Water, sanitation, and hygiene (WASH) analysis of Amansea and Ugwuoba livestock market settlements and bacteriological quality investigation of drinking water sources at Amansea, Nigeria

Water, Sanitation, and Hygiene (WASH) is a comprehensive approach aiming to improve health, well-being, and quality of life by ensuring access to safe water, adequate sanitation, and proper hygiene practices (Hanchett, 2016). Additionally, the Sustainable Development Goals (SDGs) indirectly underscore the necessity of extending WASH services beyond households to attain universal and equitable access to safe and affordable drinking water, sanitation, and hygiene for all. Within the SDGs, there is explicit mention of WASH in Schools in Target 4, indicated by the criteria for proportion of schools with access to basic drinking water, single-sex basic sanitation, and basic handwashing facilities (UNICEF & WHO, 2016). Conversely, Patil (2016) claimed that in developing and poor countries, inadequate and hazardous water, sanitation, and hygiene are significant causes of child mortality and morbidity. Further, teachers then play a vital role in being the informants of the school as well as the students’ WASH practices, as the comprehensive water, sanitation, and hygiene in school (WINS) program has been implemented by the Department of Education (DepEd) and published under the DepEd order number 10, series of 2016). Further, in the global scope, the investigation of Girmay et al. (2023) discovered that insufficient access to essential water, sanitation, and hygiene services in a sizable portion of Bishoftu Town’s schools in Ethiopia poses a severe threat to the spread of various infectious illnesses. As Otsuka et al. (2019) observe, child health in low- and middle-income countries is primarily adversely affected by poor hygiene, lack of sanitation, and unsafe drinking water. In the same way, Maréchal et al. (2022) stress the need for the Arctic region’s remote areas to reach more countries, as SDG 6 is the provision of sufficient safe water to improve the population’s health. Furthermore, many programs do not adequately involve local populations in the planning and implementation stages, leading to a lack of ownership and sustainability (Fagan, 2015). Inadequate education efforts can also lead to continued poor hygiene behaviors among communities, and existing WASH infrastructure is poorly designed or inadequately maintained, leading to service interruptions and health risks. Maintenance is often neglected due to insufficient trained personnel and funding (UNICEF, 2016). Additionally, gender disparities often result in women and girls facing barriers to accessing sanitation facilities, impacting their health and education (Boelens, 2019). In the Philippines, poor water, sanitation, and hygiene (WASH) have resulted in diseases, causing approximately 15,000 deaths yearly in 2015, according to Vally et al. (2019). Furthermore, according to the United Nations Children’s Fund (2020), 50.3 million Filipinos still lack access to adequately managed sanitary facilities. Subsequently, Rivera (2020) mentioned in her study the inclusion of the Department of Education (DepEd) order No. 65, s. 2009, stating that the most prevalent hygiene deficiency-related infectious diseases in public schools are caused by a lack of clean water and adequate sanitary facilities, which, if left untreated, can lead to malnutrition, poor physical growth, and other illnesses. such as anemia and a toothache. Rivera also pointed out that one of the difficulties encountered during the implementation of the WASH in School (WinS) Program in Tarlac Province included inadequate maintenance and administration costs for other health and nutrition facilities Locally, within the study of Udto (2022) discussing the implementation of the WASH in Schools (WinS) Program in Parang North District of Maguindanao II Division, his findings revealed that the proper execution of a school-based management approach has a significant impact on the implementation of the WASH in Schools (WINS) Program in terms of water, hygiene, sanitation, health education, and deworming. Parents and the community play a critical role in the program’s success in addressing hygiene and sanitation issues affecting students vulnerable to various diseases due to a lack of access to correct hygiene and sanitation education, safe drinking water, and suitable facilities. Furthermore, Hasan et al. (2021) emphasized that promoting basic health science education (HSE) is crucial for achieving effective WASH practices among Indigenous Peoples (IP) in Barangay Lower Panaga, Panabo, Davao del Norte. Notably, with global, international, and even local WASH challenges becoming more pressing, it is critical to investigate the hygiene practices among the elementary students in Island Garden City of Samal through the observational aid of teachers, as the school and students’ practices in this regard can have long- term consequences for sustainable resource management and public health initiatives. Nonetheless, the persistent issue of hygiene practices remains low in the locale which significantly impedes the elementary students’ ability to maintain proper sanitation and hygiene practices. Bridging this research gap is essential for increasing awareness, providing the necessary information for focused educational initiatives, and implementing policy measures to cultivate a generation of environmentally aware and responsible citizens. This study has the potential to make a significant contribution to the literature by examining water, sanitation, and hygiene (WASH) practices, with a particular focus on hygiene. It may serve as a foundation for the local Department of Education (DepEd), City Health Office (CHO), and Rural Health Unit (RHU) to develop and implement programs that promote proper sanitation and hygiene among students. Additionally, the barangay could use the findings to enhance its water services based on the students’ sanitation and hygiene practices. More importantly, students, with the support of their parents, could increase their awareness of the importance of access to safe and clean water for proper hygiene, thereby reducing their vulnerability to health risks. Consequently, the researcher wants to present this study in a barangay session that will include stakeholders and community leaders to raise awareness and strengthen cooperative efforts to improve hygiene practices in schools. Also, the researcher wants to publish the research in regional, national, and international journals with the required approval, offering insightful supplemental material for further study in this field.

BackgroundWHO and UNICEF have proposed an action plan to achieve universal water, sanitation and hygiene (WASH) coverage in healthcare facilities (HCFs) by 2030. The WASH targets and indicators for HCFs include: an improved water source on the premises accessible to all users, basic sanitation facilities, a hand washing facility with soap and water at all sanitation facilities and patient care areas. To establish viable targets for WASH in HCFs, investigation beyond ‘access’ is needed to address the state of WASH infrastructure and service provision. Patient and caregiver use of WASH services is largely unaddressed in previous studies despite being critical for infection control.MethodsThe state of WASH services used by staff, patients and caregivers was assessed in 17 rural HCFs in Rwanda. Site selection was non-random and predicated upon piped water and power supply. Direct observation and semi-structured interviews assessed drinking water treatment, presence and condition of sanitation facilities, provision of soap and water, and WASH-related maintenance and record keeping. Samples were collected from water sources and treated drinking water containers and analyzed for total coliforms, E. coli, and chlorine residual.ResultsDrinking water treatment was reported at 15 of 17 sites. Three of 18 drinking water samples collected met the WHO guideline for free chlorine residual of >0.2 mg/l, 6 of 16 drinking water samples analyzed for total coliforms met the WHO guideline of <1 coliform/100 mL and 15 of 16 drinking water samples analyzed for E. coli met the WHO guideline of <1 E. coli/100 mL. HCF staff reported treating up to 20 L of drinking water per day. At all sites, 60% of water access points (160 of 267) were observed to be functional, 32% of hand washing locations (46 of 142) had water and soap and 44% of sanitary facilities (48 of 109) were in hygienic condition and accessible to patients. Regular maintenance of WASH infrastructure consisted of cleaning; no HCF had on-site capacity for performing repairs. Quarterly evaluations of HCFs for Rwanda’s Performance Based Financing system included WASH indicators.ConclusionsAll HCFs met national policies for water access, but WHO guidelines for environmental standards including water quality were not fully satisfied. Access to WASH services at the HCFs differed between staff and patients and caregivers.

Spatial analysis of diarrhoea and environmental risk factors in an urban context in Senegal, West Africa

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Safe and adequate water supply and sanitation in schools are prerequisites for right to basic education for school children. The provision of water, sanitation, and hygiene (WASH) facilities has been linked to the achievement of Sustainable Development Goals. The objective of this study is to assess the indicators of WASH in schools falling under the Rural Health and Training Centre (RHTC), Budhi, GMC Kathua. A cross-sectional study was conducted during a period of two months in the month of September 2019 to October 2019. It was done in the rural area under CHC Nagri Parole Kathua. The total number of schools under CHC is 981. Interview of the head of the school was done using world health organization (WHO) and united nations international children's emergency fund (UNICEF) Standardized Questionnaire for WASH Practices. The Questionnaire includes core and expanded questions on drinking water, sanitation, and hygiene practices. Data were entered in Microsoft Excel and descriptive statistics was analyzed in the form of number and percentages. Out of total 139 schools, 57.72% schools had basic drinking water facilities. Only 29.11% schools have basic hand-washing facilities with soap and water; 81.29% of the schools have improved toilets. Political will and financing and effective delivery of interventions will be required to ensure universal access to WASH in schools.

Background: More than 90% of deaths from diarrhoea in under five children is caused by unsafe WASH practices. Adequate hygiene practices have been recognised to decrease the diarrhoeal incidence by 30–40 percent. 748 million people still depend on unimproved sources of drinking water almost a quarter of which depend on untreated surface water, and 2.5 billion people need to improve sanitation, including one billion who practice open defecation. Yet to date, the water, sanitation and hygiene (WASH) element has received minute attention and the potential to link efforts on WASH and NTDs has been mostly untouched. This study was planned to identify current levels of community access to and practices related to water, sanitation and hygiene facilities. Methods: Cross sectional survey of 200 households conducted in selected villages of chargawa block through multistage sampling. Data were collected using pre-designed questionnaire. Results: 66% of our responder’s were female, 86% of household are male-headed. The burden of collecting water is mostly with women & girls (89%). 51% of people still rely on the unprotected hand pump as a source of water for drinking. Majority of the population defecates in the bush/backyard/field (79%). Hand washing with soap and water during key times is practiced by 21% of the respondents, and hand washing with water only is practiced by 67%. Conclusions: The study shows that access to safe drinking water & WASH practices in the rural villages is still a big everyday challenge. This study provides baseline information’s for future interventions in this community.

Stunting is a vital health issue in developing Asian countries, where millions of individuals suffer from chronic malnutrition. Stunting not only is caused by chronic malnutrition but is also influenced by inadequate water supply, sanitation problems, and poor hygiene practices in the community. However, research on water, sanitation, and hygiene (WASH) and its association with stunting is limited, particularly in developing countries. This study aimed to analyze the associations between water, sanitation, and hygiene practices and the occurrence of stunting in Asia. This article is a systematic literature review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A total of 1,002 articles were reviewed, of which 560 were published. Additionally, articles could be selected and dropped because they had no original research. After duplicate articles were removed, 168 articles were removed. The screening and extraction results revealed 14 articles eligible for review. After the article was reviewed and read, only five articles were eligible, and only 5 articles could be reviewed because the article discussed WASH and stunting in developing countries in Asia. Inadequate WASH practices were strongly associated with stunting among children under five years of age. An insufficient water supply and access to safe drinking water contribute to this condition, as inadequate water availability can increase the risk of stunting. Additionally, groundwater unfit for consumption increases the likelihood of undernutrition, including stunting, underweight, and wasting in children. Access to improved drinking water sources is essential for reducing stunting, as households with such access report lower stunting rates. Solutions to address stunting in children under five years of age include enhancing drinking water sources, improving sanitation facilities, and promoting better hygiene practices. Local governments should provide adequate water provision and accessible drinking water.

Access to water, sanitation, and hygiene (WASH) facilities and practices have been extensively studied in urban and rural areas. However, there is a paucity of information on the coverage of water, sanitation, and hygiene facilities in the peri-urban and informal settlement areas, which could potentially exacerbate the spread of water, sanitation, and hygiene-related diseases. Therefore, this study was designed to examine access to drinking water, sanitation, and hand hygiene facilities and their determinant factors in the peri-urban and informal settlements of Hosanna town. A community-based cross-sectional study involving 292 households was conducted in 3 kebeles of Hosanna town. The primary data was collected using a pretested structured questionnaire and an observational checklist. Bivariate and multivariable logistic regressions were used to analyze the data. All the households (100%) had access to piped water on and off-premises, but the reliability of the water sources was a big challenge. Findings revealed that only 35.1% and 16.8% of the households had basic sanitation and basic handwashing facilities, respectively. Households with a middle income were identified as a determinant factor for the presence of piped water on premises (AOR = 2.23; 95% CI = 1.24-4.00), improved sanitation (AOR = 2.17; 95% CI = 1.17-4.03) and handwashing facilities (AOR = 4.36; 95% CI = 1.98-9.62). Piped water on premises was also another strong predictor of the availability of improved sanitation (AOR = 3.34; 95% CI = 1.99-5.62) and handwashing facilities (AOR = 8.18; 95% CI = 4.08-16.42). The majority of the studied households living in the selected peri-urban and informal settlements had access to unreliable drinking water sources. The study also revealed that households had poor access to basic sanitation and basic handwashing facilities. Hence, the findings call for solid government interventions to improve the reliability of the drinking water sources, basic sanitation coverage, and availability of basic handwashing facilities.

Access to safe drinking water, sanitation, and hygiene (WASH) facilities is crucial for health and human rights, impacting nutrition and weight. Multiple Indicators Cluster Survey (MICS) 2017-18 has been used in this study to examine the association between WASH and underweight, alongside other factors. Analysis included descriptive statistics, association tests, logistic regression, and population-attributable fractions (PAF). According to results child were 1.8, 1.1 and 1.04 times less likely to be underweight if they had access to improved source of drinking water, improved sanitation and hygiene facilities respectively. The likelihood of child being underweight reduces by 1.4, 1.89, 2.01 and 2.55 times if the household wealth status increases from poorest to second, middle, fourth and richest wealth quintiles, respectively. As the mothers' education level increases from no schooling to primary, middle, secondary, and higher level, the possibility of child being underweight reduces by 1.22, 1.24, 1.60 and 2.01 times, respectively. Moreover, the likelihood of a child being underweight decreases as the education level of the household head improves. If maternal age is less than 20 or more than 35 years the likelihood of the child being underweight is increased by 1.074 and 1.121 times, respectively. A child is 1.1 times more likely to be underweight if birth spacing is less than 2 years. A child's risk of being underweight decreases by 1.1 times if they have not experienced diarrhea. A child who has never been breastfed has 1.3 times higher risk of being underweight. The results of Population Attributable Fraction (PAF) indicate that holding the other factors constant, approximately 36.46% burden of underweight was preventable by access to improved drinking water, sanitation, and hygiene practices. Comprehensive strategy is needed that focuses on improving access to safe drinking water, sanitation infrastructure, and hygiene behaviors.

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 have afflicted Ethiopia, with nearly 100 000 cases and 1030 deaths reported from 2015 to 2023, emphasizing the critical need to understand water, sanitation, and hygiene (WaSH) risk factors. We conducted a cross-sectional household (HH) survey among 870 HHs in Shashemene Town and Shashemene Woreda, alongside extracting retrospective cholera case data from the Ethiopian Public Health Institute database. Relationships between WaSH and sociodemographic/economic-levels of HHs were examined. WaSH status and cholera attack rates (ARs) were described at kebele-level using geospatial mapping, and their association was statistically analyzed. Access to basic drinking water, sanitation, and hygiene facilities was limited, with 67.5% (95% confidence interval, 64.4-70.6), 73.4% (70.3-76.3), and 30.3% (27.3-33.3) of HHs having access, respectively. Better WaSH practices were associated with urban residence (adjusted odds ratio, 1.7, [95% confidence interval, 1.1-2.7]), higher educational levels (2.7 [1.2-5.8]), and wealth (2.5 [1.6-4.0]). The association between cholera ARs and at least basic WaSH status was not statistically significant (multiple R2 = 0.13; P = .36), although localized effects were suggested for sanitation (Moran I = 0.22; P = .024). Addressing gaps in WaSH access and hygiene practices is crucial for reducing cholera risk. Further analyses with meaningful covariates and increased sample sizes are necessary to understand the association between cholera AR and specific WaSH components.

Rural areas largely lack access to improved drinking water, sanitation, and hygiene (WaSH) facilities in India. This requires documentation of WaSH practices at the local level for better understanding and sustainable development. In this paper, a global positioning system (GPS)-based household survey was carried out in 67 villages of Phagi tehsil using individual questionnaires to evaluate the existing WaSH conditions spatially at the panchayat level. Three sub-indices were used for WaSH risk areas mapping and prediction with the integration of machine learning algorithms. Survey results indicate the improvement in the availability of toilet facilities; however, a gap was found between toilet ownership and its usage by villagers. Data show that only six panchayats have almost zero open defecation practices among the 32 panchayats of Phagi tehsil. The findings highlight that presence of toilets in house, water supply in toilets, and high literacy rate lead to an increase in toilet usage by the population. WaSH index scores indicate that panchayats like Mandawari, Mendwas, Chandma Kalan, and Rotwara have worst conditions and fall in the high-risk category. Moreover, support vector machine regression (SVMR) results reveal that WaSH scores are mainly affected by open defecation (r = 0.94), water supply in toilets (r = 0.92), and female members’ participation in sanitation facilities decision-making (r = 0.53), followed by literacy rate (r = 0.33). Findings demonstrate the association between gender inequalities and WaSH conditions, and the potential of the WaSH index as a monitoring tool by local policymakers to shrink the WaSH gaps.

Childhood stunting remains a major public health challenge in low- and middle-income countries (LMICs). Inadequate water, sanitation, and hygiene (WASH) conditions contribute to recurrent infections and chronic undernutrition; however, evidence regarding which specific WASH components most strongly influence stunting remains inconsistent. This study aimed to systematically evaluate the association between WASH practices and childhood stunting in LMICs. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, Cochrane Library, Epistemonikos, EBSCOhost, and Google Scholar were searched up to July 2025. Observational studies from LMICs assessing associations between WASH practices and childhood stunting were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Random-effects meta-analyses were used to pool odds ratios (ORs) with 95% confidence intervals, with publication bias and sensitivity analyses performed. Sixteen studies involving 36,574 children were included. Improved water quality (OR = 0.39; 95% CI: 0.18-0.87) and water accessibility (OR = 0.69; 95% CI: 0.49-0.98) were significantly associated with lower odds of stunting, whereas drinking water source and household water treatment were not. Among sanitation indicators, improved sanitation facility type (OR = 0.71; 95% CI: 0.53-0.94) and environmental sanitation (OR = 0.05; 95% CI: 0.00-0.64) were significantly associated with lower odds of stunting, while toilet access, safe disposal of child feces, and garbage disposal showed no consistent associations. Hygiene practices were also associated with lower odds of stunting, particularly hand hygiene (OR = 0.54; 95% CI: 0.30-0.98) and family hygiene (OR = 0.40; 95% CI: 0.21-0.74), whereas general hygiene was not significantly associated with stunting. Substantial heterogeneity was observed across several outcomes. Several WASH components were associated with lower odds of childhood stunting in LMICs, with more consistent evidence for drinking water quality, water accessibility, and sanitation facility type. Findings for other components were inconsistent. Given substantial heterogeneity and the observational nature of included studies, these results should be interpreted cautiously, and further research is needed to establish causal relationships. PROSPERO CRD420251145998.

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.

The poor practice of Water, Sanitation, and Hygiene (WASH) supports the spread of disease burdens causing high U-5 children mortality rates in developing countries like Nigeria. Knowledge, perception, attitude and other influencing factors become important in determining WASH practices. This study, guided by the Health Belief Model, assessed the knowledge, perception, and attitude of mothers of U-5 children in Lagos urban slums to WASH behaviour messages in order to understand their WASH practices. The cross-sectional study involved 361 mothers of U-5 children in selected Lagos urban slums. Applying cluster sampling and purposive sampling techniques, the study used a pre-tested structured questionnaire through interviews to collect data on knowledge, perception, attitude, and practice of WASH. IBM SPSS Version (26) was used to analyse the data collected, and the presentation was in percentages, tables and charts. The main objective was analysed using path analysis of the structural equation model (SEM) and logistic regression model. Only 15.2% used improved water sources, 44.3% stored drinking water safely, and 10.3% did not treat home drinking water. Open defecation was high (61.8%); Only 22.4% washed their hands with water and soap at critical times; 36.6% disposed of waste into the river and canal; open dumpsites (33.8%), and 29.6% used waste to fill marshy areas in the environment. The majority (90%) favourably perceived the susceptibility of children to the dangers of unsafe drinking water. The mothers positively perceived the benefits of good WASH practice for children’s health, but (31.1%) had low knowledge of the severity of the risk resulting from poor WASH. The mothers’ positive perceptions did not necessarily reflect in their WASH practices. Age, level of education, marital status, and occupation significantly influenced the respondents’ WASH practice. Economic reasons and limited WASH facilities were barriers, while contributions of community leaders were supportive. Study recommendations include; the provision of WASH facilities and more WASH behaviour education for mothers through participatory communication approaches. The WASH behaviour sensitisation model should be reviewed to have a distinct identity from routine immunization programmes; to enable mothers to understand WASH messages better.