Flush Toilets Research Articles

Sanitation and work time: Evidence from the toilet revolution in rural China

In 2020, 46% of the global population lacked safely managed sanitation services. Poor sanitation may lead to health problems and restrict economic activities. This study is the first to focus on the government-subsided Toilet Revolution in rural China and empirically investigates the causal effects of sanitation coverage increase on labor supply in developing countries. Using the China Health and Nutrition Survey data, we exploit the temporal and regional variation during the revolution and employ a difference-in-differences methodology. Our study finds that rural households with access to clean flush toilets significantly increase their work time by 0.253–0.431 h/day, and the effects are more prominent among women than men. As for the mechanism, clean toilets significantly decrease housework related to cleaning the house and raising livestock and poultry, allowing people to reallocate their time and invest more into work, which is more salient for women. Our findings highlight the importance of sanitation coverage in improving the economic outcomes in the rural areas of China. For policymakers concerned with the provision of sanitary facilities and the supply of labor force in developing countries, this study indicates that improved sanitation facilities also unexpectedly increase labor supply, particularly for women.

FACTORS ASSOCIATED WITH ACUTE DIARRHOEA AMONG ROTAVIRUS VACCINATED CHILDREN AGED 11-23 MONTHS IN KISUMU EAST SUB-COUNTY

Purpose: To investigate the relationship between behavioral factors and acute diarrhea among rotavirus vaccinated children aged 11-23 months in Kisumu East sub-County
 Materials and Methods: An observational cross-sectional sample design was used to carry out a study in Kisumu East Sub-County. Data was collected by trained field workers and community health volunteers who were residents of the 3 identified sub locations in Kisumu East Sub- County that was Nyalenda A, Manyatta B and Kolwa Central which included Nyalunya and Kasule. For quantitative results Multivariate logistic regression analysis was used to determine association between behavioral factors and acute diarrhea among rotavirus vaccinated aged 11-23 months in Kisumu East Sub-County. Data on Participants regarding behavioral factors influencing acute diarrhea among rotavirus vaccinated children aged 11-23 months in Kisumu East Sub-County, were collected with structured questions using Stata version 14 computer software. Data entry analysis was performed. Logistic regression analysis was conducted and the odds ratio was used in Kisumu East Sub-County to assess the relationship between behavioral factors and acute diarrhea among rotavirus vaccinated children aged 11-23 months. The multivariate analysis considered all variables with P values <0.05 was used to establish statistical significance.
 Findings: Bivariate analysis on behavioral factors and caregiver practices influencing diarrhea in children. Having soap for hand washing (OR: 20; 95% CI: 1.2 -3.4 p = 0.008), having piped water as the main source of drinking water ( OR: 2.6, 95% CI: 1.5 – 4.6; p = 0.0006 ), using pit without slab where child’s feaces are disposed were all associated with increased likelihood of cases of diarrhea among children (OR: 2.6; 95% CI: 1.2 -5.4; p= 0.01). It is worth noting that respondents who had pot without tap for water storage were upto 14.5 times more likely to have reported their children having diarrhea, the result however not statistically significant (p = 0.09). The chances of children presenting with diarrhea in the past 14 days prior to the survey was likely in the following situations: Washed hands after handling child’s feaces, napkins or diapers, (OR: 0.6; 95% CI: 0.4 -1.0; p= 0.030) or washing hands after visiting toilet/before preparing food or drink/before meals/after handling child`s feaces, napkins or diapers (OR: 0.4; 95% CI: 0.2 – 0.9; p= 0.02). Equally, of caregivers whose main source of water was lake (OR: 0.3 95% CI: 0.1- 1.0; p= 0.04 ) , those who were using filtration or not treating their water to make it safe ( OR: 0.2; 95% CI; 0.1 -0.8 p= 0.01 ), or respondents who were using flush toilet to dispose the child`s feaces ( OR: 0.2 ; 95% CI: 0.3- 0.9; p=0.02 ) , all with statistically significant results.
 Unique contribution to theory practices and policy: Socio-economic factors, environmental and behavioral factors and knowledge factors all influence acute diarrhea among rotavirus vaccinated children aged 11-23 months in Kisumu East sub-County. The relevant stakeholders should enlighten and educate the parents/guardians of the children on the factors associated with diarrhea among rotavirus vaccinated children aged 11-23 months in Kisumu East sub-County.

Water closets as breeding sites for Aedes mosquitoes in dry seasons

The challenges of reducing vectors that transmit diseases such as mosquitoes have been very tasking, especially in dry seasons where there are no visible breeding habitats. The identification of these breeding habitats and control measures during dry periods are important in the integrated control approach. This study assessed various water closets to ascertain the occurrence and density of mosquitoes and the physicochemical parameters of the water in a University in Southern Nigeria. Water closets in the main campus and its annexes were examined for either the presence or absence of immature stages and adult mosquitoes. Mosquito density in each sampled closet was determined. Water parameters were taken using standard techniques. The association between the density of immature stages and adults with water parameters was equally determined. Mosquitoes were morphologically identified. Hydrogen ion concentration (7.57), electrical conductivity (498.60 μS/cm), and salinity (249.20 ppm) were highest in closets with mosquitoes compared to the closets without mosquitoes. Significant differences were observed between all the sampled water parameters of closets with and without mosquitoes (p< 0.05). Mean larval density (40.77) and occurrence were higher than eggs, pupal and adults. All adult mosquitoes (49) identified was Aedes aegypti. Out of the closets sampled, 48.2% had mosquitoes. Temperature and Hydrogen ion concentration (pH) positively influenced larval and pupae density while conductivity and salinity showed no correlation to all stages of mosquitoes. This study revealed that closets in this area also serve as reservoir habitats for Aedes aegypti especially when they are not in use during dry seasons and has implications for disease transmission in the region. This requires urgent awareness and prompt public health interventions.

Importance of the Precautionary Principle With Regard to the Risk of Exposure to Aerosols Containing Viral Loads of SARS-CoV-2 Present in Feces: In Perspective.

In COVID-19 infection, the emissions of droplets and aerosols produced by the respiratory tract of contaminated subjects may represent a high risk of spreading the SARS-COV-2 virus in the environment. Thus, studies have shown that there is, at least, another source of droplets and aerosols in which viral particles of SARS-COV-2 can be found. It happens after flushing of toilet to dispose of the stools of a patient who has contracted COVID-19. The presence of viral particles of SARS-COV-2 in the stool could be linked to the concentration of angiotensin-converting enzyme 2 (ACE2) found on the surface of intestinal cells. Therefore, there is a reason to wonder whether the emission of viral particles by activating a toilet flush could represent an important potential risk of contamination for health care workers. To investigate this hypothesis, we have correlated different studies on the production of droplets and aerosols as well as the presence of viral particles following flush of toilet. This pooling of these studies led to the following conclusion: the precautionary principle should be applied with regard to the potential risk represented by viral particles of SARV-COV-2 in the stool when flushing the toilet.

Prevalence and predictors of water-borne diseases among elderly people in India: evidence from Longitudinal Ageing Study in India, 2017–18

BackgroundIndia suffers from a high burden of diarrhoea and other water-borne diseases due to unsafe water, inadequate sanitation and poor hygiene practices among human population. With age the immune system becomes complex and antibody alone does not determine susceptibility to diseases which increases the chances of waterborne disease among elderly population. Therefore the study examines the prevalence and predictors of water-borne diseases among elderly in India.MethodData for this study was collected from the Longitudinal Ageing Study in India (LASI), 2017–18. Descriptive statistics along with bivariate analysis was used in the present study to reveal the initial results. Proportion test was applied to check the significance level of prevalence of water borne diseases between urban and rural place of residence. Additionally, binary logistic regression analysis was used to estimate the association between the outcome variable (water borne diseases) and the explanatory variables.ResultsThe study finds the prevalence of water borne disease among the elderly is more in the rural (22.5%) areas compared to the urban counterparts (12.2%) due to the use of unimproved water sources. The percentage of population aged 60 years and above with waterborne disease is more in the central Indian states like Chhattisgarh and Madhya Pradesh followed by the North Indian states. Sex of the participate, educational status, work status, BMI, place of residence, type of toilet facility and water source are important determinants of water borne disease among elderly in India.ConclusionElderly people living in the rural areas are more prone to waterborne diseases. The study also finds state wise variation in prevalence of waterborne diseases. The elderly people might not be aware of the hygiene practices which further adhere to the disease risk. Therefore, there is a need to create awareness on basic hygiene among this population for preventing such bacterial diseases.

Household choices of sanitation infrastructure and impact on disease in India

In the recent past, there has been a substantial push to increase the sanitation infrastructure in India to end open defecation and improve level of hygiene. The choice of the type of sanitation, however, depends on demographic, socio-economic, tenurial, cultural and sanitation surroundings, which not only impacts sanitation practices but also incidences of diseases. This paper empirically analyses the determinants of households’ choice of toilet facility and the relation between incidence of diseases and sanitation using National Sample Survey Office’s 76th round of the survey for 2018-19. The results indicate that the social, economic and cultural factors have significant impact on the households’ choices of a toilet. There is a preference for flush type toilets connected to a sewer among households with better socio-economic status. This research finds that the quality of microenvironment within which a household lives has a significant impact on the incidence of disease. The results imply that the interventions for improved sanitation need to be holistic, emphasising microenvironment improvement and providing better access to sanitation infrastructure and inculcating more hygienic behavioural practices.

Enhancing waterborne toilets to reduce water usage in schools: experience from Kampala, Uganda

Over 620 million children worldwide lacked a basic sanitation service at their school and 12% of schools have facilities that are not usable. In Kampala’s public primary school, the pupil to stance area stands at 57:1 as compared to the required 40:1 by the public health regulation of 2000. A number of waterborne toilets have been constructed in schools to change the pupil to stance ratio from 118:1 to 57:1 in the period 2012- 2018. However, the administrators of schools have denied 07% of the toilets in schools to be accessed by pupils in an effort to control water bills. Administrators prefer pupils to use pit latrines to waterborne toilets because they use less water. This acerbates the inadequacy of access to sanitation in schools in Kampala. The objective of this work was to develop a waterborne sanitation facility that meets the school administrators’ preferences features of VIP latrine with water usage of less than 10 liters of water to flush the toilet. Kampala Capital City Authority (KCCA) has constructed water based toilets referred to as ‘channel flush’ toilets in public schools to reduce water usage. The channel flush toilet uses a channel as a receiving chamber for faecal matter which is flushed intermittently to the septic tank or bio-digester. Each toilet block is flushed four times a day with each flushing time using 60 liters of water. With the channel flush toilet, schools use about 4 liters per child per day on flushing toilets leading to a 90% water usage reduction. Emptying has been reduced from 30 cubic meters to 5 cubic meters per year. The toilet is recommended to be used in schools and public places such as markets and taxi parks.

The Gap between Willingness and Behavior: The Use of Recycled Water for Toilet Flushing in Beijing, China

Promoting the use of recycled water is an effective way to solve the problem of urban water shortage. In order to promote the utilization of recycled water, this study identified the influential factors determining the differences between willingness and behavior to use recycled water for toilet flushing. Binary logistic regression models of willingness and behavior were analyzed and the data came from 1195 Beijing residents in communities where recycled water was available for toilet flushing. The results are as follows: First, the proportion of those willing to use recycled water (92%) was significantly higher than those who actually did so (35.2%); thus, higher willingness to use recycled water did not necessarily lead to higher using behavior. Second, different factors influenced willingness and behavior, with the willingness mainly influenced by cognitive and attitudinal factors, and the behavior dependent on external environmental factors such as the convenience of installation and promotion measures. Third, the convenience of the installation of recycled water facilities is the most important factor influencing both willingness and behavior, and inconvenient facilities are the main factor hindering the use of recycled water.

Feasibility Study of Zero Discharge Concept in Sugar Industry After Anaerobic Treatment: Case Study of Solapur

Abstract: Purification and reutilisation of waste water from different industries is a challenge for a smarter and healthier environment. An important role in Indian economy is played by an agro based industry segment which is nothing but sugar industry. But the effluent from the industry is a proven fact as a threat for environment. Effective waste water management can result in smart and healthy city environment. The treated colored effluent from the industry is not preferred for reuse and recycle, though the other BOD, COD, TDS, TSS, MPN are in permissible limit. Root zone technique is one of the important approaches for, as the process is economical, easy in operation and maintenance. Pilot plant is constructed and executed using a typical species. The intake of treated effluent and the final effluent from root zone technique were collected and tested for various contact hours. To accommodate the massive urbanization it can be used to find smarter ways to reduce expenses, manage complexities that’s the treated waste water from industry can serve for following: 1) Gardening 2) Fire Fighting 3) Washing 4) Toilet Flushing etc. For a better and smart management of treated waste. Keywords: Agro based industry, sugar industry, colored, root zone technique, species, contact hours.

Reducing the particles generated by flushing institutional toilets

Airborne particles play a significant role in the transmission of SARS-CoV-2, the virus that causes COVID-19. A previous study reported that institutional flush-O-meter (FOM) toilets can generate 3–12 times as many droplets as other toilets by splashing (large droplets) and bubble bursting (fine droplets). In this study, an aerosol suppression lid was evaluated to measure the reduction of particles by size using three metrics; number, surface area, and mass concentrations. To quantify toilet flush aerosol over time, detailed particle size distributions (from 0.016–19.81 µm across 152 size bins) were measured from a FOM toilet in a controlled-environment test chamber, without ventilation, with and without use of the suppression lid. Prior to each flushing trial, the toilet bowl water was seeded with 480 mL fluorescein at 10 mg/mL. A high-speed camera was used to record the large droplet movements after flushing. An ultraviolet-visible spectrophotometer was used to analyze the wipe samples to evaluate the contamination on the lid. The particle number, surface area, and mass concentrations without a lid were elevated compared to a lid in the first 90 sec. Overall, the lid reduced 48% of total number concentration, 76% of total surface area concentration, and 66% of total mass concentration, respectively. Depending on the particle size, the number concentration reduction percentage ranged from 48–100% for particles larger than 0.1 µm. Large droplets created by splashing were captured by the high-speed camera. Similar studies can be used for future particle aerodynamic studies. The fluorescein droplets deposited on the lid back sections, which were closer to the FOM accounted for 82% of the total fluorescein. Based on two-way ANOVA analysis, there were significant differences among both the experimental flushes (p = 0.0185) and the sections on the lid (p = 0.0146). Future work should explore the aerosolization produced by flushing and the performance of the lid in real restroom environments, where feces and urine exist in the bowl water and the indoor ventilation system is in operation.

Association of Multidimensional Poverty With Dementia in Adults Aged 50 Years or Older in South Africa

Limited research exists investigating the association between multidimensional poverty and dementia in low-and middle-income countries (LMICs). To investigate the association between multidimensional poverty and dementia among adults aged 50 years or older living in South Africa. This cross-sectional study was conducted in Soweto, Johannesburg, South Africa, between November 11, 2019, and February 28, 2020. Participants included 227 adults aged 50 years or older. Data analysis was concluded from August 1 to 30, 2021. Multidimensional poverty included 7 dimensions that are central to well-being (education, health, economic activity, living standards, social participation, fair treatment, and psychological well-being) and 11 indicators of deprivation within those dimensions (limited access to education; severe limitation of activity; difficulty functioning; unemployment; deprivation of access to running water, electricity, and a flush toilet; lack of involvement in community groups; discrimination; depression; and decreased self-esteem). The 8-item Interview to Differentiate Aging and Dementia (Assessing Dementia 8 [AD8]) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to assess dementia. Level and depth of poverty were compared between adults with no dementia and those with a score above the threshold for either the AD8 or the RUDAS, or for both the AD8 and the RUDAS, adjusting for gender, age group, and marital status. Correlation analyses assessed the overlap of dimensions of deprivation. Associations between dementia and multidimensional poverty were investigated using a multivariable logistic regression model. A total of 227 adults (146 women [64.3%]; mean [SD] age, 63.7 [0.5] years) were included in the study; 101 (44.5%) had dementia identified by the AD8, 14 (6.2%) had dementia identified by the RUDAS, and 50 (22.0%) had dementia identified by both the AD8 and the RUDAS. More men than women did not have dementia (26 of 81 [32.1%] vs 36 of 146 [24.7%]), and 33 of 165 adults with dementia (20.0%) compared with 6 of 62 adults (9.7%) without dementia were found to be deprived in 4 dimensions or more. The difference between adults with and adults without dementia in the Multidimensional Poverty Index for deprivation in 4 dimensions was 145.8% for dementia identified by both the AD8 and the RUDAS and 118.2% for dementia identified by either the AD8 or the RUDAS. Education, health, and employment were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty was strongly associated with dementia as measured by the AD8 and the RUDAS (adjusted odds ratio [OR], 2.31; 95% CI, 1.08-4.95), with higher odds for older women (OR, 2.03; 95% CI, 1.00-4.12) or those living in large households (for each additional household member: OR, 1.27; 95% CI, 1.05-1.53). This study suggests that the prevalence and depth of poverty were higher among adults with dementia. A lack of education, poor health, and unemployment were major dimensions of poverty that were associated with a higher prevalence of dementia. Long-term interventions beginning early in life may affect social determinants of health through targeted structural policies (eg, access to quality education and health care) and prevent dementia later in life.

Environmental Sanitation Practices: Residents’ Involvement in Ilesa, Nigeria

This study examined residents’ involvement in environmental sanitation in Ilesa, Nigeria. Using multistage sampling, six political wards were selected: three from the high-density area, two from the medium-density area, and one from the low-density area. In all 300 copies of the questionnaire were administered. Data obtained were analysed using percentages and the Pearson correlation. This was with a view to suggesting policy response capable of enhancing healthy environment in the city and others with similar background. Information on the kind of toilet available revealed that 50.9% used flush toilet, 30.1% used pit latrine while 19.0% had no toilet. Likewise, there is paucity of public toilet in the city as 5.0% of the residents claimed availability of public toilet in their neighbourhood while 95.0% said public toilet was not available in their neighbourhood. Furthermore, the agencies responsible for environmental management were found to be wanting in some key functions with implications for healthy living in the area. Based on the findings, policy recommendations are proffered to enhance environmental friendliness in the city.

Risk Factors Associated with Diarrheal Episodes in an Agricultural Community in Nam Dinh Province, Vietnam: A Prospective Cohort Study.

In Vietnam, data on the risk factors for diarrhea at the community level remain sparse. This study aimed to provide an overview of diarrheal diseases in an agricultural community in Vietnam, targeting all age groups. Specifically, we investigated the incidence of diarrheal disease at the community level and described the potential risk factors associated with diarrheal diseases. In this prospective cohort study, a total of 1508 residents were enrolled during the 54-week study period in northern Vietnam. The observed diarrheal incidence per person-year was 0.51 episodes. For children aged <5 years, the incidence per person-year was 0.81 episodes. Unexpectedly, the frequency of diarrhea was significantly higher among participants who used tap water for drinking than among participants who used rainwater. Participants who used a flush toilet had less frequent diarrhea than those who used a pit latrine. The potential risk factors for diarrhea included the source of water used in daily life, drinking water, and type of toilet. However, the direct reason for the association between potential risk factors and diarrhea was not clear. The infection routes of diarrheal pathogens in the environment remain to be investigated at this study site.

Micropollutants removal during high rate thermophilic and hyper-thermophilic anaerobic digestion of concentrated black water

Source separated toilet water (black water; BW) is an important alternative nutrient source for agriculture. However, reuse and recovery of nutrients from BW is limited by the presence of pollutants, such as pathogens and micropollutants. In this study, the fate of micropollutants during thermophilic and hyper-thermophilic anaerobic digestion (AD) of concentrated vacuum collected BW is assessed. A total of eight pharmaceuticals were selected and spiked with two distinct loading rates to concentrated BW treated in an Upflow Anaerobic Sludge Blanket Reactors (UASB). The removal of these micropollutants was followed by measuring concentrations in the liquid phase. It was shown that the micropollutant loading rate did not affect the removal efficiency. Irbesartan, propanol, sulfamethoxazole and trimethoprim were almost completely removed under both conditions (>95% removal). Metoprolol had 74% removal under thermophilic conditions. Caffeine showed high desorption from BW solids, whereas carbamazepine is thought to be removed by sorption to the sludge in the UASB reactor. Diclofenac removal was < 30% during both temperature conditions, which may have been caused by the lack of sludge adaptation which limits the biodegradation. There were no differences in micropollutant removal efficiencies between thermophilic and hyper-thermophilic AD of concentrated BW. Therefore, it is concluded that thermophilic AD is sufficient for safe nutrient recovery in terms of micropollutants presence.

Implementation of Environmental Sanitation and Disinfection in Hospitals to Reduce the Spread of Covid19: A Literature Review

Introduction: SARS-CoV-2 is a new variant of virus that attacks the human respiratory tract which was declared by WHO as a Covid19 pandemic. Covid19 transmission through solid surfaces, air, and waste occurring in hospital areas require disinfection and sanitation monitoring to ensure that new clusters are not created and outpatients are not infected with the SARS-CoV-2 virus in hospitals. Discussion: Using literature review method, 11 relevant articles that meet the inclusion criteria were selected. In the results of the study, there was a collection of samples in the solid surfaces, air and waste in both medical and non-medical areas containing SARS-CoV-2 RNA. The common objects where SARS-CoV-2 was discovered include doorknobs, toilet bowls, toilet flush buttons, and medical devices. In non-medical areas, the objects include computer keyboards, mice, and monitors. Chlorine-based disinfection for surfaces, monitoring in environmental sanitation by changing pillow and bedsheets and cleaning tables regularly were subsequently implemented. Conclusion: The implementation of environmental sanitation and disinfection is effective in eliminating the SARS-CoV-2 virus in hospitals. Studies indicated that disinfection is 95% to 99.99% effective in eliminating the SARS-CoV-2 virus. In addition, the SARS-CoV-2 virus was not discovered in isolation rooms but was located in other public hospital areas.

Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare

BackgroundTo establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak.MethodsThe two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR.ResultsOver all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8%) predefined body and environmental sites. Specifically, positivity rates were 100% on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3% on patient phones and bed controls; 80% on intravenous pumps; 75% on toilet flush plates and door handles, and 0% on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6%), staff mobile phones (33.3%) and nurses’ keyboards (33.3%) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7%) positive follow-up samples, and transmission to the second patient occurred in one of the two runs.ConclusionsFor the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.

Greywater as an Alternative Solution for a Sustainable Management of Water Resources—A Review

In this paper, a comprehensive review on greywater is presented. Emphasis is given to the techniques used to treat and recover greywater, and special emphasis is placed on the risk of the existence of the novel coronavirus “SARS-CoV-2” in greywater and the possibility of its spread via the reuse of this water. In general, greywater is considered wastewater collected from domestic sources, with the exclusion of toilet water (which is considered as blackwater). Greywater represents 50 to 80% of the total volume of wastewater all over the world. This review provides various aspects related to greywater, such as origins, characteristics, and existing guidelines for greywater proper treatment and reuse. Several approaches and techniques have been developed to study the performance of different greywater treatment systems. These methods are critically discussed in this article. In the context of sustainable development, water management, and taking into account the scarcity of water resources, particularly in arid and semi-arid areas, the use of treated greywater is one of the alternatives methods that can reduce the burden of withdrawals from the resource. In addition, some successful examples of greywater valuation experiences in Tunisia were examined.

Water, Sanitation and Hygiene (WASH) in Japanese elementary schools: Current conditions and practices.

BackgroundWater, sanitation, and hygiene (WASH) is the foundation for preventing infectious diseases, as the current COVID‐19 pandemic has shown. WASH is essential for school health, yet there have been very few papers published on WASH in Japanese schools. The objective of this review is to describe the current conditions and practices in Japanese elementary schools using an international framework for WASH in schools and identify implications for handwashing promotion in other areas.MethodsThis research was based primarily on a literature review. Information on common WASH practices was also collected through an international workshop attended by school health experts.ResultsThere is a rigorous legal foundation for ensuring the physical infrastructure and quality control of a safe water supply in Japanese schools. Water quality is monitored regularly by Yogo teachers and school pharmacists. Strategic locations and an abundance of water supply infrastructure facilitate handwashing behavior. Hygiene promotion activities by Yogo teachers and student's health committees play a major role in increasing awareness, while health education classes provide minimal but necessary knowledge on handwashing with soap. Flush toilets are the standard, but there is still a demand for improvement of toilet facilities. Children’s participation in daily cleaning of school toilets contributes to students understanding the importance of cleanliness.ConclusionsDrawing from the Japanese example, WASH in schools' interventions are suggested to include laws and policies, a designated teacher, and children’s participation to sustain both infrastructure and hygiene promotion.

Access to Safe Drinking Water and Sanitation Facilities: A Case Study of Lagos Mainland Local Government Area, Lagos, Nigeria

Background: Access to safe drinking water will prevent water borne diseases, disability and death. Clean water and sanitation are crucial to healthy living. Access to good drinking water is indicated by safe water sources. Objectives: The study was conducted to determine access to safe drinking water and sanitation facilities amongst residents of Lagos Mainland Local Government Area (LGA), Lagos. Methods: A cross-sectional descriptive study was carried out using mainly interviewer administered questionnaire to 381 participants of not less than 18 years which focused on questions on source of drinking water, sanitation facility and incidence of water borne diseases. Results: Response rate was 94.5%. Majority of the respondents (40%) were between 38-47 years old. Half of the respondents relied on sachet water as source of drinking water while 5% from pipe water in the compound. Majority of the respondents’ households (85%) had access to water within a distance of about 100 metres or less and within 15 minutes or less. About 60% of the household had government piped water into their compound. Majority of the households (80%) had flush toilets while 20% had improved pit latrine. Most of the respondents (80%) were aware that disease can be caused by unsafe drinking water. More than half (55.56%) of the households have not treated water related diseases in the last two months. Conclusion: The surveyed households had close access to safe drinking water. Sachet water was the main source of drinking water. The sanitation facilities in the studied area were adequate for healthy living and good quality of life.

Oral hygiene practices in the pandemic- Evidence-based discussion of 8 common issues.

Oral hygiene practices in the pandemic- Evidence-based discussion of 8 common issues.