or not, will continue to be a difficult task.

Community management has been widely criticized, yet it continues to play a significant role in rural drinking water supply. In India, as with other ‘emerging’ economies, the management model must now adapt to meet the policy demand for ever-increasing technical sophistication. Given this context, the paper reviews the history and concepts of community management to propose three typologies that better account for the changing role of the community and external support entities found in successful cases. It argues that external support entities must be prepared to take greater responsibility for providing ongoing support to communities for ensuring continuous service delivery.

Globally, many populations face structural and environmental barriers to access safe water, sanitation and hygiene (WASH) services. Among these populations are many of the 200 million pastoralists whose livelihood patterns and extreme environmental settings challenge conventional WASH programming approaches. In this paper, we studied the Afar pastoralists in Ethiopia to identify WASH interventions that can mostly alleviate public health risks, within the population's structural and environmental living constraints. Surveys were carried out with 148 individuals and observational assessments made in 12 households as part of a Pastoralist Community WASH Risk Assessment. The results show that low levels of access to infrastructure are further compounded by risky behaviours related to water containment, storage and transportation. Additional behavioural risk factors were identified related to sanitation, hygiene and animal husbandry. The Pastoralist Community WASH Risk Assessment visually interprets the seriousness of the risks against the difficulty of addressing the problem. The assessment recommends interventions on household behaviours, environmental cleanliness, water storage, treatment and hand hygiene via small-scale educational interventions. The framework provides an approach for assessing risks in other marginal populations that are poorly understood and served through conventional approaches.