Water, Sanitation And Hygiene Policies Research Articles

Addressing water, sanitation and hygiene inequalities: A review of evidence, gaps, and recommendations for disability-inclusive WASH by 2030

One in six people worldwide experiences significant disability. Many of these people living in low-and middle-income countries (LMICs) are disproportionately affected by inadequate access to water, sanitation and hygiene (WASH) services, a fundamental necessity for health and well-being. This review aimed to examine the existing evidence on disability and WASH in LMICs, identify gaps and make recommendations to strengthen disability-inclusive WASH research, policies and practices to make significant progress by 2030. While evidence of WASH challenges faced by people with disabilities has grown in the last decade, revealing significant inequalities, there is a lack of controlled studies to assess the impact of disability-inclusive WASH interventions. This research gap makes it difficult to prioritise investments for scalable solutions. This review proposes three key recommendations: 1) Further expand research on WASH challenges faced by people with disabilities, prioritising climate risks, health impacts, and educational inequalities. 2) Design and test evidence-based disability-inclusive WASH interventions. 3) Rigorously evaluate these interventions to determine what successfully reduces WASH disparities for people with disabilities and their caregivers cost-effectively. This review is the first to synthesise available evidence across disability and WASH and offer a roadmap for future efforts to drive improvements in disability-inclusive WASH by 2030.

Institutional capacity assessment in the lens of implementation research: Capacity of the local institutions in delivering WASH services at Cox's Bazar district, Bangladesh.

The influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal district of Cox's Bazar with one of the greatest contemporary humanitarian crises, stressing the existing water, sanitation, and hygiene (WASH) resources and services. This study aimed to assess the existing capacity of local institutions involved in delivering WASH services and identify relevant recommendations for intervention strategies. We used a qualitative approach, including interviews and capacity assessment workshops with institutions engaged in WASH service delivery. We conducted five key informant interviews (KII) with sub-district level officials of the Department of Public Health Engineering (DPHE), Directorate General of Health Services (DGHS), Directorate of Primary Education (DPE) and Bangladesh Rural Advancement Committee (BRAC) to have a general idea of WASH service mechanisms. Seven capacity assessment workshops were organized with the relevant district and sub-district level stakeholders from August 2019 to September 2019. These workshops followed three key areas: i) knowledge of policy, organizational strategy, guidelines, and framework; ii) institutional arrangements for service delivery such as planning, implementation, coordination, monitoring, and reporting; and iii) availability and management of human, financial and infrastructural resources. Data were categorized using thematic content analysis. The majority of stakeholders lacked awareness of national WASH policies. Furthermore, the top-down planning approaches resulted in activities that were not context-specific, and lack of coordination between multiple institutions compromised the optimal WASH service delivery at the local level. Shortage of human resources in delivering sustainable WASH services, inadequate supervision, and inadequate evaluation of activities also required further improvement, as identified by WASH stakeholders. Research evidence suggests that decision-makers, donors, and development partners should consider learning from the WASH implementers and stakeholders about their existing capacity, gaps, and opportunities before planning for any WASH intervention in any particular area.

Global approaches to tackling antimicrobial resistance: a comprehensive analysis of water, sanitation and hygiene policies

BackgroundUnsafe water, sanitation and hygiene (WASH) contributes to a high burden of disease and exacerbates factors that promote the development of antimicrobial resistance (AMR). Enforceable policies are foundational to curbing...

Water, Sanitation, and Hygiene Policies and the Enhancement of Quality Education in Lower and Upper Basic Schools within Region One Education Directorate, The Gambia

This study focused on the importance of School Water, Sanitation, and Hygiene (WASH) policy in enhancing the quality of education in Lower and Upper Basic Schools within Region One Education Directorate of The Gambia. The study utilised a mixed-methods approach, combining qualitative analysis of policy documents with quantitative data obtained from questionnaires administered to head teachers. The Human Rights-Based Approach (HRBA) and Systems Thinking provide valuable theoretical lenses to analyse the lack of WASH policies. The HRBA emphasises the recognition of WASH as a fundamental human right, while the Systems Thinking approach considers the interconnectedness and complexity of the WASH system. The findings indicated that a significant number of schools in the region lack a WASH policy or rely on general directives, leading to inconsistent approaches and practices in addressing WASH issues. This inconsistency results in inadequate provision of WASH facilities, ineffective hygiene education, and a lack of clear learning objectives for students. The absence of WASH-related guidance in key school management tools and policy documents further exacerbates the challenges. The study highlighted the need for a comprehensive School WASH policy to oversee, regulate, and provide guidance for the implementation of WASH standards in educational institutions. Recommendations included developing and implementing a comprehensive School WASH policy, enhancing the curriculum framework to ensure the coverage of WASH topics, providing clear guidelines and resources, incorporating WASH into policy documents, conducting capacity-building and awareness programmes, and establishing a robust monitoring and evaluation system.

Unequal access to improved water and sanitation in a post-conflict context of Liberia: Evidence from the Demographic and Health Survey

Public health and wellbeing in Liberia have been compromised by a lack of access to safe drinking water, sanitation, and hygiene (WASH), compounded by 14 years of civil unrest. After almost two decades of relative peace and stability, disparities in WASH access persist and diseases linked to WASH such as Ebola, cholera, and COVID-19 have posed major public health challenges. Yet, there is nascent research in the context of post-war Liberia examining the determinants of access to WASH. To contribute to WASH policy in Liberia, this study examined the predictors of improved water and sanitation using the 2019–20 Liberia Demographic and Health Survey. Using the complementary log-log link function, we found that some socioeconomic and geographical factors were associated with access to improved water and sanitation. For example, poorer and rural households were less likely to have access to improved water and sanitation compared to their wealthier and urban counterparts, respectively. Based on these findings, we discussed policy implications and potential directions for future research.

Water, Sanitation, and Hygiene of Nepal: Status, Challenges, and Opportunities

Access to water, sanitation, and hygiene (WASH) has been a challenge to south Asia’s rapidly growing and climate change-sensitive region. Nepal, a water-abundant country, faces obstacles to fulfilling the highly prioritized WASH Sustainable Development Goal 6 (SDG 6). This review offers details about Nepal’s WASH status from 2000 to 2020 with regard to the challenges Nepal had in delivering reliable WASH services to the people, as well as opportunities for a sustainable way forward, and provides insights that can be applied to other developing countries. From analysis of national-level assessments, estimates point toward healthy progress in extending WASH access to the population. However, large inequalities persist at the subnational level between urban and rural residents, between poor and rich residents, and between genders. Many local constraints such as a lack of long-term infrastructural capacity to provide and maintain WASH services, financial issues, and institutional and policy incompatibilities are some of the key factors that technical considerations and private sector involvement could address. We also propose roles for Nepal’s central, provincial, and local governments for identification and adaptation to the undeniable risks of climate change. Furthermore, there is a need to capitalize on the potential opportunities for developing a much-needed robust and climate-resilient WASH sector in Nepal, safeguarding the rights of future generations to safe and clean water.

School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

BackgroundThe impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children’s health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children’s malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines.MethodsThe trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children’s physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects.ResultsNone of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal.ConclusionIncreasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed.Trial registration numberDRKS00021623.

A qualitative cross-sectional study exploring the implementation of disability-inclusive WASH policy commitments in Svay Reing and Kampong Chhnang Provinces, Cambodia

BackgroundThe Government of Cambodia references core concepts of human rights of people with disabilities in their water, sanitation and hygiene (WASH) policies and guidance. However, few references clearly articulate activities to achieve these.MethodsThis cross-sectional study in Cambodia explores the implementation of core concepts of human rights referenced in Cambodia's WASH policies in Kampong Chhnang and Svay Reing Provinces: Individualized services, Entitlement/affordability, Participation, Family resource, Access. Seven government officials and 10 service providers working in Phnom Penh and the two provinces, 16 women and men with disabilities (aged 18–65+), and four caregivers living in the study sites were included. Purposive sampling was applied to select participants. In-depth interviews were conducted via Zoom and over the telephone and analyzed data thematically using Nvivo 12.ResultsThe Three Star Approach for WASH in Schools was noted as a promising approach for implementing policy commitments to make school WASH services accessible. However, policy commitments to disability-inclusive WASH were not always enacted systematically at all levels. Organizations of Persons with Disabilities faced challenges when advocating for disability rights at WASH sector meetings and people with disabilities were inconsistently supported to participate in commune WASH meetings. Poor access to assistive devices (e.g., wheelchair) and inaccessible terrain meant few people with disabilities could leave home and many had inadequate WASH services at home. Few could afford accessible WASH services and most lacked information and knowledge about how to improve WASH access for people with disabilities. Caregivers had no guidance about how to carry out the role and few had assistive devices (e.g., commodes, bedpans) or products (i.e., lifting devices), so supporting WASH for people with disabilities was physically demanding and time-consuming.ConclusionThis study has noted several areas where Cambodia's WASH systems are focusing efforts to ensure people with disabilities gain access to WASH, but it has also highlighted aspects where implementation of policy commitments could be strengthened. A more comprehensive and cross-sectoral approach to progressively realizing the rights to water and sanitation for people with disabilities and challenging disability discrimination more broadly could significantly disrupt the vicious cycle of poverty and disability.

Effect of demographic disparities on the use of the JMP ladders for water, sanitation, and hygiene services in Bishoftu Town, Ethiopia

Reducing inequalities in all its forms is one of the key principles of the Sustainable Development Goal (SDG). However, the 2030 SDG Agenda has been a real challenge in addressing inequalities in Water, Sanitation, and Hygiene (WASH) services. There is a disparity in the use of WASH services in Ethiopia. Therefore, this study aimed to identify demographic factors affecting the use of Joint Monitoring Program (JMP) ladders for WASH services. In this study, a total of 5350 households were included. Households having heads with vocational education levels were 2.9 times higher in use of basic drinking-water services ((Adjusted Odds Ratio (AOR) = 2.9 with 95% CI 1.6–5.1) than household having heads who could not read and write. Besides, households living in urban areas were 21.7 times more likely to use basic drinking-water services (AOR = 21.7 with 95% CI 16–30) than in rural parts. Further, households with merchants’ heads were 2.1 times higher to use basic sanitation services (AOR = 2.1 with 95% CI 1.5, 3.1) than households with farmers’ heads. Moreover, households having higher monthly income per head were 2.9 times higher in utilizing basic sanitation services (AOR = 2.9 with 95% CI 2.32–3.58) than the poorest households. Similarly, households with female heads were 1.5 times higher in using the JMP ladder for basic hygiene services (AOR = 1.5 with 95% CI 1.24–1.71) than households with male heads. Additionally, respondents who live in urban areas had 2.8 times higher use of basic hygiene services (AOR = 2.8 with 95% CI 2.26–3.54) than those in rural areas. Many demographic factors that influence the use of the JMP ladders for water, sanitation, and hygiene services were identified. The use of surface water, open defecation practice, unimproved sanitation, and no hygiene services were positively associated with illiteracy. The findings suggest that state authorities should initiate firm WASH policies and strategies to achieve the SDG 6 and 10. Additionally, the government should apply effective WASH interventions that consider demographic disparities.

Water, Sanitation, and Hygiene (WASH) Practices and Outreach Services in Settlements for Rohingya Population in Cox's Bazar, Bangladesh, 2018-2021.

(1) Background: This study aimed to investigate the existing water, sanitation, and hygiene (WASH) policy and practice of the study population and strengthen the evidence base by documenting changes in the WASH policy and practice over 3 years of the Rohingya refugee humanitarian crisis, Cox’s Bazar, Bangladesh. (2) Methods: A cross-sectional surveillance design was followed; the sampling of the study population included the Rohingya refugee population and neighborhood host nationals who required hospitalization soon after seeking care and enrolled into the diarrheal disease surveillance in diarrhea-treatment centers. Throughout the study period of 3 years, a total of 4550 hospitalized individuals constituted the study participants. (3) Results: Among the hospitalized Rohingya refugee population; the use of public tap water increased significantly from 38.5% in year 1 to 91% in year 3. The use of deep tube well water significantly changed from 31.3% to 8.2%, and the use of shallow tube well water reduced significantly from 25.8% to 0.4%. Households using water seal latrine were 13.3% in year 1 and increased significantly to 31.7% in year 3. ORS consumption at home changed significantly from 61.5% in the first year to 82.1% in third year. Multivariable analysis demonstrated patients’ age groups at 5 to 14 years, and 15 years and more, drinking non-tube well water, soap use after using toilet, use of non-sanitary toilet facility, father’s and mother’s lack of schooling, and some and severe dehydration were significantly associated with the Rohingya refugee population enrolled into the diarrheal disease surveillance. (4) Conclusion: The findings indicate significant advances in WASH service delivery as well as outreach activities by aid agencies for the Rohingya refugee population living in settlements.

WASH and Health in Sindhupalchowk District of Nepal after the Gorkha Earthquake

An earthquake of magnitude 7.8 MW and 6.8 MW struck Nepal on 25 April and 12 May, 2015, respectively, which caused massive damage. In such crises, understanding the water, sanitation, and hygiene (WASH) situation is of paramount importance. Therefore, we aimed to assess the WASH situation and its impact on health, particularly in the Sindhupalchowk district. A questionnaire survey and microbial analysis of water samples were conducted. Descriptive statistics and parametric and non-parametric statistical tests were employed. The results revealed that 97.1% of water samples from the source during the pre-monsoon season and 98.5% during the monsoon season had fecal contamination. Similarly, 92.8% of water samples during the pre-monsoon season and 96.7% during the monsoon season at point of use (PoU) had fecal contamination. Furthermore, water consumption was comparatively less during the pre-monsoon season. The increase in water consumption improved hygiene behavior and lowered the prevalence of waterborne diseases. Similarly, less water consumption affected water handling behavior; for example, the cleaning interval of storage vessels was less frequent. An increase in cleaning interval resulted in fecal contamination of water at PoU. The findings of this study can be useful in the review of existing WASH policy and plans and integration with the disaster management plan for disaster risk reduction.

WASH for all: A systematic review of Physiological and Sociological Characterization Framework segmentation in WASH policies, programmes, and projects

SummaryMotivationInitially, governments started with the overarching objective of providing universal access to WASH (water, sanitation, and hygiene) services. During the Millennium Development Goals (MDGs) period 2000–2015, there was increased motivation to understand requirements of different sectors of the population in order to ensure universal, equitable access.PurposeThis article reports findings of a systematic review looking at three questions: what segments of the population have been addressed in WASH policies, and programme and projects? How do the population segments vary between sectors and regions? What barriers, strategies, and benefits for providing WASH services have been identified for different population segments?Methods and approachPopulations can be segmented using two broad paradigms: Physiological Characterization Framework (PCF), which classifies the population on the basis of the life cycle; and Sociological Characterization Framework (SCF), classifying the population on the basis of caste, ethnicity, income, location, and occupation. Policy documents and programme and project (P&P) documents pertaining to the WASH sector were synthesized.FindingsAt a policy level, SCF is used more widely than PCF. In the context of PCF, women were the focus of a relatively large number of policies. Adequacy, environmental, and attitudinal barriers were those most commonly identified across both PCF and SCF segments in WASH policies and P&Ps. In PCF, beneficiary participation and information, education, and communication (IEC) strategies were the more commonly adopted strategies, whereas project management, financing, and provision of services were more frequently adopted for SCF. Availability was the most common benefit identified across PCF and SCF in terms of policy and also P&P.Policy implicationsWASH policies can create an enabling framework by specifically mentioning the different PCF segments in order to facilitate adoption and percolation of the life‐course approach in P&Ps. Incorporating this approach within the current SCF paradigm can help achieve inclusiveness. Greater effort is required to understand barriers faced by PCF segments and to devise strategies to overcome them. Policy‐makers should expand the spectrum of benefits to all categories within PCF in WASH policies.

Towards an integrated theoretical framework for understanding water insecurity and gender-based violence in Low-and middle-income countries (LMICs).

Disparities in access to basic needs and resources such as water is largely borne out of power imbalance across scale. In examining these power dynamics in the context of health inequalities, scholars have deployed Feminist political ecology analytical framework to situate gender and other forms of vulnerability as emerging from unequal power relations, and political ecology of health to emphasise the health implications of inherent relational power in the distribution of resources. Although appealing, the two theoretical frameworks over time have proven to be limiting in the study of intersectional vulnerabilities such as gender-based violence and water insecurity which reflect multiple dimensions of unequal power structures. This study expands the theoretical space for the study of inequalities in health geography by demonstrating the utility of incorporating feminist political ecology with political ecology of health to form an integrated theoretical framework - Feminist Political Ecology of Health (FPEH). This proposed theoretical framework gives guidance for engaging with a suite of questions and methods related to multifaceted problems such as water insecurity and gender based-violence. The paper highlights these theoretical issues and then discusses how FPEH can enrich research on water security and gender-based violence in Low-and middle-income countries (LMICs).

A school-based water, sanitation, and hygiene intervention and children’s nutrition status and hydration: a cluster-randomized controlled trial in Manila

BACKGROUND AND AIM: Inadequate water, sanitation, and hygiene (WaSH) threatens the health of millions of children globally. Urban poor children suffer from health disparities because of inadequate WaSH facilities and limited availability of health education programs in schools. Our study aimed to evaluate the impacts of a school-based WaSH intervention on children’s nutrition status and hydration in Manila, Philippines. METHODS: We conducted a cluster-randomized controlled trial in 15 public schools, assigning two schools to the control group (CG) and randomizing 13 schools to one of three intervention groups (IGs), IGA, IGB, and IGC, which received low-, medium-, and high-intensity health education, respectively. The intervention consisted of: 1) WaSH policy workshops; 2) health education; 3) hygiene supplies; 4) WaSH facilities repairs. We measured: nutrition status (stunting, severe thinness, thinness, overweight, obesity) via anthropometry and the World Health Organization's standards; dehydration, defined as a urine specific gravity (USG) of 1.020 or greater, via urine test strips. RESULTS:Our sample was 756 and 701 children at baseline and end-line (8 months later), respectively (retention rate ~93%). At baseline 11% of children were stunted and 32% did not have a

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.

The Inclusion of Rights of People with Disabilities and Women and Girls in Water, Sanitation, and Hygiene Policy Documents and Programs of Bangladesh and Cambodia: Content Analysis Using EquiFrame.

People with disabilities and as women and girls face barriers to accessing water, sanitation, and hygiene (WASH) services and facilities that fully meet their needs, especially in low- and middle-income countries. Women and girls with disabilities experience double discrimination. WASH policies should support and uphold the concepts of disability and gender inclusion, and they should also act as a guide to inform WASH programs and service delivery. Using a modified version of the EquiFrame content analysis tool, this study investigated the inclusion of 21 core concepts of human rights of people with disabilities and women and girls in 16 WASH policy documents and seven end-line program reports from Bangladesh and Cambodia. Included documents typically focused on issues of accessibility and neglected wider issues, including empowerment and support for caregivers. The rights of children and women with disabilities were scarcely focused on specifically, despite their individual needs, and there was a disconnect in the translation of certain rights from policy to practice. Qualitative research is needed with stakeholders in Bangladesh and Cambodia to investigate the inclusion and omission of core rights of people with disabilities, and women and girls, as well as the factors contributing to the translation of rights from policy to practice.

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.

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention-A Randomised before and after Trial.

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene intervention (food hygiene + handwashing) relative to a food hygiene and water, sanitation and hygiene (WASH) intervention (food hygiene + handwashing + faeces management + water management). The 31-week intervention was delivered by community-based coordinators through community events (n = 2), cluster group meetings (n = 17) and household visits (n = 14). Diarrhoeal disease was self-reported and measured through an end line survey, and daily diaries completed by caregivers. Difference-in-differences results show a 13-percentage point reduction in self-reported diarrhoea compared to the control group. There were also significant increases in the presence of proxy measures in each of the treatment groups (e.g., the presence of soap). We conclude that food hygiene interventions (including hand washing with soap) can significantly reduce diarrhoeal disease prevalence in children under five years in a low-income setting. Therefore, the promotion of food hygiene practices using a behaviour-centred approach should be embedded in nutrition and WASH policies and programming.

Status of water, sanitation and hygiene services for childbirth and newborn care in eight countries in East Asia and the Pacific.

BackgroundWater, sanitation and hygiene (WASH) services are critical to providing quality maternal and neonatal care in health facilities. This study aimed to investigate availability of WASH policies, standards, and services for childbirth and newborn care in hospitals in East Asia and the Pacific.MethodsDescriptive analysis of survey data and observations of water, sanitation and hygiene services in maternity and neonatal care rooms and of deliveries in 147 hospitals in Cambodia, Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Philippines, Solomon Islands, and Viet Nam. The main outcome measures were availability of national policies and standards; availability of water, sanitation, and hygiene services in maternity rooms and neonatal care units; and practice of hygiene at childbirth.ResultsThree of seven countries had national WASH policies and three had standards for health facilities. Seventy-seven percent of hospitals had a sink with water and soap or alcohol hand rub in delivery rooms, 78% in neonatal care rooms and 42% in postnatal care rooms. Only 44% of hospitals had clean sinks with water, soap and hand drying methods in the delivery room, 40% in neonatal care units and 10% in postnatal care rooms. Flush toilets were available in or next to delivery rooms in 60% and neonatal care units in 50% of 10 hospitals with data. Countries with WASH standards had a higher proportion of hospitals with water and hand hygiene services. Appropriate hygiene was practiced by health workers in 65% of 371 deliveries observed, and more likely in delivery rooms with a sink, water and soap.ConclusionsCoverage of WASH services for maternal and newborn care must be improved to reduce risks of maternal and newborn morbidity and mortality.

Role of local actors in WASH (water, sanitation and hygiene) during disaster recovery: policy implications from evidence in Odisha, India

ABSTRACT There is a paucity of empirical insights on how existing policies in disaster recovery and water, sanitation and hygiene (WASH) play out during disaster recovery in the Global South. This paper addresses this critical gap using the case study of 2013 Cyclone Phailin in Odisha. The data was collected through participatory and learning action tools and semi-structured interviews with key informants. This study found pervasive exclusion of women and local actors from recovery decision-making. The policies and guidance at national and subnational level lacked clear emphases on roles and responsibilities of the local governments, and did not emphasise their role in setting recovery objectives and priorities. We conclude that existing policies should emphasise immediate as well as longer-term WASH needs, adopt a multi-hazard perspective in preparedness and WASH policies, and feature WASH during recovery in the existing manuals, policies and programmes.