Water, Sanitation, And Hygiene Facilities Research Articles

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.

Compliance on existing WASH facilities in community clinics of Bangladesh: A comparative study

Provisions of water sanitation and hygiene (WASH) facilities are essential to make accessible and sustainable through Community Clinics (CCs) to control infection in primary health care service. However, there is scarcity of literature to observe the scenario. This cross-sectional study with mix-method approach conducted a comparative analysis with a focus on compliance with WASH facilities between two categories of CCs in Meherpur and Kustia District in Bangladesh. There were total 420 respondents out of which 400 were selected purposively from the 20 renovated and non-renovated CCs for quantitative approach and 20 respondents for qualitative approach. Data were collected using face-to-face interview method. The study revealed that all of the renovated CCs had safe drinking water source, functioning toilet, hand washing and dust bin facilities except for a few cases with technical problem in water supply. But the reverse scenario was observed in non-renovated CCs. Compliance on WASH facilities in renovated CCs was two times higher than the non-renovated CCs. Clients aged ≤40 years (AOR = 0.41, renovated CCs), and married (AOR = 4.03, non-renovated CCs) did not comply the use of safe drinking water in CCs. Noncompliance of toilet use (AOR = 12.15, renovated CCs and AOR = 8.96, non-renovated CCs) and hand washing facility use (AOR = 8.46, renovated CCs and AOR = 16.8, non-renovated CCs) significantly found higher among respondents who had no formal education. Non-renovated CCs need to develop their WASH facilities as well as ensure maintenance whereas the renovated CCs need dedicated human resource as well as effective policies to maintain the sustainability.

COVID-19 pandemic in Africa: Is it time for water, sanitation and hygiene to climb up the ladder of global priorities?

In the current pandemic context, it is necessary to remember the lessons learned from previous outbreaks in Africa, where the incidence of other diseases could rise if most resources are directed to tackle the emergency. Improving the access to water, sanitation and hygiene (WASH) could be a win-win strategy, because the lack of these services not only hampers the implementation of preventive measures against SARS-CoV-2 (e.g. proper handwashing), but it is also connected to high mortality diseases (for example, diarrhoea and lower respiratory infections (LRI)). This study aims to build on the evidence-based link between other LRI and WASH as a proxy for exploring the potential vulnerability of African countries to COVID-19, as well as the role of other socioeconomic variables such as financial sources or demographic factors. The selected methodology combines several machine learning techniques to single out the most representative variables for the analysis, classify the countries according to their capacity to tackle public health emergencies and identify behavioural patterns for each group. Besides, conditional dependences between variables are inferred through a Bayesian network. Results show a strong relationship between low access to WASH services and high LRI mortality rates, and that migrant remittances could significantly improve the access to healthcare and WASH services. However, the role of Official Development Assistance (ODA) in enhancing WASH facilities in the most vulnerable countries cannot be disregarded, but it is unevenly distributed: for each 50–100 US$ of ODA per capita, the probability of directing more than 3 US$ to WASH ranges between 48% (Western Africa) and 8% (Central Africa).

Evaluation of Household Water, Sanitation, and Hygiene Management in a Nigerian Rural Community

The Water, Sanitation, and Hygiene (WASH) disparities between the rural and urban areas have hindered the Sustainable Development Goal 6. Recent data is required in our bid to tackle this menace effectively. This study aimed to provide data on the status of household WASH facilities in a remote village in Southwestern Nigeria. The survey was cross-sectional in design, and total sampling was used to select 70 household respondents. Data were obtained via observational checklists, questionnaire, and key informant interview guide. Data was entered and analyzed using SPSS 20. Descriptive statistics like measures of frequency and proportions were used. The respondents had a mean age of 43.1 ± 16.4 years, only 2.9% had tertiary education. The village had two handpump boreholes provided by the Water Supply and Sanitation Sector Reform Programme (WSSSRP)-II. All the respondents reported that the boreholes were their primary drinking water source, and water was available all through the year. In over 80% of households, females were assigned the duty to fetch water, while most households had the boreholes within 30 minutes from their houses. The sanitation facilities were also provided via the WSSSRP-II. The majority (90%) of the respondents owned pit latrine with slab, of which only 10% shared their facilities with other households. Most (95.7%) of the respondents still practised open defecation at instances they could not access their household latrines. All the toilets had water for handwashing, and the soap commonly used by community members was palm kernel ash. The condition of water and sanitation in the village was quite progressive. However, subsequent interventions should ensure toilet facilities are available in non-household settings like farms and markets.

Evaluation of water, sanitation and hygiene status of COVID-19 healthcare facilities in Ghana using the WASH FIT approach

Abstract Access to improved water, sanitation and hygiene (WASH) is essential for the delivery of high-quality care in healthcare facilities and the prevention of hospital-acquired infections such as the transmission of the SARS-CoV-2. In addition, unimpeded access to WASH facilities in coronavirus disease 2019 (COVID-19) treatment centres (TCs) is central in facilitating compliance with infection prevention and control protocols. However, data for the WASH status of COVID-19 TCs in Ghana are limited. We evaluated the WASH status of seven COVID-19 TCs in Ghana using the WHO/UNICEF water and sanitation for health facility improvement tool (WASH FIT). The water domain had the highest number of indicators meeting standards with an average percentage score of 90.5% (range: 66.7–100%) across the seven TCs, followed by management (66.9%) and hygiene (58.7%). The TCs performed poorly in the sanitation and healthcare waste domain, with an average percentage score of 44.6% (range: 22.2–75%). These findings highlight the challenges being faced by COVID-19 TCs in implementing WASH services. Specific WASH interventions are urgently required to strengthen WASH services in the COVID-19 TCs. This should precede the prioritisation of resources to WASH infrastructure in the treatment facilities coupled with actions that involve all stakeholders.

Water, Sanitation and Hygiene Resources Available at Higher Education Institutes of Sindh and Students’ Satisfaction

Mehran University Research Journal of Engineering and Technology Vol. 40, No. 2, 383 - 391, April 2021 p-ISSN: 0254-7821, e-ISSN: 2413-7219 DOI: 10.22581/muet1982.2102.12 This is an open access article published by Mehran University of Engineering and Technology, Jamshoro under CC BY 4.0 International License. 383 Water, Sanitation and Hygiene Resources Available at Higher Education Institutes of Sindh and Students’ Satisfaction Ubed Ur Rehman1a, Jamil Ahmed1b, Rasool Bux Maher1c, Aneela Yasmeen2RECEIVED ON 13.02.2019, ACCEPTED ON 03.05.2019 ABSTRACT The present study was focused on the available Water, Sanitation and Hygiene (WASH) facilities and students’ satisfaction in three public and two private Higher Education Institutes (HEIs) of Hyderabad and Jamshoro city. This cross-sectional study recorded WASH facilities in 21 departments of 5-HEIs and satisfaction appraisal of 630 students in total. The survey was also supplemented with quality analysis of Point of Use (PoU) drinking water. The results revealed that the overall 85.7 and 47.6% contamination of the drinking water samples were recorded due to total and thermo-tolerant coliforms, respectively. Further, physiochemical parameters were found in the permissible limits as provided by the World Health Organization (WHO) and arsenic was not detected in any of the water samples. In total 25% of the toilet facilities were found non-functional. All monitored HEIs were found having sufficient quantity of water however, 95% hand-washing stations did not supply soap/ detergent for hand-washing. Moreover, this study divulges that there is a significant relationship between WASH facilities like water quality (χ2= 7.55*; p=0.023), toilets functioning (χ2= 45.39**; p=0.002), and washing facilities (χ2= 37.29**; p=0.000) in HEIs and student’s satisfaction in HEIs. Thus, it can be concluded that the poor WASH facilities in HEIs could affect the students’ satisfaction leading to affect their performance in the studies, negatively.

Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox\u2019s bazar, Bangladesh

BackgroundThere is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB.MethodsThe qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces).ResultsKey findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement.ConclusionsAlthough the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.

Comparative Analysis of WASH Services between the Rich and Poor in Sub-Saharan Africa

Achieving the Sustainable Development Goal (SDG) 6 would mean that all people the world over would have access to basic drinking water, sanitation and hygiene (WASH) services. This study analyzed WASH services between the poorest and richest quintile in sub-Saharan Africa (SSA). The descriptive cross sectional design was adopted. Data for the study were extracted from the 2019 Joint Monitoring Programme (JMP) report, which contained disaggregated data on wealth quintiles. The data obtained were analyzed with tables, percentages and t-test. The findings revealed that WASH amenities in SSA were generally poor, especially with the poorest quintile, which was disproportionately disadvantaged. The t-test indicated a significant difference in the provision of WASH services between both quintiles in SSA, as the calculated t-test values for water and sanitation services of 18.772 and 15.317, respectively were higher than the table value of 2.021 at an alpha level of 0.05; while the calculated t-test value (10) for hygiene services was higher than the table value of 2.042 at 0.05 alpha level. Considering the state of WASH facilities, SSA would miss the SDG 6, unless concerted efforts are made to address the myriad of challenges confronting the provisions of WASH services in SSA. The study therefore made recommendations to address the challenges.

Protocol for a Trial Assessing the Impacts of School-Based WaSH Interventions on Children's Health Literacy, Handwashing, and Nutrition Status in Low- and Middle-Income Countries.

Diarrhea, soil-transmitted helminth infection and malnutrition are leading causes of child mortality in low- and middle-income countries (LMICs). To reduce the prevalence of these diseases, effective interventions for adequate water, sanitation, and hygiene (WaSH) should be implemented. This paper describes the design of a cluster-randomized controlled trial that will compare the efficacy of four school-based WaSH interventions for improving children’s health literacy, handwashing, and nutrition. Interventions consisted of (1) WaSH policy reinforcement; (2) low-, medium-, or high-volume health education; (3) hygiene supplies; and (4) WaSH facilities (e.g., toilets, urinals, handwashing basins) improvements. We randomly allocated school clusters from the intervention arm to one of four groups to compare with schools from the control arm. Primary outcomes were: children’s health literacy, physical growth, nutrition status, and handwashing prevalence. Secondary outcomes were: children’s self-reported health status and history of extreme hunger, satisfaction with WaSH facilities, and school restrooms’ WaSH adequacy. We will measure differences in pre- and post-intervention outcomes and compare these differences between control and intervention arms. This research protocol can be a blueprint for future school-based WaSH intervention studies to be conducted in LMICs. Study protocols were approved by the ethics committees of the University of Bonn, Germany, and the University of the Philippines Manila. This trial was retroactively registered, ID number: DRKS00021623.

Household levels of deprivation to WaSH and residential conditions in slum settlements of Lagos, Nigeria

Abstract Household levels of deprivation to water, sanitation, and hygiene (WaSH) and residential conditions in slum settlements of Lagos, Nigeria were assessed and mapped using slum deprivation index (SDI). A structured questionnaire was administered to 1,398 households in 16 settlements using a random sampling method. Descriptive statistics and SDI were employed to analyze the data while ArcMap was used to map the patterns of SDI. The results show that households live in poor dwelling conditions with limited access to WaSH facilities. The SDI indicates that 18.7% of the slums are highly deprived. Based on WaSH and dwelling and physical environment (DPE) components, 18.75 and 31.25% of the slums are highly deprived. Water, sanitation, and hygiene indicators show that 37.5, 12.5, and 56.25% of the slums are highly deprived respectively. About 50, 37.5, 43.75, and 31.25% of the slum are highly deprived based on dwelling, waste disposal, waste pile, and stagnant water respectively. The study concluded that six settlements live in deplorable WaSH and DPE conditions. The study recommends urgent intervention for planning and resources allocation, and sustained urban renewal programs at Oko-Baba, Ilaje, Oko-Agbon, Abule-Nla, and Badia for improved WaSH and living conditions for sustainable service delivery and healthy slum settlements.

Monitoring schistosomiasis and sanitation interventions—The potential of environmental DNA

AbstractTransmission of schistosomiasis, a human parasitic disease, is intrinsically linked to inadequate water, sanitation, and hygiene (WASH) facilities and/or their use. The mainstay of control is population‐based chemotherapy. Globally, each year, 240 million people are estimated to require this preventative treatment. However, for long‐term, sustainable control of this disease, supplementary WASH improvements are required to prevent (re)infection of humans (provision of safe water) and transmission from humans to the environment (improved sanitation). While there is established methodology for monitoring transmission in human populations, presently methods for monitoring the impact of WASH interventions, in particular sanitation, on environmental transmission are lacking. Development of such becomes paramount as integrated control programs combine drug treatments with enhanced WASH facilities and behavior change interventions, with uptake likely correlated to a reduction in fecal matter, and schistosome eggs, in the environment but any impact on infection levels in humans taking longer to become apparent. This article reports and critiques the methods currently used to monitor schistosomiasis in freshwater and soil environments and explores how environmental DNA could be used to better understand and monitor environmental contamination in relation to sanitation. Stronger evidence is required to understand how different sanitation interventions serve to limit the environmental transmission of the parasite and their relative effectiveness in preventing disease.This article is categorized under: Engineering Water &gt; Methods

Assessment of access to water, sanitation and hygiene in rural schools of Central Kazakhstan

Abstract Background The Sustainable Development Goals (SDGs) call for universal coverage and access to drinking water, sanitation and hygiene (WASH) for all by 2030. Access to WASH in schools is one of the priority areas, considering Joint Monitoring Program is lacking the data from many developing countries, particularly, rural areas including Kazakhstan. The aim of the paper is to assess the access to WASH at schools in rural regions of central Kazakhstan. Methods The study was conducted in three rural schools using focus group discussion with school heads, the observation of drinking water and sanitation units, and a questionnaire survey among 166 pupils. All tools cover the set of questions about the availability and the privacy of WASH facilities, accessibility, acceptability to pupils, functionality. Results Results of the study show that the main water source of Algabas and Kerney schools is a centralized piped water supply provided into the school building and 85,91% of pupils from these schools report the uninterrupted availability of water from this source. However, Sartau has its well, and only 51,72% of pupils from this school indicate that water from the main source is continuously available. All toilets are flushing toilets inside of schools and not connected to the centralized sewage system. The maximum number of the toilet is 6 in the Kerney school; however, this amount of toilets is not enough for the number of pupils by the national norms. Majority of pupils (89,15%) report that the school toilets are always available. Nevertheless, 34,87% of pupils indicate no toilet paper as a reason for not using the school toilet. Handwashing facilities are located near the toilets and in classrooms. Only 53,02% have soap available and 42,77% have access to hand drying facilities after handwashing. Conclusions The current study shows rural schools of Central Kazakhstan are not provided with sufficient materials for pupils to manage personal hygiene appropriately. Key messages The study is essential for mapping the situation of WASH in schools. This study provides the baseline data for JMP; consequently, it is crucial to plan the UN SDGs in Kazakhstan.

Assessment of Knowledge, Attitudes, and Practices on Water, Sanitation, and Hygiene in Some Selected LGAs in Kaduna State, Northwestern Nigeria.

Access to safe water, sanitation, and hygiene (WASH) facilities is a basic necessity for human livelihood, survival, and well-being. Adequate WASH facilities provision is a critical issue to most developing countries around the world including Nigeria. Knowledge, attitudes, and practices regarding WASH are integral to effective and sustainable WASH facilities provision. This study assessed the level of knowledge, behavior, and practices towards water, sanitation, and hygiene in Kaduna state, Nigeria, with a view to ensuring sustainable WASH facilities intervention in the region. Data collection tools included spot check observation and questionnaire involving 854 participants, selected from five local government areas (LGAs): Chikun, Kajuru, Soba, Kachia, and Zango Kataf. From the results, major drinking water sources were surface waters (52.5%) and unprotected hand dug wells (44.8%); only 46.2% treated their water supply and few (16.6%) used chlorination method. Pit latrine toilets were the major (76.5%) excreta disposal means, and open defecation practices were widespread (41.4%). Level of personal and environmental hygiene understanding was fairly good in all the local government areas, and 65.4% claimed to use water and soap for washing hands after defecation. Incidence of water related diseases is generally low in the area. Despite the commendable findings in the study areas, communities are still at risk due to lack of safe water supply and poor practices of home treatment and excreta disposal. Therefore provision of WASH facilities and WASH education is fundamental for ensuring public health in the study area.

Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia?

Reproductive tract infections (RTIs) are a public health concern in Ethiopia. However, the relationship between menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) factors to RTIs have not been well addressed. A community-based cross-sectional study was conducted from January to March 2019 among 602 systematically selected reproductive-age women aged 15-49 years in Dessie City. Data were collected using a questionnaire and a direct observation checklist. RTIs were identified by the presence during one year before data collection of one or more signs of vaginal discharge, itching/irritation or ulcers/lesions around the vulva, pain during urination and sexual intercourse, and lower abdominal pain and lower back pain. Data were analyzed using multivariable logistic regression analysis with 95%CI (confidence interval). The self-reported prevalence of RTIs was 11.0%(95%CI:8.5-13.7%) during one year prior to the survey. The most commonly reported symptoms of RTI were burning micturition (9.1%) and vaginal discharge (6.1%). Three-fourths 443(75.0%) of households used traditional pit latrines and the majority of the study participants 527(89.2%) did not meet the basic access requirement of 20 liters of water per capita per day. The majority 562(95.1%) of the study participants did not have multiple sexual partners during the last year and 97.8% did not practiced sexual intercourse during menstruation. The most common type of blood-absorbent material used was a sanitary pad 497(84.8%) followed by cloth 89(15.2%). Factors significantly associated with RTIs were using unclean latrines (AOR: 4.20; 95%CI:2.00-8.80), not washing hands with soap before touching the genital area (AOR: 3.94; 95%CI:1.49-10.45), history of symptoms of RTIs in the past year (AOR: 5.88; 95%CI:2.30-14.98), having multiple sexual partners in the past year (AOR: 4.46; 95%CI:1.59-12.53), changing absorbent material only once per day (AOR: 8.99; 95%CI:4.51-17.92), and washing the genital area only once per day during menstruation (AOR: 5.76; 95%CI:2.07-16.05). The self-reported prevalence of RTI showed that one women experienced RTI among ten reproductive-age women. Designing a women's health policy that focuses on ensuring availability of WASH facilities and improving MHM at the community level is key for sustainably preventing RTIs.

Evaluation of Water Sanitation and Hygiene (WASH) Facilities and Its Association with Urinary Schistosomiasis in Selected Settlements of Osun State, Nigeria

Background: Urinary schistosomiasisis a debilitating Neglected Tropical Disease (NTD) spreads when infected people urinate close to a water source, contaminating it with the larvae of the parasite, it is associated with lack of access to water, sanitation and hygiene (WASH) facilities in rural and semi-urban settlements. This study was conducted to evaluate the availability of WASH facilities and its impact on the prevalence of schistosomia-sis among school-aged children in Ota-Efun (Semi-urban) and Ilie (Rural) communities of Olorunda LGA of Osun State, Nigeria between June and October, 2019 Methods: Two hundred and forty-three participants from the two communities provided urine samples which were examined for Schistosoma haematobium cyst using FLOTAC filtration device and microscopy. Using structured questionnaires, information on the demographic, hygienic practices, and availability of WASH facilities in participants homes was obtained Results: Results showed a cumulative urinary schistosomiasis prevalence of 46% (51/110) in Ilie (rural) compared to 0% (0/133) in Ota Efun (Urban) settlement. In Ilie community, highest prevalence (19.1%) was recorded among participants within the age group (11-13 years) and lowest (7.3%) among age class 14 and above. When compared with the prevalence results, majority (61%) of residents in Ilie lacked access to toilet facilities while 64% were regularly involved in water contact activities such as swimming, bathing and washing of clothes by the river. Conversely, in Ota-Efun, majority (87.2%) of participants had access to pipe-borne water with controlled access to the stream (4.5%) . Conclusion: The results of this study suggest ongoing transmission of schistosomiasis in Ilie community and that frequent water contact activities including swimming and bathing are risk factors for infection .We recommend that WASH facilities should be effectively integrated into ongoing health policy for the control of neglected tropical diseases in Osun State in order to ameliorate the devastating effects of schistosomiasis in the affect-ed communities

Humanitarian WASH (water, sanitation and hygiene) technologies: exploring recovery after recurring disasters in Assam, India

PurposeThis paper develops a theoretical understanding of learning during recovery from recurring disasters when humanitarian organizations deploy WASH technologies using examples from 2012–2013 floods in Assam, Northeastern India.Design/methodology/approachA mixed methods study was conducted in Assam, where Oxfam had responded after 2012 floods and erosion. Two surveys (n1 = 313; and n2 = 279) in 2013, along with 38 semi-structured interviews, 18 household interviews and 23 focus group discussions (FGDs) were undertaken. The quantitative data were analysed using descriptive statistics and the qualitative data were interpreted thematically.FindingsOne of the product-level innovations included raised platforms with WASH facilities as a preparedness measure for future floods, enabled by a co-learning approach. Social learning within community members provided contextual inputs, while Oxfam learnt through its institutionalized learning mechanisms, namely real-time evaluations, knowledge, attitude and practice (KAP) surveys and strong monitoring mechanisms. Despite these measures, the precarity of such geographies remains a major concern in increasing vulnerability, and hence this study advocates for an approach towards innovation that equally emphasizes and advances learning within community groups as well as organizations so that lessons can be captured and revisited in future programmes and promote wider application.Research limitations/implicationsThis study is exploratory, and longitudinal in nature, although the data and findings are fairly representative of the target population, they do not imply causality and attribution. Since the study relies on a case study, there are limitations of how the findings could be generalized in other similar contexts.Practical implicationsThis paper offers a new theoretical lens emphasizing context-specific understanding of short-term but rapid onset and cyclical emergencies resulting in local population displacement. It provides a bottom-up perspective on innovations and technologies deployed by external aid agencies as a commentary on recovery of community resilience from recurring disasters.Social implicationsThis paper reframes agency approaches in how they perceive community resilience and enable flood-affected and displaced communities to recover using innovations in WASH technologies.Originality/valueThis paper expands on the key lessons to be gleamed from the many interventions in humanitarian WASH technologies from learning perspective and benefits from reflections as a practitioner in the field.

Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa.

Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), contribute to poor child health, nutritional status and physical growth. The primary responsibility for the provision of water and sanitation, as a basic service and human right, lies with the State, as such, a number of stakeholders are involved. Despite relatively high levels of WASH infrastructure coverage in South Africa, enteric infections and stunting remain high for a middle-income country. The aim of this study is to elucidate the landscape of WASH in South Africa in relation to nutritional status of children under the age of 5 years in the South African, Gauteng and City of Johannesburg contexts. The authors detailed the national and provincial public sector departments and through purposive sampling proceeded to map the various departments and associated policies that are responsible for the provision of WASH facilities, as well the nutritional status of children. Of the six policies identified for review, three mentioned WASH, nutrition and children; however, none explicitly linked WASH to nutritional status in children. An in-depth review and analysis of these three crucial policy documents was conducted. Finally, a set of expert interviews were conducted and a consensus development conference convened, with experts at the intersection between WASH and nutritional status. The authors found that the public sector would benefit from better integration of the concept of WASH into their policy, planning and implementation frameworks. The WASH sector should emphasize the role in which WASH plans consider the impact of WASH on the nutritional status of children. The various public sector departments involved in WASH service provision, and other WASH stakeholders, including community-based organizations, non-governmental organizations and intergovernmental organizations, should be involved in the decision-making of the nutrition sector.

Risk factors and transmission pathways associated with infant Campylobacter spp.prevalence and malnutrition: A formative study in rural Ethiopia.

Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.

Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study

BackgroundPoor menstrual health and hygiene (MHH) is a globally recognised public health challenge. A pilot study of an MHH intervention was conducted in two secondary schools in Entebbe, Uganda, over 9 months. The intervention included five components delivered by the implementing partner (WoMena Uganda) and the research team: (i) training teachers to implement government guidelines for puberty education, (ii) a drama skit to reduce stigma about menstruation, (iii) training in use of a menstrual kit (including re-usable pads), (iv) guidance on pain relief methods including provision of analgesics and (v) improvements to school water, sanitation and hygiene (WASH) facilities. The aim of the process evaluation was to examine implementation, context and possible causal pathways.MethodsWe collected information on fidelity, dose, reach, acceptability, context and mechanisms of impact using (i) quantitative survey data collected from female and male students in year 2 of secondary school (ages 13–21; 450 at the baseline and 369 at endline); (ii) qualitative data from 40 in-depth interviews with parents, teachers and female students, and four focus group discussions with students, stratified by gender; (iii) data from unannounced visits checking on WASH facilities throughout the study; and (iv) routine data collected as part of the implementation. Quantitative data were used primarily to assess fidelity, dose and reach. Qualitative data were used primarily to assess acceptability, context and possible mechanisms.ResultsBoth schools received all intervention elements that were delivered by the research team and implementing partner. The drama skit, menstrual kit and pain management intervention components were delivered with fidelity. Intervention components that relied on school ownership (puberty education training and WASH improvements) were not fully delivered. Overall, the intervention was acceptable to participants. Multilevel contextual factors including schools’ social and physical environment, and family, cultural and social factors influenced the acceptability of the intervention in the school setting. The intervention components reinforced one another, as suggested in our theoretical framework.ConclusionThe intervention was feasible to deliver and acceptable to the schools and students. We propose a full-scale cluster-randomised trial to evaluate the intervention, adding a school-based MHH leadership group to address issues with school ownership.Trial registrationClinicalTrials.gov NCT04064736. Registered August 22, 2019, retrospectively registered.

Access to water and toilet facilities as a predictor of adherence to antiretroviral treatment in women living with HIV/AIDS in Zambia: a cross-sectional study

BackgroundMother-to-child transmission (MTCT) of HIV is a major problem in sub-Saharan Africa despite increasing availability of free antiretroviral treatment (ART). Early diagnosis and continuous engagement in HIV care are essential for the elimination of MTCT and improvement of a mother's quality of life. MTCT risk can be reduced from 45%, with no intervention, to below 5% with the administration of an effective antiretroviral regimen. An important but less explored area is how access to potable water and adequate sanitation influence women's adherence to ART. WHO estimates are that around 319 million people lack access to potable water and 695 million people do not have adequate sanitation in sub-Sharan Africa. The aim of this study was to investigate how access to water, sanitation, and hygiene (WASH) influence ART adherence in women living with HIV/AIDS in Zambia. MethodsA cross-sectional study was conducted in women living with HIV/AIDS attending prenatal and postnatal clinics in Lusaka and Sinazongwe Districts, Zambia. We used a questionnaire to collect information on sociodemographic characteristics, WASH, quality of health care, disclosure and support, and other factors. Associations between categorical and continuous variables were assessed with Pearson's χ2 and correlation, respectively. Factors influencing ART adherence were determined using logistic regression models. FindingsWe included data from 150 women in analysis; mean age was 29 years (SD 6). In all, 64% of respondents reported that they lacked access to potable water and 70% reported having inadequate toilet facilities. There were significant associations between ART adherence and access to toilet facilities (p=0·01) and women's perception about access to water and importance of clean water (p=0·01). There was a significant association between ART adherence and belief about effectiveness of the antiretroviral drugs (p=0·01). Participants who were worried about their access to water were less likely to adhere to ART (adjusted OR=0·36 [95% CI 0·13–0·98]; p=0·046) and women who were worried about lack of a toilet facility in their house were less likely to adhere to ART (0·11 [0·03–0·39]; p=0·001). InterpretationAccess to water and toilet facilities influence ART adherence in women living with HIV or AIDS. Interventions aimed at improving ART adherence should include access to WASH facilities. FundingNone.