WASHPaLS Earth Enable Final Report – Behavioral and Biological Plausibility of the Protective Effects of Improved Flooring


Fecal matter and parasites, such as soil-transmitted helminths, are just some of the contaminants found in soil. Fleas and rats spread these toxins widely. Children are exposed to these pathogens, parasites, and vectors when they put soil-contaminated objects, including their hands, or soil directly into their mouths. Walking or sitting directly on earth floors creates another exposure point.  

Exposure to fecally contaminated soil has been associated with enteric illness and growth faltering among infants and young children. Chronic parasite infections are associated with impaired cognitive development, school performance and earning potential. Hookworm infection is associated with anemia and can lead to adverse birth outcomes among pregnant women.

Compared to unfinished flooring, finished flooring may reduce children’s exposure to pathogens. To explore how the behavioral and biological mechanisms by which improved flooring could improve child and maternal health, a team working with USAID’s Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) conducted a three-part study of improved flooring in rural Uganda. In Part 1 of the study, EarthEnable conducted in-depth interviews to explore the perceptions of improved and unimproved housing material and how installation of improved flooring alters behaviors. In Part 2, EarthEnable assessed children’s exposure to soil and other objects potentially contaminated with soil, as well as their time spent inside the house, to understand the degree to which improved flooring inside the house may impact children’s health. In Part 3, EarthEnable measured the amount of dust on improved and unimproved floors to produce a quantitative estimate of finished flooring’s potential to reduce exposure to pathogens.