Safe Sanitation Research Articles

Low schistosomiasis and soil-transmitted helminthiasis prevalence and intensities in selected communities in Davao de Oro and Davao del Norte, the Philippines: A setting for interruption of transmission?

Parasitic neglected tropical diseases, such as schistosomiasis and soil-transmitted helminthiasis (STH), remain as significant public health concerns in developing countries such as the Philippines. This study aimed to determine the prevalence and intensity of schistosomiasis and STH among school-age children (SAC) and adults in two co-endemic provinces in Mindanao in southern Philippines as part of monitoring of national control programs. Stool samples were collected, processed using Kato-Katz technique, and examined microscopically for presence of intestinal helminth ova. A total of 776 SAC and 526 adults participated in the study. Low schistosomiasis prevalence was generally observed in SAC (0.8%) and adults (0.4%). Generally low STH prevalence was reported in both SAC (3.9%) and adults (3.4%). Only three SAC had heavy intensity STH, which was not seen in adults. Results indicate a state of good morbidity control, which may be a result of effective implementation of mass drug administration (MDA) strategy for schistosomiasis, STH, and lymphatic filariasis in the last several years. The low prevalence and intensities of infections may also be partly attributed to the low diagnostic sensitivity of Kato-Katz technique in detecting low intensity intestinal helminth infections. While results of this study also indicate similarly low levels of both these infections in previous studies, sustaining high MDA coverage rates and addressing remaining challenges related to intensified case finding and treatment, improvements in safe water, sanitation, and hygiene, veterinary public health, and vector ecology and management will be necessary to interrupt transmission in these areas.

Repurposing Sewage and Toilet Systems: Environmental, Public Health, and Person-Centered Healthcare Applications.

Global terrestrial water supplies are rapidly depleting due to the consequences of climate change. Water scarcity results in an inevitable compromise of safe hygiene and sanitation practices, leading to the transmission of water-borne infectious diseases, and the preventable deaths of over 800.000 people each year. Moreover, almost 500 million people lack access to toilets and sanitation systems. Ecosystems are estimated to be contaminated by 6.2 million tons of nitrogenous products from human wastewater management practices. It is therefore imperative to transform toilet and sewage systems to promote equitable access to water and sanitation, improve public health, conserve water, and protect ecosystems. Here, the integration of emerging technologies in toilet and sewage networks to repurpose toilet and wastewater systems is reviewed. Potential applications of these systems to develop sustainable solutions to environmental challenges, promote public health, and advance person-centered healthcare are discussed.

A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs.

Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages-such as homelessness or drug injection practices-often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel 'MH WASH Domain Scale-12' among people who menstruate and who inject drugs in the Tijuana-San Diego region and identified correlates of MH access using this scale. We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0-12 points and higher scores indicating better MH access. We assessed the scale's reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020-2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our 'MH WASH Domain Scale-12' was reliable (Cronbach's alpha = 0.81, McDonald's Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing 'WASH availability' and Factor-2 contained items related to 'WASH security'-encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region.

Caste and class interactions in inequality in access to sanitation and hygiene services in India

ABSTRACT Given moderate access to WASH services at the national level, widespread socio-economic inequality still exists in India. This study assesses the status of access to different types of sanitation and hygiene services in India and how the caste and class interactions are associated with them. We use nationally representative household survey data and the Joint Monitoring Programme (JMP) sanitation and hygiene framework. For descriptive analysis, frequency distribution is used. Multivariable logistic regression is applied, and caste interactions are used to estimate the probabilities. Overall, 51.2 and 71.8% of the households have access to safe sanitation and hygiene services. However, among the Scheduled Tribe households, only 36.6 and 58.7% have access to safe sanitation and hygiene. Findings show that class and caste interactions are strongly associated with WASH services. The probability of access to safe sanitation and hygiene is 16 and 15% points lower for the poorest Scheduled Tribes and Scheduled Castes compared to ‘Other’ socially privileged but economically poor, after adjusting for other household sociodemographic characteristics. The finding suggests that an upscaling of the existing policies and programs alongside considering the caste and class intersectionality is required for equitable access to sanitation and hygiene services and to achieve SDG-6.

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

Eco-Friendly Sanitization of Indoor Environments: Effectiveness of Thyme Essential Oil in Controlling Bioaerosol Levels and Disinfecting Surfaces.

Bioaerosols and pathogens in indoor workplaces and residential environments are the primary culprits of several infections. Techniques for sanitizing air and surfaces typically involve the use of UV rays or chemical sanitizers, which may release chemical residues harmful to human health. Essential oils, natural substances derived from plants, which exhibit broad antimicrobial properties, could be a viable alternative for air and surface sanitation. The objective of this study has been to investigate the efficacy of thyme essential oil (TEO) in environmental sanitation processes. In Vitro assays through agar well diffusion, disk volatilization and tube dilution methods revealed significant antimicrobial activity of TEO 100% against foodborne and environmental isolates, with both bacteriostatic/fungistatic and bactericidal/fungicidal effects. Therefore, aqueous solutions of TEO 2.5% and 5% were formulated for air sanitation through nebulization and surface disinfection via direct contact. Bioaerosol samples and surface swabs were analyzed before and after sanitation, demonstrating the efficacy of aqueous solutions of TEO in reducing mesophilic and psychrophilic bacteria and environmental fungi levels in both air and on surfaces. The obtained results prove the antimicrobial potential of aqueous solutions of TEO in improving indoor air quality and surface cleanliness, suggesting thyme essential oil as an effective and safe natural sanitizer with minimal environmental impact compared to dangerous chemical disinfectants.

Influence of economic factors on feacal emptying, conveyance and disposal:

Safe management of faecal waste is one of the Sustainable Development Goals (SDGs) which envisions safe sanitation for all. However, although efforts to improve sanitation conditions in slums have been made, faecal emptying, conveyance and disposal still remain a challenge endangering the health of the public. The study examined the influence of economic factors on faecal emptying, conveyance and disposal in on-site sanitation facilities in Meru slums. A convergent design with a mixed methods approach was adopted. Quantitative data was collected using structured questionnaires from a sample of 228 household heads selected using cluster and proportionate simple random sampling techniques. Correlation and regression analysis was carried out to ascertain the association between emptying, conveyance and disposal of faecal waste and the economic factors. Qualitative data was gathered using focus group discussion participants with eight (8) who included four (4) pit operators, 3 household heads and 1 Public Health Officer (PHO) and results analyzed thematically. Findings showed that only 31% of slum dwellers emptied latrine pits and that manual emptying was more common (84%) than mechanical emptying because of its cost efficiency, reliability and the effectiveness in handling plastics, glasses, metal pieces, diapers and sanitary pads contained in pits. Increased cost constrained faecal emptying, conveyance, and disposal (r=0.499, p-value=0.000). Residents who were able to pay for faecal handling services were more likely to practice hygienic faecal emptying, conveyance, and disposal (r=0.524, p-value=0.000). Low level of income for majority of slum dwellers influenced the design of the latrines adopted. Emptying faeces from poorly designed pit latrines was more expensive due to operators’ safety concerns. The study concluded that the inability to meet the costs associated with faecal emptying, conveyance and disposal services facilitated poor sanitation status in slums. There is need to sensitize the slum community on the benefits of practicing safe management of faecal waste. The study recommended development of government policies to regulate mechanical emptying conveyance and disposal of faecal matter.

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.
 

Bioconversion of faecal and kitchen waste using black soldier fly larvae (Hermetia illucens):

Novel technologies to convert faecal waste into valuable nutrients provide a win-win situation in enhancing the closed sanitation loop, and providing safe sanitation. In this study, laboratory-scale experiments were set to examine the applicability of the Black Soldier Fly in bioconversion of organic matter (faecal matter (FM) and kitchen waste (KW) while producing larvae biomass rich in protein and fat compounds. To determine the mass balance process, each of the feed substrates (500g) in triplicate and 3 grams of 6-day-old larvae (844 larvae) were introduced. The larval developmental time to 50% pupation, survival rate (SR), waste reduction rates (WR), prepupal yield, bioconversion rate (BCR), feed conversion rate (FCR), and efficiency of digested feed (ECD) were monitored in triplicate at the end of the experiments for mass balance process. Mass balance determination (triplicate) yielded average prepupal yield of 70.43±0.02g and 56.77±0.01g, with protein content per unit ranging from 32.23% to 41.26% and 20.06% to 37.13% on faecal and kitchen waste respectively. The ECD of 17.63±0.01% and 12.05±0.00%, waste reduction of 79.91% and 92.24% from faecal and kitchen waste respectively were obtained. From the findings, both substrates were palatable as BSFL feeds. The study findings show the potential of using BSF larvae technology to valorise faecal and kitchen waste and produce larval biomass rich in proteins and fats.

Experiences and Perceptions of Menstrual Hygiene Management (MHM) Among Homeless Women in Cape Town

This study qualitatively explored the experiences and perceptions of period poverty among homeless women in Cape Town, South Africa, using the Capability Approach. The study was guided by a qualitative research design and non-probability sampling was used in recruiting participants. In-depth interviews were conducted with 16 homeless women who experienced period poverty. The individual interviews were done mainly in English and in IsiZulu and isiXhosa. The interviews lasted for a minimum of 45 minutes and were voice-recorded using a phone. A semi-structed interview schedule with 33 open-ended questions was used during the data collection process. The data analysis aspect of this study relied on the work of Creswell (2012) and Tesch (1990). The findings revealed that homeless women experience period poverty due to a lack of sanitary products and poor Menstrual Hygiene Management (MHM). Sen (1999) identified five ‘instrumental freedoms’ that, according to him, play a role in the general capability of a person to live more freely. Of the five instrumental freedoms, the third freedom,’ social opportunities,’ resonates deeply with this study. This freedom refers to facilities and arrangements available to uplift society. Examples of this would be access to quality education and healthcare. Homeless women lack access to quality healthcare and therefore experience obstacles to achieve effective MHM. The lack of sanitary products causes homeless women to resort to the unhygienic use of items such as rags, old socks, tissue paper, paper towels, torn pieces of clothing, or diapers, to satisfy their menstrual needs. Alternatively, they go about life without any menstrual protection and bleed through their undergarments and clothing. This results in them wearing blood-soaked items for days, or even weeks. Additionally, homeless women do not have access to safe water and sanitation facilities that are required to effectively manage their period. The paper serves as a means of highlighting how life, government policy, funding, etc. are still restricted to issues that relate to men. As a result, a multifaceted and holistic approach to addressing period poverty amongst homeless women is encouraged and provision should be made for the type of sanitary products and facilities that homeless women are most comfortable using.

The process, outcomes and context of the sanitation change induced by the Swachh Bharat Mission in rural Jharkhand, India

BackgroundThe Indian Swachh Bharat Mission (SBM) was launched in 2014 with the goal to make India open defecation (OD) free by October 2019. Although it is known that the ambitious goal was not achieved, the nature of the sanitation change brought about by the SBM in different parts of India is poorly understood. One reason is a dearth of case studies that would shed light on the performance of the SBM simultaneously across its different domains. This article provides an example of such study. Employing a Process, Outcomes, Context approach, the objective is to understand the process and outcomes of the SBM-induced sanitation change in a specific context of rural Jharkhand.MethodsThe study utilizes data collected through field research conducted in the rural areas of Ranchi district, Jharkhand, a state in east-central India. This data was obtained via repeated cross-sectional household surveys conducted at the beginning and at the end of the SBM, supplemented by key informant interviews with SBM stakeholders.FindingsWe identified political support of SBM implementation and its acceptance amongst the population. Female community workers became key agents of SBM implementation at local level. The SBM increased toilet coverage in the study area from 15% to 85% and lowered the OD rate from 93% to 26%. It substantially reduced structural inequalities in access to toilets, furthered social sanitation norms, improved some of the attitudes towards toilet use, but impacted less on hygiene and sanitation knowledge. The implementation mainly concentrated on the construction of subsidized toilets but less on improving public understanding of safe sanitation practices.ConclusionsAlthough the SBM reduced sanitation inequalities in access to toilets in the study area, the behaviour change component was underplayed, focusing more on spreading normative sanitation messages and less on public education. Sustainability of the observed sanitation change remains a key question for the future. This article calls for more systematic production of geographically situated knowledge on the performance of sanitation interventions.

Health and socioeconomic development and morbidity: A district case in Indonesia

There was a substantial inequality in health status across districts in Indonesia. The purpose of this study was to examine the association between health and socioeconomic development and morbidity in districts in Indonesia. The data used came from the Indonesia Database Policy and Economic Research (INDO-DAPOER) of the World Bank. The unit analysis was district. The observation period was 2011 and 2014. Multiple regression analysis was employed to study the impacts of health and socioeconomic development on morbidity in districts in Indonesia. The dependent variable was the morbidity rate. The health and socioeconomic development variables included the time, number of medical doctors, number of health centres and its line services, monthly per capita household health expenditure, and access to safe sanitation. The results of the study indicate that, in districts in Indonesia, lower morbidity rate was significantly associated with increasing time, higher number of medical doctor, higher number of health centres and its line services, higher monthly per capita household health expenditure, and higher access to safe sanitation. These results imply that to reduce morbidity rate, the regional governments in Indonesia should improve their health and socioeconomic development.

Spatiotemporal dynamics of cholera epidemics in Ethiopia: 2015–2021

Since the onset of the seventh cholera pandemic, Ethiopia has been affected by recurrent epidemics. However, the epidemiology of cholera in this country remains poorly understood. This study aimed to describe cholera outbreak characteristics in Ethiopia from 2015 to 2021. During this period, Ethiopia experienced four epidemic waves. The first wave involved nationwide outbreaks during the second half of 2016 followed by outbreaks predominantly affecting Somali Region in 2017. The second wave primarily affected Tigray and Afar Regions. During the third wave, multiple smaller-scale outbreaks occurred during 2019. The fourth wave was limited to Bale Zone (Oromia Region) in 2021. Overall, a north to south shift was observed over the course of the study period. Major cholera transmission factors included limited access to safe water and sanitation facilities. Severe weather events (drought and flooding) appear to aggravate cholera diffusion. Cholera transmission between Ethiopia and nearby countries (Kenya and Somalia), likely plays a major role in regional cholera dynamics. Overall, this study provides the first understanding of recent spatiotemporal cholera dynamics in Ethiopia to inform cholera control and elimination strategies.

Spatial difference analysis of water and sanitation in China's counties based on a spatial econometric model

Access to safe drinking water and sanitation are preconditions for achieving the Sustainable Development Goals, which is beneficial to promote new urbanization construction accurately. However, the urbanization rate is still less than 25%. Comprehensive governance capacity and carrying capacity are still relatively weak. This study seeks to increase knowledge of spatial differences in water and sanitation in China's counties, which can reveal the living environment and health conditions of residents in different areas. Furthermore, studying the spatial distribution of water and sanitation facilities in different counties can help understand the development differences between urban and rural areas and narrow the gap between urban and rural. Therefore, four indicators of water supply, sewage disposal, garbage disposal, and public toilets as proxy indicators of water and sanitation were selected, and Moran's I was used to test the spatial correlation between county-level sanitation and economic conditions, government fiscal behavior, and social and geographical factors. This study exploited the inverse distance spatial weight matrix to implement the spatial spillover effect of water and sanitation according to the division of the east, middle, and west and four aspects of water supply, sewage disposal, garbage disposal, and public toilets in terms of per capita occupancy. We observed that there was no significant correlation between population density and county-level water, sanitation, and hygiene enhancement. Economic growth can promote the improvement of water and sanitation to a certain extent. The comparison results indicated that the level of urbanization and education had a positive spatial spillover effect on water and sanitation. The water and sanitation of the demonstration county was characterized by siphon, which occupied the water and sanitation development space of neighboring counties. The results of this study are of great significance to improve county-level water and sanitation facilities and narrow the gap between urban and rural.

The challenges of universal access to water: some contributions to the sustainable management of water resources in rural areas

The United Nations 2030 Agenda for Sustainable Development, highlighted as Sustainable Development Goal (SDG) 6, related to access to safe drinking water and sanitation for all, including vulnerable groups, considers water a human right and advocates for its universalization. Thus, the article aims to o point out, in the field of public, social and governmental policies, assumptions for the sustainable management of water resources in rural areas or for territorially vulnerable populations. The article is based on a qualitative and descriptive methodology, using bibliographic and documentary data to analyze socioeconomic practices and public policies in water resources management. It explores the conceptual framework of the Social and Solidarity Economy and its link with sustainable territorial development, highlighting the importance of community participation and collaboration in water management. The authors suggest that shared or cooperative management of water resources is one way to address environmental, economic, and social challenges. In conclusion, shared management of water resources can solve environmental, economic, and social challenges in rural areas and vulnerable populations, promoting sustainable territorial development.

The safety and immunogenicity of a bivalent conjugate vaccine against Salmonella enterica Typhi and Paratyphi A in healthy Indian adults: a phase 1, randomised, active-controlled, double-blind trial

Enteric fever caused by Salmonella enterica Typhi and Salmonella Paratyphi A is an important public health problem, especially in low-income and middle-income countries with limited access to safe water and sanitation. We present results from, to our knowledge, the first ever human study of a bivalent paratyphoid A-typhoid conjugate vaccine (Sii-PTCV). In this double-blind phase 1 study, 60 healthy Indian adults were randomly assigned (1:1) to receive a single intramuscular dose of either Sii-PTCV or typhoid conjugate vaccine (Typbar-TCV). Safety was assessed by observing solicited adverse events for 1 week, unsolicited events for 1 month, and serious adverse events (SAEs) over 6 months. Immunogenicity at 1 month and 6 months was assessed by measuring anti-capsular polysaccharide antigen Vi (anti-Vi) IgG and IgA against Salmonella Typhi and anti-lipopolysaccharide (LPS) IgG against Salmonella Paratyphi A by ELISA, and functional antibodies using serum bactericidal assay (SBA) against Salmonella Paratyphi A. This study is registered with Clinical Trial Registry-India (CTRI/2022/06/043608) and is completed. 60 participants were enrolled. Of these 60 participants, 57 (95%) participants were male and three (5%) participants were female. Solicited adverse events were observed in 27 (90%) of 30 participants who received Sii-PTCV and 26 (87%) of 30 participants who received Typbar-TCV. The most common local solicited event was pain in 27 (90%) participants who received Sii-PTCV and in 23 (77%) participants who received Typbar-TCV. The most common solicited systemic event was myalgia in five (17%) participants who received Sii-PTCV, whereas four (13%) participants who received Typbar-TCV had myalgia and four (13%) had headache. No vaccine-related unsolicited adverse events or SAEs were reported. The seroconversion rates on day 29 were 96·7% (95% CI 82·8-99·9) with Sii-PTCV and 100·0% (88·4-100·0) with Typbar-TCV for anti-Vi IgG; 93·3% (77·9-99·2) with Sii-PTCV and 100·0% (88·4-100·0) with Typbar-TCV for anti-Vi IgA; 100·0% (88·4-100·0) with Sii-PTCV and 3·3% (0·1-17·2) with Typbar-TCV for anti-LPS (paratyphoid); and 93·3% (77·9-99·2) with Sii-PTCV and 0% (0·0-11·6) with Typbar-TCV for SBA titres (paratyphoid). Paratyphoid anti-LPS immune responses were sustained at day 181. Sii-PTCV was safe and immunogenic for both typhoid and paratyphoid antigens indicating its potential for providing comprehensive protection against enteric fever. Serum Institute of India.

Knowledge, attitude and practice towards intestinal schistosomiasis among school-aged children and adults in Amhara Regional State, northwest Ethiopia. A cross-sectional study

BackgroundSchistosoma mansoni causes intestinal schistosomiasis (SCH) in all regions of Ethiopia. Despite many years of mass treatment, the prevalence has not dropped significantly. The reduction of SCH transmission demands the integration of deworming with safe water, sanitation, and hygiene (WASH) activities. Adequate knowledge and a positive attitude towards SCH are critical to practicing those interventions. However, data on the knowledge, attitude, and practice (KAP) level in school and community settings is limited in Ethiopia.MethodsSchool and community-based cross-sectional studies were conducted from February to June 2023 among 634 school-aged children (SAC) and 558 adults. A pre-tested questionnaire was used to collect socio-demographic and KAP data. Records were entered and analyzed using SPSS software version 21. Correct responses for each of the KAP questions were scored as one, while incorrect or ‘I don’t know’ responses were scored as zero. Good knowledge, a positive attitude and good practice were declared if percentage scores were ≥ 80%, ≥ 90% and ≥ 75%, respectively.ResultsOnly 229 (19.2%) respondents, comprising 91 (14.4%) SAC and 138 (24.7%) adults, had ever heard of SCH. Adults, males, and urban residents had higher awareness level compared to their respective counterparts (p < 0.05). Only 28.4% of aware respondents knew that swimming or bathing in freshwater is a risk factor for schistosoma infection; 10.9% knew the etiologic agent; and 14.4% mentioned at least one sign and symptom associated with SCH. The majority (97.8%) of the respondents were willing to take therapeutic drugs, but only 37.6% believed that SCH is a serious disease. Regarding risky practices, 89.5% practiced swimming or bathing in freshwater, and 25.3% had no access to piped water. Among the aware respondents, only 18 (7.9%) had good knowledge, while 30 (13.1%) had a positive attitude towards SCH. Ninety-nine (43.2%) respondents had good Schistosoma infection prevention practices.ConclusionsThe knowledge, attitude, and preventive practice level towards schistosomiasis are low in the study area. Therefore, strengthening school and community-based health education, along with mass drug administration (MDA), WASH, and a vector control program, is recommended for preventing SCH.

Research priorities for water, sanitation and hygiene (WASH) in humanitarian crises: A global prioritisation exercise

Water, sanitation and hygiene (WASH) interventions should provide access to safe water and sanitation, and promote good hygiene practices with dignity, comfort and security. Multiple systematic reviews have noted evidence gaps and is a paucity of good quality evidence related to the effectiveness and implementation of WASH programmes and interventions in humanitarian crises. The aim of this study was to generate consensus-based actionable research priorities for the humanitarian WASH sector. A research prioritisation exercise was conducted by adapting the Child Health and Nutrition Research Initiative (CHNRI) method. Research questions were compiled from a rapid scoping review, key informant interviews (KIIs) and focus group discussions (FGDs). Questions were reviewed by a technical expert group. An online survey was circulated to score research questions according to five criteria. An overall prioritisation score was calculated and weighted to prioritise questions. A diverse range of 286 global WASH and health experts engaged in the CHNRI process. A list of 128 questions were generated and scored by experts. Prioritised research questions focussed on evaluating existing interventions or programmes, and making iterative changes to current programmes. Other important questions centred on describing WASH conditions and associated health risks in crises contexts. Priorities were also stratified by gender, organisation and region to understand differences globally. The WASH in Crises Research Agenda has identified key research questions of most importance to those implementing WASH in humanitarian crises and has established a list of research priorities. The identified priorities reinforce how more evidence is needed, and underlines the need for research to evaluate current practices in order to improve the quality of humanitarian response. Stakeholders, including donors, international and national organisations, governments and academic institutions, are invited to use this research agenda to encourage, inspire and enable relevant and high-quality research that will be used to inform humanitarian responses.

Application of machine learning in sanitation management prediction: Approaches for achieving sustainable development goals

Due to lack of understanding about the different conditions of sanitation systems and complexity, mostly in Asia and Africa, the occurrence of unsafely managed sanitation still exists, leading to severe environmental and health impacts. Because of the complexity of this problem, machine learning tools were applied to develop an effective model for health protection and safe sanitation management as a promising way to approach sustainable development goals. This study aimed to examine the incidences of ineffective sanitation management on the prevalence of diarrhea infections using machine learning tools. The prevailing conditions for safely sanitation management were identified, and the effective model to protect the impacts of ineffective sanitation management on the prevalence of diarrhea infections was proposed. Based on information collected from about 1000 households with relatively high diarrhea infections during the period of 2017–2021, factors relating to sanitation facilities for health protection and safe sanitation management were examined. Diarrhea infections and no diarrhea infection were recognized based on actual conditions of the surveyed households and incidences from ground-based observation. Classification tree model as J48 in WEKA was applied for analytic predictive tool using 70:30 ratio of training and validating dataset. The findings showed that the tree model obtained from the training data was with 73% accuracy prediction, while that from the validation data was with 70% accuracy. The correlation of personal hygiene (such as washing hand before meal and drinking water from natural water sources) and sanitation facilities (such as open defecation and distance from on-site sanitation facilities to open drains or storm sewer) was significant with inverse relationship for safely sanitation management and public health protection.

Water, Sanitation, and Hygiene (WASH) practices among residents of different slum settlements in a ward of Kolkata: A mixed-methods study.

Access to safe water, sanitation, and hygiene (WASH) is the most basic need for mankind. Poor WASH practices are associated with various waterborne diseases, especially in developing countries such as India. The aim of the study was to assess WASH practices among residents of different slum settlements in a ward of Kolkata, identify the factors associated with WASH practice, and explore the barriers faced by the families and municipal staff in providing adequate WASH services to the community. An observational study, cross-sectional in design with a convergent parallel mixed-methods approach, was conducted in different slum settlements in a ward of Kolkata. Quantitative data were collected by face-to-face interview, spot observation, and measuring the living area, door, and window spaces. Key informant interviews were conducted with the medical officer, ward vector-control coordinator, and municipal waste handlers, in addition to in-depth interviews with respondents who had unsatisfactory WASH practices. SPSS version 25.0 was used to analyze the quantitative data. Qualitative data were analyzed thematically using Atlas.ti 22. The overall WASH practices were considered satisfactory in 58.8% of the households. Education of the respondents up to the secondary level, presence of overcrowding, and inadequate ventilation in the house had statistically significantly higher odds of unsatisfactory practice. Poor living conditions, difficulty in collecting and storing water, waterlogging, blocked sewage drains, common toilets for men and women, and lack of motivation were the primary obstacles identified by the residents. Unsatisfactory WASH practices were observed among a high proportion of the slum population. Community engagement and education regarding WASH in communities is strongly recommended along with improvement of infrastructure and capacity building.