Latrine Cleaning Research Articles

A data-driven approach to optimize a sanitary survey for communities in Maputo, Mozambique

ABSTRACT Current approaches to align sanitary surveys to environmental fecal waste indicators have demonstrated limited success, leaving stakeholders focused on fecal waste management with limited and costly tools. We analyzed data from the Maputo Sanitation Project using exploratory factor analysis (EFA) and structural equation modeling (SEM) to enhance the survey's correlation with Escherichia coli concentration data. EFA grouped related survey questions and sampling locations into distinct latent factors. SEM was then used to assess the relationship between the survey latent factors and the mean E. coli concentrations from grouped locations. The results suggested four survey question subgroups: latrine structure, latrine cleanliness, compound/household waste management, and community waste management. In addition, three sampling location subgroups were identified: high-traffic areas (HTAs), food activity locations, and bodily cleaning areas. The largest significant effect size identified suggested that for every 1-unit increase in community waste management, there was a decrease of 1.94 in log10 E. coli per gram of soil in HTAs (p = 0.03), a substantial improvement from the initial 0.50 decrease reported for an expert-weighted metric of all survey questions. These results underscore the importance of community-level waste management and demonstrate the use of a data-driven approach in enhancing environmental health assessments and planning interventions.

An assessment of latrine front-end characteristics and associated surface E. coli indicated faecal contamination in rural Fiji

In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug–Dec 2019), endline (n = 262) (Jun–Sep 2022) and an in-depth front-end study (n = 12) (Oct–Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.

The Relationship Between Home Sanitation and Diarrhea In Toddlers In The Work Area Of The Lempake Health Center Samarinda City

Objectives: To determine the relationship between home sanitation and the incidence of diarrhea in toddlers in the working area of the Lempake Community Health Center, Samarinda City in 2023.&#x0D; Research Metodes: Quantitative method with cross sectional research design. The research sample was toddlers who had experienced diarrhea with a sample size of 79 respondents. The sampling technique uses purposive sampling technique. Data analysis in the study used the Chi-Square statistical test.&#x0D; Results: The results showed that there was a relationship between latrine cleanliness and the incidence of diarrhea P-value (0,009 &lt; 0,05), there was a relationship between waste management and the incidence of diarrhea P-value (0,046 &lt; 0,05), there was no relationship between the type of floor of the house and the incidence of diarrhea in toddler P-value 90,230 &gt; 0,05).&#x0D; Conclusion: There is a relationship between latrine cleanliness of latrines and the incidence of diarrhea in toddlers with a P-value (0,009 &lt; 0,05), there is a relatonship between waste management and the incidence of diarrhea in toddlers with a significance P-value (0,046 &lt; 0,05), there is no relationship between the type of floor of the incidence of diarrhea in toddlers with a significant P-value (0,230 &gt; 0,05).

Sustaining effective latrine cleaning in schools to protect child health in low-income settings

Sustaining effective latrine cleaning in schools to protect child health in low-income settings

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEBERHASILAN PROGRAM STOP BABS (BUANG AIR BESAR SEMBARANGAN) DI DESA LEDONG TIMUR KECAMATAN AEK LEDONG KABUPATEN ASAHAN TAHUN 2023

Currently in Indonesia there are still many health problems that have not been resolved by the Government of Indonesia. Starting from the low government budget for health to the low level of awareness of the Indonesian people about cleanliness and health, it is suspected that this is the main trigger. Based on Sanitation data from the East Ledong Community Health Center, Aek Ledong Sub District, Asahan District in 2023, there are still 38 families out of 1,524 families who have not been able to succeed in the stop babs (open defecation) program that has been implemented by the government in the last 3 years. The aim of this research was to find out the factors related to the success of the stop babs (open defecation) program. The type of quantitative research with cross-sectional design used a questionnaire instrument with interview and observation methods. The research population consisted of 38 heads of families and all of them were as samples. The research variables were analyzed univariately and bivariately with the chi square test using a p value &lt;0.05. The results of the research on the success of the stop babs program (open defecation) were 34,2% successful and 65,8% unsuccessful. There is a relationship between knowledge (p = 0.011), attitude (p = 0.022) and the role of health workers (p = 0.036) with the success of the stop defecation program (open defecation) and there is no relationship between water availability (p = 0.190) with program success stop babs (open defecation). The community give attention to the cleanliness and maintenance of latrines that meet health requirements to prevent the spread and cases of disease.

Patient’s satisfaction with clinical laboratory services in a tertiary health care hospital of Jammu and Kashmir, India

Background: A patient’s satisfaction level is a crucial aspect of quality management in clinical laboratories. Satisfaction is the client’s perception of care received compared with the care expected. Accreditation from an organization such as NABL or NABH is necessary. This study aimed to evaluate patient satisfaction with laboratory services in a tertiary care hospital in Jammu, UT of Jammu and Kashmir, India. Methods: The study conducted a prospective cross-sectional patient satisfaction survey over six months w.e.f. April 2022 to September 2022 at 05 patients/day with monthly data (05×30=150). A total of 900 patients were selected randomly at 150 patients/month (150×6=900). Data was collected using structured questionnaire, entered in Epi Info and analysed with SPSS software. A p value of less than 0.05 was taken as statistically significant. Results: The study found that 76.55% of patients were satisfied, while 11% were mildly dissatisfied and 17.94% were dissatisfied with laboratory services. Patients were dissatisfied with cleanliness of latrines (47%), long waiting times (30%), clear and understandable advisory service during specimen collection (26%), adequacy of waiting area (25%), easy accessibility of laboratory (19%), latrine location (20%), availability of requested service (18%), unfair payment of service (17%), and missing results (12%). Conclusions: The study concluded that despite most patients being satisfied, there were gaps. The study recommends that the concerned departments to improve the identified gaps and meet patients’ needs. Educational status and distance were found to be significantly associated with the overall satisfaction level of clients.

Occupational Health and Safety (OHS) Cost Measures for the Sweepers at Jashore and Benapole Paurashava in Bangladesh

Background: Jashore, the oldest and Benapole, a new municipality in Bangladesh which total area is 32 square km having 0.6 million people including 516 enlisted cleaners. They are living with limited services, though the National Policy on OHS was formulated which summarizes the existing policies, laws, and guidelines in the country. Methods: Respondents were selected through homogeneous sampling method. They were directly interviewed and provided their data which was analyzed using secondary data. Objectives: To find out the monthly health and safety cost of a sweeper and how much additional cost they will agree to spend to ensure their occupational health and safety. Results: Their income sources are restricted, which is average 12187 BDT and expenditure is around 12679 BDT monthly. They do not have any savings options or any insurance for their financial security. Their profession as well as the health and safety issues are not secured by any authorities. Considering the types of profession, 18% are doing septic tank cleaning, 21% doing pit latrine cleaning and 61% are doing both. Findings: Study shows only 7% respondents use PPE set at the time of toilet/drain cleaning and 30% nothing used. But reality is, almost all know about the benefits of using PPE. The consequences for not following safety measures were about 25% suffered accidental injury and 28% of their family were affected by skin disease. For precautionary and treatment purpose, they need to spend an additional 8% of their monthly income. Conclusion: This study sought to offer recommendations on how PPE would be more usable, respondents positively responded. Traditional manual profession is reducing day by day and it has been increasing the vulnerable situation of the sweeper community. The priority is reducing, and they are considering it as a secondary profession.

Impact of usership on bacterial contamination of public latrine surfaces in Kathmandu, Nepal

According to the United Nations (UN) Sustainable Development Goals (SDGs), community or public toilets shared by more than one household are not considered “safely managed” under SDG 6.2. However, many populations around the globe, particularly in urban settings, lack access to private sanitation facilities. For this reason, there is a need to evaluate the cleanliness of community or public toilets in these settings and examine best practices for maintaining them. This study had three aims: 1) build on previous data collected in March 2018 at public latrines to determine whether cleaning protocols were sustained, 2) examine relationships between latrine cleanliness and usership, and 3) identify latrine surfaces with higher concentrations of bacterial contamination. In March 2018 and December 2019, swab samples were collected from public latrine surfaces in Kathmandu, Nepal. Sampling occurred in “clean” conditions–after cleaning and before the latrine was opened for use–and “dirty” conditions–during operating hours. Samples were analyzed for concentrations of total coliforms (TC) and Escherichia coli (EC). The number of latrine users prior to the “dirty” sample collection was recorded (in December 2019 only). Results found that both TC and EC concentrations were significantly lower during “clean” rather than “dirty” conditions and both TC and EC concentrations increased with the number of users over time. TC and EC concentrations differed by surface type during dirty and clean conditions (p&lt;0.05). Findings suggest cleaning protocols established at this public toilet site were adequately maintained two years later.

The Association of Sanitation and Hygiene Practices With Intestinal Parasitic Infections Among Under-14 Children in Rural Dire Dawa, Eastern Ethiopia: A Community Based Cross-sectional Study.

Intestinal parasitic infections (IPIs) are neglected tropical diseases. Sanitation and hygiene are vital components for achieving sustainable control of intestinal parasitic infections. Children are the most vulnerable to intestinal parasitic infections because of their immature immune systems and frequent exposure to unsanitary environments. The aim of this study was to assess the magnitude of IPIs and associated risk factors, including sanitation and hygiene practices, among under-14-year-old children in rural Dire Dawa, eastern Ethiopia. This community-based cross-sectional 'study included 778 subjects aged 1 to 14 years. Data were collected using questionnaires and stool examinations. The direct wet-mount method and formol-ether concentration techniques were performed to identify IPIs. Data Analysis: A descriptive statistic was used to show the prevalence of IPIs. Bi-variable and multivariable analysis using the logistic regression model was carried out. The outputs are presented using an adjusted odds ratio (aOR) with 95% confidence intervals (CIs). The prevalence of 5 intestinal parasites was 33.7% (95% CI = 30.4%-37%). Giardia intestinalis (15.2%) and Hymenolepis nana (11.6%) had the highest prevalence. The odds of IPIs among children of illiterate mothers were 13.1 times higher when compared with children of mothers with secondary education (aOR = 13.1, P = .02), and the odds of IPIs among children from households that have unclean latrines were 1.8 times higher when compared with children from households that have clean latrines. (aOR = 1.8, P = .03). Children from households that discard solid waste in open fields had 1.7 times higher odds of having a positive result than children from households that burn their waste (aOR = 1.7, P = .03). However, children without a swimming habit (aOR = 0.4, P = .000) and asymptomatic children (aOR = 0.3, P = .000) were protective against IPIs. IPIs continue to be a public health problem in rural parts of Dire Dawa. The prevalence of Giardia intestinalis and H. nana could be of public health importance in this setting. Solid waste management, latrine cleanliness, mothers' level of education, and child swimming habits in unclean accumulated water were significantly associated with IPIs. Therefore, efforts should be made to ensure intervention, considering such risks.

Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren.

Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors. This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets. Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods. Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.

Barriers to cleaning of shared latrines in slums of Addis Ababa, Ethiopia.

Shared latrines and other shared sanitation facilities are vital for communities that lack private latrines. However, the cleanliness of shared latrines continues to be a problem in sub-Saharan Africa, including slums of Addis Ababa, Ethiopia. Investigating the barriers to cleaning of shared latrines may inform the future strengthening of comprehensive sanitation programs in slums of Addis Ababa, Ethiopia. Thus, a community-based unmatched case-control study was conducted among 100 case and 200 control households that were users of shared latrines from September to November 2017 in a slum district in Addis Ababa. Cases were those who had not cleaned their shared latrines and controls were those who had cleaned their shared latrines at least once during the week prior to data collection. Data were collected using a structured questionnaire and an on-the-spot-observational checklist and analyzed using bivariate (crude odds ratio [COD]) and multivariable (adjusted odds ratio [AOR]) unconditional logistic regression model. Variables having a p-value of less than 0.25 from the bivariate logistic regression analysis were retained into multivariable analysis. From the multivariable analysis, variables with p<0.05 were declared as factors significantly associated with barriers to cleaning of shared latrines. We found that about half 99 (49.5%) of shared latrines used by cases and almost one-third 32 (32.0%) of the shared latrines used by controls had visible cracks and spaces in the floor and slabs. The barriers to cleaning of shared latrines were found to be monthly household income of less than $55.60 USD (AOR = 1.80; 95%CI: 1.2-3.10), users feeling a lack of privacy during latrine use (AOR = 2.95; 95% CI: 1.60-5.43), no locking latch on the latrine door (AOR = 4.60; 95% CI: 2.43-8.79), inadequate ventilation of latrine (AOR: 4.88; 95% CI: 2.44-9.63), lack of regular monitoring of latrine by health extension workers (AOR = 2.86; 95%CI: 1.32-6.21) and a lack of enough water at home for cleaning the latrine (AOR = 4.91; 95% CI: 1.07-9.48). This study found several barriers to cleaning of shared latrines in slums of Addis Ababa. We recommend that stakeholders promote cleaning of shared latrines by designing programs to improve latrine privacy by adding or modifying the superstructure and including a door with locking latch, to make adjustments to the structure for better ventilation, to ensure regular monitoring of latrines by health extension workers and to make enough water consistently available for regular latrine cleaning.

Latrine Utilization and Associated Factors in Transformed District, West Gojjam Zone, Amhara Region, Ethiopia, 2021.

Background:Ethiopia has been encountering a higher predominance of communicable illnesses, which bring about high morbidity, mortality, and hospital admission rates. One of the higher contributing factors to this can be the lower level of latrine utilization.Objective:To assess latrine utilization and associated factors in transforming District, West Gojjam zone, Ethiopia.Methods:A community-based cross-sectional study was conducted from March to April 2021 among 352 households in the Dega Damot District, one of the transformed districts in the West Gojjam Zone. A systematic random sampling technique was used to select the study household. The data were collected through a face-to-face interview and right-away observation methods using structured questionnaires and an observational checklist respectively. Data were entered using Epi info version 7 and exported to a statistical package for social science’s version 25. Independent variables that had a P-value of <.25 were included in the multivariable binary logistic regression model. Variables with P-values of less than .05 were declared as statistically significant and an odds ratio of 95% CI was used to measure the strength of association between outcome and predictor variables.Results:We found that the prevalence of latrine utilization among households was 48.9% (95% CI: 44, 54). The household head has good knowledge of latrine utilization (AOR = 2.96, 95% CI 1.79, 4.87), a mother has formal education (AOR = 1.85, 95% CI 1.13, 3.04), daily cleaning of the latrine (AOR = 1.99, 95% CI 1.06, 3.74), and latrine having squat hole cover (AOR = 8.08, 95% CI 3.13, 20.87) were factors significantly associated with latrine utilization.Conclusion:In the transformed district latrine utilization was low Knowledge, education status, latrine cleaning frequency, and squat hole cover were factors associated with latrine utilization. Market-based sanitation, health extension program, and behavioral change communication strategies need to be strengthened to improve sustainable and consistent use of latrines.

Using path analysis to test theory of change: a quantitative process evaluation of the MapSan trial

BackgroundAlthough theory-driven evaluations should have empirical components, few evaluations of public health interventions quantitatively test the causal model made explicit in the theory of change (ToC). In the context of a shared sanitation trial (MapSan) in Maputo, Mozambique, we report findings of a quantitative process evaluation assessing intervention implementation, participant response and impacts on hypothesised intermediary outcomes on the pathway to trial health outcomes. We examine the utility of path analysis in testing intervention theory using process indicators from the intervention’s ToC.MethodsProcess data were collected through a cross-sectional survey of intervention and control compounds of the MapSan trial > 24-months post-intervention, sampling adult residents and compound leaders. Indicators of implementation fidelity (dose received, reach) and participant response (participant behaviours, intermediary outcomes) were compared between trial arms. The intervention’s ToC (formalised post-intervention) was converted to an initial structural model with multiple alternative pathways. Path analysis was conducted through linear structural equation modelling (SEM) and generalised SEM (probit model), using a model trimming process and grouped analysis to identify parsimonious models that explained variation in outcomes, incorporating demographics of respondents and compounds.ResultsAmong study compounds, the MapSan intervention was implemented with high fidelity, with a strong participant response in intervention compounds: improvements were made to intermediary outcomes related to sanitation ‘quality’ – latrine cleanliness, maintenance and privacy – but not to handwashing (presence of soap / soap residue). These outcomes varied by intervention type: single-cabin latrines or multiple-cabin blocks (designed for > 20 users). Path analysis suggested that changes in intermediary outcomes were likely driven by direct effects of intervention facilities, with little contribution from hygiene promotion activities nor core elements expected to mediate change: a compound sanitation committee and maintenance fund. A distinct structural model for two compound size subgroups (≤ 20 members vs. > 20 members) explained differences by intervention type, and other contextual factors influenced specific model parameters.ConclusionsWhile process evaluation found that the MapSan intervention achieved sufficient fidelity and participant response, the path analysis approach applied to test the ToC added to understanding of possible ‘mechanisms of change’, and has value in disentangling complex intervention pathways.Trial registrationMapSan trial registration: NCT02362932 Feb-13-2015.

Household latrine utilization and associated factors in semi-urban areas of northeastern Ethiopia.

Latrine utilization is the actual behavior in a practice of regularly using existing latrines for safe disposal of excreta. Latrine utilization is a common problem in semi-urban areas of developing countries, including Ethiopia. Since the status of latrine utilization and associated factors among semi-urban areas of northeastern Ethiopia, including Alansha in South Wollo Zone is unknown, local data is needed in order to assess the need for planning of intervention programs for the improvement of latrine utilization to support consistent and sustained latrine utilization. This study is designed to address this knowledge gap. A cross-sectional study was conducted from February to March, 2019 among 401 systematically selected households. Data were collected by trained workers using a pre-tested, structured questionnaire via face-to-face interviews and on-the-spot observations of the latrines. A systematic random sampling method was used to select participant households. Data were entered using EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The wealth index status of participants was estimated using principal component analysis. Data were analyzed using a binary logistic regression model at 95% confidence interval (CI). From the multivariable logistic regression analysis, variables with p-value < 0.05 were taken as statistically significant and independently associated with latrine utilization. Model fitness was checked using Hosmer-Lemeshow test. We found that the prevalence of latrine utilization among households was 71.8% (95% CI [67.5-76.1%]) while 28.2% (95% CI [23.9-32.5%]) did not utilize latrines. About one-fifth (21.7%) of participant households were found to have a pit latrine with slab and 78.3% (311) used pit latrines without slab. The hygienic condition of the majority (82.9%) of the latrines was dirty and only 17.1% clean. Household family size from one to three persons (AOR: 3.99, 95% CI [1.20-6.24]), presence of primary or secondary school student in a house (AOR: 2.33, 95% CI [1.42-3.83]), number of years since latrine was constructed (≥ 2 years) (AOR: 1.82, 95% CI [1.12-2.95]) and a frequency of daily cleaning of the latrine (AOR: 2.19, 95% CI [1.12-4.28]) were factors significantly associated with latrine utilization. Seven out of ten households utilized a latrine. Factors significantly associated with latrine utilization were household family size from one to three persons, presence of primary or secondary school student in the house, time since household latrine had been constructed of two or more years and daily frequency of latrine cleaning. Therefore, it is recommended that measures to promote behavioral change towards further improvement in sustainable and consistent latrine utilization should be carried out based on the evidence of the determinant factors found in this study.

Effect of a Community-Led Total Sanitation Intervention on Sanitation and Hygiene in Pallisa District, Uganda

We conducted a comparative cross-sectional study to examine the potential effects of a community-led total sanitation (CLTS) intervention on sanitation and hygiene in Pallisa district in Uganda. Quantitative data were collected from households using a semi-structured questionnaire and an observation checklist, entered and analyzed using univariate, bivariate, and multivariate analyses. Overall, knowledge on sanitation and hygiene was significantly higher (64.5%; 129/200) among households in the CLTS intervention than among those in the nonintervention subcounties (54.0%; 108/200) (P = 0.033). Latrine quality was rated as fair in a majority (73.3%; 143/195) of the CLTS intervention households compared with 50.8% (93/183) in the non-CLTS households (P < 0.001). Latrine cleanliness was rated as good in more than a half (51.3%; 100/195) of households in the intervention area, whereas only 13.7% (25/183) for the nonintervention area (P < 0.001). In this study, 35.0% (70/200) of the households in the intervention subcounty had attained open defecation-free (ODF) status compared with only 6.0% (12/200) in the nonintervention subcounty (P < 0.001). Level of knowledge on hygiene and sanitation (adjusted odd ratio [AOR]: 2.23; 95% CI: 1.24-4.03) and CLTS status (AOR: 8.89; 95% CI: 4.26-18.56) were significantly associated with achievement of ODF status in the multivariate analysis. The mean cases of diarrhea were significantly lower in CLTS implementing (subcounty (0.42 [SD ± 1.03]) than in the non-CLTS implementing subcounty (0.98 [SD ± 1.39]; t = -4.6; P < 0.001). Sanitation and hygiene outcomes were better in the CLTS intervention subcounty than in the non-CLTS intervention subcounty, suggesting that scaling up CLTS could reduce ODF and the burden of diarrheal diseases.

Landlords’ and Compound Managers’ Role in Improving and Sustaining Shared Latrines in Three Dhaka City Slums

(1) Background: Residents of Dhaka slums frequently lack clean and functional shared latrines. We explored the role of landlords and compound managers in promoting latrine cleanliness in the intervention arm of a randomized trial; (2) Methods: We conducted focus group discussions, key informant interviews, and in-depth interviews with community health promoters, landlords, and compound managers to better understand the decision-making process, barriers to contributing to sanitation, and cleanliness of shared latrines. (3) Results: Landlords’ and compound managers’ engagement in promoting clean and functional latrines depended, in part, on their own proximity to the properties they own and manage. The compound managers played a leadership role through engagement with health promoters, oversight of implementation of a cleaning schedule, and support for installation and maintenance of sanitation hardware, resulting in improved sanitation practices; (4) Conclusions: Interventions in slums in Bangladesh should consider engaging landlords and compound managers in efforts to bring about structural and organizational changes to support the adoption of improved water, sanitation, and hygiene practices.

Patients\u2019 satisfaction with clinical Laboratory Services in Public Hospitals in Ethiopia

BackgroundKnowing customers’ level of satisfaction is relevant to improve and provide quality health care services. In the clinical laboratory, monitoring customers’ satisfaction is an important indicator of the quality management system and required by international laboratory standards. However, in Ethiopia, there has not been baseline data about the satisfaction level of patients’ with laboratory services at the national level. The aim of this national level survey was to assess patients’ satisfaction level with laboratory services at public hospitals in Ethiopia.MethodsA national survey was conducted using an institutional based cross-sectional study design was employed from 01 to 30 November 2017. A total of 2399 patients were selected randomly from 60 public hospitals. Data was collected using structured questionnaire, entered in Epi Info and analyzed with SPSS software. Multiple logistic regression model was fitted to identify predictors of patients’ satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant.ResultOverall, 78.6% of the patients were satisfied with the clinical laboratory services. Patients were dissatisfied with cleanness of latrine (47%), long waiting time (30%), clear and understandable advisory service during specimen collection (26%), adequacy of waiting area (25%), easy accessibility of laboratory (19%) and latrine location (20%), availability of requested service (18%), unfair payment of service (17%) and missing of result (12%). The educational status (P = 0.032), and distance (P = 0.000) were significantly associated with client overall satisfaction level.ConclusionMost laboratory patients’ were satisfied with the service provided by public hospital laboratories in public hospitals in Ethiopia. However, patients’ were dissatisfied with the accessibility of sites, adequacy of waiting area, cleanness of latrine, long TAT, communication, missing of results, availability of requested service and cost of service. Therefore, responsible bodies in each level should act on the identified gaps and improve the need of patients in each hospital laboratory. In addition, all hospital laboratories should conduct a satisfaction survey and meet the needs of laboratory patients.

Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana

Context: Constructing latrines and getting people to use them is one of the most effective means of improving public health and saving lives. However, building toilets alone cannot eliminate open defecation.Aims: The aim was to estimate the prevalence of open defecation and factors associated with open defecation in rural areas of a district of Haryana.Settings and Design: This community-based cross-sectional study was carried out in a rural field practice area attached to the department of community medicine of a rural medical college.Subjects and Methods: The study was carried out from July to October 2019. The data were collected from 368 randomly selected households on a pretested semi-structured proforma. Ethical approval was obtained from the institutional ethics committee.Statistical Analysis Used: The data were analyzed using the software R, version 3.6.2. Chi-square, Fisher's exact test, crude odds ratio, adjusted odds ratio with 95% confidence interval, and P value were calculated.Results: The prevalence of open defecation was 30.97% despite having a household toilet. Among the study participants practicing open defecation, the prevalence of open defecation was significantly higher among scheduled caste (64.9%), illiterates (42.7%), laborers (56.6%), and low family income (41.5%). The participants who have constructed latrine recently, i.e., <1 year before (87%), latrine constructed by government expenses (76.9%), and rarely cleaning of the latrine (76.5%) also contributed significantly. Multivariate logistic regression analysis showed that four of these predictor variables, caste, occupation of the head of the family, years since latrine constructed, and latrine cleaning remained significant predictors of open field defecation.Conclusions: Open defecation is common among latrines owners. This behavior is associated with various several structural and sociocultural factors. The present sanitation campaign should consider shifting from toilet construction to toilet use.

Effectiveness of a community-based water, sanitation, and hygiene (WASH) intervention in reduction of diarrhoea among under-five children: Evidence from a repeated cross-sectional study (2007-2015) in rural Bangladesh.

Diarrhoea, the most common disease directly related to water, sanitation, and hygiene (WASH), still remains one of the most significant health problems among children under-five worldwide. In this reality, BRAC, the largest NGO in the world initiated a comprehensive WASH intervention in 50 upazilas (sub-districts) of Bangladesh in 2007 which was later scaled up to cover 150 upazilas in two subsequent phases. The intervention period of the programme was 2007-2011. The present study encompassed 30 upazilas of the first phase of intervention. The aim of the study was to investigate the effectiveness of this intervention on reduction of diarrhoea among under-five children, and to identify the factors associated with childhood diarrhoea. A repeated cross-sectional study design was followed, and a population-based survey was carried out on four occasions: baseline (2007), midline (2009), endline (2011), and post-endline (2015) among 4,775 households. This analysis considers only households having at least one under-five children. Absence of handwashing practice with soap after defecation and before eating food, unclean latrine condition, and unsafe disposal of child faeces were identified as significant risk factors associated with under-five diarrhoea from Log-binomial regression. The prevalence of under-five diarrhoea within the past 2 weeks of the survey declined from 13.7% at baseline to 3.6% at end-line (p < 0.001) in the WASH intervention area. However, the progress seemingly stalled after 2011, which may have occurred due to the lack of improvement in unsafe disposal of child faeces and unclean latrine condition after the intervention period. Study findings suggest that, to reduce the prevalence of childhood diarrhoea it is important to promote safe disposal of child faeces, maintaining cleanliness of latrines, and washing hand with soap at critical times, beyond merely increasing the sanitation coverage. Findings also underline the necessity of maintaining a small-scale monitoring component involving local community, such as a WatSan committee (a local committee comprising the user communities for supervising WASH related activities) for periodic monitoring at household level for a certain period after the program intervention works to make the behavioural change more sustainable and to keep the reduction rate of under-five diarrhoeal prevalence steady.

Memutus Penularan Kuman Penyakit Infeksi Saluran Cerna Melalui Penyuluhan Jamban Bersih dan Cuci Tangan Kepada Ibu-Ibu PKK RPTRA Harapan Mulya Jakarta

Diarrhea is an infectious disease which is a major cause of morbidityand mortality in the community. Diarrhea can be caused bygastrointestinal parasites, especially intestinal protozoa. Poor levels ofsanitation and low individual hygiene can lead to contamination of theinfective form of intestinal protozoa into food and drinks. The results ofpre-survey were at RPTRA Harapan Mulia in October 2016 that therewere still people in the settlements still not using personal latrines. Thelevel of cleanliness of mass latrines used collectively is still lacking.Latrines that are not managed properly are a description of sanitation aswell as poor hygiene so that it can disrupt the health of individuals andreduce work productivity and learning achievement. Counseling wascarried out to educate PKK group in Kelurahan Harapan Mulya, aboutthe habit of clean and healthy living through good latrine managementso as not to become a source of contamination into food and drinks, aswell as the correct way of washing hands. The extension method usedwas lectures and discussions with pre and post test assessment. Theextension activity was conducted one visit, on February 23, 2017. Totalrespondents were 27 people and had signed the approval sheet.Assessment of respondents' knowledge which is calculated from the valueof the pre and post test questionnaires shows results that increase by100%. At the end of the activity the respondent was given a leaflet on theprocedure for good hand washing and a kit for hand washing.