Assessment of the level of access to safe potable water, hygiene and sanitation in households in the commune of bonou in southern Benin in 2020

Background: Access to improved sanitation, adherence to good hygienic practices, and adequate supply of safe water are very crucial factors for the health and well-being of people within the household and the entire community. Household sanitation and hygiene promotion has largely been done by community health workers in most places in Tanzania and worldwide, especially in rural and marginalized areas. Despite the presence of community health workers in Tanzania as primary health providers, WASH-sensitive indicators such as diarrhea, stunted growth, and typhoid are still high. However, little has been done to assess their knowledge, attitude, and practices regarding household sanitation and hygiene. Aim: This study aimed to assess knowledge, attitude and practices among community health workers on household sanitation and hygiene at Mbarali and Mbeya rural districts in Mbeya region, south-west highlands of Tanzania. Methods: The study used a descriptive cross-sectional design. The sample size was estimated by using Yamane formula for calculating sample size. Data for the study were collected for one month, questionnaire guide and observation checklist were used as data collection methods. Data were entered in STATA version 15 databases by two research assistants, and then data were cleaned, validated and analyzed. Descriptive analyses included frequencies and percentages of socio-demographic characteristics such as age, sex, education, knowledge, attitude, and practice of hygiene and sanitation. To determine the association between socio-demographic characteristics and respondents 'KAP, a bivariate chi-square test was conducted. A threshold of 0.05 p-values was used for statistical significance. Results: A total of 391CHWs were recruited. Out of 391CHWs, 184 (47.1%) had adequate knowledge regarding household sanitation and hygiene, while 207(52.9%) CHWs had inadequate knowledge. 74.4% of the CHWs had a positive attitude towards, whilst 25.6% of the participants had a negative attitude regarding household sanitation and hygiene. A total of 128 (33.0%) had good practices, while (67.1%) of the participants had poor practices regarding household sanitation and hygiene. High education level and the short period from the last training on sanitation and hygiene were found to be associated with adequate knowledge (p=0012) and (p=0.008) respectively. Female participants were found to have good practices (p=0.015) than their counterparts. The observation checklist revealed that, of the total 391CHWs, 206(52.7%) CHWs didn’t receive the needed cooperation from the community members, though they had all the necessary equipment for home visits. On house-to-house visits, only 28 CHWs had all the necessary equipment. None of the CHWs had allowance at the end of the visit. Conclusion: The findings of this study underscore the need to check CHW programs to match their needs as per their roles to strengthen the knowledge, attitude, and practices hence ensuring efficiency in their provision of primary health services and promotion of improvement in household sanitation and hygiene particularly in household sanitation and hygiene.

Inadequate protection of water sources, and poor household hygienic and handling practices have exacerbated fecal water contamination in Kenya. This study evaluated the rate and correlates of thermotolerant coliform (TTC) household water contamination in Kericho District, Western Kenya. Culture and multiplex polymerase chain reaction (PCR) techniques were used to characterize TTCs. The disk diffusion method was used for antibiotic susceptibility profiling of pathogenic Escherichia coli. Out of the 103 households surveyed, 48 (46.6%) had TTC contaminated drinking water (TTC levels of >10 cfu/100 mL). Five of these households were contaminated with pathogenic E. coli, including 40% enteroaggregative E. coli, 40% enterotoxigenic E. coli, and 20% enteropathogenic E. coli. All these pathogenic E. coli strains were multidrug resistant to sulfamethoxazole/trimethoprim, ampicillin, tetracycline and ampicillin/sulbactam. Rural household locality, drinking water hand contact, water storage container cleaning practice, hand washing before water withdrawal, water source total coliforms <10 cfu/100 mL, temperature, and free chlorine levels were associated with TTC contamination of household drinking water. Significant proportions of household drinking water in Kericho District are contaminated with TTCs including with pathogenic multidrug-resistant E. coli. Source and household hygiene and practices contribute significantly to drinking water contamination.

While the first order effects of access to clean water and of personal hygiene and sanitation on health have been well documented, the effects of community hygiene and sanitation, along with personal hygiene and sanitation, have not been comprehensively studied. In this paper, incorporating the features of models from agricultural household (Bardhan and Udry, 1999) and reciprocal externalities (Dasgupta, 1993), we present a simple model of health externalities of households' hygiene and sanitation, showing how the choices of one household affects ill-health incidences of other households. Then using micro level survey data of 1,530 households in rural Uttarakhand, India, we show that both household and community hygiene are significant inputs in the determination of households' ill-health incidences (i.e. diarrhea, cholera, typhoid, dysentery, worm infestation and jaundice), with the latter having greater impact than the former, over and above effects attributable to households' socioeconomic status. That is, there is a large health externality of a household's hygiene and sanitation. In the presence of such health externality of households' hygiene and sanitation, which is strongly associated with the access to safe water, universal access to safe water may be required to combat water-related illnesses. This implies that the governments' consideration of alternative proposals to improve water services must be informed by health externalities in households' hygiene and sanitation, and in the provision of water across communities.

Lack of adequate access to safe water, sanitation, and hygiene (WASH) has contributed to increased under-five mortality and morbidity of school-age children in low- and middle-income countries. Despite the global and national intervention programs, access to safe WASH remains a critical challenge in Nigeria. This study employed spatial and non-spatial statistics to establish causal relationships between WASH conditions and household factors in Nigeria. Results show that a large proportion of Nigerian households were still associated with unimproved hygiene (88%), sanitation (47%) and water (25%). Wealth status, literacy level and residency type exhibit significant causal relationships with households’ water sources (α = 0.000). Wealth status and the gender of household head exhibit significant causal relationships with sanitation condition (α = 0.000) and hygiene condition (α = 0.004 and α = 0.345, respectively). However, the computed parameter Degree of Dependence (DoD_j) shows that the choice of water sources mostly depends on residency type (DoD_j = 0.998) compared with the level of education and wealth status (DoD_j = 0.535 and 0.485, respectively). Statistical indices show that the implemented regression models are reliable (with models’ DoD of 0.714–0.996, Adjusted R2 of 0.184–0.762 and Akaike Information Criterion (AICc) of 68–103). The study concludes that a high risk of unimproved WASH is associated with rural residence, which is usually characterised by a low level of education, poverty and large household size. It further concludes that the high prevalence of unimproved hygiene, irrespective of the household wealth status and educational level, suggests the need for proper health and hygiene education. This study suggests the need for a more focused policy action towards empowering rural and vulnerable households in Nigeria with relevant preventive environmental and health information and appropriate social support for the communities.

Water scarcity and COVID-19 in sub-Saharan Africa

Basic sanitation, safe drinking water, and proper hygiene practice may lessen the burden of waterborne illnesses and neglected tropical diseases. The current study sought, for the first time, to evaluate household water, sanitation, and hygiene (WASH) practices and acute diarrhea among children under 5 years of age and their associated factors on St. Martin's Island. Two hundred one households with at least one child aged under 5 years were interviewed using a pretested semistructured questionnaire designed according to UNICEF/WHO Joint Monitoring Program for Water Supply, Sanitation, and Hygiene 2019 and on-the-spot observations. Bivariate logistic regression analyses investigated the association between potential sociodemographic characteristics, WASH components, and acute diarrhea. Almost all sampled households (99.5%) had improved drinking water facilities. More than one-third (36.5%) did not have an improved sanitation facility, and open defecation was reported by 12.4% of study subjects. Only one-third of respondents reported washing their hands with soap or detergent after defecation, and approximately 29% of respondents reported sharing their toilet with other family members. A handwashing station with soap and water was observed in only 14.4% of cases, whereas more than 22% had none. More than one-quarter (26.4%) of children aged under 5 years were reported to experience acute diarrhea. Access to WASH facilities and the occurrence of acute diarrhea were found to be associated with a set of demographic and socioeconomic characteristics. Sanitation facilities are limited and inappropriate WASH practices are prevalent in the studied population with linkage to diarrhea in children; therefore, urgent attention is needed to improve WASH facilities and encourage health-promoting WASH behavior in St. Martin's Island population.

Cholera outbreaks are surging worldwide. Growing research supports case-area targeted interventions (CATIs), whereby teams provide a package of interventions to case and neighboring households, as an effective strategy in cholera outbreak control, particularly in humanitarian settings. While research exists on individual CATI interventions, research gaps exist on outcomes of integrated interventions during CATI responses. We conducted a prospective observational cohort study on CATIs during the 2021 cholera outbreak in Northeast Nigeria. During CATI response in Borno, Adamawa, and Yobe, research enumerators accompanied CATI teams to households and observed interventions (including provision of soap, Aquatabs, educational materials, and jerrycans; latrine and bedding disinfection; and hygiene promotion) and collected data on demographics, existing household water, sanitation, and hygiene, and household water free chlorine residual (FCR). Enumerators returned to households 10-14 days later to conduct follow-up surveys. We tested differences in reported delivery and receipt of interventions, and household drinking water FCR concentrations before and after CATIs. We also analyzed the associated relationship between CATI and environmental factors and odds of FCR <0.2 mg/L using quasi-Poisson multivariate logistic regression models with generalized estimating equations (GEE). We found household drinking water FCR significantly increased (p<0.001) post-CATI in Adamawa state. Self-reported receipt of Aquatabs and handwashing station availability were significantly associated with reduced odds of FCR <0.2 mg/L at follow-up. Self-reported receipt of hygiene promotion lacked significant associations with FCR in both Adamawa and Borno. These associations varied by type of water source. These findings suggest that CATIs improved household drinking water FCR, a key protective measure against cholera, in Northeast Nigeria. Our research highlights factors associated with FCR concentrations <0.2 mg/L post-CATI in Adamawa and Borno, offering valuable insights for response planning, and overall supports the continued use of CATIs in humanitarian settings.

Household water, sanitation and hygiene (WASH) practices in remote, rural, and unpiped communities are likely to impact exposure to pathogens beyond the fecal–oral transmission routes that are typically prioritized in WASH interventions. We studied 43 homes in two remote, rural, unpiped communities in Alaska to evaluate seasonal water haul, water sources, water quality, and water reuse, as well as greywater and human waste disposal over 1 year. Hauled quantities of water reportedly ranged from 3.0 to 5.4 gallons per capita per day (gpcd) depending on the community and season. Natural, untreated water sources contributed 0.5–1.1 gpcd to household water availability. Reported quantities of water hauled were significantly correlated with total water storage capacity in the home. Total coliforms were detected in 30–60% of stored household water samples from treated and untreated sources, and total coliform counts were significantly higher in specific sources and during specific seasons. Exposure to pathogens during periods of low water access, from untreated water reuse, from greywater disposal and from human waste disposal are important pathways of disease transmission in these remote, rural, unpiped communities. We discuss intermediate steps that can be taken at the household and community levels to interrupt exposure pathways before piped infrastructure is installed. This model of examining specific household practices to determine transmission routes can be applied to other remote communities or unique conditions to aid in the recommendation of targeted WASH interventions.

Children successfully treated through community-based management of acute malnutrition (CMAM) frequently relapse to acute malnutrition (AM) following recovery and discharge. This prospective cohort study examined associations between relapse and household water, sanitation and hygiene (WASH) conditions, as well as animal ownership, in Mali, South Sudan and Somalia. Between April 2021 and June 2022, 1115 children were enrolled, with 964 children followed for 6 months, 242 in Mali, 488 in South Sudan and 234 in Somalia. Relapse to AM occurred in 32%, 63% and 21% of children in Mali, South Sudan and Somalia, respectively. In Mali, relapse risk was higher in households using multiple drinking water sources (aRR 1.71, 95% CI: 1.21-2.43, p = 0.003) or lacking soap (aRR 1.71, 95% CI: 1.03-2.82, p = 0.037). In South Sudan, inadequate drinking water sources, open defecation and the presence of animal faeces in the compound were associated with an increased risk of relapse (aRR 1.20, 95% CI: 1.04-1.38, p = 0.010; aRR 1.16, 95% CI: 1.03-1.30, p = 0.016; aRR 1.13, 95% CI: 1.02-1.26, p = 0.019, respectively). Sheep ownership in Mali (aRR 0.57, 95% CI: 0.40-0.81, p = 0.002) and cattle ownership in South Sudan (aRR 0.78, 95% CI: 0.71-0.85, p = < 0.001) were protective. No significant WASH or animal-related factors were associated with relapse in Somalia. As nearly all household drinking water samples were contaminated across settings and time points, no association could be detected between measured water quality and relapse. While many WASH indicators were not associated with relapse, some inadequate WASH conditions were identified as risk factors for relapse, although heterogeneous across contexts. These findings may help to identify at-risk children during treatment and inform strategies to reduce relapse post-recovery.

BackgroundTyphoid fever contributes to approximately 135 000 deaths annually. Achievable improvements in household water, sanitation, and hygiene (WASH) combined with vaccination using typhoid conjugate vaccines (TCVs) may be an effective preventive strategy. However, little is known about how improved WASH and vaccination interact to lower the risk of typhoid.MethodsA total of 61 654 urban Bangladeshi children aged 9 months to <16 years, residing in 150 clusters with a baseline population of 205 760 residents, were randomized 1:1 by cluster to Vi-tetanus toxoid TCV or Japanese encephalitis (JE) vaccine. Surveillance for blood culture–confirmed typhoid fever was conducted over 2 years. Existing household WASH status was assessed at baseline as Better or Not Better using previously validated criteria. The reduction in typhoid risk among all residents associated with living in TCV clusters, Better WASH households, or both was evaluated using mixed-effects Poisson regression models.ResultsThe adjusted reduced risk of typhoid among all residents living in the clusters assigned to TCV was 55% (95% confidence interval [CI], 43%–65%; P < .001), and that of living in Better WASH households, regardless of cluster, was 37% (95% CI, 24%–48%; P < .001). The highest risk of typhoid was observed in persons living in households with Not Better WASH in the JE clusters. In comparison with these persons, those living in households with Better WASH in the TCV clusters had an adjusted reduced risk of 71% (95% CI, 59%–80%; P < .001).ConclusionsImplementation of TCV programs combined with achievable and culturally acceptable household WASH practices were independently associated with a significant reduction in typhoid risk.Clinical Trials RegistrationISRCTN11643110.

Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6–23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north‐eastern provinces and the capital and used as cross‐sectional. Socio‐demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low‐household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north‐eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity‐focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.

How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation?

ABSTRACTBackgroundThe associations between anemia and household water source and sanitation remain unclear.ObjectivesWe aimed to assess the associations between anemia and household water source or sanitation in preschool children (PSC; age 6–59 mo) using population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project.MethodsWe analyzed national and subnational data from 21 surveys, representing 19 countries (n = 35,963). Observations with hemoglobin (Hb) and ≥1 variable reflecting household water source or sanitation were included. Anemia was defined as an altitude-adjusted Hb concentration <110 g/L. Household water source and sanitation variables were dichotomized as “improved” or “unimproved.” Poisson regressions with robust variance estimates were conducted for each survey, adjusting for child sex, age, household socioeconomic status, maternal education, and type of residence.ResultsAccess to an improved water source and improved sanitation ranged from 29.9% (Burkina Faso) to 98.4% (Bangladesh, 2012), and from 0.2% (Kenya, 2007) to 97.4% (Philippines), respectively. Prevalence of anemia ranged from 20.1% (Nicaragua) to 83.5% (Bangladesh, 2010). Seven surveys showed negative associations between anemia and improved sanitation. Three surveys showed association between anemia and improved water, with mixed directions. Meta-analyses suggested a protective association between improved household sanitation and anemia [adjusted prevalence ratio (aPR) = 0.88; 95% CI: 0.79, 0.98], and no association between improved household water and anemia (aPR = 1.00; 95% CI: 0.91, 1.10). There was heterogeneity across surveys for sanitation (P < 0.01; I2 = 66.3%) and water (P < 0.01; I2 = 55.8%).ConclusionsAlthough improved household sanitation was associated with reduced anemia prevalence in PSC in some surveys, this association was not consistent. Access to an improved water source in general had no association with anemia across surveys. Additional research could help clarify the heterogeneity between these conditions across countries to inform anemia reduction programs.

BACKGROUND: Drinking water is a vital aspect in human life. The quality of drinking water should be monitored to ensure public from any health effects caused by contaminated water. Escherichia coli (E. coli) is one of the indicators of fecal contamination should not be present in drinking water (0 cfu/100 ml). However, poor hygiene and sanitation contributes to E. coli contamination in drinking water, particularly in developing countries. AIM: We investigated the household hygiene and sanitation factors and the relationship with E. coli detection in the household drinking water. METHODS: A cross-sectional study design was conducted to collect the data from three districts in the Depok city, that is, Sawangan, Bojongsari, and Cipayung. A total of 300 houses and the corresponding drinking water samples were collected during August–September 2019. E. coli was determined as microbiological indicator using total plate count method. RESULTS: The results showed that E. coli was detected in 174 (58%) of household water samples. The water container condition (OR = 2,60; CI 95%: 1.18–5.71) and the hand washing practice with soap (OR = 1,65; CI 95%: 1.04–2.62) were significantly correlated with the presence of E. coli in the water samples. CONCLUSIONS: The condition of the water container was the most dominant factors which contributed to E. coli content in the household drinking water.

Background and AimsAccess to safe drinking water, sanitation, and hygiene is a fundamental human right and essential to control infectious diseases. However, many countries, including Ethiopia, do not have adequate data to report on basic water, sanitation, and hygiene (WASH) services. Although contaminated drinking water spreads diseases like cholera, diarrhea, typhoid, and dysentery, studies on drinking water contamination risk levels in households are limited in Ethiopia. Therefore, closing this gap needs investigation.MethodsA community‐based cross‐sectional study was conducted. A total of 5350 households were included. A systematic, simple random sampling technique was used to select the participants. The information was gathered through in‐person interviews using a standardized questionnaire. Furthermore, 1070 drinking water samples were collected from household water storage.ResultsThis investigation revealed that 9.8%, 83.9%, and 4.9% of households used limited, basic, and safely managed drinking water services, respectively. Besides, 10.2%, 15.7% and 59.3% of households used safely managed, basic and limited sanitation services, respectively. Yet, 10.6% and 4.2% of households used unimproved sanitation facilities and open defecation practices. Also, 40.5% and 19.4% of households used limited and basic hygiene services. On the other hand, 40.1% of households lacked functional handwashing facilities. In this study, 12.1%, 26.3%, and 42% of households’ drinking water samples were positive for Escherichia coli, fecal coliforms, and total coliforms, respectively. Also, 5.1% and 4.5% of households’ drinking water samples had very high and high contamination risk levels for E. coli, respectively. We found that 2.5% and 11.5% of households and water distributors had unacceptable fluoride concentrations, respectively.ConclusionThe majority of households in Bishoftu town lack access to safely managed sanitation, drinking water, and basic hygiene services. Many households’ water samples had very high and high health risk levels. Hence, the government and partner organizations should implement water and sanitation safety plans.