Water Handwashing Research Articles

Water, Sanitation and Hygiene Practices in Rural Area of Goa: A Cross-sectional Study

Introduction: Access to water, sanitation and hygiene is a major challenge in developing nations and more among rural population. In India, Swachh Bharat Mission was launched with the objective to provide sanitation facilities and eliminate open defecation.
 Objective: To assess the existing facilities and practices related to drinking water, sanitation and hygiene among household members in the rural population of Goa.
 Materials and Methods: A cross-sectional study was conducted in the field practice area of Rural Health and Training Centre, Mandur, Goa. Individuals aged ≥ 18 years were interviewed from 100 households by house to house visits using semi-structured questionnaire.
 Results: Out of 100 households, 87 (87.0%) were having piped water supply into dwelling, 5 (5.0%) were using public tap and 8 (8.0%) were using water from well. Majority of the households, i.e., 94 (94.0%) were using sanitary latrine for defecation, 1 (1.0%) had community toilet and 5 (5.0%) were practicing open field defecation. Closed container was used by 89(89.0%) of the households for storing drinking water and 96 (96.0%) were using soap and water for hand washing.
 Conclusion: This study revealed that overall water and sanitation practices among the study population were satisfactory. However, measures need to be taken to abolish some of the bad practices such as open defecation and drainage of waste water in the open which was seen in few participants.

Real-time coverage surveys and monitoring during emergency vaccination campaigns in insecure humanitarian contexts of DRC and Somalia

Purpose: Mass vaccination campaigns in low-resource settings traditionally rely on ground coordination and post-campaign activities to assess coverage and programmatic performance. However, complex humanitarian crises in highly insecure settings present increased limitations on informational and operational access, suppressing accurate measurement and achievement of target coverage rates. To mitigate these contextual constraints, a real-time monitoring strategy implemented concurrently with immunisation activities may quickly identify and address low coverage causes before the campaign concludes. Methods & Materials: Independent monitoring approaches were implemented during two recent emergency outbreak vaccination campaigns for yellow fever in the Democratic Republic of Congo (DRC) and cholera in Somalia. Enumerators conducted post-vaccination exit interviews and focus group discussions (nDRC = 591, nSomalia = 3025) with children and adults at clinical sites, and a two-stage, stratified clustered community household coverage survey (mDRC = 300, mSomalia = 1684). Daily coverage rates, barriers to uptake, and indicators of community awareness, mobilisation and communications strategies, and service delivery were captured. Results: DRC beneficiaries indicated high levels of service satisfaction while also highlighting a lack of visual communication materials and insufficient instruction from clinical staff. Respondents in Somalia experienced good service delivery and emphasised lower understanding around adverse events reporting. Knowledge of cholera disease and prevention strategies centred around hand washing and clean drinking water, varying by age group. Primary barriers of vaccination were incompatible working hours (DRC) and distance to clinical sites (Somalia). Daily coverage indicators from the household survey identified low coverage areas and demonstrated final rates of 93.1% (DRC) [87.4,98.8] and 99.08% (Somalia) [98.64,99.41]. Conclusion: Collective results from the monitoring activities regularly informed coordinators in real-time, allowing them to refine outreach strategies during the campaign. Changes included identifying new communications and information sources, modifying campaign messaging to correct erroneous community perceptions, and targeting geographical areas. The resultant increasing daily coverage trends demonstrate that this monitoring framework can act as a vital source of independent evaluation during emergency vaccination campaigns. It enables immediate feedback and operational modification to increase coverage. This is crucial when pre-campaign information is incomplete and post-campaign activities may be limited or delayed.

Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality.

Sustainable Development Goal (SDG) Indicator 6.2.1 requires household handwashing facilities to have soap and water, but there are no guidelines for handwashing water quality. In contrast, drinking water quality guidelines are defined: water must be "free from contamination" to be defined as "safely managed" (SDG Indicator 6.1.1). We modeled the hypothesized mechanism of infection due to contaminated handwashing water to inform risk-based guidelines for microbial quality of handwashing water. We defined two scenarios that should not occur: (1) if handwashing caused fecal contamination, indicated using Escherichia coli, on a person's hands to increase rather than decrease and (2) if hand-to-mouth contacts following handwashing caused an infection risk greater than an acceptable threshold. We found water containing <1000 E. coli colony-forming units (CFU) per 100 mL removes E. coli from hands with>99.9% probability. However, for the annual probability of infection to be <1:1000, handwashing water must contain <2 × 10-6 focus-forming units of rotavirus, <1 × 10-4 CFU of Vibrio cholerae, and <9 × 10-6 Cryptosporidium oocysts per 100 mL. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.

Assessment of hand hygiene practices among rural population in Davangere

Background: Handwashing is well-recognized preventive tool for disease prevention. Handwashing with soap has been viewed as one of the most cost-effective ways of reducing the global infectious disease burden. Hence, the present study was conducted with an aim to study handwashing practices in rural communities. Objectives: The objectives are as follows: (i) To assess the handwashing practices in rural areas, (ii) to identify the factors associated with handwashing practices, and (iii) to determine the association between handwashing and certain infections. Materials and Methods: A cross-sectional study was conducted among 128 respondents, residing in Kukkuwada village, Davangere Taluk. Data were collected by house to house surveys using semi-structured and pre-tested questionnaire. Data were entered into Microsoft Excel and analyzed using SPSS version 16.0. Results: A total of 128 (44 males and 84 females) individuals participated in the study. The majority were from 21 to 40 years age-group (49.2%). All of them practiced handwashing after defecation. A majority, 80 (62.5%) were using soap and water, 12 (9.4%) used water and antiseptic solution for handwashing, and 36 (28.1%) used only water for handwashing. Handwashing practices (medium and technique) were significantly associated with history of episode of diarrhea and upper respiratory tract infection in the past 3 months. Conclusions: Among all the study participants who practiced handwashing, majority of them used water with soap and is influenced by factors such as age, frequency of health facility visits, and previous infections. The findings were found encouraging, and we recommend measures for sustainable practice.

Clostridioides difficile Infection in Chronic Kidney Disease/End-Stage Renal Disease.

Clostridioides difficile infection (CDI) is a major health-care burden and increasingly seen in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Increased antibiotic use, alteration in host defenses, and gastric acid suppression are some of the etiologies for increased risk of CDI in these populations. Patients with CKD/ESRD have a higher risk of initial episode, recurrence, and development of severe CDI than those without CKD or ESRD. Diagnosis and management of CDI in patients with CKD/ESRD are similar to that in the general population. The mortality, length of stay, and health-care costs are higher in patients with CDI and CKD/ESRD. Antimicrobial stewardship with reduction in antibiotic use along with infection-control measures such as contact isolation and hand hygiene with soap and water is essential in the control and prevention of CDI in patients with CKD/ESRD.

Comparing the anti-bacterial performance of chlorination and electrolysis post-treatments in a hand washing water recycling system

Innovative solutions are necessary to enable the decentralized recycling of greywater for applications requiring high-quality water, such as hand washing. While physical barriers such as ultrafiltration membranes effectively prevent the passage of bacteria, and chemical and biological treatments can effectively reduce the carbon content of the treated water, there exists a knowledge gap regarding the application of anti-bacterial strategies to prevent the growth of harmful bacteria following treatment. In this study, the effluent water from a household-scale greywater treatment system was fed to seven parallel experimental post-treatment tanks: three receiving direct chlorination with free chlorine residuals of 0.2, 1 or 5 mg Cl2/L, three with chlorine produced through electrolysis at the same residual concentrations, and one control with no chlorine added. For increasing concentrations of direct chlorination, the median total cell count (TCC) values were 9 × 104, 2.9 × 104 and 1.8 × 103 cells/mL, respectively. Electrolysis treatment produced very similar TCC concentrations, 8.8 × 104, 1.1 × 104 and 2.3 × 103 cells/mL. The TCC concentrations were lower than the concentration of the water entering each tank (∼3 × 105 cells/mL). Intact cell count (ICC) measurements indicated that the viable cell concentrations, were less than 10% of the TCC values. Though electrolysis treatment can produce powerful oxidants, such as hydroxyl radical, there was no evidence that electrolysis in this system provided additional benefits beyond chlorine production for control of total or intact cell counts. Oxidation of bacteria by chlorine was the dominant anti-bacterial mechanism in our system. Monitoring of dissolved organic carbon (DOC) and assimilable organic carbon (AOC) did not suggest that carbon-limitation significantly impacted cell counts when chlorination or electrolysis treatment was applied. This work demonstrates that either direct chlorination or electrolysis treatment are able to reduce bacteria concentrations over long-term operation of a hand washing water treatment system. We recommend selecting chlorine residual targets such that a chlorine residual is maintained during periods of challenging operating conditions. We observed that a target residual of 1 mg Cl2/L, in our system, maintained the TCC below the concentration found in Zürich drinking water.

Hygienic and Sanitary Quality in Street Food Stalls Located in a University Sector of Barranquilla, Colombia

Foodborne diseases are one of the main public health problems worldwide, especially due to the consumption of foods that made with poor hygienic practices, such as those prepared on a public thoroughfare. Some factors that contribute to its contamination are the use of non-potable water, inadequate handling, cross-contamination and environmental contamination. This study aimed to perform a sanitary profile with the completion of a survey of 12 food stalls to evaluate their hygienic and sanitary quality and through observation. Four samples of food were taken from each stand, for a total of 48 samples such as hamburger, hot dog, pizza, meat empanada, stuffed potato, stuffed arepa, chicken skewer, chicken finger, fruit salad and orange juice. Coliforms, Escherichia coli and Staphylococcus aureus were analyzed. 83.3% of the samples exceeded the acceptable limits of coliforms and in the 16.7%, it was detected Escherichia coli . No S. aureus was detected in any sample. Eighty-three point three percent of the vendors do not wear appropriate clothing, 75% use accessories and 83.3% do not use potable water for hand washing. Thirty-three point three percent of the stalls do not have surface with sanitary material, 100% do not have access to sanitary service and drinking water, 58.3% have the presence of animals in their surroundings, 50% have uncovered garbage containers, 91.7% store food at high temperatures and 100% do not have a sanitary authorization of operation. The lack of good hygiene practices in the food stalls on this public thoroughfare affects the quality and safety of food, making it a risk to the health of consumers.

Study to assess knowledge, perception and practices regarding Swachh Bharat Abhiyan among rural people of Nalgonda district in Telangana state

Background: Swachh Bharat Mission was launched by our Hon. Prime Minister, Shri Narendra Modi on October 2, 2014 with Mahatma Gandhi as the inspiration, to create a clean India of his dream by 2019, on his 150th birth anniversary. The basic objective is to create sanitation facilities for all and eliminate completely the unhealthy practice of open defecation. This study is conducted to assess knowledge, perception and practices regarding Swachh Bharat Abhiyan among rural people.Methods: A cross-sectional study was conducted among 328 subjects of rural area with a pre-tested, semi structured questionnaire in order to assess their knowledge, perception and practices regarding Swachh Bharat Abhiyan. Data collected was analysed using SPSS software.Results: In our study, it was found that 62.2% have heard about SBA and 82.84% of them have identified both the objectives of SBA. 81.8% of the literates felt that people must actively participate in SBA and this was statistically significant. 26.52% were defecating in the open field, 69.81% were using soap and water for hand washing after defecation and 34.75% of the subjects were disposing solid waste in community bins.Conclusions: Though most of the people were having positive perception only 25.98% have participated in SBA activities and main source of information was found to be television and newspaper. The proportion of people disposing solid waste in community bins and using soap and water for hand washing was significantly higher among people who were aware about SBA.

Chemical composition, nutrient-balancing and biological treatment of hand washing greywater

On-site biological hand washing water treatment can improve global access to safe hand washing water, but requires a thorough understanding of the chemical composition of the water to be treated, and an effective treatment strategy. This study first presents a detailed characterization of the individual inputs to hand washing water. We demonstrate (i) that soap is likely the most significant input in hand washing water, representing ∼90% of mass loading, and (ii) that inputs to hand washing water have low concentrations of biologically-essential macro- and micro-nutrients (nitrogen, phosphorus, potassium, copper, zinc, molybdenum and cobalt) with respect to carbon, which may impair biological carbon removal. This study next formulates a recipe that recreates a representative composition of hand washing water and develops a procedure to identify and supplement nutrients in which this recipe is estimated to be deficient. Batch testing of the nutrient-supplemented hand washing water with an inoculum of planktonic bacteria demonstrated improved assimilable organic carbon removal (99% vs. 86% removal) and produced lower final dissolved organic carbon concentrations (1.7 mgC/L vs. 3.5 mgC/L) compared to realistic (nutrient-deficient) washing water. Supplementing nutrients did promote cell growth (50x higher final total cell count). Full-scale testing in a biologically activated membrane bioreactor (BAMBi) system treating 75 L/day of nutrient-supplemented hand washing water showed that long-term operation (100 days) can deliver effective carbon removal (95%) without detrimental fouling or other disruptions caused by cell growth. This work demonstrates that biological treatment in a BAMBi system, operated with appropriate nutrient-balancing offers an effective solution for decentralized treatment of light greywater.

Hand hygiene practices among nurses in health facility in a semi-urban setting

INTRODUCTION: Hand is an important medium of infection transmission. This is further worsened in the hospital setting where sources of contamination are abundant. Nurses play a vital role in patient care, and while doing so, they are often exposed to health hazards. Therefore, they may act as conduits for transmitting infectious diseases to themselves, family members, and other patients. Good hand hygiene is a prerequisite for infection control; therefore, the objective of this study is to determine the knowledge and practices of hand hygiene among nurses in our institution. MATERIALS AND METHODS: This was a cross-sectional study involving 113 nurses and it was conducted over 12 weeks; it was questionnaire based, which was pretested and self-administered. Convenience sampling was adopted. RESULTS: Data from 96 (85%) respondents consisting of 41 (42.7%) males and 55 (57.3%) females with male:female ratio of 0.7:1 were analyzed. All respondents reported using water and soap for hand-washing. Furthermore, majority (59%) of the respondents were not aware of the five moments of hand hygiene. Although majority (76%) reported adhering to the principles of good hand hygiene, 54.2% of the respondents could not correctly mention the steps of hand-washing technique. Sixty-six (68.8%) respondents wash their hands before attending to patients; however, almost all (99%) of the respondents wash their hands after attending to patients and after removing hand gloves. Similarly, all respondents wash their hands after using the restroom. CONCLUSION: The act of hand-washing is common among respondents in this study; however, the major challenge is with practicing the correct technique involved in hand-washing. Furthermore, knowledge of the critical moments of hand-washing was also deficient among most of the respondents.

Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial

SummaryBackgroundPoor nutrition and infectious diseases can prevent children from reaching their developmental potential. We aimed to assess the effects of improvements in water, sanitation, handwashing, and nutrition on early child development in rural Kenya.MethodsIn this cluster-randomised controlled trial, we enrolled pregnant women in their second or third trimester from three counties (Kakamega, Bungoma, and Vihiga) in Kenya's western region, with an average of 12 households per cluster. Groups of nine geographically adjacent clusters were block-randomised, using a random number generator, into the six intervention groups (including monthly visits to promote target behaviours), a passive control group (no visits), or a double-sized active control group (monthly household visits to measure child mid-upper arm circumference). The six intervention groups were: chlorinated drinking water; improved sanitation; handwashing with soap; combined water, sanitation, and handwashing; improved nutrition through counselling and provision of lipid-based nutrient supplements; and combined water, sanitation, handwashing, and nutrition. Here we report on the prespecified secondary child development outcomes: gross motor milestone achievement assessed with the WHO module at year 1, and communication, gross motor, personal social, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at year 2. Masking of participants was not possible, but data assessors were masked. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105.FindingsBetween Nov 27, 2012, and May 21, 2014, 8246 women residing in 702 clusters were enrolled. No clusters were lost to follow-up, but 2212 households with 2279 children were lost to follow-up by year 2. 5791 (69%) children were measured at year 1 and 6107 (73%) at year 2. At year 1, compared with the active control group, the combined water, sanitation, handwashing, and nutrition group had greater rates of attaining the standing with assistance milestone (hazard ratio 1·23, 95% CI 1·09–1·40) and the walking with assistance milestone (1·32, 1·17–1·50), and the handwashing group had a greater rate of attaining the standing alone milestone (1·15, 1·01–1·31). There were no differences when comparing the other intervention groups with the active control group on any of the motor milestone measures at year 1. At year 2, there were no differences among groups for the communication, gross motor, personal social, or combined EASQ scores.InterpretationThe handwashing and combined water, sanitation, handwashing, and nutrition interventions might have improved child motor development after 1 year, although after 2 years there were no other differences between groups. Future research should examine ways to make community health and nutrition programmes more effective at supporting child development.FundingBill & Melinda Gates Foundation.

Epidemiological and demographic profile of patients with Noma in Nigeria, 1999 - 2015

Introduction : noma (Cancrum oris) is a severe acute gangrene of the tissues of the mouth and face that kills or disfigures its victims. Although rarely reported in developed countries, it is prevalent in sub-Saharan Africa. The incidence in Nigeria is estimated at 6.4 per 1000 children. We described the epidemiology and demographic characteristics of Noma surgical patients in Nigeria from 1999 to 2015. Methods : we conducted a retrospective descriptive study using two data sources. We obtained data on Noma surgical patients for 1999-2015 from Noma Children’s Hospital, Sokoto, Nigeria. Variables analyzed were age, sex, nationality, and location of patients. In addition, we reviewed the 2013 Nigeria Demographic and Health Survey to identify demographic characteristics of location of patients. Results : a total of 1,182 Noma surgical patients were reported with a mean age of 22.4 ± 13.4 years. Those of age group 10-14 years were 209 (17.7%) and constituted majority of patients. Males were 670 (56.7%). Nigerians were 1170 (99.0%) out of which 909 (77.0%) came from five states. There is no access to improved drinking water in 78.1% of households in Kebbi. There is no practice of principles of infant and young child feeding in 99% of households in Zamfara. In Sokoto, 78.5% of females six years and above have no education. In Kano, 74.7% of children had not received measles immunization. In Katsina, 80.2% of households do not have soap and water for hand washing. Conclusion : most patients came from five states in Northwest Nigeria. Northwest Nigeria has demographic risk factors that promote Noma. Access to safe drinking water, good child feeding practices, education of people to improve health seeking behavior, supplementary immunization and good oral and general hygiene should be improved in these areas.

Hand hygiene practices among doctors in health facility in a semi-urban setting

INTRODUCTION: Hand hygiene is an integral part of personal hygiene; poor hand hygiene practice may result not only in self-hurt but also may serve as a vehicle for transmission of infection among patients. Hence, knowledge of proper hand hygiene practice will significantly reduce the burden of infectious diseases. MATERIALS AND METHODS: This was a cross-sectional study involving doctors at Federal Medical Centre Birnin Kebbi; it was conducted from September 2015 to November 2015. Convenience sampling method was adopted. Pretested self-administered questionnaire based was used; relevant information such as age, sex, profession, years of working experience, awareness of Global HandWashing Day, hand-washing technique, steps in hand washing, ability to list the five moments in hand washing, and principles of hand washing were obtained. RESULTS: There were 33 males and 12 females with a male to female ratio of 2.8:1. All respondents believed hand washing reduces the risk of transmitting or contracting infections. Soap and water was the most common agent for hand cleansing, majority of the respondents (86.7%) had been taught on the technique of hand washing; however, only 19 (42.2%) of them wash their hands before examining patients; but all the respondents (100%) wash their hands after examining patient or handling their secretions; similarly, they all reported washing their hands after using the restroom. Almost all of the respondents (97.8%) use water and soap for hand washing. Furthermore, only 44.4% of the respondents had their personal hand rub. CONCLUSION: Soap and water was the most common agent for hand cleansing, and there was poor utilization of hand rub; and most respondents did not wash their hands before patient contact.

The Investigation of Finger Contamination after Wiping off the Hand Wash Water Drops on a Washbasin

The Investigation of Finger Contamination after Wiping off the Hand Wash Water Drops on a Washbasin

Cost analysis of the implementation of portable handwashing and drinking water stations in rural Kenyan health facilities

Abstract Many health care facilities (HCFs) in developing countries lack adequate infrastructure for handwashing and drinking water, increasing the risk of healthcare-associated infections. Attaining permanent, 24-hour/day piped water access – the long-term goal – is time-consuming and expensive. To address this problem in the short- to medium-term, low-cost portable handwashing water stations (HWSs) and drinking water stations (DWSs) were installed in rural Kenyan HCFs in 2011. Access to HWSs with soap and DWSs with safe water was ascertained at baseline and 1-year follow-up. Cost data were obtained from the program budget and beneficiary data (number of health workers, households, and individuals within HCF catchment areas) from the Ministry of Health. A cost analysis was adjusted for incremental gains from baseline to follow-up in access to improved handwashing and safe DWSs. The cost of improved access to handwashing with soap was $1,527/HCF, $217/health worker, and $0.17/individual, and to safe drinking water was $720/HCF, $103/health worker, and $0.08/individual. The favorable cost of this intervention per beneficiary justifies its use for rapid improvement of handwashing and drinking water access in HCFs during planning and construction of permanent infrastructure.

Water, Sanitation, and Hygiene in Rural Health-Care Facilities: A Cross-Sectional Study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.

Safe and sufficient water, sanitation, and hygiene (WaSH) prevent the spread of disease in health-care facilities (HCFs). Little research has been conducted on WaSH in HCF in sub-Saharan Africa. We carried out a cross-sectional study of WaSH in 1,318 randomly selected rural HCF (hospitals, health centers, health posts, and clinics) in regions throughout Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Methods included questionnaires with head doctors and nurses to document WaSH access, continuity, quality, quantity and reliability, and analysis of drinking water samples for Escherichia coli. We found that fewer than 50% of rural HCFs had access to improved water sources on premises, improved sanitation, and consistent access to water and soap for handwashing (Ethiopia [7%), Kenya [30%], Mozambique [29%], Rwanda [50%], Uganda [30%], and Zambia [21%]). Adequate hand hygiene reduces disease transmission and health-care-acquired infections, but fewer than 25% of HCF in each country reported that a combination of water, soap, and hand-drying materials were always available. Our research points to a lack of basic WaSH services in rural HCFs in regions of sub-Saharan Africa, which poses a threat to the health of patients and health-care workers in these settings.

Assessment of knowledge, attitude and practices of personal and oral hygiene among undergraduate university students in Sulaimani city

Poor hygiene performance and insufficient sanitary conditions assume real parts in the expanded weight of communicable diseases inside developing nations. Lack of resources such as hand washing materials, water and sanitation facilities may be essential factors why students do not wash their hands, also struggling of affordable toothpaste and absence of awareness regarding oral hygiene may be affected by improper cleaning teeth and tongue. This study was carried out to assess the knowledge, attitude and practices (KAP) of personal and oral hygiene among undergraduate university students in Sulaimani city /Iraq and evaluated the degree to which appropriate information of hygiene was related with individual hygiene character. This cross-sectional study was carried out among 1055 undergraduate students who were met via trained staff. Data comprised of cleanliness and hand washing practices, learning about sanitation, individual cleanliness qualities, nearness of gastrointestinal parasitic disease, oral and dental diseases including dental decay and bad breathes. University students with satisfactory information of legitimate personal and oral hygiene probably had clean clothes 68.8% (P value &lt; 0.05), clean hair 72% (0.0001 P value), fingernail trimmed 139% (P value&gt; 0.05), clean teeth 59.4% (P value &lt;0.05), good mouth breath 57% (P value &lt;0.05). Approximately 57.2% of students were delegated having sufficient information of legitimate cleanliness (P value &lt;0.05). Most students preferred hand washing after defecation (96.5%) (P value &lt;0.05), while 93.8% revealed utilizing shampoo. On the other hand 62.7% of contributors reported brushing their teeth before going to sleep (P value &lt;0.05) and 74% of participants revealed cleaning their tongue sometimes (P value&lt; 0.01). this study discovered underscore the requirement for more cleanliness training in universities; and give target confirm that may direct the improvement of far reaching personal, oral hygiene and health mediation programs in Sulaimani universities. Furthermore the effective usage of this study is probably going to significantly weaken the transmissible diseases.

Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.

Adequate access to water, sanitation, and hygiene (WaSH) in schools impacts health, educational outcomes, and gender disparities. Little multi-country research has been published on WaSH in rural schools in Sub-Saharan Africa. In this multi-national cross-sectional WaSH study, we document WaSH access, continuity, quality, quantity, and reliability in 2270 schools that were randomly sampled in rural regions of six Sub-Saharan African countries: Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Data collection included: school WaSH surveys containing internationally established WaSH indicators, direct observation, and field- and laboratory-based microbiological water quality testing. We found 1% of rural schools in Ethiopia and Mozambique to 23% of rural schools in Rwanda had improved water sources on premises, improved sanitation, and water and soap for handwashing. Fewer than 23% of rural schools in the six countries studied met the World Health Organization's recommended student-to-latrine ratios for boys and for girls. Fewer than 20% were observed to have at least four of five recommended menstrual hygiene services (separate-sex latrines with doors and locks, water for use, waste bin). The low access to safe and adequate WaSH services in rural schools suggest opportunities for WaSH interventions that could have substantive impact on health, education, and gender disparities.

Prevalence of Soil-Transmitted Helminthiases and Schistosomiasis in Preschool Age Children in Mwea Division, Kirinyaga South District, Kirinyaga County, and Their Potential Effect on Physical Growth.

Intestinal parasitic infections can significantly contribute to the burden of disease, may cause nutritional and energetic stress, and negatively impact the quality of life in low income countries of the world. This cross-sectional study done in Mwea irrigation scheme, in Kirinyaga, central Kenya, assessed the public health significance of soil-transmitted helminthiases (STH), schistosomiasis, and other intestinal parasitic infections, among 361 preschool age children (PSAC) through fecal examination, by measuring anthropometric indices, and through their parents/guardians, by obtaining sociodemographic information. Both intestinal helminth and protozoan infections were detected, and, among the soil-transmitted helminth parasites, there were Ascaris lumbricoides (prevalence, 3%), Ancylostoma duodenale (<1%), and Trichuris trichiura (<1%). Other intestinal helminths were Hymenolepis nana (prevalence, 3.6%) and Enterobius vermicularis (<1%). Schistosoma mansoni occurred at a prevalence of 5.5%. Interestingly, the protozoan, Giardia lamblia (prevalence, 14.7%), was the most common among the PSAC. Other protozoans were Entamoeba coli (3.9%) and Entamoeba histolytica (<1). Anthropometric indices showed evidence of malnutrition. Intestinal parasites were associated with hand washing behavior, family size, water purification, and home location. These findings suggest that G. lamblia infection and malnutrition may be significant causes of ill health among the PSAC in Mwea, and, therefore, an intervention plan is needed.

English

This study was carried out to determine the magnitude to which Community Led Total Sanitation (CLTS) approach leads to improved sanitation and its potential threats to groundwater quality and health of people. A comparative study was carried out between eight CLTS and non CLTS villages to measure the outcomes of CLTS approach. Water samples were collected to assess the level of contamination in groundwater sources near pits in villages where CLTS approach was adopted. Semi structured interviews, focused group discussions (FGDs) and transit walks were used for data collection. Results revealed the tendency of high level of groundwater contamination in CLTS as compared to non CLTS villages which might be because of pit latrines in the area. Water for hand washing is available, but the use of soap depends upon the economic status of the households. However, 5% increase in the hand washing practices was noticed during the field data collected in CLTS implemented village as compared to non CLTS villages. In addition, water borne disease prevalence was also noticed in CLTS villages, but some improvements were observed in terms of hygiene among the people in CLTS implemented villages. The findings showed that the drinking water quality is deteriorated in the study areas which could be linked to promotion of sanitation systems that do not break the pathogen cycle. Key words: Community Led Total Sanitation (CLTS) villages, groundwater contamination, Environmental sanitation, health, hygiene.