Water, Sanitation And Hygiene Services Research Articles

Development of a Framework to Improve the Provision of Water, Sanitation, and Hygiene in Healthcare Facilities of Mwandi District in Western Province

Healthcare facilities (HCFs) require safe water, sanitation, hygiene, environmental cleaning, and waste management (WASH) in the provision of quality services to promote, restore, maintain, and improve health. However, the unavailability of studies on the challenges and opportunities of WASH services in HCFs of Mwandi District has limited the potential for improved health care and quality of life. Without proper elucidation, this has the potency to dissuade women from using HCFs for childbirth and healthcare, potentially increasing maternal mortality rates. To examine the challenges and opportunities in accessing safe WASH services in HCFs in Mwandi District, more of Qualitative techniques were utilized to gather data from 8 HCFs in Mwandi District. This involved initial observations employing the WASH Status Checklist, followed by focus group discussions with expectant mothers and 23 key informant interviews. Thematic analysis was used to analyse the data.  The results showed that only half of the investigated facilities provided basic water services, hampered by water salinity issues. Even though most facilities had improved sanitation facilities, they, however, do not meet the basic sanitation standards. This was primarily due to issues such as corroded pipes, insufficient accessible toilets for people with disabilities, and the absence of menstrual hygiene facilities. Many facilities lacked gender-segregated staff facilities. Most of the facilities had functional hand hygiene facilities but also did not meet the basic standards due to a lack of soap for hand washing. A significant number encounter inefficiencies in cleaning protocols, and the majority face poor infrastructure conditions. The findings further revealed that these challenges stem from inadequate prioritization and funding for Water, Sanitation, and Hygiene (WASH) initiatives. The existing knowledge often concentrates on individual components, the findings stress the necessity for an integrated approach that collectively addresses water supply, sanitation, hygiene, and waste management. This holistic perspective can significantly contribute to the development of more effective guidelines and policies, offering a nuanced understanding of the interconnected nature of WASH components. Furthermore, the research sheds light on the pivotal role of localized political will, specifically highlighting the influence of Health Centre Advisory Committees (HAHC) in shaping governance at the community level, especially concerning WASH projects. The study offers a comprehensive overview of challenges and sustainability opportunities related to WASH services, crucial for their effective functioning. It emphasizes the necessity for heightened awareness and increased budget allocation for the sustainable maintenance of WASH services

Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Children with disabilities lack access to nutrition, healthand WASH services: A secondary data analysis.

Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitationand hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy amonghouseholds with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASHand dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher amonghouseholds with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.

Beyond a facility: A cross-sectional survey on WASH service levels and informal social accountability in childcare centres in Nairobi's informal settlements

Abstract Access to clean water, sanitation, and hygiene (WASH) services is crucial for a healthy start in life. Social accountability has a potential for enhancing WASH services in childcare centres. However, there are inadequate studies to understand how informal social accountability mechanisms contributes to WASH service provision. To address this gap, we conducted a cross-sectional survey in Korogocho and Viwandani informal settlements in Nairobi, Kenya, to explore the relationship between different levels of WASH services (ranging from basic to limited or nonexistent) and indicators of informal social accountability, including rewards, sanctions, voice, and responsiveness. We employed multinomial regression analysis, utilizing a robust error variance estimator to account for potential biases. Our findings revealed disparities in WASH service provision between the two studied areas, with childcare centres in Korogocho exhibiting higher access to basic WASH services compared to those in Viwandani. Our analysis also highlighted a significant association between informal social accountability mechanisms and the provision of WASH services. Notably, the sanction mechanism exhibited a correlation with all WASH services, suggesting its pivotal role in shaping service delivery outcomes. In light of these findings, it is imperative to prioritize efforts aimed at reinforcing social accountability mechanisms in WASH service delivery frameworks.

Multi-level factors associated with utilization of water, sanitation and hygiene services by mothers in Nepal.

Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal. A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH. At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63-8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH. Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households.

Water, Sanitation, and Hygiene (WASH) practices among residents of different slum settlements in a ward of Kolkata: A mixed-methods study.

Access to safe water, sanitation, and hygiene (WASH) is the most basic need for mankind. Poor WASH practices are associated with various waterborne diseases, especially in developing countries such as India. The aim of the study was to assess WASH practices among residents of different slum settlements in a ward of Kolkata, identify the factors associated with WASH practice, and explore the barriers faced by the families and municipal staff in providing adequate WASH services to the community. An observational study, cross-sectional in design with a convergent parallel mixed-methods approach, was conducted in different slum settlements in a ward of Kolkata. Quantitative data were collected by face-to-face interview, spot observation, and measuring the living area, door, and window spaces. Key informant interviews were conducted with the medical officer, ward vector-control coordinator, and municipal waste handlers, in addition to in-depth interviews with respondents who had unsatisfactory WASH practices. SPSS version 25.0 was used to analyze the quantitative data. Qualitative data were analyzed thematically using Atlas.ti 22. The overall WASH practices were considered satisfactory in 58.8% of the households. Education of the respondents up to the secondary level, presence of overcrowding, and inadequate ventilation in the house had statistically significantly higher odds of unsatisfactory practice. Poor living conditions, difficulty in collecting and storing water, waterlogging, blocked sewage drains, common toilets for men and women, and lack of motivation were the primary obstacles identified by the residents. Unsatisfactory WASH practices were observed among a high proportion of the slum population. Community engagement and education regarding WASH in communities is strongly recommended along with improvement of infrastructure and capacity building.

Water sanitation and hygiene at households and its implications on diarrhoea among under-five children of slums at field practice area of a Peripheral Medical College of West Bengal.

Inadequate water, sanitation and hygiene (WASH) may lead to an increase in water-borne diseases like diarrhoea. The objective of the study was to assess water, sanitation and hygiene in the urban slums of Patpur, Bankura and to determine the implications of WASH on the occurrence of diarrhoea among under-five (U-5) children. A cross-sectional observational study was conducted during January-March 2020 by interviewing persons involved in water collection from each of the 182 slum households of Patpur, by two-stage sampling using a pre-designed structured schedule and the core questions on drinking WASH for household surveys: 2018 update by UNICEF and WHO. For testing the association between categorical variables, a Chi-square test was done. Binary logistic regression and the Hosmer Lemeshow test were done to know the predictors of diarrhoea in U-5 children. A P value of < 0.05 was considered statistically significant. The proportion of diarrhoea among U-5 children was 0.34. Limited drinking WASH services were found in 3.30, 45.05 and 24.18% of households, respectively. Mobile objects users for handwashing were 14.05 times more prone to diarrhoea in U-5 children than those who had fixed handwashing facilities at their dwellings, yards or plots. Feeding children without handwashing had 5.70 times increased chances of diarrhoea among U-5 children than those who washed their hands before feeding. Handwashing facilities (fixed, mobile object or no facility) and handwashing with soap and water before feeding the child significantly affected the occurrence of diarrhoea among U-5 children.

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.

Analysis of water, sanitation, and hygiene facilities using the WASH-FIT approach and its relation to patient satisfaction and maternal mortality at hospitals in Indonesia.

The provision of Water, Sanitation, and Hygiene (WASH) is critical to reducing infection and enhancing the quality of health care services. The study aims to assess WASH facilities in Indonesian hospitals using the Water, Sanitation, and Hygiene Facility Improvement Tool (WASH-FIT) approach and examine their association with customer satisfaction and maternal mortality owing to infection. We utilized the national scale Health Facilities Research dataset in Indonesian hospitals in 2019. WASH status is determined using WASH-FIT indicators, i.e., water, sanitation, waste management, hand hygiene, environmental cleaning, and management services, and then divided into three levels: poor, adequate, and good categories. The majority of hospitals in Indonesia had a good category, i.e., the range of hospitals with a good category was 79-97% nationally, in 6 aspects: water, sanitation, hand hygiene, environmental cleaning, and management services, except for waste management services (13%). Good WASH service facilities are more frequently found in government hospitals than in private and specialized hospitals, while lower-level hospitals tend to have poor levels of all WASH-FIT indicators. There are significant relationships between adequate sanitation services (β = 0.724), adequate and good categories of hand hygiene services (β = 0.712 and 0.866, respectively), environmental cleaning (β = -0.501 and -0.503, respectively), and management (β = -0.645 and 0.446, respectively), with the proportion of maternal mortality owing to infection. Furthermore, there was no relationship between WASH-FIT indicators and patient satisfaction, except for good hand hygiene services (β = 0.453). Despite good conditions in almost all WASH-FIT indicators, the improvement of waste management is urgently needed to improve the WASH services in hospitals in Indonesia, as also found in other developing countries.

Accessibility to WASH and waste management services in African urban informal settlements: A comparative analysis

Abstract The study investigates the existing scenario and spatial distribution pattern disparity of service distribution of water, sanitation, and hygiene (WASH) and waste management services (WMS) in urban informal settlements within the Zaria metropolis and generates recommendations for the policymakers for improvements. The study highlights challenges in urban settlements, including insufficient water, sanitation, and waste services, contributing to diseases like diarrhea and cholera. It stresses the importance of better water quality, sanitation, and waste management, and highlights the impact of governance and policies on service gaps. It also suggests using collaborative methods and technologies like GIS for solutions, employing GIS and statistics to analyze service availability and access for residents. The findings underscore the dominant role of the private sector in water treatment plant distribution (71.43%) over public facilities (28.57%). It highlights disparities in toilet types between public and private spaces: pit toilets (55.11%) are prevalent in public restrooms, while the data indicate that most water sources are poorly maintained: Only 0.50% of boreholes are newly constructed, while a significant 43.15% are poorly maintained, and 30.62% are well maintained. Moreover, private toilets are predominantly pit toilets, constituting 3.11% of the total, with no water closets toilets reported.

Examining factors driving inequities in water, sanitation, hygiene, and waste management services in healthcare facilities in Ghana: An analysis of routine national data

Abstract In Ghana, little is known about the drivers of inequities of basic water, sanitation, and hygiene (WASH) services in healthcare facilities (HCFs). We aim to examine the status and factors driving access to basic WASH services in Ghana. This survey involved an analysis of routine health service data submitted to the District Information Management System 2 (DHIMS 2). Complete data were available for 1,646 HCFs across Ghana for analysis. Coverage of basic Water, Sanitation and hygiene services was 69, 58, and 64%, respectively. About 50% had a WASH-IPC action plan, and 67% had a WASH-IPC manager who is responsible for the day-to-day WASH management. Regional inequities in access to basic WASH services exist, with the newly established regions and those in Northern Ghana being disadvantaged. Significant drivers of basic WASH services were the location of HCF, the level of service delivery, and availability of a trained facility-based assistant WASH manager. WASH services in Ghanaian HCFs have improved, but it is still not up to the standards set by the Sustainable Development Goals for WASH. Universal access to basic WASH services can be attained by mounting targeted WASH interventions and appointing WASH-IPC managers at all levels of the health system.

Optimal control strategies for water, sanitation, and hygiene in mitigating spread of waterborne diseases

Improving access to water, sanitation and hygiene (WASH) can help to eliminate the root cause of waterborne disease transmission. WASH has the potential to function as a sustained and effective mechanism for controlling enteric diarrheal disease (EDD) over the long term. To address this question, we formulate a mathematical model to study the impact of WASH services on reducing the transmission of waterborne diseases. The model is analyzed using the stability theory of differential equations in order to determine the threshold condition in disease control. We utilize optimal control theory to find the right balance in WASH interventions, ensuring a decrease in waterborne disease over a specific planning period. The total number of EDD cases is minimized when there are specific financial restrictions. To analyze the outcomes, we employed numerical simulations and conducted a sensitivity analysis on different weights in the cost index. Furthermore, we compared the numerical simulations of the optimal solutions and performed multiple regression analyses to gain insights into the impact of control strategies. Our findings reveal that wastewater and sewage treatment (WST) control has the most significant impact. When multiple controls are necessary, WST and drinking water supply (DWS) control provide the most effective combination. These results have significant implications for controlling infectious diseases, especially in developing countries where budgets are typically limited. Implementing these strategies could potentially reduce disease transmission and improve public health outcomes.

Healthcare facility water, sanitation, and hygiene service status and barriers in Addis Ababa, Ethiopia

Abstract Inadequate water, sanitation, and hygiene (WASH) practices within healthcare facilities heighten the likelihood of hospital-acquired infections. Therefore, this study aimed to assess the status of WASH services and barriers at public healthcare facilities in Addis Ababa. A converging parallel mixed design was conducted among 86 public health care facilities and 16 key informants. A stratified sampling technique was used to select health care facilities. Quantitative data was collected using a semi-structured checklist, and qualitative data was collected using key informant interviews. Thematic data analysis was done to identify the barriers. Independent analysis of the healthcare WASH domain revealed that 86% and 14% of healthcare facilities had access to basic and limited water services, respectively; 100% had limited access to sanitation services; and 88.4% had limited hand hygiene services. While 97.7% and 29% did not have environmental cleaning or waste management services, respectively. Lack of WASH service infrastructure, resource availability, governance and collaborative work, capacity and awareness building, and a framework for monitoring and evaluation were found to be barriers to WASH services. Lack of basic WASH service access and existing challenges at healthcare facilities hinder efforts towards infection prevention and control.

Water, sanitation, and hygiene global research: evolution, trends, and knowledge structure.

Water, sanitation, and hygiene (WASH) services play a crucial role in promoting public and environmental health as well as social and economic development. At the global level, particularly in the developing world, WASH issues continue to present significant challenges. These challenges have been further intensified by factors such as the COVID-19 pandemic, escalating conflicts, climate change, water scarcity, and rising inequality. The scientific community has actively engaged in constructive discussions on these issues, as evidenced by the notable research findings. Therefore, the aim of this study was to comprehensively examine and evaluate global knowledge on WASH. To search for relevant publications, the Scopus database was utilized using specific terms associated with WASH. VOSviewer 1.6.18 software was employed to generate network visualization maps, which assessed collaborative patterns and research trends in the field of WASH. The research output of countries was adjusted considering their gross domestic product (GDP) and population size. The total number of WASH-related publications, including all types of documents, was 1805. By narrowing the search to articles and reviews, the overall global productivity yielded 1589 documents: 1367 (86.0%) original articles and 222 (14.0%) review articles. The USA had the highest number of WASH publications (n = 668; 42.0%), followed by the UK (n = 396; 24.9%), Switzerland (n = 151; 9.5%), and Australia (n = 141; 8.9%). Ethiopia emerged as the leading country in terms of GDP per capita and the number of publications, followed by Uganda, Malawi, India, and Bangladesh. The USA, the UK, and Switzerland exhibited the most extensive collaboration among countries. The main research areas encompassed the role of WASH in sustainable development, the impacts of inadequate access to WASH services on gender equality, children, infants, and the outbreak of COVID-19 and other diseases, as well as the significance of hygiene practices and community and school-based WASH interventions in reducing infections. This study provides a novel analysis of global WASH-related research and highlights the distribution of outcomes across nations. Continued and increased collaboration between developed and developing nations will facilitate the sharing of responsibility for WASH research outcomes and the implementation of effective policies.

Factors influencing access to water, sanitation, and hygiene among crisis-affected populations

Abstract Background The Central African Republic is suffering a long and complex humanitarian crisis. Population access to water, sanitation, and hygiene (WASH) services remain a challenge in the context of protracted conflicts. However, research on access to WASH in this population is limited. The purpose of the study was to investigate factors associated with access to WASH among crisis-affected populations in the Central African Republic. Methods This study analyzed 11,723 crisis-affected households from the 2020 Central African Republic Multi-Cluster Needs Assessment survey data. This survey was conducted between June to August 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative and geographically covered all sub-prefectures of the country.Sampling weighted multivariable binary logistic regression analysis was performed. Results Internally displaced persons (IDPs) were more likely to affect their access to WASH than their host families.Movement restricted due to COVID-19, household members with difficulties in self-care (e.g., washing, dressing), education level, and monthly household income were significantly associated with access to WASH. Discussion This study suggests that certain factors place the crisis-affected populations in the Central Africa Republic a thigh risk for access to WASH, especially among IDPs. The findings in this study can inform public health professionals to develop support and education programs and shape health care policies. In addition, the results highlight the importance of access to safely managed WASH services during infectious disease outbreaks, including the current COVID-19 pandemic Key messages • The findings in this study can inform public health professionals to develop support and education programs and shape health care policies. • The results highlight the importance of access to safely managed WASH services during infectious disease outbreaks, including the current COVID-19 pandemic.

Assessment of Water, Sanitation, and Hygiene Conditions in Public Elementary Schools in Quetzaltenango, Guatemala, in the Context of the COVID-19 Pandemic.

Water, sanitation, and hygiene (WASH) services in schools are essential to reduce infectious disease transmission, including that of COVID-19. This study aimed to establish a baseline of WASH services in six public elementary schools in Guatemala, with a focus on hand hygiene. We used the WHO/UNICEF Joint Monitoring Programme (JMP) report indicators to assess the WASH infrastructure at each school. We collected water samples from easily accessible water points (pilas, or bathroom sinks) at each school to test for the presence of total coliforms and E. coli. In-depth interviews were carried out with teachers to understand hand hygiene practices and systems at school. Results indicate that all schools had water available at the time of the survey. All water samples at four schools tested positive for total coliforms and at one school, positive for E. coli. All schools had sanitation facilities, but services were limited. Only 43% of handwashing stations at schools had soap available. No school had disability-inclusive WASH services. Financial constraints and a lack of appropriate WASH infrastructure were the main barriers reported by teachers to meet hand hygiene needs at school. Appropriate access to WASH infrastructure and supplies could increase hand hygiene practices and improve learning conditions for students.

Spatial Distributions of Diarrheal Cases in Relation to Housing Conditions in Informal Settlements: A Cross-Sectional Study in Abidjan, Côte d'Ivoire.

In addition to individual practices and access to water, sanitation, and hygiene (WASH) facilities, housing conditions may also be associated with the risk of diarrhea. Our study embraced a broad approach to health determinants by looking at housing deprivation characteristics as exposures of interest and confronting the latter's spatial distribution to that of diarrheal cases. We tested the hypothesis that the risk of diarrhea in informal settlements is not only associated with WASH services, but also with inadequate dwelling characteristics, and that their spatial distributions follow similar patterns. We designed a cross-sectional study and collected primary data through georeferenced household surveys in two informal settlements in Abidjan, Côte d'Ivoire. We used local join count statistics to assess the spatial distribution of events and multiple logistic regressions to calculate adjusted odds ratios between diarrhea and exposures. A total of 567 households were enrolled. We found that constant access to basic WASH services, non-durable building materials, cooking outdoors, and water service discontinuity were associated with higher risks of diarrhea in the general population. The spatial distribution of diarrheal cases coincided with that of dwelling deprivation characteristics. We observed significant heterogeneity within the study sites regarding the spatial distribution of diarrheal cases and deprived dwellings. Along with WASH infrastructure, communities also need dignified housing to effectively prevent diarrhea. We recommend that decision-makers acknowledge a "spectrum" of deprivation within the heterogeneous universe of informal settlements, adopting a site-specific approach based on high-resolution data to address diarrhea and improve people's well-being.

Towards more sustainable Water, Sanitation and Hygiene (WASH) projects in Magway Region, Myanmar

AbstractClean water and sanitation are essential for human development. Governments, international and national aid organizations have implemented water, sanitation, and hygiene (WASH) projects worldwide, notably in low- and middle-income countries. However, the majority of such projects experience failure. As a result, 2.4 billion people worldwide are deprived of improved WASH services. Research revealing how WASH projects can be sustained and which factors need to be considered is crucial. Despite the gap and its importance, existing studies on the sustainability assessment of WASH projects are limited. This study attempted to assess and compare the sustainability of WASH projects in Myanmar that used the Community Led Total Sanitation (CLTS) and Participatory Hygiene and Sanitation Transformation (PHAST) approaches with the “Sustainability Check” developed by The United Nations Children’s Fund (UNICEF). This research also evaluated the extent to which WASH projects contributed to the Myanmar National WASH Strategy. The study results show that both CLTS and PHAST project operations fully met the sustainability standards regarding accessibility and intra-village equity. Other sustainability indicators, such as water quality, use of sanitation facilities, and handwashing facilities, were at or above 85% and had already met the 2025 national targets. In contrast, handwashing practices have reached the 2030 national targets. The findings revealed that technical factors, institutional factors (at the community level), social, financial, and sanitation factors contributed to WASH project sustainability. The results also highlight the need for strengthening collaboration with local government to ensure that communities receive post-implementation support from local authorities, to encourage community participation and foster sense of ownership, to empower community-based bodies for O&amp;M and monitoring of water and sanitation facilities, to integrate appropriate behavioral change activities, and to align with the National WASH Strategy. This study would be beneficial for WASH practitioners to ensure the inclusion of factors that support sustainability in the execution of future WASH projects. Graphical abstract

Exploring the association between household access to water, sanitation and hygiene (WASH) services and common childhood diseases using data from the 2017–2018 Demographic and Health Survey in Benin: focus on diarrhoea and acute respiratory infection

ObjectiveThe paper aimed to study the association between household access to water, sanitation and hygiene (WASH) services and the occurrence of diarrhoea and acute respiratory infection among children under 5...

Socio-political barriers to sustainable urban water governance: the case of Cartagena, Colombia

ABSTRACT Socio-political factors shape urban water insecurity, yet are often not incorporated into urban water, sanitation and hygiene (WASH) planning. WASH service coverage rates in Cartagena, Colombia, suggest high water security, yet the history of water policy and governance in the city from 1991 to 2019 reveals a more complex reality of water insecurity that is not reflected in service coverage indicators. This case study bridges scientific enquiry with policy to demonstrate how weak institutions and governance at municipal levels undermine local water security and the implementation of national sustainable development policy.