Hygiene Services Research Articles

Mapping access to basic hygiene services in low- and middle-income countries: A cross-sectional case study of geospatial disparities

Handwashing with water and soap is among the most a cost-effective interventions to improve public health. Yet billions of people globally lacking handwashing facilities with water and soap on premises, with gaps particularly found in low- and middle-income countries. Targeted efforts to expand access to basic hygiene services require data at geospatially explicit scales. Drawing on country-specific cross-sectional Demographic and Health Surveys with georeferenced hygiene data, we developed an ensemble machine learning model to predict the prevalence of basic hygiene facilities in Malawi, Nepal, Nigeria, Pakistan and Uganda. The ensemble model was based on a multiple-level stacking structure, where four predictive modelling algorithms were used to produce sub-models, and a random forest model was used to generalise the final predictions. An inverse distance weighted interpolation was incorporated in the random forest model to account for spatial autocorrelation. Local coverage and a local dissimilarity index were calculated to examine the geographic disparities in access. Our methodology produced robust outputs, as evidenced by performance evaluations (all R2 were above 0.8). Among the five study countries, Pakistan had the highest overall coverage, whilst Malawi had the poorest coverage. Apparent disparities in basic hygiene services measured by local coverage were found across geographic locations and between urban and rural settings. Nigeria had the highest level of inequalities in basic hygiene services measured by a dissimilarity index, whilst Malawi showed the least segregation between populations with and without basic hygiene services. Both educational attainment and wealth were important predictors of the geospatial distribution of basic hygiene services. By producing geospatially explicit estimates of the prevalence of handwashing facilities with water and soap, this study provides a means of identifying geographical disparities in basic hygiene services. The method and outputs can be useful tools to identify areas of low coverage and to support efficient and precise targeting of efforts to scale up access to handwashing facilities and shift social and cultural norms on handwashing.

Eco-Hammam: The Complexity of Accelerating the Ecological Transition of a Key Social Heritage Sector in Morocco

Hammams are key providers of affordable hygiene and wellbeing services for the less wealthy in the Maghreb region. However, the UN climate change conference COP22, held in Marrakech in 2016, highlighted hammams are major contributors to air pollution, deforestation, loss of ecosystems, water overconsumption and wastage in Morocco. This paper analyses the complexity of advancing their energy transition from the viewpoint of key stakeholders engaged in two half-day virtual forums focusing on the water–energy nexus; organised as part of the AHRC funded project “Eco-Hammam: engaging key stakeholders with bespoke low-carbon technologies for lighting, heating, and water recycling to sustain a Moroccan heritage”. Results reveal that the Moroccan hammam sector could benefit greatly from stakeholders’ networking and collaboration to accelerate the uptake of low-carbon technologies and ecological practices. Key stakeholders’ priorities and barriers (economic, policy-induced or governance related) are presented and show that the lack of coordination between governmental and non-governmental organisations is perceived as contributing to the slow pace of the hammam energy transition. Although managers seem fully aware of available energy transition technologies for their furnaces, energy and water are treated independently and disconnected in their governance. Finally, Marrakech is identified as a potential hammam sustainability hub.

The Lancet Commission on water, sanitation and hygiene, and health

The Lancet Commission on water, sanitation and hygiene, and health

Decolonising the London School of Hygiene & Tropical Medicine's Archives Service

ABSTRACT This article will give an in-depth analysis of our journey in decolonizing the archives of the London School of Hygiene & Tropical Medicine (LSHTM) which began in 2019 and is ongoing. It will give readers the opportunity to understand how an institution created by the Colonial Office is confronting its history and its colonial legacy, and how the Archives Service is changing its practices in a way that seeks to confront and disrupt the colonial narrative. This has been achieved through an overview of the colonial history of the School by a research fellow and the development of decolonizing principles covering cataloguing practice, archival practice, dissemination, education and inclusion.

Pathways for collaboratively strengthening water and sanitation systems

Collaborative approaches are seen as a promising way to strengthen Water, Sanitation, and Hygiene (WASH) service delivery systems when challenges exceed the mandates and capabilities of any single entity. While collaborative approaches are well studied in high-income country contexts, current understanding of their application to international development contexts is limited. This paper uses fuzzy-set Qualitative Comparative Analysis to assess what conditions and pathways drove or impeded progress within eleven collaborative approaches for WASH service delivery in Eastern Africa. Evidence supported three main findings: (1) Government uptake of recommendations is necessary for progress but cannot be guaranteed solely by government participation in the collaboration, (2) different forms of problem identification are possible; problem scopes are often predefined to align with funders and partner government agendas, but flexible scopes that foster collective problem identification can reap benefits, and (3) hub convening power can be critical and convening power can be gained in different ways. Political dynamics, shifting priorities, and turnover undermine collaborative efforts, but collaborative approaches can still make progress in spite of turnover if funds are available for implementation of activities (i.e. in addition to funds for meetings and hub roles) and program implementers either facilitate collective problem identification or establish a hub with convening power. Yet even these tactics are vulnerable to instability, thus in highly unstable contexts, stakeholders and funders should be realistic from the outset about what they may be able to achieve. Building on existing theories of collaborative approaches, this work revealed that there is no single best design for collaborative approaches in WASH, rather, core elements worked together in different ways depending on the context.

Benchmarking corporate water reporting in emerging economies: the case of Peru

PurposeThis paper aims to develop a framework to examine corporate water reporting (CWR) that considers the context in emerging economies and determine if and how companies are addressing the distinct water-related challenges and opportunities that they face in any given location.Design/methodology/approachThis study combines a concise profile of the context of water resources management in Peru with a review of CWR guidelines and thematic content analysis of water information in sustainability reports for 34 companies operating in Peru. These data are then used to inform the development of a CWR typology via the use of a cluster analysis complemented by within-case and cross-case qualitative analysis of companies.FindingsThis study highlights the incomplete nature of most CWR practices of companies in Peru, with an emphasis on internal firm operations. Where companies do provide information on water risk and stakeholder engagement, there is insufficient detail to provide a clear picture of contributions to sustainable water management at the local level. The main drivers for CWR in Peru appear to be pressure from international markets, regulation and other normative issues.Practical implicationsThe findings indicate that companies need to place more emphasis on the local context when reporting on water risks and activities, which could be achieved through the use of CWR frameworks that integrate both international and sectoral CWR guidelines, along with indicators related to good water governance, water, sanitation and hygiene service delivery and the sustainable development goals, as together they provide a more comprehensive reflection of the broader challenges and opportunities related to corporate water management.Originality/valueThis paper presents the first framework specifically developed to evaluate CWR practices with consideration of the context of an emerging economy.

The role of integrated programs in the prevention of COVID-19 in a humanitarian setting.

The COVID-19 pandemic has caused a severe depletion to health systems worldwide. In the South Kordofan state, a war-torn humanitarian region in Sudan, the United Nations High Commissioner for Refugees and the WHO Emergencies Programme have led the development of integrated programs for health, peace and rehabilitation by training rapid response teams to strengthen both surveillance system and response capacities, engaging the communities at risk with health education and promotion activities, as well as following proper infection, prevention and control measures during case investigation. Also, Early Help Assessment coordinators met with health services managers and recruited 14 teams who were trained to ensure a rapid response to COVID-19. Also, the implementation of water, sanitation and hygiene services was upscaled. Although the local community of South Kordofan is fragile and at high risk of infectious diseases, the limited numbers of detected cases of COVID-19 and COVID-19 deaths could be attributed to the early preparation and integration of programs that helped to prevent the local spread of COVID-19. This lesson needs to be thoroughly investigated to estimate whether it is cost-effective and to determine the feasibility of it being successfully implemented in other humanitarian settings.

How secured and safe is the sanitation and hygiene services in a maximum-security correctional facility in Southwest Nigeria: a descriptive cross-sectional study

ABSTRACT Poorly maintained living conditions and infrastructure are the banes of Nigerian prisons. The study investigated its environmental conditions and the prevalent diseases among inmates. The descriptive, cross-sectional study enrolled 420-inmates through a multistage sampling technique. Pre-tested instruments were administered and results presented with descriptive and logistic regression to identify predictors of toilet-cleaning and handwashing practices at P∝0.05. The mean(±SD) age and modal inmates/cell were 30±7.2 years and 36. Most inmates were males (97%), await-trial (79%) and lives in overcrowded cells (58%). Sixty-nine percent of free-cells has pour-flush toilets and 36% waits for 2–5 minutes before accessing toilets. Fifty-three percent of inmates clean latrines with water and soap, 71% burn solid waste while handwashing period-prevalence was 36%. Religion, toilet-cleaning, and education were predictors of handwashing while types of toilets and access predict toilet-cleaning behaviour. Malaria (81.1%) and scabies (7.3%) were endemic. The prison rehabilitation shall satisfy basic life needs and promote prisoners’ health.

Measuring household hygiene access and handwashing behaviors: Findings from 14 low- and middle-income countries.

Handwashing with soap (HWWS) is critical for preventing diarrheal and respiratory infections and is an important policy priority to achieve the Sustainable Development Goals (SDGs). We analyzed hygiene data from 36,860 household surveys from rural areas in India, Honduras, and twelve countries in sub-Saharan Africa (SSA). We report descriptive statistics and compare and critique three indicators: (1) access to basic hygiene services, defined as a reported designated handwashing area with observed water and soap at the time of the survey; (2) use of both soap and water during demonstrated handwashing; and (3) reported handwashing both after defecation and before preparing food. Overall, 10% of surveyed households (4% in SSA) had access to basic hygiene services and 48% of respondents (45% in SSA) used both soap and water during demonstrated handwashing. Inconsistencies between these indicators suggest no single indicator can provide a holistic picture of household hygiene; reporting on handwashing infrastructure alone may underestimate household access to soap and water and HWWS behaviors. Across the 14 countries, there was an average 22 percentage point (p.p.) gap (median 20 p.p.) in use of both water and soap during demonstrated handwashing between respondents in the wealthiest and poorest quintiles surveyed. This finding highlights the continued need to emphasize inclusivity aspects of the SDGs. Data around respondents' reported exposure to hygiene promotion showed that respondents rarely heard messaging about cleanliness from faith leaders, revealing an overlooked opportunity to empower faith leaders to promote handwashing in low- and middle-income countries.

Reaching those left behind: knowledge gaps, challenges, and approaches to achieving SDG 6 in high-income countries

Abstract Even as progress has been made in extending access to safe water and sanitation under the Sustainable Development Goals (SDGs), substantial disparities in water, sanitation, and hygiene (WASH) services persist in high-income countries around the world. These gaps in service occur disproportionately among historically marginalized, rural, informal, and Indigenous communities. This paper synthesizes results from a side session convened at the 2020 University of North Carolina, Chapel Hill, Water and Health conference focused on knowledge gaps, challenges, and approaches to achieve SDG 6 among marginalized communities in high-income countries. We provide approaches and next steps to advance sustainable WASH services in communities that have often been overlooked.

The Urbanization Of The City Of Bukavu And Its Involvement In The Socio-Economic Situation Of The Urban Population, South Kivu, Democratic Republic Of Congo

This study examines the urbanization of the city of Bukavu and the implications for the socio-economic situation of the inhabitants. It aims to determine the impacts of increasing urbanization on the socio-economic life of the population in order to propose strategies to reconcile urbanization and the improvement of the living conditions of the urban population. The methodology combined field observations, household survey and interviews. The aspects covered are mainly household characteristics and socio-economic characteristics. The survey covered a sample of 150 households for the entire city in terms of 50 households per municipality. The questionnaire was submitted to the public from March to April 2020. The survey results show that the population of this city lives in difficult conditions with precarious housing whose plots do not meet the standards, difficult access to drinking water with dramatic consequences on the health of the population, difficult access to electricity, the virtual absence of public hygiene services... From the statistical analysis of Chi-square that we carried out, it follows that there is no relationship between the variables tested including membership in a municipality and other variables that have been the subject of this analysis. This conclusion is made by the fact that the p-values obtained at the end of this test are well above 0.05 as the results demonstrate. The impacts of urbanization are clearly negative in this city, which needs to be given special attention to reconciling urban development with improving the living conditions of the urban population.

Assessment of Services at Tertiary Care Hospital Located in Central India, using ‘Kayakalp Initiative Tool’

Background: Kayakalp is an innovative initiatory started by the Health and Family Welfare Ministry through Swachh Bharat Abhiyan campaign on 15th May 2015. These instructions concentrate on advancement of desirable schemes for housekeeping facilities, pest control procedure, water sanitation, appointment & tutoring of manpower, advancement and accomplishment of appropriate cleansing procedure in terms of protocols / Standard Operating Procedures (SOPs), powerful management and inspection by the employees and inherent Machinery in the treaties linked with an organizational framework which places a bonus on excellent cleaning services and sanitary facilities. This study aims to describe the experiences and knowledge based on assessment of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District using this tool.
 Objectives: To assess and document hospital upkeep, Sanitation, Hygiene Practices, Hygiene Promotion and to study Handling of Biomedical Waste, Infection Control and Hospital Support Services.
 Methodology: This cross sectional hospital based study that will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District.
 Apart from observation of various practices and Processes, the participants to be interviewed will be Nursing staff in-charge in different wards along with Biomedical engineers, Administrative officers and beneficiary patients. For Quantitative data collection, a kayakalp checklist will be used. Data will be collected through observation, staff interview, record keeping, and patient interview forms as per Kayakalp Initiative Tool.
 Results: This study would help to understand current hospital sanitation procedures, hospital hygiene, infection prevention, general maintenance, waste management, and support services, etc. and will help to improve services based on findings of the study so as to improve satisfaction of population catered by hospital and provide an ideal working environment for all stakeholders.
 Conclusion: This work will assist in improving hospital/facility management and will aid in improvement of sanitation and hygiene practices, it will also improve overall satisfaction of all stakeholders after due implementation of changes suggested at the end of study.

DYNAMIC SPACE-TIME DIFFUSION SIMULATOR IN A GIS ENVIRONMENT TO TACKLE THE COVID-19 EMERGENCY. TESTING A GEOTECHNOLOGICAL APPLICATION IN ROME

In this paper, we start from a contextualization about the measures used to contain the COVID-19 diffusion and the need to promote geotechnological proposals, data sharing and homogenous centralised systems for data collection and analysis. Successively, we present the “Dynamic Space-Time Diffusion Simulator in a GIS Environment to Tackle the COVID-19 Emergency” that we have elaborated on the basis of the data provided by the UOC Hygiene and Public Health Service – Local Health Unit Rome 1. Particularly, after describing the main technical process able to predispose the dynamic simulator, we underline the possible added value that it can provide in terms of infection surveillance and monitoring, precision preparedness, support to decision making and territorial screening. For this demonstrative application, we have extracted from the simulator some groups of four digital screenshots which are able to show synoptic photographs in temporal perspective concerning the total number of cases of COVID-19 in Rome (Italy) for the period February 25th-September 26th. Specifically we have selected:-four screenshots for the period February 25th-June 11th, to provide significant evidence about the first three months and a half;-four screenshots for the period March 1st – March 29th, to add an insight into the geographically and statistically meaningful month of March;-four screenshots for the period June 12th-September 26th, to supply an efficacious geovisualisation of the last three months and a half available;-four screenshots for the period February 25th-September 26th, to show a cumulative elaboration aimed at geolocating all the cases recorded in the seven months examined;-four screenshots for the period March 26th-September 26th, with a distinction about the first and second data sets, for a detailed (cumulative) zoom. This simulator, elaborated for the COVID-19 emergency, can be replicated in any circumstance for which specific data and information are available for the scientific community, shared and progressively updated in order to provide a productive contribution to the identification of serious infectious disease clusters, patterns and trends, and quickly respond to specific needs. © 2021, Asociatia Geographia Technica. All rights reserved.

Assessment of sanitation service gap in urban slums for tackling COVID-19

Coronavirus disease 2019 (COVID-19), caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been declared as a global pandemic by the World Health Organization (WHO). As the disease is highly infectious, the Global South countries are in a vulnerable situation with high urban population density and lack of Water, Sanitation, and Hygiene (WASH) services. The situation for the urban slum dwellers and low-income group clusters are becoming worse. Lack of health and sanitation service availability has already been an issue for them before the beginning of the pandemic. So, it is predictable that adopting this massive global pandemic is a critical challenge for them. This paper assesses the sanitation service gap in urban slums, which has become a severe challenge to tackle due to COVID-19. The study areas of this research are the Ranarmath slum and the Khema slum of Khulna city, Bangladesh. The SERVQUAL model has been used to identify the quality of sanitation service available in these informal residential settlements. The interpretation of questionnaire survey data from the two slums reveals that one slum lacks Assurance and Empathy, where the other slum lacks Tangibility and Responsiveness. However, the Tangibility, Reliability, and Responsiveness condition of both slums are flawed with the lack of latrine functionalities and services from concerned authorities. The incompatibility of the condition has been identified by evaluating the WHO's different sanitation management policy for COVID-19. The research concludes that sanitation services like handwashing facilities and water supply availability in the latrine directly related to COVID-19 prevention are indigent for these slums.

Are the rights of people with disabilities included in international guidance on WASH during the COVID-19 pandemic? Content analysis using EquiFrame

PurposePeople with disabilities are at increased risk from COVID-19. Access to water, sanitation and hygiene (WASH) services and facilities is a fundamental right for all, and is vital in stopping...

임상 치과위생사의 공감역량에 영향을 미치는 요인

Objectives: The purpose of this study is the relationship between the humanistic knowledge, emotional intelligence and compassion competence. Methods: This study examines factors influencing empathy competence in clinical dental hygienists through hierarchical regression analysis. Results: As a result of hierarchical regression analysis, in Model 1, job satisfaction and the presence or absence of educational experience in patient empathy were found to have significant influences. In Model 2, it was found that job satisfaction, patient empathy ability education experience, and emotional intelligence had an effect. Conclusions: These results can be seen as the competence necessary to provide high-quality dental hygiene services in the relationship between the subject and the dental hygienist

Water, Sanitation and Hygiene Practices in the Philippines: Meeting National and Global Targets at the Local Level

As national and global water, sanitation, and hygiene targets have been set and programs have been implemented, the study aimed to assess the attainment of these targets at the local level in selected areas in Davao region, the Philippines. Randomly selected households were assessed for water, sanitation, and hygiene indicators using a modified tool that combined national guidelines and global recommendations. Validated access to improved water source for drinking was below the targets in most barangays, while validated sanitary toilet coverages in all barangays did not meet the targets. Significant difference was observed between validated and reported access to improved water and sanitation services in some barangays. Approximately 87.5% of households had a handwashing facility, but only 51.2% of which had both water and soap available. Achieving the targets is challenged by the gap in monitoring due to a decentralized health system in the Philippines. There is a need to standardize indicators and optimize the tool to allow a comprehensive assessment of water, sanitation, and hygiene practices. This will help generate local data that are in line with national guidelines and global recommendations to enhance policy and to determine priority areas for improved water, sanitation, and hygiene service delivery.

Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013\u20132018: Results of health facility surveys and implications for COVID-19 transmission

BackgroundThe COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services.ResultOverall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households.ConclusionsAvailability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.

Water sanitation and hygiene in Sub-Saharan Africa: Coverage, risks of diarrheal diseases, and urbanization

Sub-Saharan Africa (SSA) has a rapidly growing urban population, with water, sanitation, and hygiene (WASH) services representing the central needs for this population. Incidentally, this region has the lowest global WASH coverage. Data from the ‘WHO/UNICEF Joint Monitoring Programme for Water supply, Sanitation and Hygiene’ and the ‘Global Burden of Disease’ study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA, its subregions, and rural and urban areas in SSA. WASH coverage in the SSA region appears to be low, but urban coverage is better than that in rural areas; however, there is unequal access to urban WASH and poor urban areas are underserved. In addition, 7.75% (5.99–9.7%) of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution (RFA) percentage of 95.93% (91.94–98.24%). Therefore, a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas, although these areas have high incidence of WASH-related diseases including diarrhea. Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas, which would be helpful in ensuring a more inclusive implementation of WASH services.

Challenges facing sustainable water supply, sanitation and hygiene achievement in urban areas in sub-Saharan Africa

ABSTRACT Better water supply, sanitation and hygiene systems are among the sustainable development goals which need to be achieved by 2030. However, it is challenging for developing countries especially sub-Saharan Africa to achieve sustainable sanitation and hygiene. Thus, a systematic review has been conducted to provide a deep discussion of the current and previous works on challenges facing sanitation and hygiene sector in SSA countries. The results indicate that lack of financial resources, rapid population increase, socioeconomic disparities among the urban inhabitants, topography, lack of skilled, and experienced personnel, inadequate policies and strategies, and people’s behaviours and attitudes were identified as the main constraints to sustainable sanitation and hygiene in SSA. Moreover, it recommended that SSA countries can achieve sustainable sanitation and hygiene if there are political commitments, an increase of education and awareness on sanitation to the community, and cooperation among the government, non-government organisations, civil societies, and communities in addressing the issues of sanitation. These efforts will lead to enhanced and improved sanitation and hygiene services in the SSA region.