Sanitation Facilities Research Articles

SDG 6 progress analyses in sub-Saharan Africa from 2015–2020: the need for urgent action

This study used data from various international databases to track the progress of SDG 6 target indicators in sub-Saharan Africa (SSA) region between 2015 and 2020. Findings showed that although minimal positive progress was realized in the evaluation period, more than half of SSA residents had no access to safe drinking water services, improved sanitation facilities, hygiene services and safe wastewater treatment. The computed SDG 6 profile index conformed with the trend of indicators as progress of the region to the goal’s realization was rated as medium–low. The trend was further compounded by limited data, preferential access to water and sanitation services to the urban rich and poor monitoring of progress. The analysis also noted that despite these challenges the region was putting concerted efforts to promote transboundary cooperation in water management and had 6% of water stressed resources. The study recommended on the need to revamp water data collection and monitoring efforts to enable decision-making and planning on management actions, use of technology to treat and reuse wastewater as well as device new sources of water, enhanced participation of communities in water projects and improved water use efficiency to steer progress towards SDG 6 realization in SSA region.

Strategy for the Development of the Street Area Hygiene Sanitation Standards in Astanaanyar Market Bandung

Bandung, as one of the most popular tourism destinations in West Java, offers unique cultural, natural and culinary treasures. However, culinary tourism in Bandung City faces challenges such as the problem of implementing sanitary hygiene, especially for street vendors. This study aims to create a strategy for the development of a street food area with sanitary hygiene standards in Pasar Astanaanyar, Bandung City, focusing on the availability of sanitation facilities and knowledge of food handlers, from the data on facilities and knowledge obtained, appropriate strategies will be formulated to be implemented. The method in this study uses a Likert scale and a multiple choice statement test given to street vendors by analyzing the data descriptively. The results obtained that the sanitation hygiene facilities in Astanaanyar market are categorized as not good with the largest result more than half (87.5%) of traders do not have sewerage facilities, but the knowledge possessed by traders is categorized as quite good regarding personal hygiene , food hygiene and sanitation facilities with the largest average score of 68.75 regarding food hygiene. The conclusion of this study is the need for involvement between the government, the private sector, and the street vendors themselves to develop a hygienic sanitation standardized street vendor area.

Identification of environmental, socioeconomic, water, sanitation, and hygiene (WaSH) factors associated with COVID-19 incidence in the Philippines: A nationwide modelling study

Despite the implementation of non-pharmaceutical interventions, the threat of coronavirus disease 2019 (COVID-19) remains significant on a global scale. Identifying external factors contributing to its spread is crucial, especially given the World Health Organization's recommendation emphasizing access to water, sanitation, and hygiene as essential in curbing COVID-19. There is a notable discrepancy in access to sanitation facilities, particularly evident in low- and middle-income countries. However, there is a lack of quantitative assessments regarding these factors. This study examines various environmental, socioeconomic, water, sanitation, and hygiene factors and their associations with COVID-19 incidence. All regions in the Philippines were categorized into clusters based on socioeconomic factors. A conceptual structural equation model (SEM) was developed using domain knowledge. The best-fitting SEM for each cluster was determined, and associations between factors and COVID-19 incidence were estimated.The correlation analysis revealed that rainfall, minimum temperature, and relative humidity were positively correlated with weekly COVID-19 incidence in urban regions. Maximum temperature, mean temperature, wind speed, and wind direction were negatively correlated with weekly COVID-19 incidence in rural regions, with time lags of 0, 3, and 7 weeks. In urban regions (Cluster 1), factors such as urbanization rate (1.00), area (−0.93), and population (0.54) were found to be associated with weekly COVID-19 incidence. Conversely, in rural regions (Cluster 2), factors including area (0.17), basic sanitation (0.84), and wind direction (0.83) showed associations with weekly COVID-19 incidence. These factors were causally associated with a latent variable reflecting the hidden confounders associated with COVID-19 incidence. It is important to note that sanitation factors were associated only in rural regions. Improving access to sanitation facilities in rural regions of the Philippines is imperative to effectively mitigate disease transmission in future pandemics. Identification of the causal effect of unobserved confounders with COVID-19 incidence is recommended for future research.

Perilaku Hidup Bersih dan Sehat Serta Pemberian Makanan Sehat Pada Anak Sekolah Dasar

This study focuses on clean and healthy living behavior (PHBS) and the provision of healthy food to elementary school children. The aim is to enhance PHBS habits and healthy food intake among students through a participatory approach involving students, teachers, and parents. The research method includes sosialitation and interviews, with subjects being third to 4 and 5 students in elementary schools in 56 Perumnas Poka. Results show significant improvements in personal hygiene habits, the use of sanitation facilities, and the purchase and consumption of healthy food at school. Involvement teachers support also increased, contributing to the program's success. Positive feedback was received from the school community, though challenges such as resource limitations and the need for consistent monitoring remain. This study highlights the importance of community collaboration in promoting children's health.

Women's sanitation matters: Unpacking the conundrums associated with open defecation among women in Harper City, Liberia

Ending open defecation (OD) is a major global policy goal—anchored by the Sustainable Development Goal 6. While women are vulnerable to the risks associated with poor sanitation and are disproportionately impacted by OD, little is known in the scientific literature about the intricacies, drivers, implications and the challenges women face in OD practices in low and middle income countries’ cities. Using the FOAM analytical framework and the coastal city of Harper, Liberia, as a case study, the paper aims to unravel the day-to-day hustles and hostilities women face in defecating in the open. Data were sourced through desk review, face-to-face interviews with 30 women, 7 key informants and observation. Our findings demonstrate that the beach serves as the major destination for OD in the city. Institutional failure—a low commitment of the Liberia government towards the construction of public sanitation facilities and socioeconomic factors—a general high incidence of poverty among the populace influence women's OD practices in the city. Women are exposed to insecurity, psychological trauma, loss of privacy and dignity under OD practices. The findings underscore the need for policymakers and stakeholders to prioritize women's sanitation in emerging cities. The paper recommends that the government of Liberia should prioritize providing women access to improved sanitation by scaling up the construction of public sanitation facilities, subsidising the cost of building and sanitary materials, and promoting behavioural change through public health and sanitation education as measures to curtail OD in the country.

Prevalence and risk factors of intestinal parasitoses among residents of Ekemkpon and Idim Ita of Cross River State, Nigeria

Background: intestinal parasitic infections are the most common infections in the world, with the most prevalent burden occurring in poverty-stricken areas. Intestinal parasitic infections are endemic in certain parts of Nigeria as a result of poor hygiene practices and pollution, which result in contamination of food and water. In semi-urban and rural communities where the dwellers are generally poor and uneducated and lack basic amenities like potable water supply and good sanitary facilities, intestinal parasitic infections cause major health problems. This study was to evaluate the influence of socio-demographic factors in the transmission of intestinal parasitoses among the residents of Ekemkpon and Idim Ita Communities of Cross River State, Nigeria. Materials and Methods: this was a cross-sectional survey between April 2019 and August 2019. Samples were obtained from 359 participants in the study areas and examined for stool analysis using direct microscopy and brine floatation technique. Socio-demographic data of the study subjects were obtained using questionnaires. Results: the prevalence of intestinal parasites was higher in Ekemkpon (41.0%) than in Idim Ita (14.9%). Participants with mixed infections in Ekemkpon were 7.9%, while those in Idim Ita were 2.2%. The study has shown that level of education had an influence on the transmission of intestinal parasites in Ekemkpon (p<0.05). Open defecation played a major role as a source of contamination of domestic water and farm products in the Ekemkpon community. The overall helminthic infections in the two study areas were higher than the protozoan infections observed in this study. The only intestinal protozoa in Ekemkpon was Entamoeba histolytica/dispar while hookworm species were the commonest helminthic parasites in Ekemkpon. Balantidium coli (4.4%) was the most prevalent intestinal protozoan parasites in Idim Ita while hookworm and Ascaris lumbricoides (2.8%) were the most occurring helminthic parasites in Idim Ita. Conclusions: it is recommended that strategies aimed at health education, diagnosing and treating those positive for intestinal parasite infections, and improving the general well-being of the masses be encouraged.

Identification of Bacteria from Public Toilets of Modern Market (Goico) in Musanze Town, Rwanda

Background: Bacteria are present on all surfaces, to which they were carried by many direct and indirect methods of transmission. A toilet is simply a receptacle into which both solid and liquid waste of human origin, in the form of urine and excreta are discharged. In public toilets, complete strangers mix and use the same sanitary facilities, with all the related risks of bodily fluid exchange, contamination and organism transmission. Unhygienic use of the toilet’s facilities may cause urine and fecal residues after use to serve as a major reservoir or source of human pathogen, which may in turn bring about disease outbreak. Aim: This study aimed at Identification of Bacteria from Public Toilets of Modern Market (Goico) In Musanze Town, Rwanda Method: This cross-sectional study was conducted to identify bacteria from GOICO market toilets. About 40 samples; 20 from male and 20 from female toilets were collected and transported to INES-clinical microbiology laboratory for microbiological analysis. Laboratory techniques including culture, gram stain, biochemical tests and antibiogram were performed. Results: The most predominant bacteria isolated was S. aureus (31.43%), followed by S. typhi (20%), Streptococcus(15.71%), E. coli(12.86%), P. aeuriginosa(10%), P. mirabilis(7.14%), C. freundi(1.43%), S. epidermidis (1.43%). It was noted that female toilets were more contaminated (51.43%) than male toilets (48.57%). All gram positive and gram-negative bacteria were sensitive to Gentamicin. Almost all bacteria except P. mirabilis were sensitive to Norfloxacin, gram negative showed a resistance to Vancomycin and Novobiocin. Conclusion: These results should alert public toilets users that extreme caution must be executed while using these toilets, as they may be a source of pathogenic bacteria. The best way to keep a toilet and its seat free of bacteria is to clean it with bleach. Otherwise, keep the bacteria at bay by washing your hands, and if you just don't trust that toilet seat, wipe it down with a disinfectant or antibacterial wipe before you sit. Keywords: Bacteria, Public toilets, E. coli, S. typhi, Urinary tract

Holistic citywide sanitation for an urban area in the Global South: A case study of the Noakhali Pourashava of Bangladesh

ABSTRACT Urban areas currently grapple with the consequences of poor sanitation systems and a burgeoning population. The issue remains acute for developing nations where financing and governance structures for urban sanitation remain inadequate. Using cutting-edge techniques such as shit flow diagrams (SFDs), city service delivery assessments (CSDAs), and SWOT analysis, this study provides an in-depth exploration of the sanitation scenario in the Noakhali Pourashava of Bangladesh. The study reveals a critical lack of sanitation infrastructure and inadequate fecal sludge management, with implications for public health and environmental sustainability. Findings indicate that only 3% of excreta enters the sewer system, while 88% is improperly disposed of through SFDs and CSDAs, highlighting areas for improvement. Recommendations include increased investment in sanitation infrastructure, public awareness campaigns, adoption of innovative technologies, improved stakeholder coordination, and addressing cultural and behavioral barriers. These insights aim to inform policy and decision-making processes to achieve sustainable and inclusive urban sanitation, ultimately improving public health and environmental outcomes in Noakhali and similar coastal urban areas.

Left alone and behind: Experiences of living with incontinence in a Sudanese refugee camp and how WASH practitioners can support

ABSTRACT Being able to manage incontinence with dignity is intrinsically linked to access to appropriate water, sanitation, and hygiene (WASH) services; yet it is overwhelmingly overlooked in humanitarian contexts and not consistently included in WASH interventions. A mixed-methods study (including market assessment) was conducted in two refugee camps in eastern Sudan in late 2022. Tigrayan refugees with incontinence faced extreme challenges to managing it, including no or limited access to necessary hygiene products (such as mattress protectors, toilet chairs, and soap), a lack of water for personal hygiene and washing, and long distances to communal sanitation facilities and distribution sites (or markets) where they often needed to queue or lacked privacy. Refugees with incontinence faced high levels of stigma, shame, and isolation. WASH practitioners need increased awareness of incontinence to carry out quality WASH assessments, to better understand and support people with incontinence. WASH interventions must include appropriate hygiene and non-food items (NFIs) to enable people to manage incontinence at home, and accessible toilets, water points and hygiene and washing facilities. A mixed modality of both in-kind and cash or voucher support can help to ensure hygiene and NFI items are accessible and meet the needs of people living with incontinence.

Water Stress: Between Farmers' Needs and Public Policies the Case of Smallholder Farmers in the Villages of Nabatieh Governorate

Water scarcity is a paramount developmental and livelihood issue globally, posing life-threatening challenges in the Arab world and the Eastern Mediterranean. This scarcity manifests in two forms: physical scarcity, due to insufficient water resulting from local environmental conditions, and economic scarcity, characterized by inadequate water infrastructure. When these forms of scarcity converge, they lead to severe water stress, exemplified by regions experiencing both low rainfall and inadequate water storage and sanitation facilities. In Lebanon, state policies, or the lack thereof, have significantly exacerbated water scarcity. Governmental negligence and mismanagement of water resources, compounded by insufficient investment in infrastructure, have intensified both physical and economic water scarcities. The lack of effective water conservation policies, poor maintenance of existing water facilities, and failure to develop new water projects have led to severe water stress, hindering developmental progress and threatening the livelihoods and health of the population. The combined effect of environmental challenges and governmental inaction has made water scarcity a critical issue, necessitating immediate and comprehensive interventions to ensure sustainable water management and availability for the future.

Water Sanitation Quality Assessment for Hand-Dug Wells

Purpose: Public toilet sanitation facilities need to be analyzed for water sanitation quality. This research aims to explain the benefits of hand-well water for sanitation in densely populated communal environments. Theoretical framework: This article presents literature support regarding sanitation, water quality, and pollutant index in Indonesia, regarding water sanitation conditions in dense urban organizations. Method: Comprehensive data on the quality of water sanitation used by people in dense settlements. Data was collected in the form of water as a laboratory test from 24 random dug wells in four sub-districts in Bandung City and analyzed by the regulations of the Minister of Health of the Republic of Indonesia. Results and Discussion: The research results show that an average of 75% of air wells are contaminated based on water sanitation quality and pollutant index based on Minister of Health Regulation Number 32 of 2017 and Number 2 of 2023 concerning Indonesian Environmental Health and Water Health Quality Standards. Research Implications: Our findings are important for policymakers, health workers, public health practitioners, and so that the community provides public toilet facilities that can be monitored and receive government attention to improve their quality. Originality/Value: The novelty of this research lies in that it presents a comprehensive assessment of water quality indices and physical, chemical, and microbiological parameters of hand wells in dense urban organizations.

Assessment of capacity and performance of points of entry in detection of public health events, reporting and responding to public health emergencies, Uganda, July–September 2022

IntroductionExpanded human mobility has increasingly led to the spread of disease outside of the areas in which it first occurs. Consequently, there is an enhanced focus on building capacity to detect disease at points of entry (PoEs). We assessed capacity and performance in the detection of public health events, reporting, and responding to public health emergencies (PHEs) at PoEs in Uganda.MethodsWe conducted a cross-sectional assessment from June 27 to September 12, 2022, at official PoEs in Uganda. We adopted a standardised assessment tool for the World Health Organisation’s (WHO) PoE capacity requirements. Capacity areas included coordination and communication, routine prevention and control measures expected at all times, and response to PHEs. We abstracted and analysed surveillance data on the performance of PoEs including completeness of PoE reporting, proportion of travellers screened, and proportion of suspected ill travellers isolated, investigated and referred for further care if necessary.ResultsWe assessed all 53 gazetted PoEs (4 airports, 16 inland ports, and 33 ground crossings). Most (94%) reported communication capacities with national and sub-health authorities with 88% completeness of reporting. Forty-two per cent provided access to appropriate medical services for assessment and care of ill travellers, 42% had access to sanitary facilities, 21% had access to safe water, and 23% had appropriate waste management and vector control. Regarding the capacity to respond to PHEs, all designated PoEs had a public health emergency contingency plan,74% provided screening of all travellers but screened 56% of the travellers, 38% had the capacity to quarantine and isolate suspected human cases, and 15% had the capacity to transport suspected cases to referral health facilities. Twenty three percent of the suspected ill travellers were isolated, investigated and referred for further care if necessary. Only 8% assessed animals being transported through PoEs for priority animal transboundary diseases.ConclusionExisting capacity and performance gaps in detection and response to PHEs may limit the ability to respond effectively to potential PHEs if they occur. There is a need to establish infrastructure, equipment and personnel for and assessment, isolation and quarantine of humans and animals.

Epidemiologic and clinical updates on viral infections in Saudi Arabia

In the past two decades, the world has witnessed devastating pandemics affecting the global healthcare infrastructure and disrupting society and the economy worldwide. Among all pathogens, viruses play a critical role that is associated with outbreaks due to their wide range of species, involvement of animal hosts, easily transmitted to humans, and increased rates of infectivity. Viral disease outbreaks threaten public health globally due to the challenges associated with controlling and eradicating them. Implementing effective viral disease control programs starts with ongoing surveillance data collection and analyses to detect infectious disease trends and patterns, which is critical for maintaining public health. Viral disease control strategies include improved hygiene and sanitation facilities, eliminating arthropod vectors, vaccinations, and quarantine. The Saudi Ministry of Health (MOH) and the Public Health Authority (also known as Weqayah) in Saudi Arabia are responsible for public health surveillance to control and prevent infectious diseases. The notifiable viral diseases based on the Saudi MOH include hepatitis diseases, viral hemorrhagic fevers, respiratory viral diseases, exanthematous viral diseases, neurological viral diseases, and conjunctivitis. Monitoring trends and detecting changes in these viral diseases is essential to provide proper interventions, evaluate the established prevention programs, and develop better prevention strategies. Therefore, this review aims to highlight the epidemiological updates of the recently reported viral infections in Saudi Arabia and to provide insights into the recent clinical treatment and prevention strategies.

Determinants of Food Safety Practices in Food Handlers: A Literature Review

Food safety is an effort to ensure food is safe for consumption, free from physical, chemical, and biological hazards, so that there is no risk of it causing disease if consumed. Creating these conditions is closely related to food safety practices among food handlers. It is necessary to control food safety practices that can be carried out if the determining factors are known in advance. Thus, this study aims to summarize and describe the determinants of food safety practices among food handlers based on previous research articles. This study uses the literature review method to identify research articles that are relevant to the research objectives. The keywords used are "food safety practices" and "food handler" from the PubMed, SAGE, and Wiley databases. Search articles using the PRISMA method. Of the 974 identified articles, 10 met the inclusion criteria and research objectives. The results obtained identified 12 variables related to food safety practices, namely food safety knowledge (7 articles), education level (6 articles), food safety training/courses (5 articles), attitudes towards food safety (4 articles), household income/wealth household (3 articles), work experience (2 articles), sanitation facilities (2 articles), work status (1 article), marital status (1 article), ethnicity (1 article), and registered food seller (1 article). It can be concluded that the dominant determinants of food safety practices among food handlers are knowledge of food safety, level of education, food safety training or courses, attitudes towards food safety, household income or wealth, work experience, and sanitation facilities.

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.

The Effect of Decentralisation on Access to Sanitation and Water Services: An Empirical Test using International Data

Decentralisation promises efficiency gains and improved access to public goods and services, especially at the local level. Under a decentralised governance arrangement, regional and environmental peculiarities are considered prominently in delivering public goods and services. Given the impact of the environment in influencing sanitation and water services, particularly water provision, this study examines the effect of decentralisation, as measured by revenue share and expenditure share, on access to improved sanitation facilities and drinkable water. Exploiting the variation in the access to sanitation facilities and drinking water using the Hausman-Taylor estimator, this study suggests a positive impact of decentralisation on the access to sanitation and drinkable water.

Effects of Free Education Policy on the Provision of Primary and Secondary Education in Zambia

The study sought to establish the effects of the Free Education Policy on learner enrollment, school infrastructure, financing and the quality of teaching and learning in community primary and secondary public schools in Zambia. The study participants included the District Education Board Secretaries, head teachers, class teachers, learners and parents from 10 provinces, selected using probability and non-probability sampling techniques. Quantitative data was collected from teachers through a structured questionnaire. In addition, qualitative data was collected from the District Education Board Secretaries, learners and parents through in-depth interviews and Focus Group Discussion guides. Quantitative data was processed, cleaned and analyzed using the SPSS 23.0 to produce descriptive statistics. Qualitative data was transcribed, sorted and analyzed along with survey data to establish emergent trends. The study found that the implementation of the Free Education Policy had increased school enrollments and government funding. The increase in the number of learners in schools has put pressure on the already overstretched educational resources like teachers, desks, textbooks, toilets and laboratory facilities, indirectly affecting the quality of education. The study suggests that Zambia's Free Education Policy implementation can be strengthened by prioritizing desks, textbooks, sanitary facilities, teacher deployment, modern classroom construction, especially in rural areas, and enacting sustainable financing legislation. The study, within the lens of the Capability Approach, has practical implications on how the implementation of the Free Education Policy can be strengthened in Zambia.

Basic Sanitation in Residential Areas of Wakal Village, Leihitu Subdistrict, Central Maluku Regency

Basic sanitation is an effort to provide minimum facilities in accordance with health standards, such as TPS, SPAL, healthy latrines, and clean water, in order to prevent humans from coming into direct contact with dirt and aiming to promote healthy living. Both community and family based, basic sanitation facilities are very important in supports health. Sanitation is a process carried out in monitoring environmental factors whose role can be detrimental to health. Sanitation is a process carried out in monitoring environmental factors with a role that can disrupt health. This is a descriptive survey that is sent to households which is used to provide information not only about the family but also information about the environment and the house. The research will be carried out in Negeri Wakal, Leihitu District. The results of this research were conducted to determine community behavior patterns in managing basic residential sanitation which was studied in terms of clean water facilities, latrines, waste facilities and waste water disposal channels (SPAL). In the residential area of Wakal Village, Leihitu sub-district. The number studied was 30 heads of families who were taken randomly

Menstrual Hygiene Management Among Vulnerable Rural Adolescent Schoolgirls in South Africa's Rural Learning Ecologies

This qualitative research paper examined the menstrual health challenges and hygiene that were faced by vulnerable rural adolescent schoolgirls in South Africa, their negative effects on school attendance, academic performance and wellbeing. Seeing the above challenges as barriers to sustainable development goals (SDG) 4 quality education and SDG 5 gender equality, the study used a critical emancipatory approach alongside the theory of change (ToC) as its framework. The purpose was to give a hearing to the voiceless and lived experiences of this group of people to provided a platform for empowering and transformative actions. The focus group discussions (FGDs) with vulnerable rural adolescent schoolgirls, their parents and teachers and school administrators were held at a designated learning ecology. Open-ended Interviews (OEIs) assisted to collect phenomenological narratives with many ethnographic perspectives. The data was analysed thematically to make major themes inductively reflect their real life conditions. The research findings reflected that the gaps in menstrual information, restricted availability and the use of sanitary products, conformity of cultural norms and inadequate amount of water, sanitation and hygiene facilities (WASH) helped creating considerable barriers for many rural adolescent schoolgirls thereby compelling them to miss school during their menstruation. The study highlighted the importance of comprehensive MHM programmes that envisage availability of materials and amenities, menstruation education and psychological support, as well as stigmatisation measures. To move forward with context relevant and community centred interventions, the study suggested a collaborative, multi-stakeholder approach involving the community. Tackling these converging problems was paramount to the preservation of the menstrual health rights of vulnerable rural schoolgirls, education gender equity as well as the attainment of the SDG 4 and SDG 5 goals by 2030. The practice would comprehend all-encompassing evidence-based policies and curricula, and promotion of life-long learning opportunities for all vulnerable rural adolescent schoolgirl through active learning ecologies.

SOCIOECONOMIC INEQUALITIES, WATER, SANITATION, HYGIENE AND DIARRHEAL DISEASE AMONG CHILDREN UNDER FIVE YEARS IN INDONESIA

Background: Diarrheal diseases are still a serious digestive tract infection in Indonesia. The geographical areas with lower socioeconomic inequalities and water, sanitation and hygiene (WASH) contribute to incline diarrheal disease among children under 5 years old. Purpose: This study aimed to map the distribution of diarrheal diseases among children under 5 years old and identify areas with higher risk in socioeconomic status and WASH. Methods: This study used secondary spatial data repository from Indonesia Demographic Health Survey 2017. This study used ecological approach to provide visual geographic distribution of diarrheal diseases among children under 5 years old, as well as to identify the risk based on the socioeconomic inequalities and WASH. The map production was performed by GIS software. Results: We found that provinces with higher percentage of diarrheal diseases in children also had higher percentage of population with the lowest socioeconomic status. Additionally, the provinces which had higher unimproved drinking water sources, unimproved sanitation facility, and limited handwashing facility, had the higher percentage of diarrheal disease among children under 5 years. Conclusion: The percentage of the lowest socioeconomic status and unimproved WASH might contribute to incline the percentage of diarrheal disease among children under 5 years. The government needs to consider the geographical area to decrease the diarrheal diseases among children under 5 years.