Water, Sanitation And Hygiene Coverage Research Articles

Tracking water, sanitation, and hygiene (WASH) indicators in tribal districts of India: a secondary data analysis through 2015–2020

Abstract Under Sustainable Development Goal targets 6.1 and 6.2, every nation is committed to ensure universal and equitable access to water and sanitation to its people and India is no exception. The country has made a considerable progress toward these targets through various policy and programmatic initiatives since 2015. Within an overall improvement at the country level, this paper examines the coverage of key WASH indicators in tribal population of the country. Secondary data pertaining to the WASH indicators were obtained from the NFHS 2015–2016 and NFHS 2019–2021 for 90 tribal-dominated districts of the country and were analyzed. We ranked these tribal districts on the basis of their performance. The analysis showed a distinct improvement in terms of marked fall in open defecation, uptake of improved toilet facilities, accessibility to improved sources of water, and improved behaviors in relation to the handwashing and treatment of drinking water in tribal population with varying levels of coverage, which was captured in WASH ranking of these districts. The districts falling toward the bottom side of the ranking ladder need prioritization and entail more attention of programmatic interventions in order to sustain the overall progress and to reach the SDG targets of 100% WASH coverage.

The status of water access, sanitation, and hygiene in schools: A cross sectional survey to identify capacities and assess coverage in Garoua, North Cameroon

There has been an increasing global interest in understanding, documenting, and monitoring water, sanitation, and hygiene (WASH) services in schools. This study is the first to identify existing WASH-in-school capacities and understand the magnitude of the gaps in WASH coverage in schools in the Northern Cameroon, a region of the country marked by recurrent sanitary emergencies, the highest prevalence of acute malnutrition, and representing the largest and heaviest focus of food and water insecurity. Using a cross-sectional design, relevant authorities of 176 schools in Garoua, were interviewed. The survey guide included core questions for monitoring WASH in schools from recommended guidelines. Eleven indicators-related variables were extracted from data to calculate the WASH-in-school indicators composite score, which could be used as a more reliable and useful tool for comparison across settings and can contribute to harmonize data with WASH in schools related indicators applied in national surveys. The results of this research showed suboptimal drinking water supply systems and sanitation facilities whereas most schools had hand washing points available. However, activities that aimed to promote and sustain a WASH positive environment among children still need to be put in place. The WASH-in-school indicators composite score predictive value corroborated the disparities related to WASH access in schools located in Garoua. This score hence provides an assessment of the spatial dimensions of reduced access to water in schools, improper hygiene practices, and inadequate sanitation facilities. Such a score could be used to identify hotspots lacking WASH infrastructural facilities and strategize optimal interventions to reduce the incidence of WASH related diseases in schools.

Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya's new 2022-2030 cholera elimination plan.

Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.

Factors influencing access to basic water, sanitation, and hygiene (WASH) services in schools of Bishoftu Town, Ethiopia: a cross-sectional study

Access to basic water, sanitation and hygiene services is the most effective mechanism to reduce many infectious diseases. WASH in schools related to better educational outcomes although adequate water, sanitation, and hygiene services were unavailable to millions of school-age children in Ethiopia. Therefore, it is crucial to assess the level of WASH coverage and identify factors affecting access to basic water, sanitation, and hygiene services. A cross-sectional study was carried out among 82 school facilities. A structured questionnaire and an observational checklist were used to gather the data. Water samples were taken from the schools' water storage. Descriptive and multivariable logistic regression analyses were used to analyze the data. In this study, 74.7%, 61. 3% and 37.3% of the schools had access to basic drinking water, sanitation, and hygiene services, respectively. Additionally, 21.3%, 29.4%, and 30.7% of the schools had access to limited drinking water, sanitation, and hygiene services, respectively. However, 4%, 9.3%, and 32% of the schools lacked water, sanitation, and hygiene services, respectively. We discovered that schools with male heads were 7% less likely to have access to basic hygiene services (AOR = 0.07 with 95% CI 0.01–0.5) than those with female directors. In addition, schools with hygiene and environmental health clubs had an 11.8-fold higher access rate to basic hygiene services (AOR = 11.8 with 95% CI 1.35–104) than schools without such clubs. Besides, schools that conduct WASH lessons at least once a week were 8.63 times more likely to use basic hygiene services (AOR = 8.63; 95% CI 1.18–63.22) than schools that did not. This study offers scientific evidence that could be used for sound decisions to fill the school WASH gaps. This is a unique study in determining the level of WASH coverage and identifying factors affecting access to basic hygiene services. The investigation provides some insights into how access to WASH services can be improved at the grassroots level. Federal and regional governments should implement effective interventions that assist schools to attain Sustainable Development Goal 6 by 2030. School administrators and other partner organizations should take proactive measures to enhance and maintain the WASH services.

The Status of School Water, Sanitation, and Hygiene Services in Addis Ababa, Ethiopia: Progress Towards Achieving the SDG 6.

The provision of safe water, sanitation, and hygiene (WASH) facilities and services for schools is vital to students' health, development, and educational performance. However, school WASH coverage in developing countries remains low. This study aimed to assess the adequacy of WASH services in Addis Ababa, Ethiopia. A school-based quantitative cross-sectional study was conducted from January to March 2020 in 98 schools. A multistage sampling technique was used to select schools included in the study. Data were collected using observational checklists and pretested interviewer-administered questionnaires. We entered the data into EPI Info version 7.2.2.6 and analyzed using SPSS 22.0. Logistic regression was used to examine the associated factors with school WASH services. The basic school water, sanitation, and hygiene services were found to be 65.3%, 31.6%, and 36.7%, respectively. The facility-to-student ratio was 1:48 for drinking water point, 1:59 for toilet stance, and 1:147 for handwashing point. The analysis of facilities access by sex revealed that the toilet to student ratio was 1:68 for females and 1:49 for males, whereas the handwashing point-to-student ratio was 1:179 for females and 1:114 for males, indicating disparities in facilities access by sex. The non-functionality rates for drinking water, toilets, and handwashing facilities were 22.5%, 8%, and 19.5%, respectively. School ownership was significantly associated with the availability of basic water services [COR = 4.6, 95% CI: 1.466-14.426] and basic sanitation services [COR = 15, 95% CI: 3.27-68.28]. Moreover, the results demonstrate training on WASH [COR = 5, 95% CI: 1.087-23.018] and teaching programs on WASH [COR = 0.21, 95% CI: 0.056-0.810] were significantly associated with basic hygiene services. The provision of WASH facilities and services in schools was inadequate and not on track to meet the targets of SDG 6. Training, WASH education program, and stakeholder commitment and cooperation at all levels are required to achieve the goal.

Water, sanitation, and hygiene (WASH) coverage and practices of children from five public primary schools in Guinea

Abstract The water, sanitation, and hygiene (WASH) coverage and practices in and out of primary schools are crucial to the well-being of children. Using a questionnaire analysis method, this study focuses on the WASH coverage and practices of children from five public primary schools in the city of N'Zerekore, the second-largest city in Guinea. Our results reveal that the WASH coverage and practices in all five schools are inadequate. Our data indicated that 100% (n=1,048) of pupils don't wash their hands with soap after defecation in school, and over 87.9% (n=922) of students do not wash their hands before eating. The poor WASH coverage, inadequate hygiene practices, and other activities and/or causes result in a higher incidence of diseases among children, such as malaria, typhoid, and diarrhea. Some effective interventions, including the provision of clean water, sanitation and hygiene infrastructure, and widespread and effective health education, should be implemented to address these health issues among young African students.

Neighbors’ use of water and sanitation facilities can affect children’s health: a cohort study in Mozambique using a spatial approach

BackgroundImpact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection – community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children’s morbidity and mortality using recorded health data.MethodsWe conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012–2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality.ResultsHousehold use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition.ConclusionHousehold and neighbors’ access to improve water and sanitation can affect children’s health. Accounting for household WASH and herd protection in interventions’ evaluation could foster stakeholders’ investment and improve WASH related diseases control.Graphical Distribution of main water and sanitation facilities used during study period.

Prevalence of Trachoma from 66 Impact Surveys in 52 Woredas of Southern Nations, Nationalities and Peoples’ and Sidama Regions of Ethiopia, 2017–2019

ABSTRACT Purpose Trachoma is endemic in Southern Nations, Nationalities and Peoples’ (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation—follicular (TF) among children aged 1 – 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions. Methods From 2017 – 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children’s Fund/WHO Joint Monitoring Programme questionnaire. Results By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 – 6-year-olds and 7 – 9-year-olds than 1 – 3-year-olds. Conclusion Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required.

Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India.

BackgroundThe Sustainable Development Goals identified universal access to water and sanitation facilities as key components for improving health. We assessed water, sanitation, and hygiene (WASH) practices and associated determinants among residents of urban slums in Kolkata, India.MethodsInformation on WASH practices was collected in 2 surveys (2018 and 2019) from participants of a prospective enteric fever surveillance conducted in 2 municipal wards of Kolkata. A composite WASH practice score was computed and a hierarchical stepwise multiple linear regression model constructed to identify key determinants of improved WASH score.ResultsOver 90% of households had access to piped water; 6% reported access to continuous supply. Adult women (61% in 2018; 45% in 2019) spent 20 minutes daily to fetch water. Access to improved latrines was almost universal, although 80% used shared facilities. Unhealthy disposal of children’s stools was reported in both rounds. Food hygiene practices were high, with most (>90%) washing uncooked items before eating; frequent consumption of street food items was reported.ConclusionsThe study area reported high WASH coverage. Unhygienic behavioral patterns predisposing to food- or water-borne diseases were also noted. Awareness building and sustainable community mobilization for food hygiene needs to be emphasized to ensure community well-being.

Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia.

Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0-5 months. In children aged 6-59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting.

Drinking water, sanitation, and hygiene (WASH) situation in primary schools of Pakistan: the impact of WASH-related interventions and policy on children school performance.

The United Nation's Sustainable Development Goals include the target of ensuring access to water and sanitation and hygiene (WASH) for all; however, very few studies have assessed comprehensive school WASH service in Pakistan. The purpose of this study was to identify WASH services in primary schools of Pakistan, and to assess how recent WASH interventions and policies are associated with the school's academic performance. A representative cross-sectional study was conducted in primary schools in the Sindh province of Pakistan. Structured observations and interviews were done to ascertain the schools' WASH conditions. The primary exposures of interest were the implementation of previous WASH interventions and National WASH policy in the school and the WASH coverage. Outcomes of interest included WASH conditions and school performance. The structural equation modeling (SEM) using a bootstrap resampling procedure was employed to characterize how WASH exposures were associated with WASH conditions and school performance. Data were collected from 425 schools. The Basic WASH facilities coverage in the primary schools of Sindh remains overall low according to WHO WASH service ladder criteria. Also, inconsistency in all three inclusive domains of WASH (availability, accessibility, and functionality) facilities were found. The school performance was significantly associated (P<0.001) with the presence of WASH interventions and/or WASH policy, while WASH policy and/or recent WASH intervention at the school were not associated with overall water quality. Our assessment unveiled several WASH gaps that exist, including high heavy metal and fecal contamination. Adoption of national WASH policy and financing of evidence-based WASH interventions are recommended in primary schools to improve educational outcomes.

Water sanitation and hygiene in Sub-Saharan Africa: Coverage, risks of diarrheal diseases, and urbanization

Sub-Saharan Africa (SSA) has a rapidly growing urban population, with water, sanitation, and hygiene (WASH) services representing the central needs for this population. Incidentally, this region has the lowest global WASH coverage. Data from the ‘WHO/UNICEF Joint Monitoring Programme for Water supply, Sanitation and Hygiene’ and the ‘Global Burden of Disease’ study from the Institute for Health Metrics and Evaluation were used to assess WASH coverage and related health burden in SSA, its subregions, and rural and urban areas in SSA. WASH coverage in the SSA region appears to be low, but urban coverage is better than that in rural areas; however, there is unequal access to urban WASH and poor urban areas are underserved. In addition, 7.75% (5.99–9.7%) of total deaths due to diarrheal diseases across SSA are attributed to unsafe WASH with a risk factor attribution (RFA) percentage of 95.93% (91.94–98.24%). Therefore, a correlation between WASH coverage and mortality due to diarrheal diseases could be established.There is a lack of data on WASH coverage in poor urban areas, although these areas have high incidence of WASH-related diseases including diarrhea. Disaggregated urban WASH data are needed to better understand the WASH service needs of poor urban areas, which would be helpful in ensuring a more inclusive implementation of WASH services.

Using the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) in Zimbabwe: A Cross-Sectional Study of Water, Sanitation and Hygiene Services in 50 COVID-19 Isolation Facilities.

The availability of water, sanitation and hygiene (WASH) services is a key prerequisite for quality care and infection prevention and control in health care facilities (HCFs). In 2020, the COVID-19 pandemic highlighted the importance and urgency of enhancing WASH coverage to reduce the risk of COVID-19 transmission and other healthcare-associated infections. As a part of COVID-19 preparedness and response interventions, the Government of Zimbabwe, the United Nations Children’s Fund (UNICEF), and civil society organizations conducted WASH assessments in 50 HCFs designated as COVID-19 isolation facilities. Assessments were based on the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a multi-step framework to inform the continuous monitoring and improvement of WASH services. The WASH FIT assessments revealed that one in four HCFs did not have adequate services across the domains of water, sanitation, health care waste, hand hygiene, facility environment, cleanliness and disinfection, and management. The sanitation domain had the largest proportion of health care facilities with poor service coverage (42%). Some of the recommendations from this assessment include the provision of sufficient water for all users, Menstrual Hygiene Management (MHM)- and disability-friendly sanitation facilities, handwashing facilities, waste collection services, energy for incineration or waste treatment facilities, cleaning supplies, and financial resources for HCFs. WASH FIT may be a useful tool to inform WASH interventions during the COVID-19 pandemic and beyond.

Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda

BackgroundImproved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.MethodsA cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software.ResultsOverall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).ConclusionsOur findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Can Existing Improvements of Water, Sanitation, and Hygiene (WASH) in Urban Slums Reduce the Burden of Typhoid Fever in These Settings?

Sustained investments in water, sanitation, and hygiene (WASH) have lagged in resource-poor settings; incremental WASH improvements may, nonetheless, prevent diseases such as typhoid in disease-endemic populations. Using prospective data from a large cohort in urban Kolkata, India, we evaluated whether baseline WASH variables predicted typhoid risk in a training subpopulation (n = 28 470). We applied a machine learning algorithm to the training subset to create a composite, dichotomous (good, not good) WASH variable based on 4 variables, and evaluated sensitivity and specificity of this variable in a validation subset (n = 28 470). We evaluated in Cox regression models whether residents of "good" WASH households experienced a lower typhoid risk after controlling for potential confounders. We constructed virtual clusters (radius 50 m) surrounding each household to evaluate whether a prevalence of good WASH practices modified the typhoid risk in central household members. Good WASH practices were associated with protection in analyses of all households (hazard ratio [HR] = 0.57; 95% confidence interval [CI], .37-.90; P = .015). This protection was evident in persons ≥5 years old at baseline (HR = 0.47; 95% CI, .34-.93; P = .005) and was suggestive, though not statistically significant, in younger age groups (HR = 0.61; 95% CI, .27-1.38; P = .235). The level of surrounding household good WASH coverage was also associated with protection (HR = 0.988; 95% CI, .979-.996; P = .004, for each percent coverage increase). However, collinearity between household WASH and WASH coverage prevented an assessment of their independent predictive contributions. In this typhoid-endemic setting, natural variation in household WASH was associated with typhoid risk. If replicated elsewhere, these findings suggest that WASH improvements may enhance typhoid control, short of major infrastructural investments.

Evaluation of an Inexpensive Handwashing and Water Treatment Program in Rural Health Care Facilities in Three Districts in Tanzania, 2017

Unsafe water, sanitation, and hygiene (WASH) conditions in healthcare facilities (HCFs) can increase the risk of disease transmission, yet WASH coverage is inadequate in HCFs in most low- and middle-income countries. In September 2017, we conducted a baseline survey of WASH coverage in 100 HCFs in three rural Tanzanian districts. Based on needs calculated from the baseline, we distributed handwashing and drinking water stations, soap, and chlorine solution; we repeated the survey 10 months later. The intervention improved coverage with handwashing stations (82% vs. 100%, p &lt; 0.0001), handwashing stations with water (59% vs. 96%, p &lt; 0.0001), handwashing stations with soap and water (19% vs. 46%, p &lt; 0.0001), and handwashing stations with soap and water within 5 m of latrines (26% vs. 53%, p &lt; 0.0001). Coverage of drinking water stations increased from 34% to 100% (p &lt; 0.0001) HCFs with at least one drinking water station with free chlorine residual (FCR) &gt; 0.2mg/ml increased from 6% to 36% (p &lt; 0.0001), and in a sample of HCFs, detectable E. coli in stored drinking water samples decreased from 46% to 5% (p &lt; 0.001). Although the program increased access to handwashing stations, drinking water stations, and safe drinking water in HCFs in rural Tanzania, modest increases in soap availability and water treatment highlighted persistent challenges.

Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries.

Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity—if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups—we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention.

Associations between Water, Sanitation and Hygiene (WASH) and trachoma clustering at aggregate spatial scales, Amhara, Ethiopia

BackgroundTrachoma is the leading infectious cause of blindness globally. The WHO has recommended the SAFE (Surgery, Antibiotics, Facial cleanliness and Environmental improvements) strategy to eliminate trachoma as a public health problem. The F and E arms of the strategy will likely be important for sustained disease reductions, yet more evidence is needed detailing relationships between hygiene, sanitation and trachoma in areas with differing endemicity. This study addressed whether the regional differences in water, sanitation, and hygiene (WASH) variables were associated with the spatial distribution of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years in the Amhara National Regional State of Ethiopia.MethodsData from 152 multi-stage cluster random trachoma surveys were used to understand the degree of clustering of trachoma on two spatial scales (district and village) in Amhara using a geographical information system and the Getis-Ord Gi* (d) statistic for local clustering. Trained and certified graders examined children for the clinical signs of trachoma using the WHO simplified system. Socio-demographic, community, and geoclimatic factors thought to promote the clustering of the disease were included as covariates in a logistic regression model.ResultsThe mean district prevalence of TF among children aged 1 to 9 years in Amhara was 25.1% (standard deviation = 16.2%). The spatial distribution of TF was found to exhibit global spatial dependency with neighboring evaluation units at both district and village level. Specific clusters of high TF were identified at both the district and the village scale of analysis using weighted estimates of the prevalence of the disease. Increased prevalence of children without nasal and ocular discharge as well as increased prevalence of households with access to a water source within 30 minutes were statistically significantly negatively associated with clusters of high TF prevalence.ConclusionsWater access and facial cleanliness were important factors in the clustering of trachoma within this hyperendemic region. Intensified promotion of structural and behavioral interventions to increase WASH coverage may be necessary to eliminate trachoma as a public health problem in Amhara and perhaps other hyper-endemic settings.

Status of Water, Sanitation and Hygiene Facilities in Public Secondary Schools in Yenagoa, Nigeria

Adequate water, sanitation and hygiene (WASH) services have positive implications on students learning outcomes. Hence, this study assessed the status of WASH services in public secondary schools in Yenagoa. The study adopted a descriptive cross-sectional survey design, which involved direct field observation of WASH facilities and the administration of structured questionnaire to the entire 16 public secondary schools in Yenagoa. However, the analysis involved 15 schools, as one of the schools did not return its questionnaire. Data obtained was analyzed using descriptive statistics and the Joint Monitoring Programme (JMP) classification of WASH services in schools. The results show that WASH services in most of the schools are inadequate and unsatisfactory. Hygiene service was the worst provided WASH services in the schools as only two (13.33%) schools had basic hygiene service, one (6.67%) school had limited hygiene service and 12 (80%) schools had no service. Next was water service where three (20%) schools had basic drinking water service, another three (20%) schools had limited drinking water service and nine (60%) schools had no water service. Although sanitation had the best WASH coverage in the schools, basic sanitation service was only obtainable in seven (46.67%) schools, limited sanitation service in five (33.33%) schools and no service in three (20%) schools. Also, the toilet to students’ ratio ranges from 1:27 to 1:760, which were higher than the WHO recommended average of 1:25 for girls and 1:50 for boys. The study recommends the prioritization of the provision of WASH services in schools.

Geographic Inequalities in Accessing Improved Water and Sanitation Facilities in Nepal.

In this study, we aimed to assess the geographic inequalities in access to improved water and sanitation facilities among Nepalese households. We conducted this study based on cross-sectional data obtained from Nepal Demographic and Health Surveys. The quality of water sources and sanitation were defined by World Health Organization (WHO) guidelines. The geographic categories used in the analyses included developmental region, ecological zone, and urbanicity. Percentages of households having access to improved toilet (5.6% in 1996 vs. 40.5% in 2016) and water (19.3% in 1996 vs. 27% in 2016) facilities has been increasing steadily since 1996 with a great proportion of the households still lacking access to these services. The number of households sharing the same toilet and traveling time to reach water sources have also decreased at the same time. Households in Far Western and Mountains had the lowest odds of having access to improved toilet and water facilities. Noticeable progress has been achieved in improving WASH (water, sanitation, and hygiene) coverage at national level, however, it is uneven across developmental and ecological zones. Households in the Far Western and Mountain regions appeared to be the most geographically disadvantaged in terms of having access to improved water and sanitation facilities.