Water, Sanitation And Hygiene Programming Research Articles

A Review of Sanitation Options and Programming in Ghana, West Africa

This review examines Ghana’s progress in sanitation. These efforts include the containment, transport, treatment, and disposal or reuse of human waste. This research specifically examined the current sanitation processes and programming efforts within Ghana, West Africa. Some reports indicate that Ghana is the second dirtiest country in Africa and the seventh dirtiest country in the world. A review of the current water, sanitation, and hygiene (WASH) options within the country indicates that significant efforts need to be undertaken. There are multiple toilet options and current practices within the country for the disposal of excrement. Unfortunately, the municipal sewer systems and wastewater treatment facilities within the country are either broken down or severely inadequate compared to their surrounding population. Current WASH programming, extension efforts, and key factors affecting the uptake of sanitation investment are reviewed. The price point where consumers would utilize sanitation products and services was analyzed, as well as the cost-to-benefit ratio of specific technologies for community members. This review demonstrated that initiatives should be undertaken to provide more sanitation professionals, renovate and expand urban municipal sewerage systems, and provide basic access to rural community areas. It was recommended that future programming, extension, and policy efforts be intentional and include relevant stakeholders and community members to provide a greater opportunity for establishing successful and substantial efforts.

Impact of a school-based water and hygiene intervention on child health and school attendance in Addis Ababa, Ethiopia: a cluster-randomised controlled trial

BackgroundSchool-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance.MethodsThe WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an ‘open cohort’. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat.ResultsOf 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes.ConclusionsThis large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes.Trial registrationClinicalTrials.gov, number NCT05024890.

Soil-transmitted helminth (STH) infections in the Wolaita zone in Southern Ethiopia: mid-stage evaluation of the Geshiyaro project and progress towards the interruption of transmission

BackgroundThis paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia.MethodsThe Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time.ResultsThe prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato–Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly.ConclusionsThe reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method.Graphical

Water, sanitation, and hygiene factors associated with nutrition status among children under five years in Ewaso Narok Wetland, Laikipia County, Kenya

Background: Wetlands are known to harbor disease-causing bacteria, posing health risks that can be mitigated through improved water, sanitation, and hygiene (WASH) practices. This study aimed to understand the factors affecting nutritional status and its connection to WASH-related diseases among children under five in Ewaso Narok Wetland, Laikipia County. Methods: Using a mixed-method approach, qualitative and quantitative data were collected. Simple random method was used to identify the respondents. Results: Findings revealed that 36% of households surveyed had children with nutritional edema, with mean age, weight, and height at 21 months, 11 kilograms, and 73 centimeters respectively. Using WHO standards, a significant proportion of children were found to be undernourished at 45.3% and stunted at 41.3%. Socio-demographic factors like caregiver education level and marital status were identified as influential on the nutrition status. While 51% of households had unimproved water sources, 86% had access to toilet facilities, predominantly traditional pit latrines. 67% of the respondents were located near a wetland with a proximity ranging from 1km to 5km. Disease prevalence among children included diarrhea (46%), typhoid-related fevers (22%), and malaria (12%), with edema significantly associated with WASH diseases. Conclusions: Factors such as feces disposal, wetland proximity, protective gear use, handwashing, and toilet facilities were linked to child nutrition. Recommendations include implementing WASH programs, improving water and sanitation access, promoting hygiene practices, ensuring safe feces disposal, using protective gear in wetlands, and advocating for improved toilet facilities. Further research is warranted to assess intervention effectiveness and explore additional influencing factors.

Case-control study of drinking water quality in Yemen

Background: Water, sanitation and hygiene (WASH) activities collapsed in Yemen due to the 2015 war, causing acute safe water shortage, poor sanitation and hygiene, and degraded microbial water quality. The cholera outbreaks in 2016/2017 triggered emergency WASH interventions to improve water quality and reduce cholera and other water-borne disease incidence. Aim: This study aimed to assess the microbial water quality in Sana’a, Yemen, following cessation of the WASH activities. Methods: We collected and analysed water samples in 2022 from 64 out of the 381 mini water purification plants that benefitted from WASH interventions in Sana’a in 2018, 2019 and 2020. Face-to-face interviews with representatives of each mini water purification plant were conducted alongside observatory evaluations. We compared results of the 2022 analyses with those of 2018, 2019 and 2020. We analysed our data using Microsoft Excel 2010 and descriptive statistics and presented the results in tables and charts. Results: By 2022, one year after suspending the WASH interventions, the purification system rating had decreased slightly from 87.4% to 84.1%, and the water safety requirements rating had decreased significantly from 78.1% to 62.1%, compared to the 2018–2020 values. This caused a nearly double value, from 15.1% to 31.3%, for the microbial pollution, confirming an inverse relationship between microbial pollution and both purification system and water safety requirements. Conclusion: The microbial water quality of the plants was degraded due to the cessation of the WASH programme. It is important to consider sustainability issues when designing and implementing WASH programmes to ensure that they achieve their goals. It is also crucial to monitor WASH activities rigorously and invest in raising awareness of WASH benefits among operators and community members so they can become effective partners in preventing contamination and water pollution.

Research priorities for water, sanitation and hygiene (WASH) in humanitarian crises: A global prioritisation exercise

Water, sanitation and hygiene (WASH) interventions should provide access to safe water and sanitation, and promote good hygiene practices with dignity, comfort and security. Multiple systematic reviews have noted evidence gaps and is a paucity of good quality evidence related to the effectiveness and implementation of WASH programmes and interventions in humanitarian crises. The aim of this study was to generate consensus-based actionable research priorities for the humanitarian WASH sector. A research prioritisation exercise was conducted by adapting the Child Health and Nutrition Research Initiative (CHNRI) method. Research questions were compiled from a rapid scoping review, key informant interviews (KIIs) and focus group discussions (FGDs). Questions were reviewed by a technical expert group. An online survey was circulated to score research questions according to five criteria. An overall prioritisation score was calculated and weighted to prioritise questions. A diverse range of 286 global WASH and health experts engaged in the CHNRI process. A list of 128 questions were generated and scored by experts. Prioritised research questions focussed on evaluating existing interventions or programmes, and making iterative changes to current programmes. Other important questions centred on describing WASH conditions and associated health risks in crises contexts. Priorities were also stratified by gender, organisation and region to understand differences globally. The WASH in Crises Research Agenda has identified key research questions of most importance to those implementing WASH in humanitarian crises and has established a list of research priorities. The identified priorities reinforce how more evidence is needed, and underlines the need for research to evaluate current practices in order to improve the quality of humanitarian response. Stakeholders, including donors, international and national organisations, governments and academic institutions, are invited to use this research agenda to encourage, inspire and enable relevant and high-quality research that will be used to inform humanitarian responses.

WASH Levels and Associated Human Health Risks in War-Prone West African Countries: A Global Indicators Study (2015 to 2021).

Water, Sanitation and Hygiene (WASH) levels have been shown to have impacts on health. However, the knowledge of WASH levels in war-prone West African countries is limited. The study extracted data (2015-2021) from the Joint Monitoring Programme (WHO/UNICEF), World Bank and Demographic and Health Surveys (DHS) to estimate WASH levels in the study countries. Pearson correlation analysis was used to establish the association among the WASH levels. Results showed that women had better access to safe water (56.39%), good sanitation (59.36%) and good hygiene (60.23%) compared to men. The urban population had better access to safe water (57.60%), good sanitation (61.23%), and good hygiene (65.65%) than the rural population. Among the countries under study, Nigeria had the highest access to safe water (36.10%) and good sanitation (24.41%), while Mali had the highest access to good hygiene (27.93%). Pearson correlation analysis showed a strong positive association between safe water and good hygiene (r = .998), safe water and sanitation (r = .996) and hygiene and sanitation (r = .998) at .00 significant levels. Based on the findings, it is recommended that integrated WASH programmes with combined infrastructure development, behaviour change campaigns and community engagement should be encouraged to ensure peaceful and sustainable access to WASH levels.

Integration of water, sanitation, and hygiene program with biosecurity: A One Health approach to reduce the prevalence and exposure of antibiotic-resistant bacteria in the livestock community

The global spread of antibiotic resistance poses a significant threat to public health and is one of the main causes of this problem. Livestock farming plays a significant role in the horizontal and vertical transmission of treatment-resistant genes and bacteria. These processes involve contact with agricultural products and the environment, raising concerns for public health, and farming communities. The farming community is composed of a staggering 608 million farms worldwide, and their livelihood depends heavily on livestock farming. To address this issue, a multidisciplinary One Health approach focusing on integrated monitoring and intervention for humans, animals, and the environment is essential. Water, sanitation, and hygiene (WaSH) programs have the potential to significantly reduce the risk of exposure to antibiotic-resistant bacteria, particularly extended spectrum beta-lactamase (ESBL) Escherichia coli, by obstructing the transmission route between humans and animals. Additional risk reduction measures for ESBL E. coli infection in animals include vaccination and biosecurity program implementation. Water, sanitation, and hygiene and biosecurity measures must be combined to maximize the effectiveness of the One Health program. Therefore, this study aimed to describe recent advances in biosecurity and WaSH interventions in the livestock environment, analyze the effects of these interventions on human and animal health, and investigate potential future scenarios within the quantitative microbial risk assessment framework. This study used an integrative literature review through searches of four databases, a review of World Health Organization documents through websites, and an examination of relevant texts from previously obtained reference lists. Although hygiene and sanitation are often combined, there is still a lack of quantitative evaluation of the efficacy of integrating WaSH with biosecurity in livestock. In addition, the integration of the WaSH program with biosecurity has potential as a One Health intervention in the coming years. Keywords: antibiotic-resistant bacteria, biosecurity, extended-spectrum beta-lactamase Escherichia coli, One Health, scenario, water, sanitation, and hygiene.

Progress on drinking water, sanitation and hygiene in schools: global overview on the WASH programme

Abstract Context Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme (JMP), produce internationally comparable estimates of progress on drinking water, sanitation and hygiene (WASH) and are responsible for monitoring the Sustainable Development Goal (SDG) targets related to WASH. Since the establishment of the SDGs, the JMP has published global baseline reports on WASH in households (2017), WASH in schools (2018) and WASH in health care facilities (2019), and a progress update on households (2019). Objectives To put the European findings in a global perspective regarding school toilets. Results Findings from the last report published under this JMP (2021) will be presented, updating national, regional and global estimates for WASH in schools up to the year 2019, with a special focus on the implications for ensuring the safety of students and school staff during and after the coronavirus disease 2019 (COVID-19) pandemic. Using service ladders to benchmark and compare progress across countries on WASH in schools by tracking progress towards a basic level of service, as the indicator used for global monitoring of SDG targets related to WASH in schools, we will see that situations are contrasted. Globally 63% of schools had a basic sanitation service in 2019, while it is the case of 99% of schools in Europe and Northern America. The differences are of the same level regarding basic drinking water service in schools (respectively 69% vs. 99%), as well as for basic hygiene (resp. 57% vs. 98%). Conclusions Those results illustrate the paradox that existence of a given facility, access and use are not equivalent and need to be explored further.

Assessment of knowledge, attitudes and practices on water, sanitation and hygiene in Zaria Local Government Area, Kaduna State

Water, Sanitation and Hygiene (WASH) Knowledge, Attitudes and Practices (KAP) are relevant concerns for sustained and effective implementation of WASH programs. This research was conducted in Zaria Local Government Area (LGA), Kaduna State to Assess the KAP on WASH to avail reliable data for informed interventions. 174 randomly selected households were interviewed. The result reveals four main sources of drinking water, viz borehole (31%), well (19%), pipe-borne (13.1%) and water packaged in sachet (24.7%). The result shows that 34.5% of households dispose solid waste through unauthorized waste collectors, 16.1 % use authorized collectors, 17.2% at public approved dumpsite, 16.1% at unapproved dump sites, 16.1% by burning, 4% bury their waste and 4% dispose waste in open water bodies/ways/drainages. The results shows that 30.5% of households have modern water closets, 42.8 % use pit latrine, and 11.5 % use public toilets. Based on the findings, it is evident that there is high accessibility of improved water to households, availability of improved toilet facility is also high, but waste management practice is poor. In conclusion, Zaria LGA is in need of WASH interventions especially as regards waste management. It is recommended that efforts should be made to intensify awareness about WASH.

Knowledge, attitudes, practices and acceptability of a school preventive chemotherapy programme for schistosomiasis and soil-transmitted helminths control in Angola.

Schistosomiasis and soil-transmitted helminth (STH) control programs require target population engagement, assessed through knowledge, attitudes and practices (KAP) surveys. We report the results of a KAP survey of Angolan schoolchildren supported by a school preventive chemotherapy (PC) programme, without or with a school water, sanitation and hygiene (WASH) programme (PC+/WASH- and PC+/WASH+, respectively); and schoolchildren without a school PC or WASH program (PC-/WASH-). Schoolchildren from PC+/WASH- (N = 218), PC+/WASH+ (N = 250) and PC-/WASH- (N = 254) schools were interviewed. Descriptive statistics were used to report demographics and survey responses. Chi-square or Fisher's exact test was used to compare PC+/WASH- schoolchildren with (i) PC+/WASH+ and (ii) PC-/WASH- schoolchildren. A lower proportion of PC+/WASH- schoolchildren used latrines and a higher proportion practised open defecation at school compared with PC+/WASH+ schoolchildren. A lower proportion of PC+/WASH- schoolchildren always washed their hands after toileting and before meals at school compared with PC+/WASH+ schoolchildren. However, the PC+/WASH- schoolchildren reported better toileting and handwashing practices at school compared to PC-/WASH- schoolchildren. Over 90% of PC+ schoolchildren agreed with schistosomiasis and STH control and accepted schoolteacher PC delivery. Expanding the integration of both school PC and WASH programs will improve health behaviours relevant to reduce the risk of schistosomiasis and STHs in schoolchildren. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Developing context-specific water, sanitation and hygiene guidance for National Cholera Plans: Qualitative inputs

Globally, cholera continues to cause morbidity and mortality, and the Global Task Force on Cholera Control (GTFCC) works with countries affected by cholera to develop National Cholera Plans (NCPs). Water, sanitation, and hygiene (WASH) can prevent and/or control cholera. However, WASH program success varies, and is not necessarily replicable across contexts. Thus, guidance needs to be developed to assist countries in appropriately designing WASH programming in NCPs. The objective of this project was to develop guidelines for selecting context-specific WASH for cholera response. For that, a literature review of WASH interventions in cholera was completed, a Working Group was convened to collaboratively develop the guidelines, and we conducted key informant interviews (KII) with Working Group experts, representing international and national non-governmental organizations, donors, international organizations and health authorities. Inductive qualitative content analysis of KIIs was completed. KIIs were conducted with 18 informants, and data was coded into 26 subcategories, categorized under: 1) intervention objectives; 2) decision factors; 3) intervention circumstances; 4) influencing factors; and, 5) WASH activities. Based on these categories, we developed guidelines with the following steps: 1) define the disease objective (control, prevention, or elimination); 2) understand and define the broad context (including existing WASH infrastructure and population habits, available funding, outbreak sources and transmission pathways, stakeholder capacity, and access difficulties); and, 3) focus on monitoring of activities, multi-sectoral coordination (including WASH and health), and targeted approaches, both for implementation and future research. Overall, while building upon previous research and guidance, our results expand to include specific guidance for countries incorporating WASH into their NCPs, and highlight the necessity of a broad contextual understanding to select the most appropriate and successful WASH for cholera programming. These results have been used, with GTFCC, to develop a guidance document for including context-specific WASH in NCPs.

Understanding the relationship between WASH and malnutrition: Analysis of anthropometric data of children attending WASH-supported schools in Ogun State, Nigeria

There has been a growing interest in better understanding the association between water, sanitation, and hygiene (WASH) and malnutrition. We analysed anthropometric data of children attending WASH intervention schools and those from non-intervention schools in Ogun State, Nigeria. A total of 353 children across six schools (three interventions and three non-interventions) participated in this study. WASH conditions were assessed using WHO standardized tools and anthropometric data of children were analysed in WHO AnthroPlus and R Software. The prevalence of stunting was 26.2% in the intervention group, and 29.4% in the control group (p = 0.045). Underweight was lower in the intervention group (3.9% vs. 10.1%) (p = 0.45). However, wasting was higher in the intervention group (32.3% vs. 8.2%) (p = 0.001). Of the variables included in our multivariate model (age, gender, and school category, i.e. intervention/control and class grade), only age was selected, and negatively associated with underweight, stunting and wasting (p = 0.000). Regardless of WASH programming status, nutritional outcomes were significantly influenced by age of the children. Children are more likely to have lower z-scores as they grow older.

Working together: A study of civil society partnerships between WASH (water, sanitation, and hygiene) and GESI (gender equality and social inclusion) organisations in Timor-Leste

This article reports on an empirical study conducted in Timor-Leste that explored the drivers, benefits, and challenges of partnerships and collaborations between water, sanitation, and hygiene (WASH) and gender equality and social inclusion (GESI) organisations as integral parts of the WASH system. The research design was primarily qualitative and included a data-collection workshop with 30 representatives from 16 civil society organisations (CSOs) in Dili, longitudinal research involving two rounds of semi-structured interviews over 2.5 years with five organisations, and semi-structured interviews with an additional 18 CSOs. We applied a framework of post-development theory, including critical localism and working contingently. Key drivers to form partnerships were found to be the identification of community WASH service gaps and the alignment of advocacy agendas. Key benefits reported were increased inclusion and empowerment outcomes and strengthened organisational knowledge and capacity. Challenges emerge when organisations' key staff change, strategies misalign, and financial and administrative capabilities differ. The study contributes practical insights into how civil society organisations (CSOs) partner to strengthen mutual WASH and GESI strategies and programmes and their outcomes. We recommend strengthening the partnerships between WASH and GESI organisations in ways that are cognisant of power dynamics, local priorities, and capacity needs and promote longevity and continuity through ownership of decisions at the local level. Our findings suggest that meaningful, reciprocal, and respectful engagement with WASH and GESI organisations enables WASH programmes to be in a better position to address the harmful norms that drive inequitable behaviours, thus strengthening localism, and the WASH governance system overall.

The Correlation Between Demographic Characteristics With Wash Practices In Stunting Locus

Human factors are very complex in the spread of disease. Stunting is caused by chronic malnutrition and infections in toddlers. Lack of access to clean water, hygiene, and sanitation contributes to stunting. Demographic factors can affect a person’s motivation to maintain hygiene. This study aims to be determined the correlation between demographic characteristics and water, sanitation, and hygiene (WASH) practices at the stunting locus. The method in this study used a correlational quantitative method with a cross-sectional design to be measured demographic characteristic and WASH practices variables. The study population consisted of Sukamulya village residents, and 463 Sukamulya village residents were sampled using total sampling. SPSS Version 26 for Windows was used for univariate and bivariate Chi-Square analysis. The results showed that 228 (49.2%) out of 463 of respondents had poor WASH practices. The results of the correlation test showed that there was a correlation between level of education and WASH practices with a score of Chi-Square 17,564 (p-value = 0,002). There is a correlation between education level and WASH practices at the stunting locus. Education affects a person’s perspective and decision-making, including environmental hygiene and health. Thus, the government and policymakers should hold WASH programs to educate the public about keeping the stunting locus clean.

Revisiting transformative WASH: measuring impact

Revisiting transformative WASH: measuring impact

An Analysis of Factors Influencing Household Water, Sanitation, and Hygiene (WASH) Experiences during Flood Hazards in Tsholotsho District Using a Seemingly Unrelated Regression (SUR) Model

Communities around the world living in either urban or rural areas continue to experience serious WASH problems during flood episodes. Communities and individual households are affected differently depending on their coping capacities and their resource base. Flooding causes extensive damage to water and sanitation infrastructure, leaving communities vulnerable to WASH-related illnesses. This paper aimed to analyze factors influencing the community WASH experiences during flood incidences in Tsholotsho District using a Seemingly Unrelated Regression (SUR) model. The quantitative approach was used in this study. A questionnaire was used to collect data from household heads in Tsholotsho District. A total of 218 Questionnaires were administered in four wards that were purposively selected for this study. Gathered data were analyzed using the Statistical Package for Social Sciences (SPSS Version 22) and principal component analysis was done, which culminated in a SUR model. The key findings of the study were that outbreaks of water and hygiene-related diseases, ponding of water which provides a breeding ground for mosquitoes, and contamination of surface water were the major WASH problems experienced in Tsholotsho District among other problems. The study also found that access to Non-Governmental Organisations (NGOs) programs, access to treated water, and level of education were positive and statistically significant in influencing some of the problems experienced during flooding. To increase the coping capacities of Tsholotsho communities, it is pertinent for governments and NGOs to consider implementing more WASH programs, increasing access to safe and clean drinking water, and increasing the level of education of communities.

Obstetric fistula-induced incontinence and WASH programming in humanitarian settings: agenda for research, innovation, and practice

Women living with obstetric fistula-induced incontinence (OFII) have heightened need for water, sanitation and hygiene (WASH) services because they experience involuntary leaking of urine, feces, or both. In humanitarian settings where access to WASH services is notably limited, research and innovation relating to OFII and WASH programming has not been granted the requisite attention, relative to menstrual hygiene management. The paper is intended to bring to the attention of humanitarian researchers and practitioners the research needs of women living with OFII. Three thematic areas that have the propensity to arouse interest in this neglected topical issue and help to set the stage for research and actions are discussed. These are the prevalence of OFII, prevention of OFII, and WASH programming for women living with OFII. Empirical studies dedicated to the above thematic issues will generate the needed evidence base to inform decision-making processes relating to improving the WASH needs of women living with OFII.

Formative Research for the Development of Evidence-Based Targeted Water, Sanitation, and Hygiene Interventions to Reduce Cholera in Hotspots in the Democratic Republic of the Congo: Preventative Intervention for Cholera for 7 Days (PICHA7) Program.

Compared to the general public, household members of cholera patients are at a 100 times higher risk of contracting cholera during the 7-day high-risk period after a cholera patient has been admitted to a health facility for treatment. The Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program aims to reduce household transmission of cholera during this 7-day high-risk period through a health facility-initiated water, sanitation, and hygiene (WASH) program promoting handwashing with soap, water treatment, and safe water storage. The PICHA7 program is delivered to cholera patient households through: (1) a pictorial flipbook delivered by a health promoter; (2) a cholera prevention package (handwashing station, drinking water vessel with lid and tap, and chlorine tablets); and (3) weekly WASH mobile messages sent to patient households in the Democratic Republic of the Congo (DRC). The objectives of this study were to conduct formative research to identify facilitators and barriers of the promoted WASH behaviors for cholera patient households and to tailor the PICHA7 program to target these facilitators and barriers. Formative research included 93 semi-structured interviews with diarrhea patient households and healthcare workers during exploratory research and a pilot study of 518 participants. Barriers to the promoted WASH behaviors identified during exploratory and pilot study interviews included: (1) low awareness of cholera transmission and prevention; (2) unaffordability of soap for handwashing; and (3) intermittent access to water limiting water for handwashing. For intervention development, narratives of the lived experiences of patient households in our study were presented by health promoters to describe cholera transmission and prevention, and soapy water and ash were promoted in the program flipbook and mobile messages to address the affordability of soap for handwashing. A jerry can was provided to allow for additional water storage, and a tap with a slower flow rate was attached to the handwashing station to reduce the amount of water required for handwashing. The pilot findings indicate that the PICHA7 program has high user acceptability and is feasible to deliver to cholera patients that present at health facilities for treatment in our study setting. Formative research allowed for tailoring this targeted WASH program for cholera patient households in the DRC.

Necessary conditions for sustainable water and sanitation service delivery in schools: A systematic review.

Access to water, sanitation, and hygiene (WASH) services confers significant health and economic benefits, especially for children, but only if those services can be delivered on a consistent basis. The challenge of sustainable, school-based WASH service delivery has been widely documented, particularly in resource-constrained contexts. We conducted a systematic review of published research that identifies drivers of, or tests solutions to, this challenge within low- and middle-income countries (PROSPERO 2020 CRD42020199163). Authors in the first group employ cross-sectional research designs and interrogate previously implemented school WASH interventions. Most conclude that dysfunctional accountability and information sharing mechanisms drive school WASH service delivery failures. By contrast, most of the interventions developed and tested experimentally by authors in the second group focus on increasing the financial and material resources available to schools for WASH service delivery. Overall, these authors find negligible impact of such infusions of cash, infrastructure, and supplies across a variety of sustainability outcome metrics. Taken together, the evidence suggests that sustainable service delivery depends on three simultaneously necessary components: resources, information, and accountability. Drawing upon theory and evidence from social psychology, public management, and political science, we identify priority knowledge gaps that can meaningfully improve the design of effective interventions. We also highlight the importance of both interdisciplinary collaboration and local expertise in designing WASH programming that aligns with sociocultural and institutional norms, and is thus more likely to generate sustainable impact.