Toilet Facilities Research Articles

Subnational mapping of anemia and etiologic factors in the West and Central African Region.

Despite bold commitments to reduce anemia, little change in prevalence was observed over the past decade. We aimed to generate subnational maps of anemia among women of reproductive age (WRA), malaria transmission, and hemoglobinopathies to identify priority areas, but also explore their geographical overlap. Using the most recent Demographic and Health Surveys (DHS), we first mapped anemia clusters across Sub-Sahara Africa (SSA) and identified the WCA as a major cluster. Geographic clusters with high anemia and related etiologic factors were identified using spatial statistics. Multilevel regression models were run to identify factors associated with any, moderate and severe anemia. West and Central African countries (n=17). WRA (n= 112,024) residing in 17 WCA countries. There was a significant overlap in geographical clusters of anemia, malaria, and hemoglobinopathies, particularly in the coastal areas of the WCA region. Low birth interval (0.86 [0.77, 0.97]), number of childbirth (1.12 [1.02, 1.23]), being in the 15-19 age range (1.47 [1.09, 1.98])) were associated with increased odds of any anemia. Unimproved toilet facility and open defecation were associated with any anemia, whereas the use of unclean cooking fuel was associated with moderate/severe anemia (P<0.05). Access to health care facility, living in malaria prone areas, and hemoglobinopathies (HbC and HbS) were all associated with any, moderate or severe anemia. Interlinkages between infection, hemoglobinopathies, and nutritional deficiencies complicate the etiology of anemia in the WCA region. Without renewed efforts to integrate activities and align various sectors in the prevention of anemia, progress is likely to remain elusive.

Prediction of undernutrition and identification of its influencing predictors among under-five children in Bangladesh using explainable machine learning algorithms.

Child undernutrition is a leading global health concern, especially in low and middle-income developing countries, including Bangladesh. Thus, the objectives of this study are to develop an appropriate model for predicting the risk of undernutrition and identify its influencing predictors among under-five children in Bangladesh using explainable machine learning algorithms. This study used the latest nationally representative cross-sectional Bangladesh demographic health survey (BDHS), 2017-18 data. The Boruta technique was implemented to identify the important predictors of undernutrition, and logistic regression, artificial neural network, random forest, and extreme gradient boosting (XGB) were adopted to predict undernutrition (stunting, wasting, and underweight) risk. The models' performance was evaluated through accuracy and area under the curve (AUC). Additionally, SHapley Additive exPlanations (SHAP) were employed to illustrate the influencing predictors of undernutrition. The XGB-based model outperformed the other models, with the accuracy and AUC respectively 81.73% and 0.802 for stunting, 76.15% and 0.622 for wasting, and 79.13% and 0.712 for underweight. Moreover, the SHAP method demonstrated that the father's education, wealth, mother's education, BMI, birth interval, vitamin A, watching television, toilet facility, residence, and water source are the influential predictors of stunting. While, BMI, mother education, and BCG of wasting; and father education, wealth, mother education, BMI, birth interval, toilet facility, breastfeeding, birth order, and residence of underweight. The proposed integrating framework will be supportive as a method for selecting important predictors and predicting children who are at high risk of stunting, wasting, and underweight in Bangladesh.

Association of anemia with poor housing quality among older Indian adults: Multilevel modeling analysis of nationally representative cross-sectional study in India

ABSTRACT Introduction: Anemia is an important public health disorder. There is a significant chunk of India’s population residing in poor housing quality with inadequate sanitation and hygiene, which might lead to higher anemia prevalence. The objective was to determine the association between anemia with poor housing quality among the older Indian adult population (≥45 years) as per residence. Methods: This study analyzed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). Bivariate analysis and logistic regression were conducted to show the association of anemia (outcome variable) with poor housing quality (explanatory variable). Multivariable logistic regression was conducted by adjusting for covariates as per their models. P value &lt;0.05 was considered statistically significant. STATA version 17 was used for analysis. Results: Our study found that higher adjusted odds of having anemia among older Indian adults were observed among participants with overcrowding (AOR 1.30, 95%CI 1.19–1.42), having access to open/nonsanitary toilet facility (AOR 1.56, 95%CI 1.41–1.72), no electric supply (AOR 1.31, 95%CI 1.12–1.53), and overall poor housing quality (AOR 1.34, 95%CI 1.21–1.48). All of these associations were even higher in urban areas except for having access to open/nonsanitary toilet facilities, which was much higher in rural areas (AOR 1.61, 95%CI 1.45–1.79). Conclusion: Through a nationally representative large dataset, this study generated compelling evidence despite several obstacles indicating a positive association between anemia and poor housing quality among older Indian adults. It might raise awareness and assist individuals in steering clear of the negative effects of overcrowding, using open/nonsanitary toilet facilities, lack of electric supply, and overall housing quality on anemia status. It is advised to conduct additional research to determine temporality and causation.

ABUNDANCE AND PUBLIC HEALTH SIGNIFICANCE OF ASCARIS LUMBRICOIDES AMONG PATIENTS ATTENDING FEDERAL MEDICAL CENTRE, KEFFI, NASARAWA STATE

Ascaris lumbricoides, a soil-transmitted helminth, remains one of the most prevalent parasitic infections globally, particularly affecting children in low-resource settings with inadequate sanitation and hygiene practices. This study determined the prevalence of Ascaris lumbricoides among patients attending the Federal Medical Centre Keffi, Nasarawa State, Nigeria, between May and July 2024. A total of 100 patients participated in this study. Stool samples were analyzed using the concentration technique. The results of the study show that, of the 100 fecal samples examined, 5 (5%) were positive. The highest prevalence was found among the age group 1-30, with 4 (0.04%), followed by 31-60, with 1 (0.01%), while the age group &gt;60 recorded no infections. The highest prevalence of Ascaris lumbricoides infection was among females, with 4 (0.04%), compared to males, with 1 (0.01%). Ascaris lumbricoides remains a public health concern, especially among children in the study area. The provision of potable water, toilet facilities, and regular deworming will enhance control measures.

Binary Logistic Regression Modeling on Household Poverty Status in Bengkulu Province

Binary logistic regression is a statistical method used to analyze the relationship between one or more predictor variables and a binary or dichotomous response variable. Poverty is an issue in every province in Indonesia. One of the provinces with a relatively high poverty rate is Bengkulu Province, ranking seventh in Indonesia with a poverty rate of 14.62%. The Central Bureau of Statistics of Bengkulu Province (2023) explains that efforts to reduce poverty must involve all levels of society. Various government programs and policies in various fields such as health, social, and other areas are continuously being implemented to reduce the number of households classified as poor. Identifying the characteristics of households in Bengkulu Province by poverty status is important to study, as it serves as a reference to ensure that government programs are implemented according to the target. One method that can be used to identify household characteristics is binary logistic regression. This study aims to model the poverty status of households in Bengkulu Province using binary logistic regression and to identify the factors that influence it. The data used are social and economic household data from March 2022. The response variable used is household poverty status (poor and not poor), while the predictor variables include the ownership of toilet facilities, the source of lighting, floor area, family size, and per capita calorie consumption. Modeling is done using binary logistic regression with simultaneous and partial parameter significance tests, as well as model fit tests. The analysis results show that the factors significantly influencing household poverty status in Bengkulu Province are the ownership of toilet facilities, the source of household lighting, floor area, family size, and per capita calorie consumption. The formed binary logistic regression model has a classification accuracy of 89.98% with a sensitivity of 18.34% and a specificity of 98.61%.

Urban slum housing quality, and its public health implications in Nigeria: a case of urban slum residents in Enugu metropolis, South East, Nigeria

IntroductionHousing remains a strategic social determinant of health. In Sub-Saharan Africa, most urban dwellers live in slums with attendant health implications. This study assessed the housing conditions of the slums of Enugu metropolis and the public health implications.MethodsThis is a community-based cross-sectional study of 459 slum residents of the Enugu metropolis. Ethical clearance was obtained from the UNTH, Health Research Ethics Committee (HREC). Data was collected using a pretested semi-structured interviewer-administered questionnaire and an observational checklist. Data was analysed using IBM SPSS version 23. Data were summarised using mean and standard deviation, frequency and proportion as appropriate and presented in tables and figures. The chi-square test was used for association at p-value ≤ 0.05 significance.ResultsThe mean age (SD) of the respondents was 32.93(12.34) years. A higher proportion (N = 180, 39.2%) were 18-27years, females (N = 282, 61.4%), married (N = 297, 64.7%), attained secondary education (N = 273, 59.5%), Igbo (N = 453, 98.7%), and self-employed (N = 327, 71.2%). They demonstrated good knowledge of standard housing specifications (N = 231, 50.3%) and the effects of housing conditions on health (N = 297, 64.7%). Also, most lived in a one-room apartment (N = 201, 43.8%) and cooked in a separate kitchen (N = 150, 32.7%) with a gas cooker as the major source of heat supply for cooking (N = 249, 54.2%). Sixty-three (13.7%) of the respondents didn’t have access to suitable toilet facilities. A higher proportion, (N = 171, 37.3%) used pipe-borne water, and electricity as the major source of light (N = 447, 97.4%). The most prevailing health condition was malaria/fever (N = 258, 97.4%). Despite having pests and rodents-infested dwellings, only (N = 156, 34.0%) had insecticides in the house. Equally, (N = 132, 28.8%) of them lived with broken floors.ConclusionsDespite good knowledge of the public health implications of poor housing, most dwellings remained substandard and unhealthful with associated prevalent health conditions.RecommendationThere is a need for a health campaign against the poor living conditions in the slums.

Bayesian Accelerated Failure Time Model With Spatial Dependency: Application To Under Five Mortality Rate

Nigeria is one of the top five in the world with the highest under-five mortality (U5M) rate. The risk of U5M in Nigeria is assumed to vary from one state to another due to diversity in socio-economic and even environmental factors. Thus, this study aimed to quantified the hazard of U5M using Bayesian Accelerated Failure Time (AFT) with spatial dependency. The data for the study were obtained from 2018 Nigerian Demographic and Health Survey (NDHS). The study utilized Bayesian technique based on Markov Chain Monte Carlo (MCMC) technique to obtained the posterior estimates of the parameters. The Loglogistic, Weibull and Lognormal AFT models with and without spatial dependency were considered in this study. Out of these models used, the log-logistic AFT model with Intrinsic Conditional Autoregressive (ICAR) spatial prior performed better than the other models considered in the study. The findings revealed that the survival of under-five children (U5C) was not homogeneous across the states (95% CI: 2.6330, 11.4630). The subject-specific factors such as maternal age at birth, duration of breast feeding, preceding birth intervals, maternal educational qualification, wealth index, region, number of antenatal visits, duration of pregnancy, gender of child, twin status, contraceptive used and toilet facility were the significant risk factors of U5M. Based on these findings, it was recommended among others that the disparities observed across states should be taken into account at the policy level in order to meet the Sustainable Development Goal (SDG) 2030 targets.

Kualitas Pelayanan Dalam Pengurusan Perizinan Tanda Daftar Usaha Pariwisata (TDUP) Pada Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu Kota Pematang Siantar

The process of obtaining a Tourism Business Registration Certificate (TDUP) at the Integrated Investment and Licensing One-Stop Office in Pematang Siantar City, issues related to service quality have been identified. The problems is the low quality of service, permit issuance is often not fulfilled or takes a significant amount of time. This research aims to evaluate the quality of services provided in the process of obtaining (TDUP) at the Integrated Investment and Licensing One-Stop Office in Pematang Siantar City. The research method used is qualitative descriptive. Data is collected through observation, interviews, and documentation. The theoretical framework used in this research is the service quality theory by Zeithhaml, with indicators including tangible evidence, reliability, responsiveness, assurance, and empathy. The research results indicate that the quality of service in the process of obtaining a Tourism Business Registration Certificate has not reached an optimal level. This is evident from various indicators, such as the incompleteness of facilities, including toilet facilities in the service area and fully functional computers to support online systems. Employees involved in serving the public have not fully mastered their core tasks. Responsiveness in service is also lacking, as many individuals feel that the employees handling the Tourism Business Registration Certificate process provide slow and complicated responses. The assurances given by employees regarding service completion times are not in line with the promised deadlines.

A Localized GIS-Based Multi Decision Criteria Approach in Determining Suitable Sites for Community Toilet Facilities in BASECO Compound, Manila City

Abstract. Access to sanitation remains a major concern in the Philippines due to the increasing population and growing demand for basic needs. This study addresses poor sanitary conditions in slum areas, specifically in BaSECo Compound, Manila, where informal settlers rely on shared toilets. Utilizing GIS and MCDA, the study identifies areas suitable for community toilet facility (CTF) development. The Modified Huff Three-Step Floating Catchment Area (MH3SFCA) method quantified spatial accessibility to existing toilets. The SPAI map shows low accessibility in blocks 15 and New Site, with Gawad Kalinga, Habitat, and Old Site (N) having none. The Analytical Hierarchy Process (AHP) prioritized six criteria, with accessibility being the most significant (33.18%), followed by proximity to water supply (31.76%), communal septic tanks (14.53%), land use (8.2%), flood-prone areas (7.44%), and ground slope (4.89%). The final suitability map identified 14.12% of the 0.6 sq. km. area as highly suitable, including Block 15, Gawad Kalinga, Habitat, and Old Site (N). Ground truth verification visited five candidate sites, which were tested for improved SPAI maps. The inclusion of facilities in Block 15, GK 2, OSN, and H improved accessibility in northern BaSECo. Significant service area improvements for each CTF were observed using Voronoi polygons. This study demonstrates the effectiveness of integrating GIS and MCDA methods for CTF site selection.

Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Women of Reproductive Age in Nigeria in 2018.

Congenital transmission of Toxoplasma gondii can occur when a woman becomes infected for the first time during or just before pregnancy. Toxoplasma gondii in the fetus can lead to miscarriage, stillbirth, ocular or neurological abnormalities at birth, or progressive visual, hearing, motor, and cognitive deficiencies. The national seroprevalence of T. gondii infection in Nigeria was previously unknown. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey collected demographic, socioeconomic, and HIV-related data and stored blood specimens with consent for future analysis for other pathogens of public health importance. We evaluated toxoplasmosis seropositivity and risk factors in a sample of 44,269 women of reproductive age (WRA) between 15 and 44 years. The national T. gondii seroprevalence among WRA was 26.8% (95% CI: 25.8-27.7%). We found that WRA from all 36 states and the Federal Capital Territory had T. gondii exposure. Seroprevalence was higher in 25- to 44-year-olds than in 15- to 24-year-olds. A similar proportion of pregnant and nonpregnant women were seropositive. Increased odds of seropositivity were associated with unimproved toilet facilities and drinking water sources, being in a higher wealth quintile, and primary and secondary education compared with no education. Decreased odds of seropositivity were associated with living in an urban area and owning livestock. This study provides the first-ever national seroprevalence estimate for WRA in Nigeria. Although information on known risk factors for toxoplasmosis (e.g., consumption of undercooked meat, cat ownership) was not collected, future studies could further investigate potential risk factors to inform the development of effective toxoplasmosis prevention measures.

Determinants of Posttraumatic Stress Disorder (PTSD) among children and adolescents in the subacute stage of Kahramanmaras earthquake, Turkey

BackgroundEarthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake.MethodsIn this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children’s Depression Inventory, Children’s Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method.ResultsThe median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p < 0.001). Access time to the potable water supply (p = 0.045), toilet facilities (p = 0.045), shelter facilities (p = 0.004), heating facilities (p = 0.001), clothing supply (p < 0.001) and healthcare services (p = 0.009) were found to be associated with probable severe PTSD right after the earthquake. In the fifth month of the earthquake, inadequate meeting of clothing needs (p = 0.018), educational services (p = 0.028) and social activity opportunities (p < 0.001) were significantly associated with probable severe PTSD. In the multivariate analysis, the risk of probable severe PTSD was increased 2.9 times in those with post-earthquake sleep changes (p = 0.001) and 11.1 times in those with probable anxiety disorders (p < 0.001). Also, it has been shown that each unit increase in the APP-family score reduces probable severe PTSD risk by 2% (p = 0.002).ConclusionIn the current study, the rates of probable PTSD, depression and anxiety disorders were considerably high. Probable anxiety disorder and sleep disturbance were significant predictors of probable severe PTSD. On the other hand, social support from family was found to be a significant protective factor for severe PTSD risk. We conclude that the lack of meeting needs that increase the risk of probable severe PTSD differs in the acute and subacute phases.

Influence of socio-economic factors on obstetric morbidity in Eastern India: A study based on NFHS 5

Abstract Background Obstetric morbidity encompasses health issues related to pregnancy or childbirth, excluding accidental causes. The whole process of childbearing is not just a biological phenomenon, rather it is governed by personal, social, cultural, and institutional factors. The entire eastern region of India including the four provinces of Bihar, Jharkhand, Odisha, and West Bengal is susceptible to high maternal mortality and morbidity. It presents a strong background to further envisage the factors responsible for such situation. Thus, the study aims to explore regional variations and socio-economic factors associated with obstetric morbidity among women in eastern India. Methods This study uses data from the 2019-2021 National Family and Health Survey (NFHS 5). The explanatory variable, obstetric morbidity, includes issues during pregnancy and delivery- vision difficulties, bleeding, swelling, convulsions, fever, breech presentation, and prolonged labor. Predictor variables include age, age at marriage and first birth, wealth index, residence, toilet facility, caste, working status, media exposure, religion, birth order, and education level. Bivariate and binary logistic regression analyses have been used as a methodological tool. Results In the eastern region, 53.76% women experience obstetric issues. Women belonging to 15-24 years with higher educational attainment increases the prevalence of obstetric morbidity. The probable reason is, with education, awareness about reproductive morbidity increases and in turn the reporting for morbidity increases. Therefore, the findings showed age, educational attainment, wealth quintile, media exposure, residence, work status, birth order and toilet facilities are highly associated with obstetric morbidity among women. Conclusions Implementing of targeted interventions, and awareness campaigns are crucial to reducing obstetric complications and maternal mortality in the eastern region of India Key messages • Socioeconomic correlates impact obstetric morbidity in eastern India in manifolds especially education, age, and wealth quintile of women in eastern India. • Obstetric morbidity is a growing concern in eastern India, thus implementing targeted interventions and awareness campaigns are much needed.

Determinants of Acute Watery Diarrhea in Children Under Five Years: A Comprehensive Analysis

Background: Acute watery diarrhea (AWD), which has a sudden onset and is associated with a risk of severe dehydration, is primarily spread through unsafe water, poor sanitation, and inadequate hygiene. Socioeconomic factors, like low parental education and poverty, further increase risks. WHO-recommended interventions, including oral rehydration therapy, zinc supplementation, and rotavirus vaccinations, have reduced diarrhea-related deaths globally. Aim of the study: This study aims to explore the socio-demographic, environmental, and behavioral factors associated with childhood watery diarrhea, particularly in high-risk regions. Methods: This prospective observational study was conducted at the Department of Pediatric, 250 Bedded General Hospital, Khulna, Bangladesh, with 210 children aged 0–60 months presenting acute watery diarrhea, enrolled over one year July 2023 to June 2024. Eligible children met specific inclusion criteria, while exclusion was applied to cases of chronic diarrhea or unrelated pre-existing conditions. Data confidentiality was maintained, with ethical approval granted. The analysis involved descriptive statistics in SPSS (version 26) for comprehensive result interpretation. Result: The study included 210 children under five, with a mean age of 14.51±5.34 months; most were aged 7-12 months (38.10%), and 54.29% were male. Caregivers were predominantly aged 28.39±4.11 years, with 73.81% having completed primary education. Key findings included high MMR vaccination rates (62.38%), significant exclusive breastfeeding for six months (58.57%), and recent diarrhea reports among 20.95% of caregivers. In terms of WASH practices, 60.48% used piped water, 57.62% stored drinking water separately, and 95.71% had toilet facilities. Notably, 67.14% used water only for handwashing, and 45.24% washed hands with soap post-toilet use. Conclusion: Safe water, sanitation, and handwashing practices are essential to reducing acute watery diarrhea in children under five. Children in households with untreated water and inconsistent caregiver handwashing face higher risks. Targeted public health initiatives to improve water treatment and hygiene could greatly reduce diarrhea incidence and improve child health outcomes.

Pendampingan Sanitasi Total Berbasis Masyarakat melalui Gerakan Toilet Sekolah Ramah Anak di SD Muhammadiyah Balayuda Palembang

Healthy schools are something that is very necessary in creating a healthy and strong generation, one of which is toilet conditions. Adequate toilets, both in terms of number, appearance and facilities, have a significant impact on students' psychology. The aim of this community service is to increase school students' knowledge of using toilets and create child-friendly toilets. The implementation method is carried out by counseling using poster media and evaluation to determine the success of education for school children. At the end of the activity, the service team provided equipment for the school toilet, namely trash boxes with lids, hand washing soap, toilet tissue and slippers. The results of the activity were carried out on November 18 2023 in the Muhammadiyah Balayudha High School building in Palembang, attended by 20 grade 11 students. The material presented outlined 10 indicators of healthy toilets in terms of number, appearance and facilities including clean, bright, available tissue and soap, fragrant, dry, available running water, not slippery, available trash box, larva-free water tank. Participants were enthusiastic about taking part in this activity because each class in their school was equipped with toilet facilities. The conclusion of this activity is good information and input for the school in maintaining student health, it is necessary to pay attention to aspects of toilet cleanliness and comfort.

Práticas higiênico-sanitárias em feiras de arte e gastronomia de Niterói/RJ, Brasil

Introduction: Street food is an important market segment with an impact on the generation of jobs, income, and appreciation of food culture. However, it poses a challenge for public health because it increases the risk of transmission of pathogens from foodborne disease. Objective: Evaluate the hygienic-sanitary practices of food handlers at fairs and the physical-functional conditions of gastronomy and arts fairs in the city of Niterói/RJ. Method: The descriptive methodology was applied, using a qualitative and quantitative approach. For data collection, two scripts were developed and applied to evaluate the functional conditions of the fairs and the hygienic-sanitary practices of the handlers during sales, and a questionnaire was administered to outline the socioeconomic profile of the workers. Results: 68.1% were women; average income of 3 minimum wages; 51.1% had completed higher education; 46.8% had never taken a Good Food Handling Practices course; 70.5% did not use hair protection; and 86.8% used adornments. In 40% of the fairs visited, there was the presence of animals/vectors, as well as the absence of toilet facilities for handlers. Conclusions: Thus, despite its socioeconomic importance, the street food trade represents a potential health risk. Therefore, it is necessary to expand the hygienic-sanitary training of handlers and improve the environmental conditions of fairs.

WASH recommendations for improving disaster preparedness and recovery in schools in Indonesia

Access to functional and clean toilets which maintain privacy and dignity and support girls’ Menstrual hygiene management (MHM) plays a crucial role to getting girls back to school post-disaster. This could also help in managing feelings of shame and disgust experienced when using toilets in schools in post disaster settings. In this paper, we report on our assessment of water, sanitation and hygiene (WASH) facilities in schools three-years post the 2018 multi-hazard event in Indonesia. We used a mixed-methods approach using visual observations, interviews with school principals, surveys with schoolgirls and focus group discussions with schoolgirls and teachers to understand the lived experiences of students using toilets at school. Our results highlight that across schools descriptive and injunctive social norms were supportive of littering, inadequate toilet facilities for girls to manage their menstruation and bullying and antisocial behaviour by opening toilet doors while the facilities were occupied. Based on these results, we developed two types of interventions, physical and behavioural, piloted in three schools to increase WASH and MHM awareness and the safety of sanitation facilities. Our interventions showed that approaches for WASH interventions in schools can only be designed if we understand the local barriers to carrying out interventions that integrate maintenance plans. We provide recommendations to support practitioners in mitigating risk and improving circumstances for girls in schools in Indonesia, which have the potential to address SDG 4 on inclusive and equitable education and SDG 5 on gender equality and girls’ empowerment.

The role of toilets in public spaces: An interview study with individuals experiencing gastrointestinal issues

This study, conducted in Norway, addresses the issue of inadequate access to toilets in public spaces and transportation systems, particularly concerning individuals with disabilities who have heightened needs of toilets. The study employed in-depth interviews with individuals experiencing various gastrointestinal issues, including bladder-related problems. Utilizing a qualitative approach, interviews were conducted via telephone to accommodate potential travel difficulties. This approach also leveraged previous successes with sensitive topics. A sample size of 10 interviews was chosen based on prior research indicating that key themes typically emerge within this range. Key findings indicate significant barriers to participation in societal activities due to insufficient toilet facilities. For transport in particular, boats and trains emerge as preferred modes over buses, trams and subways due to the presence of onboard toilets. Notably, urban areas and recreational spots like parks and beaches suffer from a lack of restroom facilities. In order to improve these facilities, informants highlighted measures such as provision of open, hygienic toilets with barrier-free access. These measures should be coupled with clear signage and awareness campaigns regarding toilet facilities tailored to individuals with diverse health needs. The study underscores the critical role of toilets in maintaining public health and acknowledges the right to access toilets as recognized by the United Nations. Testimonials from individuals with disabilities underscore the profound impact of toilet accessibility on their daily lives, revealing instances of social isolation and restricted activities due to inadequate facilities. Proposed interventions encompass improved hygiene standards, increased toilet availability, and enhanced staff training to cater to the diverse needs of users. The study advocates for legislative reforms and policy guidelines to address the pressing issue of toilet accessibility, aiming to foster inclusivity and equal participation in public life for individuals with disabilities.

Sociodemographic Factors and Antenatal Service Utilization among Severe Acute Malnutrition Children under 2 Years of Age, Western India (Rajkot, Gujarat) – A Hospital-based Case-Control Study

Abstract Severe Acute Malnutrition (SAM) is multifactorial including poor maternal health, sociodemographic factors, and poor quality of diet of both the mother and child. Present study was carried out to determine sociodemographic factors and antenatal service utilization for SAM occurrence. This hospital-based case-control study was carried out from April 2021 to April 2022. Cases (77) and controls (77) were matched for age and sex with 1:1 ratio. Cases were selected from Nutritional Rehabilitation Centre and controls from an immunization clinic using WHO’s Multicentric Growth Reference Study Criteria 2006. Mothers of study participants were interviewed by using semistructured questionnaires. The weight and height of study participants were measured. The odds of children having SAM increased significantly with illiterate parents, working mothers, and labor work of fathers. The absence of toilet facility at home and poor hygienic practices of mothers were significant risk factors. Mother’s &lt;4 antenatal visits, home deliveries, and participants with low birth weight were associated with SAM. Logistic regression stated laborer fathers, poor hand washing practices of mothers, absence of toilet facility at home, and low birth weight of study participants were found independent determinants for SAM. Risk factors identified in the present study are modifiable and can be addressed through health system interventions.

Assessing the Utilization of Commercialized Public Toilets in Kakamega Town

Human waste management continues to be a major global challenge facing urban growth. Managing sanitation is therefore a challenge facing most governments. The objective of this study was to assess the utilization of commercialized public toilets in Kakamega Town. The study adopted a descriptive research design carried out in Kakamega Town. The target population comprised residents of Kakamega town and those on daily transit. Purposive sampling was done for Kakamega County town and key informants, while Simple random sampling was done for town residents and business people. Systematic sampling was conducted on individuals using public toilets. A sample size of 351 participants was finally used and data was collected using observation, interviews, questionnaires, and document review. 265 (75.5%) of respondents knew of public toilets and their location with only 25.9% of females being very often users. The majority of respondents 256 (72.9%) chose public toilets because of their cleanliness and appearance. Physically challenged respondents were less likely to use commercial toilets in contrast to the able-bodied respondents (OR: 0.4; 95%CI: 0.2 – 0.8; p=0.008). Location, signage, and maps were among the factors identified as determining the utilization of the public toilet facilities in Kakamega Town. There were low incidents of open defecation, urination, and flying toilets in places where commercialized public toilets were. In conclusion, commercialized public toilets were highly utilized and preferred in Kakamega town due to their cleanliness, location, and accessibility. The study recommends the town increase the number of commercialized public toilet facilities and the management of non-commercialized public toilets in the county government of Kakamega to enhance cleanliness and access to all public toilets within the town

Awareness Levels of Small-Scale Contractors Regarding the Provision of Welfare Facilities on Construction Sites in Sarawak, Malaysia

Welfare facilities on construction sites are critical to ensure workers' health, safety, and well-being. However, there is a lack of studies focusing on the awareness level of welfare facilities provisions, especially those focusing on small-scale contractors (G1-G3) in Sarawak. Hence, this study explores small-scale contractors' awareness levels regarding welfare facilities in Sarawak, Malaysia. To address this issue, the researchers employed a thorough quantitative research methodology with cross-sectional descriptive analysis, delivering a well-organized questionnaire survey primarily to small-scale contractors in Sarawak. The respondents with convenience sampling were chosen from the contractor registry of the Construction Industry Development Board (CIDB), specifically from Grade 1 to Grade 3. A total of 27 questionnaires were handed out, and 283 replies were gathered. The data collected from a survey utilizing a 5-point Likert Scale were analyzed using Excel and SPSS software. The research findings show that small-scale contractors are highly aware of toilet facilities, washing facilities, changing rooms and lockers, and rest facilities. Nevertheless, they are moderately aware of the drinking water based on the mean score. Therefore, the report proposes enhanced regulatory enforcement and the establishment of focused training initiatives to enhance contractors' understanding and compliance with welfare standards, particularly with the provision of drinking water. These findings are essential for improving occupational health and safety protocols within the construction industry in Sarawak.