Sanitation Practices Research Articles

Microbiological and nutritional assessment of ‘<i>ncha iwu</i>’ (edible emulsion) vended in selected markets in Umunneochi Lga, Abia State, Nigeria

‘Ncha iwu’ is commonly used as a sauce in the preparation of ready-to-eat African salad, a wellknowndelicacy among the Igbo tribe in Nigeria. A total number of fifteen (15) samples of ‘ncha iwu’ were randomly purchased from three (3) vendors in Orie Ngodo and Eke Eziama market in Umunneochi Local Government Area of Abia state. The microbiological quality, proximate composition, and mineral content of the samples were determined using Standard Methods. ‘Ncha iwu’ prepared in the laboratory served as the control. The results showed that total bacterial, Staphylococcal, Coliform and fungal counts of the samples ranged from 3.81-4.37, 2.0-3.58, 3.0-3.8, and 2.0-3.0 log10 CFU/g, respectively. The bacterial species isolated and frequency of occurrence were Staphylococcus aureus (28 %), Klebsiella spp. (18 %), Pseudomonas spp. (18 %), Escherichia coli (18 %) while the fungal species were Penicillium spp. (50 %), Aspergillus spp. (40 %), and Candida spp. (10 %). Proximate analysis indicated that ‘ncha iwu’ contains ash (63.93%), moisture (15.88 %), fibre (8.99 %), lipid (7.70 %), protein (3.50 %) and carbohydrate (0.0 %) while minerals content include Fe (3.679 mg/g), Mg (1.055 mg/g), K (1.054 mg/g), Ca (1.030 mg/g), Mn (0.469 mg/g) and Na (0.222 mg/g). Although ‘ncha iwu’ contains beneficial nutrients, majority of the commercial samples were contaminated with potential pathogenic microorganisms which is a public health concern unlike the control. This is as a result of poor handling by the producers and vendors. Good hygienic practices by the handlers, proper packaging and storage of ‘ncha iwu’ will reduce the microbial contamination of the product. Hence, adequate public health awareness campaign, training on food safety, sanitation and hygenic practices should be provided to the local processors and vendors of ‘ncha iwu’.

Evaluation of Sanitation Technologies Across Sanitation Service Chain in Kericho Town, Kenya

In 2020, over half of the world's population resided in cities, with projections indicating that by 2050, this figure will rise to 70%. Providing adequate sanitation services in urban and peri-urban areas presents significant challenges due to the dense concentration of people, particularly in low- and middle-income countries. Poor sanitation practices in these areas can lead to the spread of diseases with high morbidity and mortality rates. The focus of the study was on Kericho town, Kenya, facing a notable sanitation challenge due to dilapidated sewer system and inadequate sanitation facilities . The aim of this study was to evaluate the safety of sanitation technologies used in Kericho Town. Descriptive study design was adopted. Data collection methods included surveys, interviews, and observations, with a sample size of 409 households. The findings revealed that 66.5% of the population relies on pit latrines with slabs, 13.69% use pour/manual flush systems, 11.49% have ventilated improved pit latrines, 8.07% employ automatic cistern flush, and a minimal 0.24% practice open defecation. 25% of population discharged waste directly into the sewerage system whereby 5% were considered safely managed. Additionally, 4% of waste from user interfaces was discharged directly into open ground or open drains. 2% of population used septic tanks connected to soak pits, whereas 6% of population used septic tanks connected to open ground. Sludge from septic tanks, comprising 20%, was delivered to the WWTP by exhausters for further treatment, of which only 20% underwent treatment, with the remainder released untreated into the environment. 49% of the population used lined pits, while 14% used unlined pits. Approximately 20% of faecal sludge from the pits was exhausted, with only 20% of it considered safely treated, and the remainder released into the environment. Notably, open defecation accounted for less than 1% based on the survey findings. Consequently, the current trend in faecal sludge management in Kericho Town posed potential health hazards to the community unless measures such as rehabilitating the existing wastewater treatment plant are implemented.

The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana

ABSTRACT Water, sanitation and hygiene practices (WASH) have been a major challenge facing many basic schools in Ghana for many decades. The school authority have made a number of complaints to the Ghana government through the Ministry of Education in relation to the inadequate potable water, sanitation facilities and hygiene practices in basic schools which the government has remained silent on. The aim of this study was to assess the level of implementation of Water, sanitation and hygiene practices in basic schools in the Sunyani East Education Directorate. Both qualitative and quantitative data were collected using questionnaires and interviews. The results indicate that hygiene and sanitation facilities available in schools under study included urinals, toilets, handwashing materials and solid waste disposal facilities. It was revealed that wooden slap pit latrine toilet was present in all schools except Methodist school which has cemented slaps. There were absence of toilet rolls, tap facilities and hand washing soap in all schools visited. The pupils fetched water from neighbouring houses and used it. The study recommends that the Parent-Teacher Association, School Management Committee, District Education Directorate and Ghana Education Service should team up to provide these essential facilities to basic schools in Sunyani East.

Knowledge, Attitudes and Practices (KAP) Towards Community-Led Total Sanitation (CLTS) Behaviours Among Communities in Northern Ghana

Community-Led Total Sanitation (CLTS) programs have been implemented extensively to eradicate open defecation and enhance sanitation practices. However, concerns about the sustainability of CLTS outcomes persist, necessitating a nuanced examination of the phenomenon. This study assessed the knowledge, attitudes and practices (KAP) of people in the Northern region of Ghana towards behaviors associated with the community-led total sanitation (CLTS) programme. The study design was a descriptive cross-sectional one and the approach for the study was quantitative. It involved the use of questionnaire to collect data from respondents. Data were gathered through survey among respondents in 12 communities across 3 districts. Socio-demographic characteristics were analyzed for their associations with knowledge, attitude, and practice. Results revealed significant associations between district, age, religion, occupation, and monthly income level with knowledge, attitude, and practice. Specifically, respondents from Saboba demonstrated higher odds of knowledge compared to Mion and Kpandai districts, while Muslims exhibited higher odds of knowledge compared to Christians. Monthly income levels of 200-500 and 501-1500 Ghanaian cedis were associated with improved knowledge and practice compared to incomes less than 200 cedis. Notably, good knowledge was positively correlated with good attitude. These findings underscore the importance of considering socio-demographic factors in designing and implementing sanitation interventions. Tailored strategies addressing specific factors identified in this study may enhance the effectiveness and sustainability of CLTS programs in the Northern Region of Ghana and similar contexts. Further research and targeted interventions are warranted to address the complex interplay between socio-demographic characteristics and sanitation behaviors.

Intestinal Parasites Prevalence on Patients Visiting Afgoi General Hospital, in Afgoi District, Somalia

Purpose Intestinal parasitic infection stands as a significant public health concern in developing nations. This study aims to determine the intestinal parasites prevalence on patients visiting Afgoi General Hospital, in Afgoi District, Somalia.  Methods A cross-sectional study design was implemented involving 195 patients at Afgoi General Hospital. Stool samples were obtained to assess intestinal parasite prevalence, while questionnaires were administered to gather and analyze the demographic profiles of the patients.  Results The intestinal parasite prevalence was determined to be 61%. Among the identified species, Giardia lamblia exhibited the highest prevalence at 33.3%, followed by Trichuris trichura at 12.3%, Ascaris lumbricoides at 10.8%, Entamoeba histolytica at 9.2%, Hymenolepis nana at 3.6%, Strongyloides stercoralis at 1.5%, Hookworm at 1%, and both Hymenolepis diminuta and Entamoeba coli at 0.5%.  Conclusion The study revealed a notable prevalence of intestinal parasitic infections among Afgoi General Hospital patients. Thus, enhancing sanitation practices, improving access to clean water, and initiating routine deworming programs are imperative measures.

Geospatial insights into open defecation vulnerability in Gulumbe, Nigeria

Open defecation (OD) poses a serious public health risk by exposing communities to diseases and compromising the well-being of people. One potential approach to mitigating its impact is the application of spatial planning techniques. However, spatial data paucity is one of the major problems in addressing open defecation issues in Nigeria. This study employed spatial analysis to identify areas particularly susceptible to OD using Geographical Information System (GIS) including Merginmap applications on Android and QGIS software, which were used with field observations to georeferenced residential areas, public toilets, and instances of open defecation. Proximity analysis and local indicators of spatial autocorrelation, based on Moran’s I, were employed to assess vulnerability. Buffer analysis was conducted to identify residential areas within 100 m of an OD site, and the findings indicated residential areas at high risk of experiencing negative impacts from OD. The LISA analysis revealed a high-to-high clustering pattern (p < 0.05) in the southern region of the study area, which aligns with the results of the buffer analysis and further suggests consistent spatial patterning. Furthermore, OD was more prevalent near water bodies and inner residential areas, increasing the risk of water and air pollution. This pollution could facilitate the spread of harmful bacteria, such as E. coli and Salmonella, from OD sites to nearby households, increasing the risk of disease. This study stresses the potential of GIS in evaluating areas vulnerable to OD and highlights the need to expand awareness campaigns regarding proper hygiene and sanitation practices in rural communities.

Physicochemical and Bacteriological Assessment of Traditional Sorghum Beers in Jimeta, Nigeria

Sorghum beer popularly known as “burukutu” in Nigeria is a traditional beverage whose consumption has been passed down through generations. This beer, consumed while actively fermenting, harbors a diverse array of microorganisms. This study aims to evaluate the bacteriological and physicochemical characteristics of traditional sorghum beers sold in Jimeta, Adamawa State, Nigeria. Beer samples were obtained from eight traditional beer joints within the Jimeta metropolis, Adamawa State, Nigeria. The physicochemical analysis of the samples revealed titratable acidity ranging from 0.91% to 2.65%, pH values from 4.20 to 4.50, total reducing sugars from 10.1 mg/mL to 15.0 mg/mL, ethanol content from 3.12% to 4.69%, and total solids from 6.50 mg/mL to 7.60 mg/mL. The total bacterial count, determined using aerobic plate count, ranged from 8.0 × 10² to 1.0 × 1010 CFU/mL. Pure cultures from each sample were identified through cultural characteristics, Gram staining, motility, and biochemical tests including citrate utilization, catalase, indole, urease, methyl red, Voges-Proskauer and coagulase. Total of 44 isolates were identified, with Staphylococcus aureus and Streptococcus sp. being the most prevalent (8 isolates), followed by Escherichia coli and Pseudomonas aeruginosa (6 isolates), Klebsiella pneumoniae and Acinetobacter sp. (4 isolates), and Bacillus subtilis, Bacillus cereus, Serratia sp. and Proteus mirabilis (2 isolates). The presence of these potential pathogens raises great concerns about the safety of these beers. Improved sanitary practices during production, handling and serving are necessary to ensure consumer safety.

Impacts of Sanitation Practices on Human Development: A Decade-Long Analysis of the Malang District

This study explores the influence of various sanitation practices on the Human Development Index (HDI) in the Malang District from 2011 to 2020. Employing a multiple linear regression analysis, the research examines the relationship between the HDI and five critical sanitation practices: access to wastewater treatment plants, open defecation prevalence, septic tank usage, and direct waste disposal into water bodies and onto land. Secondary data was sourced from the Badan Pusat Statistika of Malang District, ensuring robust and authoritative information spanning over a decade. Preliminary diagnostics were performed to affirm the data's suitability for regression analysis. The results indicated a significant negative impact of direct disposal into water bodies on HDI, emphasizing the critical role of effective waste management practices in promoting human development. The study underscores the need for integrated policy approaches that address sanitation infrastructure improvements, environmental protection, and education on public health practices. This paper contributes to the literature by quantifying the effects of sanitation on human development over an extended period. It offers evidence-based recommendations for policymakers to support sustainable development goals in the region.

Assessment of Sanitation Services and Practices among Local Community in West B Municipality in Zanzibar Island, United Republic of Tanzania

Good basic sanitation services and practices are essential in maintaining generally accepted standards for personal hygiene and public health. The objective of this paper is to assess the sanitation services and practices among the local community in West B Municipality in Zanzibar Island, United Republic of Tanzania. The study uses a cross-sectional study design. Raosoft online sample calculator was used to determine the sample size while systematic random sampling was applied to select the respondents. Results show that a substantial proportion of the community uses on-site sanitation systems by which excreta and wastewater are collected and stored in containments within the vicinity, requiring emptying when full. Many toilets have security issues as they lack privacy and user comfort. About 28.8% have unlockable doors, 21.2% have fixed clothing curtains and 3.8% are completely open. In the area, Indian-type squat toilets are dominant (78.75%), followed by traditional pit latrines (20%). A slightly large percentage (55%) of households use motorised but the remaining percentage (45%) use non-motorised means of emptying and transportation. The study further found limited or ineffectual use of Personal Protective Equipment (PPE) among the sludge workers, thus risking their health and safety. The conveyed sludge waste is usually taken to a designated treatment plant, disposed of in excavated pits or dumped openly in the forest. This implies that sanitation services and practices in West B are inadequate, leading to disease transmission due to environmental pollution. The study recommends compliance with standards and guidelines, awareness and advocacy, technological innovations, stakeholder involvement and research and development on sanitation services and practices.

Crafting Language for Culinary Excellence: Customizing ESP Content to Align with Student and Industry Needs

The alignment of English for Specific Purposes (ESP) materials with the needs of students and the culinary industry is crucial for preparing graduates to excel in the competitive fields of tourism and hospitality. In particular, essential English language skills such as culinary terminology, effective communication in professional kitchen environments, and writing recipes or menus in English should be addressed more in existing curricula. This study aimed to assess the relevance and practicality of current ESP materials within the context of culinary education at an Indonesian university. Using a qualitative descriptive approach, the research involved 40 second-semester students who had completed a course in Professional English, along with 11 waitstaff from hotels and restaurants in West and North Sumatra. The findings revealed significant gaps in the current materials, particularly in areas critical for international customer service and multicultural teamwork, such as food presentation, customer interaction, and sanitation practices. The study concludes that English learning materials must be tailored to meet the general needs of English learners and the specialized demands of the culinary industry. Incorporating relevant terminology, practical communication skills and industry-specific content is essential for better preparing students for professional roles in catering and hospitality. The research suggests that focused classroom techniques on communication and specialized vocabulary can guide educators in developing more effective ESP materials for the culinary field.

Swachh Bharat Mission and Municipal Reforms in India

As India advances toward its aspirations of a cleaner nation, integrating the Swachh Bharat Mission (SBM) with effective municipal reforms will be critical in ensuring sustainable sanitation practices that benefit all citizens, ultimately leading to improved public health and enhanced quality of life. The SBM is closely intertwined with municipal reforms, which are essential for the efficient implementation of sanitation programs at the local level. This editorial explores the SBM’s objectives, its impact on municipal reforms, the challenges faced, and the way forward.

A Comparative Analysis of Drinking Water Provision and Hepatitis A Incidence in Uzbekistan in 2010-2023.

Objective This study aims to analyze the relationship between access to safe drinking water and the incidence of hepatitis A in Uzbekistan from 2010 to 2023to inform public health strategies for disease prevention. Methods We utilized hepatitis A incidence data from the Sanitary and Epidemiological Well-Being and Public Health Authority and drinking water provision data from the Government Statistics Agency of Uzbekistan. A linear regression analysis was performed using R 4.3.2 to investigate the correlation between these variables. The study examined hepatitis A cases per 100,000 population and the percentage of households with access to safe drinking water. Results Hepatitis A incidence fluctuated significantly over the study period, with a notable spike to 162 cases per 100,000 population in 2023, despite relatively stable access to safe drinking water (ranging from 67.4% to 77% of households). The analysis revealed a complex relationship between water access and hepatitis A incidence. The linear regression coefficient was 3.89 (adjusted R-squared: 0.3021, P-value: 0.02), indicating that each growing percent of water supply is raising the incidence of hepatitis 3.89 cases of hepatitis infection. Conclusion The reverse effect of water supply percentage and the incidence of hepatitis A incidence in Uzbekistan suggests that other factors play significant roles in disease transmission. These may include sanitation practices, hygiene behaviors, and vaccination coverage. The findings emphasize the need for a multifaceted approach to hepatitis A prevention, incorporating improved water infrastructure, enhanced sanitation, public education, and comprehensive vaccination programs. Further research is needed to identify specific determinants of hepatitis A transmission in Uzbekistan to guide targeted interventions and public health policies.

Women's toilet use behaviors and water use in a urine diversion squat pan toilet pilot

ABSTRACT Understanding user behavior is critical to the adoption of technology; however, there is a paucity of data related to gender-specific sanitation practices and water-use patterns in toilet use despite the global imperative to increase attention toward the needs of women and girls. This user-focused study sought to understand the role of women's behavior related to the urine diversion performance of a novel toilet design. Forty-one female users of urine diversion toilets installed in two shared bathroom sites in Coimbatore, India, were surveyed about their behavior during toilet use. About 32% of respondents reported behaviors that reduce urine separation efficiency in this system, including aiming urine directly into the hole of the squat pan instead of the ceramic surface (15%); facing backwards (12%); squatting only part way down (7%); and pouring water onto the pan while urinating (5%). Separately, 88% of respondents use available water to clean the floor around the toilet, a practice that may alter the relative volumes of generated blackwater and graywater. These findings may aid the design of future sanitation solutions. Most respondents did not identify the specific toilet design as different from conventional ones, suggesting that these behaviors may apply to broader use cases.

Morphofunctional changes in the internal organs of laying hens affected by chronic thiamethoxam intoxication

Insecticides play an important role in agriculture, general sanitary and veterinary practices, providing protection of the plants and yield from harmful insects and preventing the spread of arthropods which cause diseases in people and animals. Therefore, the objective of our study was to analyze the morphofunctional changes in the internal organs of laying hens affected by chronic intoxication with Actara 25 WG (thiamethoxam). Identification of the toxic action of theamethoxam was carried out in 150 day-old laying hens. The chronic intoxication with the insecticide was modeled by feeding mixed feed treated with the preparation in the doses that were calculated in mg of the active compound per 1 kg of body mass. The birds of the one group were the control and received mixed feed with no supplements. The hens of the first experimental group were given mixed feed that contained the insecticide in the dose of 360 mg/kg of body mass, and hens of the second experimental group consumed mixed feed containing the preparation in the dose of 180 mg/kg per body mass. We determined that laying hens of Experimental Group 1 had significant 1.24-fold decrease in the ventriculus and significant 1.39-fold increase in the spleen. Laying hens of Experimental Group 2 were observed to have increase in the absolute mass of the heart, measuring 1.36-fold compared with the control and 1.34-fold compared with Experimental Group 1. At the same time, the absolute masses of the spleen, liver, and ventriculus in Experimental Group 2 were 1.20, 1.46, and 1.19 times lower than in Experimental Group 1. Compared with the control, the absolute mass of the liver and ventriculus, was 1.54 and 1.48 times lower, respectively. Intake of feed with thiamethoxam by laying hens of the experimental groups led to decrease in the coefficient of relative mass of the liver and ventriculus. Those results significantly correlated with the absolute mass values of those organs, indicating the toxic impact of the insecticide on laying hens, with the digestive organs being the first to react. In Experimental Group 1 chickens, we observed dystrophic-necrotic changes in the liver, round-cell infiltration of the portal tracts; dystrophic-necrotic changes in epitheliocytes of the nephrons of the kidneys’; granular dystrophy of cardiomycetes, plethora of the capillaries, and stasis and edema of the stroma in the myocardium; pericellular edemas in the brain; mucous dystrophy, desquamation of the epithelium of the mucous membrane, decrease in lymphocytes in the lymphoid structures, and atrophy of the epithelium of the glandular structure in the stomach; hyperemia and necrosis of the villus tips, and round-cell infiltration of the crypt region in the thin intestine; and reproduction of cellular elements of the connective tissue between the crypts in the thin intestine. The insecticide in the dose of 180 mg/kg of body mass caused dystrophic-necrobiotic changes in the liver and kidneys; hyperemia and edema in the myocardium; pericellular edema, swelling, and vacuolar dystrophy of neurons in the brain; necrobiotic changes in the mucous membrane epithelioctes in the proventriculus; and deformation of the villi and edema of the mucous membrane in the small intestine.

Caregivers’ knowledge, attitude, and practices on complementary feeding of young children aged 6-23 months in Naga City, Philippines

A cross-sectional study was conducted to investigate the knowledge, attitudes, and practices of 60 caregivers regarding complementary feeding and its impact on the nutritional status of their children aged 6–23 months in Panicuason, Naga City, Philippines. Face-to-face interviews were conducted to collect data using pre-designed and pre-tested questionnaires. Descriptive statistics and Pearson’s R Correlation tests were used to analyze the data at p&lt;0.05. The results indicated that the households involved had poor conditions in terms of educational attainment, occupation, and household income of the caregivers. The prevalence rates revealed a medium level of underweight (10.0%) and stunting (23.4%), and a poor level of wasting (5.0%). The KAP results demonstrated medium knowledge, positive attitudes, and poor practices among the caregivers. Several KAP components were found to be significantly associated with socioeconomic factors and water sanitation practices. The study found a weak positive correlation between weight-for-age and employment and a weak negative correlation between height-for-age and caregiver-child relationship. This study highlights the urgent need for nutrition education interventions focused on complementary feeding to improve the knowledge and practices of the caregivers. Such interventions are essential for enhancing child nutrition outcomes and potentially influencing positive changes in the attitudes of the caregivers.

Factors Associated with the Access and Use of Improved Latrine Facilities in Tanzania

Access to improved latrine facilities is a basic human right and fundamental to good health. Inadequate sanitation practices cause serious health problems especially transmission of diarrhea. The study aimed to determine associated factors with access to and use of improved latrine facilities in Tanzania. The data for this study was obtained from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2022 TDHS-MIS) by visiting https://www.dhsprogram.com. Data were analyzed using STATA Version 16, whereby a multilevel logistic regression model was chosen as the statistical approach. The study revealed that overall 67.76% of the households had access to improved latrines. The study revealed that head of households with higher education, rich 55+ years and with television had higher odds of using improved toilets compared to others. The study concludes that more than half of the households in Tanzania had access to an improved latrine which is not common in most developing countries, especially in sub-Saharan Africa, and thus can be used as a reference for learning. This implies the government and stakeholders’ interventions have brought positive changes. Hence, the need of policy enforcement in specific areas as well as government and stakeholders creating awareness campaigns to enable more households’ access to improved latrine in both rural and urban areas

Implementasi Hygiene dan Sanitasi di Kantin Kopikir Ika Universitas Mulawarman

Food is a necessity for humans, yet cases of food poisoning and infectious diseases related to food continue to rise. Contributing factors include poor personal hygiene, inadequate food handling, and unclean equipment. Food vendors often lack educational backgrounds in hygiene and sanitation, which affects the quality of the dishes they serve. This community service initiative emphasizes the importance of implementing hygiene and sanitation practices in the Kopikir Ika canteen at Mulawarman University. The methods used include socialization, observation, and education for the canteen operators. The results show increased awareness and understanding of the operators regarding the importance of hygiene and sanitation, as well as the steps taken to improve cleanliness standards in the canteen and the quality of the food products served.

Culinary Hygiene and Sanitation: A Systematic Literature Review

Healthy food refers to food that is both sanitary and nourishing. Edible sustenance Hygienic food refers to food that is free from pathogens and contaminants that can pose a health risk. Food processed products typically exhibit vulnerabilities in terms of their safety, including biological or microbiological, chemical, and physical dangers. The occurrence of hazards or pollution, typically resulting from substandard raw materials, processing techniques, and insufficient sanitation and hygiene practices, has raised concerns regarding the awareness of workers or producers involved in handling processed food. This research aims to investigate the topic of Culinary Hygiene and Sanitation through a systematic review of existing literature. This review was conducted utilizing the latest and most advanced methodologies, following the recommended reporting items for reviews and meta-analyses (PRISMA) standards. The findings of this study clarify that food plays a multifaceted role and serves various purposes, including promoting health, reflecting political and social status, exerting power and fostering cooperation, influencing social and economic standing, embodying cultural values, responding to population density, reflecting changing times, and adhering to principles of hygiene and sanitation. The key elements of the facility are the physical location and structure, the sanitary facilities, the kitchen area, the dining room, and food storage area, the handling of food ingredients and prepared food, the food processing area, the storage area for food ingredients and prepared food, the food serving area, the presentation of food, the equipment used, and the labor involved.

Monkey bars and medical masks: a photo-voice study of children’s playground safety in British Columbia, Canada

ABSTRACT Children’s perspectives on their outdoor play safety can provide unique insight into what activities and environments are injurious for them. In this study, we conducted photo-elicitation interviews with 13 children (7 girls, 6 boys) from low- to mid-income communities who were between the ages of 9- to 13-years-old. The goal of the study was to examine their perspectives of outdoor play safety around urban playgrounds over a two-week period while they participated in day camp activities. Our thematic content analysis resulted in three themes: (1) fear of falling; (2) illness prevention; and (3) need for excitement. Our findings suggest children’s perception of safe play may be shaped by exposure to sanitary practices throughout the COVID-19 pandemic. Further, findings demonstrate children can experience tensions in participating in desirable play that is exciting, novel, and challenging, while fearing they could fall from higher structures that afford them with these opportunities.

Analyzing child health and water, sanitation, hygiene facilities in Punjab, Pakistan: A multilevel and spatial approach

AbstractThe health and well‐being of children can be achieved through access to clean water, proper sanitation, and hygiene practices. The current study investigates the effect of water, sanitation, and hygiene (WASH) on health outcomes using the multiple indicator cluster surveys (MICS) data. The household‐level and district‐level determinants of child health are analyzed using logistic regression models and multilevel logistic regression models. The results indicate that there are significant relationships between water availability, sanitation facilities, hygiene practices, and health outcomes. Access to clean water, an increase in sanitation facilities, and proper hygiene have a significant positive relationship with child health. Better access to clean water enhances children's well‐being. The level of parental education, household head dynamics, and WASH indicators at the district level also have a significant relationship with child health. The bivariate Local Moran's I analysis of child health and WASH facilities shows positive spatial autocorrelation (0.441). It also identifies the districts with significant high–high and low–low clustering patterns. This study contributes to achieving SDGs 3 and 6 to develop policies, programs, and future‐based solutions to promote the health and well‐being of children in Punjab and other similar areas.