Improved Sanitation Facilities Research Articles

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

BackgroundPoor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children’s linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6–59 months in Ethiopia.MethodsWe used pooled Ethiopia Demographic and Health Survey data (2005–2016) comprising 21,918 (weighted data) children aged 6–59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.ResultsOur analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18–1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.ConclusionOpen defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study.

Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

Development of a Framework to Improve the Provision of Water, Sanitation, and Hygiene in Healthcare Facilities of Mwandi District in Western Province

Healthcare facilities (HCFs) require safe water, sanitation, hygiene, environmental cleaning, and waste management (WASH) in the provision of quality services to promote, restore, maintain, and improve health. However, the unavailability of studies on the challenges and opportunities of WASH services in HCFs of Mwandi District has limited the potential for improved health care and quality of life. Without proper elucidation, this has the potency to dissuade women from using HCFs for childbirth and healthcare, potentially increasing maternal mortality rates. To examine the challenges and opportunities in accessing safe WASH services in HCFs in Mwandi District, more of Qualitative techniques were utilized to gather data from 8 HCFs in Mwandi District. This involved initial observations employing the WASH Status Checklist, followed by focus group discussions with expectant mothers and 23 key informant interviews. Thematic analysis was used to analyse the data. The results showed that only half of the investigated facilities provided basic water services, hampered by water salinity issues. Even though most facilities had improved sanitation facilities, they, however, do not meet the basic sanitation standards. This was primarily due to issues such as corroded pipes, insufficient accessible toilets for people with disabilities, and the absence of menstrual hygiene facilities. Many facilities lacked gender-segregated staff facilities. Most of the facilities had functional hand hygiene facilities but also did not meet the basic standards due to a lack of soap for hand washing. A significant number encounter inefficiencies in cleaning protocols, and the majority face poor infrastructure conditions. The findings further revealed that these challenges stem from inadequate prioritization and funding for Water, Sanitation, and Hygiene (WASH) initiatives. The existing knowledge often concentrates on individual components, the findings stress the necessity for an integrated approach that collectively addresses water supply, sanitation, hygiene, and waste management. This holistic perspective can significantly contribute to the development of more effective guidelines and policies, offering a nuanced understanding of the interconnected nature of WASH components. Furthermore, the research sheds light on the pivotal role of localized political will, specifically highlighting the influence of Health Centre Advisory Committees (HAHC) in shaping governance at the community level, especially concerning WASH projects. The study offers a comprehensive overview of challenges and sustainability opportunities related to WASH services, crucial for their effective functioning. It emphasizes the necessity for heightened awareness and increased budget allocation for the sustainable maintenance of WASH services

Explore Indonesian Spatial Patterns: Poor House Sanitation and Critical Environmental Disease in East Kalimantan

Objective Community-Led Total Sanitation, along with its contained 5 pillars, impacts on the fundamentals of status environmental health. This study aims to determine the spatial distribution pattern with sanitation facilities. This research aimed to analyze the distribution of houses with low economic priority in terms of topografi and their occupants' health conditions, focusing on critical environmental-based diseases, particularly stunting. Methods In order to improve sanitation facilities in terms of the community-based total sanitation pillar, this program was utilized as the stimulant recipient in this study, which had a population of 45 homes with special attention categories. Total sampling was employed to establish the research sample. Average Nearest Neighbor (ANN) and one-way analysis of variance (ANOVA) were used to examine the gathered data. Results As a result, the distribution pattern of the houses by looking at the poor environmental health condition, is categorized as clustered. The topography is hilly, with poor access to clean water, and there is no difference in the physical condition of the houses. Conclusion The pattern of distribution of houses with low economy is obtained in groups in areas that do not have access to adequate clean water. Diseases that exist in these community groups include diarrhea, tuberculosis, ISPA, and stunting.

Associated factors of child wasting among children aged 0 – 23 months in India: Analysis of the National Family Health Survey-5

The enduringly high prevalence of child wasting (weight-for-height-2SD) in India is a significant cause for concern. The objective of this study is to identify areas with high incidence of wasting among children aged 0 &amp;ndash; 23 months and to uncover the factors influencing wasting among young children in India. The analysis utilized individual and district-level data from the National Family Health Survey-5 in 2019 &amp;ndash; 2021. The wasting prevalence exceeding 30% was found in 81 districts, with 501 districts surpassing 15%. Our analysis indicated that children from the poorest households (adjusted odds ratio [AOR] = 1.60, 95% confidence interval [CI] = 1.43 &amp;ndash; 1.79), those lacking access to improved sanitation facilities (AOR = 1.18, 95% CI = 1.11 &amp;ndash; 1.25), belonging to other backward class families (AOR =1.12, 95% CI = 1.04 &amp;ndash; 1.20), and born to mothers with body mass index (BMI) &lt;18.5 (AOR = 1.30, 95% CI = 1.23 &amp;ndash; 1.37) faced higher odds of wasting. In addition, low birth weight (&lt;2500 g) increased the odds of wasting by 27% (AOR = 1.27, 95% CI = 1.20 &amp;ndash; 1.36). The study further found that a minimum acceptable diet and female gender had protective effects on wasting among children aged 6 &amp;ndash; 23 months. These findings underscore the need for a comprehensive programmatic response to addressing wasting in young children. Urgent policies and programmatic actions are warranted, with a specific focus on strengthening the care of low birth weight and premature babies, as well as promoting optimal child feeding practices. There is a call for intensified nutrition services as an integral component of routine health services for mothers. Early identification and management of wasting and counseling during pre-conception and pregnancy should be prioritized.

Factors affecting financing of communal sanitation facilities by the public sector in Informal Settlements: A case of Nyalenda informal settlement, Kisumu City.

To close the current sanitation gap, public funding for sanitation has become increasingly insufficient, particularly in Sub-Saharan Africa. What is concerning in Kenya is not the large number of people who lack access to safe sanitation facilities, but the slow rate at which households can gain access to improved sanitation facilities. A sustainable financing strategy is required, one that will increase resource allocations to the sector, improve the efficiency and effectiveness of existing resources wherever they are found, and tap the potential of alternative financing mechanism. A critical review of policy documents like the County Integrated Development Plan (CIDP) shows that there is hardly any documentation on County sanitation plans. Once sanitation lacks in the CIDP, the county can hardly plan for the sector hence making the residents suffer. The study objectives are to examine different sanitation financing options for communal sanitation facilities in Nyalenda informal settlement, to assess factors affecting financing of communal sanitation facilities by public sector in Nyalenda informal settlement and to establish challenges of financing communal sanitation facilities in Nyalenda informal settlement. The study is a descriptive cross-section design. The study used closed and open-ended questionnaires and key informants’ interview in collection of data where n=400. The study established that the dominant communal sanitation financing option in Nyalenda informal settlement was personal contribution (56.0%), followed by NGO financing (40.3%), while the last was County Government financing (0.5%). Public-private partnerships played a crucial role in facilitating sustainable onsite financing for sanitation facilities as evidenced by majority of the respondents agreeing (35.75%). The study recommended the need for diverse financing sources, awareness of available options, and supportive policies to overcome financial challenges.&#x0D; &#x0D;

Biosecurity Challenges: How Defense Strategies Against Tuberculosis In Asean Countries

This comprehensive research provides a thorough analysis of tuberculosis (TB) incidence trends and sanitation challenges within the ASEAN region spanning from 2005 to 2021. It underscores the critical need for robust defense strategies against TB, particularly in light of setbacks exacerbated by the COVID-19 pandemic. The research, conducted in Jakarta, Indonesia, from June to July 2023, delved into biosecurity challenges of tuberculosis in ASEAN countries, using a quantitative approach and cross-sectional design. Data from 2005 to 2021, sourced from the ASEAN database, underwent descriptive statistics and trend analysis to explore TB incidence rates, ensuring a comprehensive investigation scope. The study places emphasis on the imperative of implementing comprehensive measures encompassing prevention, screening, swift diagnosis, utilization of advanced treatment regimens, and ensuring robust patient support systems. Moreover, it highlights the pivotal role of addressing sanitation challenges, as substandard conditions significantly heighten the risks of TB transmission. The study's scope encompasses an array of critical subjects, with a central focus on TB incidence rates, as well as the crucial aspects of access to improved sanitation facilities and sanitation services. The conclusion is the ASEAN region, especially the Philippines, faces a notable tuberculosis burden, coupled with uneven access to sanitation. Effective interventions and collaboration are vital for improving public health and sanitation standards in ASEAN countries.

Factors associated with the cholera outbreak in Al-Mahweet-Yemen: Analytic Study.

The emergence of cholera in 2016 in Yemen, worsened the morbidity and mortality of diarrheal diseases, particularly among children under five. Multiple outbreaks in Yemen are triggered by years of conflict and the collapse of basic infrastructure including water supply and sanitation systems. This study aims to assess factors associated with the cholera outbreak, in a cholera-prone region, in Al-Mahweet, Yemen. We conducted a multivariate analysis of the data collected through a household survey of 384 households in Al-Mahweet, Yemen. Families with children under five years, large households, and those living in Al Mahweet district were associated with a higher incidence of cholera. Water treatment by boiling, filtering, and chlorination as a protective practice against cholera showed a borderline significance, while other WASH practices including regular hand washing, open defection, safe water source, and improved sanitation facilities were statistically insignificant. Community awareness of cholera transmission and prevention measures showed no association with cholera incidence. Findings suggest that living conditions, including large households and lack of access to treated water, increase the risk of cholera. Interventions to increase access to treated water and improve the hygienic conditions of large households are of central importance. Affected communities must receive effective educational campaigns that are adjusted to change hygienic practices and improve knowledge of cholera transmission and protection measures.

Identifying and Characterizing the Poorest Urban Population Using National Household Surveys in 38 Cities in Sub-Saharan Africa.

Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis.

Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries. We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software. The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception. Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

Early-life exposure to unimproved sanitation and delayed school enrollment: Evidence from Bangladesh

Exposure to environmental stressors during early childhood can significantly impact a child’s development and educational outcomes. In this paper, we examine the effects of exposure to unimproved sanitation in the surrounding environment during early childhood on primary school enrollment later in life in Bangladesh between 2007 and 2014. While Bangladesh has made significant progress towards eradicating open defecation, the country still suffers from inadequate access to improved sanitation. Additionally, although policies aiming at improving primary school enrollment have been in place since the 1990s, many children of school age were not enrolled at the appropriate time during the period studied. Using a pseudo-panel dataset for children aged six to nine compiled from the 2007, 2011, and 2014 DHS surveys, we find that children exposed to a higher proportion of unimproved sanitation in their community early in their life are less likely to be enrolled in primary school at the time of survey by about five percentage points on average, indicating delayed school enrollment. This effect is more pronounced for children aged six and seven than those eight and nine, likely because parents of children experiencing poor health or cognitive development delay enrolling their children in school until they are slightly older or healthier. Our results are robust to potential omitted variable biases and are further supported by additional analyses on matched samples. Taken all together, our findings highlight that increasing coverage of improved sanitation facilities can help improve school enrollment rates. However, this should not only occur at the household level alone but also should extend to cover all households in the community to ensure achieving maximum benefits. The findings indicate that the provision of safer sanitation facilities is not only good by itself but also is crucial for achieving improvements throughout the human capital development cycle, including health and nutrition, as well as education.

Socioeconomic predictors of access to improved water sources, sanitation facilities, and household water treatment in Nigeria

Abstract In Nigeria, the widespread lack of access to water, sanitation, and hygiene (WASH) represents a critical public health challenge. Yet, the socioeconomic determinants of WASH access at the national level remain poorly understood. This study uses 2018 Nigeria Demographic and Health Surveys (NDHS) cross-sectional data to investigate the socioeconomic factors associated with WASH access. The majority of survey respondents lived in rural areas (57%); used an improved source of drinking water (73%) and an improved sanitation facility (55%); and did not treat their drinking water (92%). Binary logistic regression showed that Nigerians living in rural areas were less likely to have access to an improved water source (p &amp;lt; 0.001, OR = 0.42 [0.41, 0.44]) and less likely to have access to an improved sanitation facility (p &amp;lt; 0.001, OR = 0.79 [0.77, 0.81]). A sub-group regression analysis of respondents without access to improved WASH found that rural residence (OR = 0.84 [0.76, 0.93]), along with lower levels of education and wealth were associated with non-treatment of their unimproved drinking water. This study suggests that efforts are needed to increase WASH access in rural areas and to improve household water treatment in areas without access to improved water and sanitation.

Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Spatial distribution and determinants of limited access to drinking water and sanitation services of households in India

Abstract Good health and well-being require safe drinking water and improved sanitation facilities. Lack of access to drinking water and sanitation facilities poses serious health risks. There are few studies based on the NFHS-5 data in the literature. Therefore, the present study used the NFHS-5 data to investigate the spatial distribution of limited access to drinking water and sanitation facilities in India. The Stata version 14.1 software was used for statistical analysis and Arc Map 10.4 was used for spatial analysis. A binary logistic regression model was applied to investigate the association between dependent and independent variables. The prevalence of limited access to drinking water and sanitation facilities was higher in Madhya Pradesh (12.28%) and Manipur (22.65%), respectively. Besides, the spatial distribution of limited access to drinking water and sanitation facilities was spatially clustered among a few central and western Indian states. In the binary logistic regression, education, wealth index, and place of residence were significantly associated with limited drinking water and sanitation services. There is regional heterogeneity in drinking water and sanitation services. With this in mind, we suggest spatially optimized target-oriented policy measures in unprivileged areas. Improving the water distribution networks and construction of sanitation facilities is also recommended.

Single-wavelength colorimetric tests for low-cost estimation of bacterial activity, chemical oxygen demand, and turbidity in domestic wastewater

Abstract Monitoring the characteristics of wastewater can enable a better choice of the options available for its treatment and also provide a rational basis for the surveillance of the spread of waterborne diseases. Our work focused on bringing down the costs associated with the estimation of the biological and physico-chemical parameters of wastewater at a common wavelength of 600 nm. We demonstrated the advantages of using the Dye Reduction-based Electron-transfer Activity Monitoring (DREAM) assay to estimate bacterial activity as an alternative to the bacterial colony count method. This assay relies on the colorimetric measurement of the extent of reduction of methylene blue in response to bacterial electron transfer. We also present the results of estimating COD and turbidity, using the standard methods of wastewater analysis, at the same wavelength of 600 nm using samples having known values of chemical oxygen demand (COD) and turbidity. Our results open up the possibility of replacing expensive spectrophotometers with LED-based, microcontroller enabled colorimeters that can be easily automated. The results of our study set the stage for the establishment of a greater number of wastewater analysis laboratories in economically backward regions which can in turn support measures to improve sanitation facilities.

Sensitive Intervention Policy Recommendations to Reduce Stunting Rates Based on Spatial Analysis of Sanitary Factors on the Prevalence of Stunting in DKI Jakarta Province in 2021

The purpose of this study was to describe the prevalence of stunting in children under five and the percentage of proper sanitation, as well as recommendations for priority areas for stunting control interventions in the Province of the Special Capital Region of Jakarta in 2021. This study used a descriptive approach to present an overview of the percentage of sanitation and prevalence of stunting in children under five by sub-district in 38 districts in DKI Jakarta. Data is displayed as a map to show distribution areas based on high, medium, and low categories. An overlay was made between the distribution map of the percentage of sanitation and the prevalence of stunting to determine the areas with the highest risk. Analysis was carried out on the area's characteristics obtained from the spatial mapping results to determine the recommended intervention program policies. Based on the results of the overlay on the distribution of stunting prevalence and sanitation percentage maps, the recommended areas for priority intervention are Tambora, Sawah Besar, Johar Baru, Senen, Menteng, Jatinegara, Tebet, and Mampang Prapatan sub-districts. The recommended program to be carried out is sensitive interventions consisting of improving sanitation facilities and increasing knowledge and perceptions about sanitation. Improving sanitation facilities means increasing access to gooseneck latrines with septic tanks and access to clean water. Increasing knowledge and perception of the importance of sanitation to prevent stunting is carried out intensively and routinely through community activities and optimizing the role of community leaders.

Lessons from a successful national sanitation programme: the case of Nyumba ni Choo in Tanzania.

Universal access to hygienic sanitation is a Sustainable Development Goal for international development. However, many countries are liable to miss this target by the deadline of 2030. As provision and subsidy are prohibitively expensive, promotion is the tactic commonly taken by governments and stakeholders in many countries, even though it is often not effective at generating significant changes in sanitation coverage. A recent 5-year programme used an international consortium made up of organizations' experts in consumer research, creative communication, programme management and event implementation, media monitoring and programme evaluation, to achieve significant increases in the coverage of improved sanitation facilities throughout Tanzania, using adaptive programming. A number of lessons, outlined here, can be drawn from this experience which are likely to be applicable to promotion efforts in other countries and contexts and which can hopefully help countries to reach their sanitation targets. These lessons include the use of motivation and targeted expertise rather than reliance on training, the use of the theory of change to guide development processes, targeting of high-level government support, collaboration with private sector actors, testing and refreshing of messaging, continuous monitoring of on-ground conditions, use of multiple modes of outreach and branding of all programme outputs.

Understanding the Dynamics of Multi-Dimensional Poverty Index: BIMARU States: An Econometrics Approach

The research study analyzes multidimensional poverty in seven states of India, namely Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, and Uttar Pradesh. The study focuses on three key dimensions of poverty: infant mortality rate, birth rate, and educational dropout rates at both primary and upper primary levels. Additionally, the study examines the availability of basic amenities such as clean cooking fuel, improved sanitation facilities, and safe drinking water. By calculating the Multidimensional Poverty Index (MPI), the study ranks the states based on their performance in these dimensions. Madhya Pradesh emerges as the top-performing state with the lowest MPI score of 0.310745, followed by Uttar Pradesh, Rajasthan, Chhattisgarh, Odisha, Bihar, and Jharkhand. The study reveals that despite having relatively low MPI scores, Madhya Pradesh and Uttar Pradesh still struggle with high infant mortality rates and birth rates. This indicates the need for targeted interventions to improve healthcare and family planning services in these states. Additionally, the study highlights the importance of education in poverty reduction. It identifies Jharkhand and Chhattisgarh as states with the highest primary and upper primary education dropout rates. This emphasizes the need for improving the quality of education and implementing strategies to encourage school completion. It also states the importance of addressing issues related to healthcare, education, and basic amenities in order to reduce poverty and improve overall well-being. The normalized index approach used in this study provides a comprehensive and objective measure of poverty, enabling policymakers and stakeholders to make informed decisions and allocate resources effectively.

Determinants of Stunting among Children under Five in Pakistan.

Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1000 days of life. Across south Asia, Pakistan has the second-highest prevalence of stunting. This study assessed the most recent nationally representative data, the National Nutrition Survey (NNS) 2018, to identify the stunting prevalence and determinants among Pakistani children under five. The NNS 2018, a cross-sectional household-level survey, was used to conduct a secondary analysis. Data on malnutrition, dietary practices, and food insecurity were used to identify the prevalence of stunting among children under five years in terms of demographic, socioeconomic, and geographic characteristics. The prevalence of stunting was calculated using the World Health Organization (WHO) height for age z-score references. Univariate and multivariable logistic regressions were conducted to identify the factors associated with child stunting. The analysis showed that out of 52,602 children under five, 40.0% were found to be stunted. Male children living in rural areas were more susceptible to stunting. Furthermore, stunting was more prevalent among children whose mothers had no education, were between 20 and 34, and were employed. In the multivariable logistic regression, male children (AOR = 1.08, 95% CI [1.04-1.14], p < 0.001) from rural areas (AOR = 1.07, 95% CI [1.01-1.14], p = 0.014), with the presence of diarrhea in the last two weeks (AOR = 1.15, 95% CI [1.06-1.25], p < 0.001) and mothers who had no education (AOR = 1.57, 95% CI [1.42-1.73], p < 0.001) or lower levels of education (primary: AOR = 1.35, 95% CI [1.21-1.51], p < 0.001; middle: AOR = 1.29, 95% CI [1.15-1.45], p < 0.001), had higher odds of stunting. Younger children aged < 6 months (AOR = 0.53, 95% CI [0.48-0.58], p < 0.001) and 6-23 months (AOR = 0.89, 95% CI [0.84-0.94], p < 0.001), with mothers aged 35-49 years (AOR = 0.78, 95% CI [0.66-0.92], p = 0.003), had lower odds of stunting. At the household level, the odds of child stunting were higher in lower-income households (AOR = 1.64, 95% CI [1.46-1.83], p < 0.001) with ≥ 7 members (AOR = 1.09, 95% CI [1.04-1.15], p < 0.001), with no access to improved sanitation facilities (AOR = 1.14, 95% CI [1.06-1.22], p < 0.001) and experiencing severe food insecurity (AOR = 1.07, 95% CI [1.01-1.14], p = 0.02). Child stunting in Pakistan is strongly associated with various factors, including gender, age, diarrhea, residence, maternal age and education, household size, food and wealth status, and access to sanitation. To address this, interventions must be introduced to make locally available food and nutritious supplements more affordable, improve access to safe water and sanitation, and promote female education for long-term reductions in stunting rates.

Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018.

Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001). The child's age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.