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Hand Washing with Soap and Water

Home > Programmes > Hand Washing with Soap and Water



Global Handwashing Day

Global Handwashing Day (GHD) was created by the Global Public-Private Partnership for Handwashing in 2008 to:

• Foster and support a global culture of handwashing with soap.
• Shine a spotlight on the state of handwashing in every country.
• Raise awareness about the benefits of handwashing with soap.

Global Handwashing Day was originally created for children and schools, but can be celebrated by anyone promoting handwashing with soap. Each year, over 200 million people are involved in celebrations in over 100 countries around the world. Global Handwashing is endorsed by a wide array of governments, international institutions, civil society organizations, NGOs, private companies, and individuals.


Hand Washing with Soap and Water

Usage of Soap and Water

Promote the habit of Hand Washing with Soap and Water to decrease episodes of diarrhoea. To ensure the sufficient availability of soap, partnerships with local manufacturers will be used to promote this practice.

Diarrhoea is the single biggest cause of infant and child mortality in India.

Worldwide, surveys have shown that hand-washing alone reduces the instance of diarrhoea by as much as 43 percent.


Name: Hand Washing with Soap and Water
Theme: Safe Water Management Region and Country: Maharashtra, India
Partners: Beneficiaries:
Funding Need: Budget:
Duration: Contact:

Proper hand washing is important in preventing the spread of communicable disease. Proper hand washing is not just a quick cold rinse of the hands. It requires 20 seconds of your time, warm water, soap (liquid is best) and some devoted scrubbing. This means washing around tips of fingers, fingernails, and the web, as well as the front and back of your hands. The dirtier the hands, the longer the wash time. Use the paper towel to turn off the faucet handle. This reduces the risk of picking up bacteria from the handle.

Hands should be washed:

  • After using the restroom
  • After coughing, sneezing or using a tissue
  • Before and during food preparation
  • If changing from raw to ready to eat food preparation
  • Before meals, snacks or refreshment
  • After eating, drinking or using tobacco
  • After handling or touching pets or other animals
  • As often as necessary to remove contamination
  • After any activity that might soil the hands

Programme Activities:
Parents can help to protect young children against diarrhoea by adopting certain hygienic practices. One very important practice is hand-washing. This programme will promote and educate about washing hands with soap as a habit and a way of life for the people in Maharashtra.

Promotion will be of good hand-washing procedures which requires the use of soap (or a local substitute), plenty of water, and careful cleaning of all parts of the hands. If water is scarce, it can be used more than once to wash hands. It can then be used to wash the floor, to clean the latrine, or to irrigate the vegetable garden.

Families will be advised to create a place within the home for hand-washing. This should have a wash basin, a container for water, and soap (or a local substitute).

All members should wash their hands well:

  • after cleaning a child who has defecated, or after disposing of a child's stool;
  • after defecating;
  • before preparing food;
  • before eating;
  • before feeding a child.

An adult or older sibling should wash the hands of young children.

Intended Results:
Through promotion of correct hand-washing procedures, and education about why this is necessary, families and members of the community will become more aware of the necessity and importance about hand-washing. Episodes of diarrhoea will be significantly decreased through this habit.

Programme Management and Implementation:
Messages and information about proper hand-washing procedures will be provided to mothers, health care providers, and the general public through training programmes, TV and radio broadcasts, and instructive pamphlets. The materials designed for and used in the program will be pre-tested to ensure clarity and success on a larger scale. Additionally, to ensure the sufficient availability of soap, campaigns, collaborated with local manufacturers will be used to promote this practice.

Programme Monitoring and Evaluation:
Initially programme monitoring will ensure that soap is available and instructional material is reaching the targeted audiences. Eventually, monitoring will check recall, understanding, and application of correct hand-washing practices among all members of the community. Statistics on those washing hands with soap when recommended will be evaluated and compared to statistics before program implementation. The program will be accommodated as necessary.

Learning and Dissemination:

The results of the initiative include improvements in handwashing behaviour associated with reductions in diarrhoeal disease, leveraging of significant additional resources for public health, and sustained involvement of the private sector partners in public health promotion.

Related Videos:

On 14 October, 2010 10,000 children, together with the Chief Minister of Madhya Pradesh, gathered at Bhopal's Nehru Stadium for a mission. The mission to spread hand washing with soap and water as a life saving behaviour among their peers - key idea behind the 2010 Global Hand Washing Day.


When Must you Wash your Hands

  • Employees must wash their hands right before they begin food preparation. This includes working with food equipment and utensils, handling unwrapped single-use utensils, such as disposable cups and spoons, and touching food that is not pre-packaged.
  • Hand Washing for Food Workers
  • Hand washing is also required after a person touches bare skin on their body. For example, if a person touches their face or hair, they must wash their hands before handling food again.
  • When to Wash Your Hands (PDF)
  • Employees also must wash their hands after using the restroom. Places of business need to post signs that clearly state that employees must wash their hands before starting work again.
  • Wash Your Hands!
  • A person needs to wash their hands after they touch or handle an animal, such as a seeing eye dog or other service animal. The rule also applies to animals that will be butchered or turned into a meal.
  • Healthy Pets, Healthy People
  • Hand washing is a must after a person sneezes or coughs. They must also wash up after eating or drinking, either while working or on a break. People must also wash their hands after using tobacco.
  • Benefits of Hand Washing
  • Employees need to wash their hands after handling dirty dishes, whether the dishes are from the tables or are equipment used to prepare the meals. Typically, cooks do not handle dirty dishes, but the kitchen may be understaffed on occasion.
  • Hand Washing
  • People may need to wash their hands frequently when preparing food to prevent cross-contamination. For example, if a cook is preparing raw chicken, then will cut raw vegetables, they should wash their hands between handling the chicken and vegetables.
  • Prevent Cross Contamination
  • If a person is working with raw food, then plans to work with packaged food, they need to wash their hands before handling the packaged food to prevent the spread of bacteria from the raw food to the pre-made food.
  • Hand Washing in Food Service
  • Hand washing is essential before a person puts on latex or vinyl gloves to handle food. Most likely, the person will have just been performing another activity that requires them to wash their hands anyway.
  • Properly Put on Gloves
  • Servers should wash their hands before they present food to customers.
  • Health and Hygiene Standards for Food Handlers


Hand Washing Basics

Related Resources:


Health & Hygiene Kit - Sesame Workshop

Health & Hygiene Kit - Sesame Workshop
Sesame Workshop is the non-profit organization behind Sesame Street and other educational children’s media. They create innovative and engaging educational content for children from birth to age 12 in over 120 countries worldwide. In India, as elsewhere, their unique approach brings together local experts to determine educational goals based on the specific needs of children in the country.

1. A poster on hand washing 553 kb
2. Activity worksheets for children
3. Caregiver guides to create/design activities related to hand washing
4. Set of Sequencing cards
5. Set of flash cards on healthy habits

A Guide for Developing a Hygiene Promotion Program to Increase Handwashing with Soap
The Handwashing Handbook 79 pages 661 kb
The Handwashing Handbook lays out the experiences of the Public-Private Partnership for Handwashing in a practical guidance document. The Handbook is designed for staff in governments and development organizations charged with carrying out handwashing programs. Decision makers in ministries and funding agencies will also find assistance in designing policies and programs to improve public health. The Handbook outlines a large-scale approach to handwashing promotion and covers laying the foundation for a national program, consumer research, program implementation, and organization.

TippyTap - Save water. Save lives.
Hand washing with soap is simple, but working to increase this behaviour requires thoughtful, tailored and creative interventions with sustained follow up.

Tanzania: A Handwashing Behavior Change Journey - October 2011
The Handwashing Handbook 8 pages 1.67 mb

Global Scaling Up Handwashing is a Water and Sanitation (WSP) project focused on applying innovative behavior change approaches to improve handwashing with soap behavior among women of reproductive age (ages 15–49) and primary school-age children (ages 5–9). It is being implemented by local and national governments with technical support from WSP in four countries: Peru, Senegal, Tanzania, and Vietnam.

Handwashing for Diarrheal Disease Prevention 102 pages 2.5 mb

The Story of a Successful Public-Private Partnership in Central America

Camille Saad�, Massee Bateman, Diane B. Bendahmane. Published by the Basic Support for Child Survival Project (BASICS II), the Environmental Health Project, the United Nations Children’s Fund, the United States Agency for International Development, and The World Bank. Arlington, Virginia, September 2001.

The Central American Handwashing Initiative aimed to reduce morbidity and mortality among children under five through a coordinated communication campaign promoting proper handwashing with soap to prevent diarrheal disease. The Initiative was conceived and facilitated by the United States Agency for International Development (USAID) through two of its projects: Basic Support for Institutionalizing Child Survival (or BASICS) and the Environmental Health Project (EHP).

Hand decontamination: influence of common variables on hand-washing efficiency - download pdf
Miller Thomas, Patrick Daniel, Ormrod Douglas. - Healthcare Infection 2011; 16: 18–23.
Published: 28 March 2011 - - abstract

This study has evaluated the effects of wash time, friction and soap on the decontamination of hands seeded with Escherichia coli. In one protocol contaminated hands were held passively under running tap water. In another, contaminated hands were again held under running tap water and the fingers and palms rubbed together. In the final protocol soap and friction were used under running water. The number of contaminant E. coli transferred by touch contact to food or a surrogate item representing skin was quantified, before washing and after washing for intervals up to 20 s. Decontamination profiles were determined for each protocol. When hands were washed under running water with friction over a period of 20 s, the number of E. coli contaminating food and the skin surrogate was progressively reduced respectively to 0.18% and 0.34% of the baseline level. Running water alone was comparatively ineffective. The addition of soap showed a modest benefit. We conclude that in situations where hands are not visibly soiled, a purposeful hand wash under running water for 20 s, with friction, will deliver an effective outcome that can be improved marginally by the addition of soap.
Water music for hand hygiene
Is soap really needed after using the toilet?

London School of Hygiene and Tropical Medicine (LSHTM)
"The Dangers of Dirt: Household Hygiene and Health" by V. Curtis,

"Actions Speak: The study of hygiene behaviour in water and sanitation projects" IRC International Water and Sanitation Centre

"Happy, Healthy and Hygienic: How to Set up a Hygiene Promotion Programme" UNICEF, LSHTM

"Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities", S.A. Esrey, R.G. Feachem and J.M. Hughes. Bulletin of the WHO, 63(4):757-772 (1985)

"Interventions for the control of diarrhoeal diseases among young children: promotion of personal and domestic hygiene", Feachem, R.G. Bulletin of the WHO, 61: 641-652 (1983).

"Preventing Diarrhoea: what are the policy options?", R.G.Feachem, Health Policy and Planning 1986:1(2):109-117.

"Improving Water and Sanitation Hygiene Behaviours for the reductions of diarrhoel disease: The Report of an Informal Consultation", Community Water Supply and Sanitation Unit (CWS), WHO, 1993.

"Review: Domestic hygiene and diarrhoea - pinpointing the problem"
V. Curtis, S. Cairncross and R. Yonli, Tropical Medicine and International Health, 5(1):22-32.

"Dirt, Disgust and Disease: Is hygiene in our genes?"
V. Curtis and A. Biran. Perspectives in Biology and Medicine 44(1), 2001.

"Structured Observations of hygiene behaviours in Burkina Faso: validity, variability and utility"
V., S. Cousens, T. Mertens, E. Traore, B. Kanki, I. Diallo. Bulletin of the WHO, 71(1):23-32, 1993.

Effect of handwashing on child health: a randomised controlled trialThe Lancet, Volume 366, Number 9481, 16 July 2005

Handwashing With Soap Key to Reducing Burden of Childhood Disease  -  The Lancet

Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis  -  The Lancet

Handwashing  -  The Lancet

Effect of washing hands with soap on diarrhoea risk in the community: a systematic review  -  The Lancet

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Publication links from Hygiene Central


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Hygiene and Hand washing

  1. Cairncross, S., Curtis, .V, Greenland, K. (2012). What can hand hygiene do for the world?Ahead of Global Handwashing Day, the Hygiene Centre has updated estimates of the number of lives that can be saved by handwashing with soap.
  2. *Biran, A., Schmidt, W.-P., Wright, R., Jones, T., Seshadri, M., Isaac, P., Curtis, V et al. (2009). The effect of a soap promotion and hygiene education campaign on handwashing behaviour in rural India: a cluster randomised trial. Tropical Medicine and International Health 14(10), 1303-1314.
  3. *Schmidt, Wolf-Peter, Robert Aunger, Yolande Coombes, Peninnah Mukiri Maina, Carol Nkatha Matiko,Adam Biran and Valerie Curtis (2009) 'Determinants of handwashing practices in Kenya: The role of media exposure, poverty and infrastructure.' Tropical Medicine and International Health 14: 1534-1541.
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  13. *Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A. (2011) Hygiene: new hopes, new horizons. Lancet Infect Dis. Apr;11(4):312-21.
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  15. *Schmidt, W., & Curtis, V. (2011). Respiratory and Hand Hygiene in an Influenza Pandemic: Scientific Evidence Base Review. London: UK Department of Health.
  16. *Aunger, Robert, Katie Greenland and Val Curtis (2011) 'Determinants of Hygiene Behaviour World-Wide-a quantitative study' [Hygiene Council]
  17. *Aunger, Robert and Katie Greenland (2011) 'Neonatal Handwashing Study, Serang, Indonesia' [USAID-MCHIP-Unilever]
  18. *Dodrill L, Schmidt WP, Cobb E, Donachie P, Curtis V, de Barra M. (2011) Male commuters in north and south England: risk factors for the presence of faecal bacteria on hands. BMC Public Health. 12;11:31.
  19. *Fleischman, Diana, Gregory D Webster, Gaby Judah, Míchèal de Barra, Robert Aunger and Valerie Curtis (in press) 'Changes in rates of hand washing with soap in response to the media reports of the H1N1 pandemic in Britain'. BMJ Open.
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    CAIRNCROSS S. Tropical Medicine and International Health. 2003 Aug;
  27. Is hygiene promotion cost-effective? A case study in Burkina Faso.
    Borghi J, Guinness L, Ouedraogo J, CURTIS V. Tropical Medicine and International Health. Nov; 7 (11):960-9, 2002.
  28. Domestic hygiene and diarrhoea - pinpointing the problem.
    CURTIS V, CAIRNCROSS S, and Yonli R Tropical Medicine and International Health, 2001, Vol. 5 (1), 22-32.
  29. Hygiene: How myths, monsters and mothers-in-law can promote behaviour change.
    CURTIS V. Journal of Infection 2001: 43: 75 - 79
  30. Hygiene and Disease: pinpointing the risk practices.
    CURTIS V, CAIRNCROSS S, Yonli R. Tropical Medicine and International Health. 2000, 5 (1) 22-32.
  31. Potties, pits and pipes: explaining hygiene behaviour in Burkina Faso.
    CURTIS V, Kanki B, Mertens T, Traore E, Diallo I, Tall F, Cousens S. Social Science and Medicine. 1995 Aug; 41(3):383-93.
  32. Child defecation behaviour, stool disposal practices, and childhood diarrhoea in Burkina Faso: results from a case-control study.
    Traore E, Cousens S, CURTIS V, Mertens T, Tall F, Traore A, Kanki B, Diallo I, Rochereau A, Chiron JP, et al. Journal of Epidemiology and Community Health. 1994 Jun; 48(3):270-5.
  33. Too clean, or not too clean: the Hygiene Hypothesis and home hygiene. Clinical and Experimental Allergy 2006
    Bloomfield, S,.F, Stanwell-Smith, R., Crevel, R.W.R. and Pickup, J. 36 402-425.


  1. Clasen T, Sugden S (2009). Water and Sanitation (Chapter 2.7), in Beaglehole R. et al. (eds.), Oxford Textbook of Public Health. Oxford: Oxford University Press
  2. *Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010) Hygiene, Sanitation, and Water: What Needs to Be Done? PLoS Med 7(11): e1000365.
  3. Ensink, J HJ, Scott, Christopher A, Brooker, Simon, Cairncross, Sandy (2010) Sewage disposal in the Musi-River, India: water quality remediation through irrigation infrastructure. Irrigation and Drainage Systems 24: 65-77.
  4. Mauricio L. Barreto,Bernd Genser, Agostino Strina, Maria Gloria Teixeira, Ana Marlucia O. Assis, et al, and Sandy Cairncross (2010) Impact of a Citywide Sanitation Program in Northeast Brazil on Intestinal Parasites Infection in Young Children Environ Health Perspect. 118(11): 1637–1642.
  5. Fry LM, Cowden JR, Watkins DW, Clasen T, Mihelcic JR (2010). Quantifying health improvements from water quantity enhancement: an engineering perspective applied to rainwater harvesting in West Africa. Environmental Sci & Tech 15;44(24):9535-41
  6. *Clasen T (2010). Household water treatment and the Millennium Development Goals: keeping the focus on health. Environmental Sci & Tech. 44 (19): 7357–7360
  7. *Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung IC, Jenkins MW, Scott B, Sugden S, Cairncross S. (2010) Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database Syst Rev. 16;(6):CD007180.
  8. Preston K, Lantagne D, Kotlarz N, and Jellison K (2010). Turbidity and chlorine demand reduction using alum and moringa flocculation before household chlorination in developing countries. J Water Health 8(1), 60-70.
  9. *Marion W. Jenkins and Sandy Cairncross (2010) Modelling latrine diffusion in Benin: towards a community typology of demand for improved sanitation in developing countries. Journal of Water and Health 8:166-183.
  10. Brown, J. and Sobsey, M. 2010. Microbiological effectiveness of locally produced ceramic filters for drinking water treatment in Cambodia. Journal of Water and Health 8(1): 1-10.
  11. *Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I., et al. (2010). Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol, 39(Sup 1), 193-205.
  12. Andreia C. Santos, Jennifer A. Roberts, Mauricio L. Barreto, Sandy Cairncross (2011) Demand for sanitation in Salvador, Brazil: A hybrid choice approach, Social Science & Medicine 72:1325-1332
  13. *Saboori S, Mwaki A, Oketch B, Porter S, Freeman MC, Rheingans R. (in press) Sustainability of School Water, Sanitation, and Hygiene. Lessons Learned and to be Learned. Waterlines.
  14. Wachira S, El-Fatih M, Gitau S, Freeman MC, Snel M. (in press) The use of urinals in Kenyan schools. Waterlines
  15. *Freeman MC, Greene L, Dreibelbis R, Saboori S, Muga R, Rheingans R. (submitted) Assessing the impact of a school-based water, sanitation, and hygiene program on pupil absenteeism, enrollment, and test scores: A cluster-randomized trial. Trop Med International Health
  16. *Freeman MC, Clasen T, Brooker S, Akoko D, Brumback B, Rheingans, R. (submitted) The impact of a school-based school hygiene, water treatment, and sanitation intervention on reinfection with soil-transmitted helminthes in Western Kenya: A cluster-randomized trial. PLoS NTD
  17. Clasen T, Fabini D, Boisson S, Song J, Aichinger E, Bui A, Dadashi S, Taneja J, Schmidt W-P, Burt Z, Nelson K. (submitted) Making Sanitation Count: Developing and Testing a Novel Device for Assessing Latrine Use In Low-Income Settings.
  18. Biran A and Jenkins M. Communal Toilets in Urban Poverty Pockets: Use and user satisfaction associated with seven communal toilet facilities in Bhopal, India. WaterAid (2011).
  19. Achieving the 'good life': why some people want latrines in rural Benin.
    JENKINS MW, CURTIS V. Social Science and Medicine. 2005 Dec; 61(11):2446-59.
  20. The Case for Marketing Sanitation. Water & Sanitation Programme Field Note.
    CAIRNCROSS S. 2004. Nairobi: The World Bank.
  21. Sanitation in the developing world: Current status & future solutions. (Currently Unavailable)
    CAIRNCROSS S. International Journal of Environmental Health Research. (2003) 13, S123-S131.
  22. Water Supply and Sanitation. Some misconceptions.
    CAIRNCROSS S. Tropical Medicine and International Health, (2003) Vol. 8, no. 13, pp 193-195
  23. Low-cost sanitation technology for the control of intestinal helminths.
    CAIRNCROSS S. Parasitology Today. 1987 Mar; 3(3):94-8.
  24. Irrigation water as a source of drinking: is safe use possible? Tropical Medicine and International Health,
    van der Hoek, W., Konradsen, F., Ensink, J.H.J., Mudasser, M. & Jensen, P.K. (2001). 6 (1), 46-54.

Household Water Treatment

  1. *Lantagne D, and Clasen T (2009). Point-of-use Water Treatment in Emergency Response. London School of Hygiene and Tropical Medicine, London, UK.
  1. Boisson S, Schmidt WP, Berhanu T, Gezahegn H, Clasen T. (2009) Randomized controlled trial in rural Ethiopia to assess a portable water treatment device. Environ Sci Technol. Aug 1;43(15):5934-9.
  2. Tiwari SS, Schmidt WP, Darby J, Kariuki ZG, Jenkins MW. (2009) Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial. Trop Med Int Health. 14(11):1374-82.
  3. Boisson S, Tadesse G, Gezahegn H, Gerhanu T, Schmidt W-P, Clasen T (2009). A randomized controlled trial in rural Ethiopia to assess the LifeStraw personal water filter. Environmental Sci. & Tech. 43(15):5934–39
  4. Clasen T, Bartram J, Colford J, Luby S, Quick R, Sobsey M (2009). Comment on "Household Water Treatment in Poor Populations: Is There Enough Evidence for Scaling up Now?" Environmental Sci. & Tech. 43 (14), 5542-5544
  5. Clasen T, Naranjo J, Frauchiger D, Gerba C (2009). Laboratory assessment of a gravity-fed ultrafiltraton water treatment device designed for household use in low-income settings. Am J. Trop. Med. Hyg. 80(5) 819-823.
  6. Schmidt WP, Cairncross S. (2009) Household water treatment in poor populations: is there enough evidence for scaling up now? Environ Sci Technol. 15;43(4):986-92.
  7. *Clasen T (2009). Scaling Up Household Water Treatment and Safe Storage: in Low-Income Populations.Geneva: World Health Organization
  8. Brown, J. And Sobsey, M. 2009. Metal oxide amended ceramic media for the capture of viruses in drinking water. Environmental Technology 30(4): 379-391.
  9. Brown, J., Proum, S., and Sobsey, M. 2009. Sustained use of a household-scale water filtration device in rural Cambodia. Journal of Water and Health 7(3): 404-411.
  10. Lantagne D, Meierhofer R, Allgood G, McGuigan KG, and Quick R (2009). Comment on Point of use household drinking water filtration: a practical, effective solution for providing sustained access to safe drinking water in the developing world. Environ Sci Technol 43(3), 968-9; author reply 970-1.
  11. Kotlarz N, Lantagne D, Preston K, and Jellison K (2009). Turbidity and chlorine demand reduction using locally available physical water clarification mechanisms before household chlorination in developing countries. J Water Health 7(3), 497-506.
  12. Boisson S, Kiyombo M, Sthreshley L, Tumba S, Makambo J, Clasen T (2010). Field assessment of a novel household-based water filtration device: a randomised, placebo-controlled trial in the Democratic Republic of Congo. PLOS One 5(9): e12613. doi:10.1371/journal.pone.0012613
  13. *Rosa G, Miller L, Clasen T (2010). The microbiological effectiveness of disinfecting water by boiling in Guatemala. Am. J. Trop. Med. Hyg. 82(3): 473-77
  14. *Clasen T (2010). Household water treatment and safe storage in low-income countries, in Selendy J., et al.(eds.) Water and Sanitation Related Diseases and the Environment: Challenges, Interventions and Preventive Measures. New York: Wiley and Sons.
  15. Lantagne D (2010). Comment on An observational study on the effectiveness of point-of-use chlorination. J Environ Health 72(2), 38-9.
  16. Lantagne D, Klarman M, Mayer A, Preston K, Napotnik J, and Jellison K (2010). Effect of production variables on microbiological removal in locally-produced ceramic filters for household water treatment. Int J Environ Health Res20(3), 171-87.
  17. Lantagne D, Preston K, Blanton E, Kotlarz N, Gezagehn H, van Dusen E, Berens J, and Jellison K (2011).Hypochlorite solution expiry and stability in household water treatment in developing countries. Journal of Environmental Engineering 137(2), 131-6.
  18. *Freeman M., Clasen T (2011). As assessment of the impact of a school-based safe water intervention on household adoption of point-of-use water treatment practices in Southern India. Am. J. Trop. Med. Hyg.84(3):370–378
  19. *Peletz R, Simuyandi M, Sarenje K, Baisley K, Kelly P, Filteau S, Clasen T. (2011) Drinking Water Quality, Feeding Practices and Diarrhea Among Children Under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia. Am. J. Trop. Med. Hyg. 85(2).
  20. Sodium dichloroisocyanurate (NaDCC) tablets as an alternative to sodium hypochlorite for the routine treatment of drinking water at the household level.
    CLASEN T, Edmondson P (2006) Int'l J. Hyg. & Environ. Health [epub ahead of press: doi:10.1016/j.ijheh.2005.11.004]
  21. Interventions to improve water quality for preventing diarrhoea (Cochrane Review).
    CLASEN T, Roberts I, Rabie T, Schmidt W-P, Cairncross S (2006) In: The Cochrane Library, Issue 3, 2006. Oxford: Update Software (in press)
  22. Microbiological performance of a water treatment unit designed for household use in developing countries.
    CLASEN T, Nadakatti S, Menom S (2006) Trop. Med. Int'l Health (in press)
  23. Preventing diarrhoea with household ceramic water filters: assessment of a pilot project in Bolivia.
    CLASEN T, Brown J, Collin S (2006) Intl J. Environ Health Research (in press)
  24. The Drinking Water Response to the Indian Ocean Tsunami, including the role of household water treatment.
    CLASEN T and Smith L. Protection of the Human Environment: Water, Sanitation and Health, Geneva 2005.
  25. Household-based ceramic water filters for the prevention of diarrhea: a randomized, controlled trial of a pilot programme in Colombia
    CLASEN T, Parra GG, Boisson S, Collin S. American Journal of Tropical Medicine and Hygiene. 2005 Oct; 73(4):790-5.
  26. Safe household water treatment and storage using ceramic drip filters: a randomised controlled trial in Bolivia.
    CLASEN T, Brown J, Suntura O, Collin S. Water Science and Technology. 2004; 50(1):111-5.
  27. Household water management: refining the dominant paradigm.
    CLASEN T, CAIRNCROSS S. Tropical Medicine and International Health. 2004 Feb; 9(2):187-91.
  28. Reducing diarrhea through the use of household-based ceramic water filters: a randomized, controlled trial in rural Bolivia.
    CLASEN T, Brown J, Collin S, Suntura O, CAIRNCROSS S. American Journal of Tropical Medicine and Hygiene. 2004 Jun; 70(6):651-7.
  29. Is there an association between bacteriological drinking water quality and childhood diarrhoea in developing countries?
    Jensen PK, Jayasinghe G, van der Hoek W, CAIRNCROSS S, Dalsgaard A. Tropical Medicine and International Health. 2004 Nov; 9(11):1210-5.
  30. Effect of chlorination of drinking-water on water quality and childhood diarrhoea in a village in Pakistan.
    Jensen PK, Ensink JH, Jayasinghe G, van der Hoek W, CAIRNCROSS S, Dalsgaard A. Journal of Health and Population Nutrition. 2003 Mar; 21(1):26-31.
  31. Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use.
    CLASEN TF, Bastable A. Journal of Water and Health. 2003 Sep; 1(3):109-15.
  32. Domestic transmission routes of pathogens: the problem of in-house contamination of drinking water during storage in developing countries.
    Jensen PK, ENSINK JH, Jayasinghe G, van der Hoek W, CAIRNCROSS S, Dalsgaard A. Tropical Medicine and International Health. 2002 Jul; 7(7):604-9.
  33. Reviewing the health impacts of improvements in water supply.
    Lewin S, Stephens C, CAIRNCROSS S. Urban Health Newsletter. 1997 Mar; (32):34-47.

Behaviour Change

  1. *Curtis, Valerie, Lisa Danquah and Robert Aunger (2009) 'Planned, motivated and habitual hygiene behaviour: an eleven country review.' Health Education Research 24(4): 655-673.
  2. Sniehotta, Falko and Robert Aunger (2010) 'Stage models of behaviour change'. Health Psychology (2nd edition), edited by David P French, A Kaptein, K Vedhara and John Weinman. Oxford: Wiley/Blackwell.
  3. Aunger, Robert (2010) 'Three roads to cultural replication'. Evolutionary Psychology and Information Systems Research: A New Approach to Studying the Effects of Modern Technologies on Human Behavior,edited byNed Kock. New York: Springer Verlag, pp. 341-354.
  4. Curtis, V. (in press). Disgust. In V. Ramachandranagain (Ed.), The Encyclopaedia of Human Behaviour (2nd ed.). Oxford: Elsevier.
  5. *Curtis, Valerie and Robert Aunger (in press) 'Motivational mismatch: Evolved motives as the source of – and solution to – global public health problems'. Practical Uses of Evolutionary Psychology, ed. by Craig Roberts. Oxford University Press.
  6. *Judah, Gaby, Benjamin Gardner Sood, and Robert Aunger (submitted) 'Forming a flossing habit: An investigation into the psychological determinants of habit formation'. British Journal of Health Psychology.
  7. *Aunger, Robert and Valerie Curtis (submitted) 'Consolidating behaviour change approaches.' Basic and Applied Social Psychology.
  8. Formative research for hygiene promotion in Kyrgyzstan.
    BIRAN A, Tabyshalieva A, Salmorbekova Z. Health Policy and Planning. 2005 Jul; 20(4):213-21.
  9. Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe.
    WATERKEYN J, CAIRNCROSS S. Social Science and Medicine. 2005 Nov; 61(9):1958-70.
  10. What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India.
    CAIRNCROSS S, Shordt K, Zacharia S, Govindan BK. Social Science and Medicine. 2005 Nov; 61(10):2212-20.
  11. Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.
    CURTIS V, Kanki B, Cousens S, Diallo I, Kpozehouen A, Sangare M, Nikiema M. Bulletin of the World Health Organisation. 2001; 79(6):518-27.
  12. Hygiene promotion in Burkina Faso.
    CURTIS V, Kanki B. Africa Health. 1998 Jan; 20(2):9, 11-12.
  13. Behavioural Indicators of Household Decision-Making and Demand for Sanitation and Potential Gains from Sanitation Marketing in Ghana.
    JENKINS M, and SCOTT B. 2006.
  14. Serotonin-a link between disgust and immunity?
    Rubio-Godoy, M., R. Aunger, and CURTIS V. (2007). Medical Hypotheses 68(1): 61-66.


  1. *Curtis, Valerie, Míchèal DeBarra and Robert Aunger (2011) 'Disgust as an adaptive system for disease avoidance behaviour.' Philosophical Transactions of the Royal Society B: Biological Sciences 366: 389-401.
  2. *Curtis, V. (in press). Why disgust matters. Philos Trans R Soc Lond B Biol Sci.
  3. *de Barra, Míchèal, Robert Aunger, Diana Fleischman, and Valerie Curtis (submitted) 'Infection cues and disgust sensitivity'. Journal of Personality and Social Psychology.
  4. Evidence that disgust evolved to protect from risk of disease.
    CURTIS V, AUNGER R and RABIE T Proceedings of the Royal Society Biology Letters Supplement, 2003, 0144.
  5. Dirt, Disgust, and Disease: Is Hygiene in Our Genes?
    CURTIS V and BIRAN A. Perspectives in Biology and Medicine, 44.1, 2001.
  6. Hygiene: How myths, monsters and mothers-in-law can promote behaviour change.
    CURTIS V. Journal of Infection 2001: 43: 75 - 79
  7. Dirt and Disgust: a Darwinian perspective on hygiene.
    CURTIS V, Voncken N and Singh S. Medische Antropologie 11 (1) 143-158 1999.


  1. Schmidt WP, Cairncross S, Barreto ML, Clasen T, Genser B. (2009) Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years. Int J Epidemiol. 38(3):766-72.
  2. Schmidt WP, Genser B, Barreto ML, Clasen T, Luby SP, Cairncross S, Chalabi Z. (2010) Sampling strategies to measure the prevalence of common recurrent infections in longitudinal studies. Emerg Themes Epidemiol. 3;7(1):5.
  3. Lantagne D, Cardinali F, and Blount BC (2010). Disinfection by-product formation and mitigation strategies in point-of-use chlorination with sodium dichloroisocyanurate in Tanzania. Am J Trop Med Hyg 83(1), 135-43.
  4. Schmidt WP, Boisson S, Genser B, Barreto ML, Baisley K, Filteau S, Cairncross S. (2010) Weight-for-age z-score as a proxy marker for diarrhoea in epidemiological studies. J Epidemiol Community Health. Dec;64(12):1074-9.
  5. *Brown, J., Stauber, C., Murphy, J., Khan, A. Mu, T., Elliott, M., and Sobsey, M. Ambient temperature incubation for the field detection of E. coli in drinking water. (2011) Journal of Applied Microbiology 110(4): 915-923.
  6. *Psutka R, Peletz R, Michelo S, Kelly P, Clasen T (2011). The microbiological effectiveness and potential cost of boiling drinking water in peri-urban Zambia: a costly and ineffective approach to improve microbiological quality. Environmental Sci & Tech 45(14):6095-101
  7. Krentel, Alison and Robert Aunger (2011) 'Causal chain mapping: a novel method to analyse treatment compliance decisions, with application to lymphatic filariasis elimination in Alor, Indonesia'. Health Policy and Planning 26(4): 1-12.
  8. Greenland K, Rondy M, Chevez A, Sadozai N, Gasasira A, Abanida EA, Pate MA, Ronveaux O, Okayasu H, Pezzoli L. Clustered-LQAS: a pragmatic tool to timely assess vaccination coverage. The example of Polio in Northern Nigeria. (2011) Trop Med Int Health. Apr 11
  9. *Wolf-Peter Schmidt, Benjamin F Arnold, Sophie Boisson, Bernd Genser, Stephen P Luby, Mauricio L Barreto, Thomas Clasen, Sandy Cairncross. 2011. Epidemiological methods in diarrhoea studies– an update.International Journal of Epidemiology
  10. Lantagne D, and Clasen T (Accepted). PoUWT in Emergency Response. Waterlines.
  11. Enger K, Nelson K, Clasen T, Rose J, Eisenberg J. (submitted) The sensitivity of effectiveness to incomplete compliance: analysis of a household water treatment intervention trial in the Congo.
  12. Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies.
    Ezzati M, Utzinger J, CAIRNCROSS S, Cohen AJ, Singer BH. Journal of Epidemiology and Community Health. 2005 Jan; 59(1):15-22
  13. Happy, Healthy and Hygienic, How to set up a Hygiene Promotion Programme (books 1-4).
    Unicef, The London School of Hygiene and Tropical Medicine, & Ministere de la Sante du Burkina Faso.
  14. Dirt and Diarrhoea: formative research for the design of hygiene promotion programmes.
    CURTIS V, Kanki B, Cousens S, Sanou A and Mertens T. Health Policy and Planning. 1997, 12(2): 122-131.
  15. Reactivity and repeatability of hygiene behaviour: structured observations from Burkina Faso.
    Cousens S, Kanki B, Toure S, Diallo I, CURTIS V. Social Science and Medicine. 1996 Nov; 43 (9):1299-308.
  16. Measuring Hygiene behaviours: Experiences of a comprehensive approach in Burkina Faso.
    Kanki B, CURTIS V, Mertens T, Cousens S and Traoré E. In Studying Hygiene Behaviour: Issues and Experiences. Cairncross A & Kochar V. London, Sage publications 1994.
  17. Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility.
    CURTIS V, Cousens S, Mertens T, Traore E, Kanki B, Diallo I. Bulletin of the World Health Organisation. 1993; 71(1):23-32.
  18. Masters of Marketing: Bringing Private Sector Skills to Public Health Partnerships.
    CURTIS VA, Garbrah-Aidoo N, Scott B. American Journal of Public Health 2007; 97 (4):634-41.

Policy and Implementation

  1. *Clasen, T (2010). Scaling up household water treatment among low-income populations (Chapter 10), Smith et al. (eds), From One to Many: Scaling Up Health Programs. Dhaka: BRAC University
  2. Lantagne D (2009). Viability of commercially available bleach for water treatment in developing countries. Am J Public Health 99(11), 1975-8.
  1. Schmidt WP. (2009) Setting priorities in diarrhoeal disease research: merits and pitfalls of expert opinion. J Health Popul Nutr. 27(3):313-5.
  2. Curtis, V. (2009). Keep Clean! In L. Gollogly (Ed.), Public Health campaigns: getting the message across.Geneva: WHO.
  3. *Brown J, Outlaw T, Clasen T, Wu J, Sobsey M (2009). Safe Water for All: Harnessing the Power of the Private Sector to Reach the Underserved. Washington, DC: International Finance Corporation/World Bank Group.
  4. *Freeman, MC, Quick, RE, Ougtu, P. Abbott, DP, Rheingans R, (2009) Removing barriers to point-of-use water treatment products through social marketing and entrepreneurship: A case study in Western Kenya. Journal of Water and Health. 7(3): 527-34.
  5. *Sobsey, M. and Brown, J. (2011) Evaluating household water treatment options: health- based targets and performance specifications. Geneva: World Health Organization.
  6. *Lantagne D, Clasen T (2011). Assessing the Implementation of Selected Household Water Treatment and Safe Storage (HWTS) Methods in Emergency Settings. London School of Hygiene and Tropical Medicine. London, UK
  7. Cravioto A, Lanata C, Lantagne D, and Nair GB (2011). Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti. Presented to the Secretary-General of the UN.
  8. Rayner J, Lantagne D, and working group members (2011). Best Practice Recommendations for Local Manufacturing of Ceramic Pot Filters for Household Water Treatment. Atlanta, GA, USA.
  9. *Lantagne D, and Clasen T (2011). Assessing the Sustained Uptake Of Selected Point-of-Use Water Treatment Methods (PoUWT) In Emergency Settings. LSHTM, London, UK.
  10. Kahn JG, Harris B, Mermin JH, Clasen T, Lugada E, Grabowsky M, Vestergaard M, Garg N. (submitted) Cost of integrated community prevention campaign for malaria, HIV, and diarrhea in rural Kenya.
  11. *Trinies V, Freeman M, Hennink M, Clasen T. (submitted) The role of social networks on the adoption of household water filters by women in self-help groups in rural India. J of Water, Sanitation and Hygiene for Development.
  12. *Mark Grabowsky, Eric Lugada, Mikkel Vestergaard, Navneet Garg, James G. Kahn, Rose Donna, Rose Bosire, John Haskew, Thomas Clasen, Jonathan Mermin. (submitted) Rapid, high and equitable coverage and use of HIV testing, bednets and water filters following an integrated mass implementation campaign in Kenya.
  13. International network to promote household water treatment and safe storage.
    CLASEN TF, Mintz ED. Emerging Infectious Diseases. 2004 Jun; 10(6):1179-80.
  14. Water, sanitation, and hygiene at Kyoto.
    CURTIS V, CAIRNCROSS S. British Medical Journal. 2003 Jul 5; 327(7405):3-4.
  15. The public-private partnership for the Central American handwashing initiative: reflections from a private sector perspective.
  16. Financing the development and commercialization of small-scale water treatment systems.
    Clasen T In Proceedings of the Third NSF International Symposium on Small Drinking Water and Wastewater Systems 329-38, 2001.

Wastewater Use

  1. Wastewater use in agriculture
    Editorial: New international guidelines for wastewater use in agriculture. Tropical Medicine and International Health,
    Ensink, J. H. J. & van der Hoek, W. (2007).12 (5), 575- 577.
  2. Giardia duodenalis infection and wastewater irrigation in Pakistan. Transactions of the Royal Society of Tropical Medicine and Hygiene,
    Ensink, J.H.J., van der Hoek, W & Amerasinghe, F. P. (2006). 100, 538-542
  3. High risk of hookworm infection among wastewater farmers in Pakistan. Transactions of the Royal Society of Tropical Medicine and Hygiene,
    Ensink, J.H.J., van der Hoek, W., Mukhtar, M., Tahir, Z., & Amerasinghe, F.P. (2005). 99, 809-818.
  4. A nation-wide assessment of wastewater use in Pakistan: an obscure activity or a vitally important one? Water policy, Ensink, J.H.J., Mahmood, T., van der Hoek, W., Raschid-Sally, L. & Amerasinghe, F.P. (2004). 6, 197- 206.
  5. Wastewater-irrigated vegetables: market handling versus irrigation water quality. Tropical Medicine and International Health, 12 suppl. 2, 2-7
    Ensink, J. H. J., T. Mahmood & A. Dalsgaard. (2007).
  6. Water management and vector breeding
    The importance of waste stabilization ponds and wastewater irrigation in the generation of vector mosquitoes in Pakistan. Journal of Medical Entomology,
    Mukhtar, M., Ensink, J.H.J., van der Hoek, W., Amerasinghe, F.P. & Konradsen, F. (2006). 43 (5), 996-1003.
  7. Adult anopheline ecology and malaria transmission in an irrigated area of south Punjab, Pakistan. Medical and Veterinary Entomology,
    Herrel, N., Amerasinghe, F.P., Ensink, J., Mukhtar, M., van der Hoek, W., & Konradsen, F. (2004). 18, 141-152.
  8. Role of wastewater irrigation in mosquito breeding in South Punjab, Pakistan. Southeast Asian Journal of Tropical Medicine and Public Health,
    Mukhtar, M., Herrel, N., Amerasinghe, F.P., Ensink, J., van der Hoek, W., & Konradsen, F. (2002). 34 (1), 72-80.
  9. Breeding of Anopheles mosquitoes in irrigated areas of South Punjab, Pakistan. Medical and Veterinary Entomology,
    Herrel, N., Amerasinghe, F.P., Ensink, J., Mukhtar, M., van der Hoek, W., & Konradsen, F. (2001). 15 (3), 236-248.


  1. Aunger, Robert (2009). 'Human communication as niche construction,' in Pattern and Process in Cultural Evolution, ed. by Stephen Shennan. Berkeley: University of California Press, pp. 33-44.
  2. Baune BT, Schmidt WP, Roesler A, Berger K. (2009) Functional consequences of subcortical white matter lesions and MRI-defined brain infarct in an elderly general population. J Geriatr Psychiatry Neurol. 22(4):266-73.
  3. Aunger, Robert (2010) 'Types of technology.' Technological Forecasting and Social Change 77:762-782.
  4. Aunger, Robert (2010) 'What's special about human technology?' Cambridge Journal of Economics 34:115-123.
  5. *Peletz, R.; Filteau, S. (2010) Safe water and HIV-exposed infants. J Infect Dis 201(9):1441-2; author reply 1442-4.
  6. Schmidt WP, Pebody R, Mangtani P. (2010) School absence data for influenza surveillance: a pilot study in the United Kingdom. Euro Surveill. 15(3). pii: 19467.
  7. Ousmane Touré, Salimata Coulibaly, Aminata Arby, Farmata Maiga and Sandy Cairncross (2011) Improving microbiological food Safety in peri-urban Mali; an experimental study. Food Control 22:1565-1572
  8. Wolf-Peter Schmidt, Motoi Suzuki, Vu Dinh Thiem, Richard G White, Ataru Tsuzuki,Lay-Myint Yoshida, Hideki Yanai, Ubydul Haque, Le Huu Tho, DangDuc Anh, Koya Ariyoshi (2011) Population density, water supply and the risk of dengue fever in Vietnam: cohort study and spatial analysis. PLoS Medicine
  9. Revisiting the tsunami: health consequences of flooding.
    Morgan O, Ahern M, CAIRNCROSS S. PLoS Med. 2005 Jun; 2(6):e184.
  10. The intensity of transmission of hepatitis A and heterogeneities in socio-environmental risk factors in Rio de Janeiro, Brazil.
    Amaku M de Almeida, RS Azevedo, S CAIRNCROSS & E Massad; Trans R Soc Trop Med Hyg; 2002, 96, 605-610.
  11. The Electric Meme: A new theory of how we think.
    AUNGER R Free Press, 2002
  12. Evaluation of the dracunculiasis surveillance system in 4 districts in Ghana.
    CAIRNCROSS S. Weekly epidemiological record No.32, 2005; 80, 12 Aug;


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