Water, Sanitation And Hygiene Research Articles

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.

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.

Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience

Water, sanitation and hygiene (WASH) play key roles in management of infectious diseases like cholera and other waterborne diseases; given that millions of people globally have no access to safe water. This cross-sectional study, conducted in 7 communities of Ogoni region (Khana, Gokana, Tai and Eleme LGAs), Orashi region (Abua/Odual, Ahoada West, Ahoada East and Ogba-Egbema-Ndoni LGAs) and Obolo region (Andoni LGA) all in Rivers State, Nigeria, enrolled 274 inhabitants comprising 164 females and 110 males. These included persons passing watery stools accompanied with vomiting, abdominal cramps and those with such prehistory. Questionnaires were used to obtain socio-demographic data. A total of 274 faecal samples were collected and transported in Cary-Blair stool culture transport medium to Rivers State University Teaching Hospital laboratory; and inoculated on Thiosulphate sulphate citrate bile salt-sucrose agar. Gram staining and biochemical tests were performed using standard procedures. Among the 274 subjects, 40 were infected giving a prevalence rate of 14.6%, including 26(15.9%) females and 14(12.7%) males though this was statistically insignificant, (U=8738.000, p=0.474). On educational levels, those who attended secondary schools had the highest prevalence rate (26.3%), compared with others and it was statistically significant, (p=0.00). WASH perceived predisposing factor showed the prevalence rate among those without access to safe water was 33(21.6%) against those with access to safe water 7(5.8%) and was statistically significant, (p=0.00). Subjects engaged in routine environmental sanitation and hygiene practices had lower prevalence 7(7.6%) than their counterparts, 33(18.1%), p=0.02. Respondents who think climate change had a positive impact on cholera transmission had prevalence of 34(23.3%) against those who disagreed, 6(4.7%), which was statistically significant. The study deduced that unavailability of safe drinking water, climate change, and unhygienic practices were major predisposing factors to cholera infection. Provision of safe water is advocated as greater percentage of the communities lacked access to safe drinking water. Routine environmental sanitation exercise should be revisited and enforced.

The Interplay Between Household Risk Perception of Parasitic Infections and Water, Sanitation, and Hygiene (WASH) Practices: Evidence From an Urban Poor Community in the Philippines

The Interplay Between Household Risk Perception of Parasitic Infections and Water, Sanitation, and Hygiene (WASH) Practices: Evidence From an Urban Poor Community in the Philippines

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.

Review of remote monitoring systems for the delivery of sustainable and resilient water infrastructure

Purpose This paper aims to present a literature review of remote monitoring systems for water infrastructure in the Global South. Design/methodology/approach Following initial scoping searches, further examination was made of key remote monitoring technologies for water infrastructure in the Global South. A standard literature search methodology was adopted to examine these monitoring technologies and their respective deployments. This hierarchical approach prioritised “peer-reviewed” articles, followed by “scholarly” publications, then “credible” information sources and, finally, “other” relevant materials. The first two search phases were conducted using academic search services (e.g. Scopus and Google Scholar). In the third and fourth phases, Web searches were carried out on various stakeholders, including manufacturers, governmental agencies and non-governmental organisations/charities associated with Water, Sanitation and Hygiene (WASH) in the Global South. Findings This exercise expands the number of monitoring technologies considered in comparison to earlier review publications. Similarly, preceding reviews have largely focused upon monitoring applications in sub-Saharan Africa (SSA). This paper explores opportunities in other geographical regions and highlights India as a significant potential market for these tools. Research limitations/implications This review predominantly focuses upon information/data currently available in the public domain. Practical implications Remote monitoring technologies enable the rapid detection of broken water pumps. Broken water infrastructure significantly impacts many vulnerable communities, often leading to the use of less protected water sources and increased exposure to water-related diseases. Further to these public health impacts, there are additional economic disadvantages for these user communities. Originality/value This literature review has sought to address some key technological omissions and to widen the geographical scope associated with previous investigations.

Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS)

BackgroundThe burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. MethodsWe performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. ResultsWe recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DiscussionThis study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.

Gendered Disparities in Water and Sanitation through an Intersectional Lens: Emphasising Women’s Perspectives

The relationship between gender and water, sanitation, and hygiene (WASH) has been a widely accepted concern among academicians, activists, and social workers in India, but research and policies focusing on gender and sanitation often fail to address the issue of the intersectionality of identities. Analysing the complex intersection of caste, class, age and gender with water and sanitation in rural India extends new opportunities to explore the complex power dynamics prevalent in society. A focus group study with 54 female participants of seven discussions and in-depth interviews has been conducted in the Hardoi district of Uttar Pradesh to explore the social relations and differences in the physical world within the context of accessibility, affordability, and availability in the water and sanitation sector. Given gendered and other social divisions, we elaborate on how women play an essential role in water and sanitation management in the household. This study also offers evidence of rural women’s experiences of intra-personal, household, and social harassment and violence related to poor or absence of sanitation and water infrastructure due to intersectional social dynamics. We also demonstrate how theorising about a single dimension of social difference ignores the different groups’ access to power, leading to inequality and disparity. 

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.

Locally Led Opportunities for Water, Sanitation and Hygiene, Climate Change and Gender Equality Partnerships in the Blue Pacific

Partnerships between water, sanitation and hygiene (WASH) and rights-holder organisations (RHOs) have become more common, important and impactful in the international development sector, and they have been driven by aligned agendas, mutual benefits and the pursuit of locally owned and inclusive development agendas. There are opportunities to broaden partnerships and coalitions to include climate change advocacy, adaptation and mitigation organisations given the increased focus on the links between WASH, resilience and climate change action. This article takes a first step in addressing the question: How can the experience of WASH, gender equality and climate organisation partnerships and coalitions in the Blue Pacific inform the WASH sector in its growing support of and investment in diverse partnerships in support of localism? We conducted a systematic scoping review to identify the literature on gender equality, WASH and climate change-related partnerships and coalitions in the Blue Pacific. Three key themes emerged from the systematic scoping review based on 23 studies published from 1996 to 2024. Firstly, partnerships and coalitions are part of a critical localism agenda, though care needs to be taken by potential partners and donors to understand and manage power dynamics between actors and organisations working within and across sectors. Secondly, a range of benefits and success factors have been documented on partnerships and coalitions in the Blue Pacific, including support for emerging leadership, leveraging policy outcomes, facilitating learning and the sharing of frameworks and tools between partners. Thirdly, like all parts of the community and governance ecosystem, gender dynamics and social norms inform and influence partnerships and coalitions. At the same time, partnerships are important for informing and driving gender equality and inclusion at the local and regional levels including within the WASH sector. This article is useful for local actors, donors and civil society organisations wishing to pursue the mutually beneficial goals of WASH, gender equality, climate change action and localisation in the Blue Pacific.

Investigating the effect of a school-based WASH intervention on soil-transmitted helminth and schistosome infections and nutritional status of school children in Ethiopia: a quasi-experimental study

BackgroundThe impact of access to improved water, sanitation and hygiene (WASH) and health education on large-scale deworming programs aimed at controlling soil-transmitted helminth (STH) and schistosome (SCH) infections has not been well studied. We assessed the additional impact of improved WASH infrastructure and health education at schools on STH and SCH infections in Ethiopia.MethodsThe study used a quasi-experimental design under which 30 schools were assigned to either an intervention (15 schools) or control (15 schools) arm. Both arms received a standard deworming treatment and lunch. In the intervention arm, improved WASH and health education were provided. At three consecutive time points (baseline in 2013, 2014 and 2015), the prevalence and intensity of STH and SCH infections and the nutritional status [hemoglobin concentrations and physical growth (height and weight)] were determined. To verify whether interventions were successfully implemented, the WASH status at school and the student knowledge, attitudes and practices related to WASH (WASH-KAP) were recorded. Differences in metrics between arms at baseline (2013) and follow-up (2015) were assessed both within and between the arms.ResultsA significant increase in scores for both the school WASH and student KAP was found in the intervention arm, indicating successful implementation of the intervention. The prevalence of any STH infection was significantly reduced in the intervention arm but not in the control arm (F = 4.486, p = 0.034). There was a significantly greater reduction in the intensity of infection of hookworm and Ascaris lumbricoides compared to baseline in both arms. The intervention did not affect school children’s height-for-age z-score (intervention arm * time coef = 0.12, p = 0.400) and body mass index-for-age z-scores (intervention * time coef = − 0.06, p = 0.526). Hemoglobin concentrations increased significantly more in the control than the intervention arm (coef = − 0.16, p = 0.006).ConclusionsAlthough the intervention did increase school WASH and student WASH-KAP, our study found poor evidence of the additional benefit of improved WASH and health education to deworming and school food programs on parasite re-infection and the health outcomes of children.Graphical

Knowledge, attitude and practice towards intestinal schistosomiasis among school-aged children and adults in Amhara Regional State, northwest Ethiopia. A cross-sectional study

BackgroundSchistosoma mansoni causes intestinal schistosomiasis (SCH) in all regions of Ethiopia. Despite many years of mass treatment, the prevalence has not dropped significantly. The reduction of SCH transmission demands the integration of deworming with safe water, sanitation, and hygiene (WASH) activities. Adequate knowledge and a positive attitude towards SCH are critical to practicing those interventions. However, data on the knowledge, attitude, and practice (KAP) level in school and community settings is limited in Ethiopia.MethodsSchool and community-based cross-sectional studies were conducted from February to June 2023 among 634 school-aged children (SAC) and 558 adults. A pre-tested questionnaire was used to collect socio-demographic and KAP data. Records were entered and analyzed using SPSS software version 21. Correct responses for each of the KAP questions were scored as one, while incorrect or ‘I don’t know’ responses were scored as zero. Good knowledge, a positive attitude and good practice were declared if percentage scores were ≥ 80%, ≥ 90% and ≥ 75%, respectively.ResultsOnly 229 (19.2%) respondents, comprising 91 (14.4%) SAC and 138 (24.7%) adults, had ever heard of SCH. Adults, males, and urban residents had higher awareness level compared to their respective counterparts (p < 0.05). Only 28.4% of aware respondents knew that swimming or bathing in freshwater is a risk factor for schistosoma infection; 10.9% knew the etiologic agent; and 14.4% mentioned at least one sign and symptom associated with SCH. The majority (97.8%) of the respondents were willing to take therapeutic drugs, but only 37.6% believed that SCH is a serious disease. Regarding risky practices, 89.5% practiced swimming or bathing in freshwater, and 25.3% had no access to piped water. Among the aware respondents, only 18 (7.9%) had good knowledge, while 30 (13.1%) had a positive attitude towards SCH. Ninety-nine (43.2%) respondents had good Schistosoma infection prevention practices.ConclusionsThe knowledge, attitude, and preventive practice level towards schistosomiasis are low in the study area. Therefore, strengthening school and community-based health education, along with mass drug administration (MDA), WASH, and a vector control program, is recommended for preventing SCH.

Centring participant experience: a realist evaluation of a menstruator-friendly facility design project in a refugee settlement, Lebanon

IntroductionMenstrual health in humanitarian contexts is a neglected topic. Its taboo nature presents difficulties for participants in menstrual health projects in these particularly challenging settings. Namely, their experiences may be concealed or overlooked in projects that are typically outcome focused. Realist Evaluation is a useful method to unearth and explore the hidden mechanisms and their causes, which lead to positive or negative participant experiences. The authors have applied this approach to a robust humanitarian menstrual health project to explore how to centre the emotional wellbeing of participants at all stages: prior to, during, and post-participation.Study settingThe project studied was led by the International Federation of Red Cross and Red Crescent Societies who piloted their adaptable manual for menstruator–friendly water, sanitation and hygiene (WaSH) facility design in humanitarian contexts. It was conducted by the Lebanese Red Cross in an informal tented settlement hosting Syrian refugees in Qaa, Lebanon.MethodsThe authors collected interview and focus group data on the contextual factors and processes within the project from nine project staff and 16 settlement inhabitants. They used a realist process of theory development, testing, and consolidation to understand how and under what circumstances the project inputs affected participants’ wellbeing.ResultsThe contextual factors and causal mechanisms promoting participant experience comprised individual (choices influencing and experience during participation), interpersonal (group dynamics and the role of non-menstruators), and organisational (expertise and knowledge, relationship to participants and cultural differences) factors.ImplicationsThe research uses a case study from a renowned humanitarian organisation who provided a well-delivered project in a conducive environment to explore the mechanisms and contexts that can promote wider learning and refine understanding and programming in this under-researched and -theorised space. Specifically, it informs which contextual factors and project inputs must be present within a menstrual health project to ensure participant satisfaction whilst efficiently delivering well-designed menstruator-friendly WaSH facilities.

Experiences of children's self-wetting (including urinary incontinence) in Cox's Bazar's Rohingya refugee camps, Bangladesh.

Self-wetting is the leakage of urine, either due to the medical condition of urinary incontinence (UI), or because a person does not want to, or cannot, access a toileting facility in time. This study explored the attitudes towards self-wetting and experiences of children (aged five to 11), their caregivers, community leaders and humanitarian practitioners in the Rohingya refugee camps in Cox's Bazar, Bangladesh. We particularly focused on how water, sanitation and hygiene (WASH) and protection interventions might assist in improving these experiences. We purposively selected participants from two camps where our partner organisation works. We conducted Key Informant Interviews (KIIs) with community leaders and camp officials, Story Book (SB) sessions with Rohingya children and in-depth Interviews (IDIs) with caregivers of children who participated in the SB sessions, as well as surveying communal toilets. Self-wetting by children was common and resulted in them feeling embarrassed, upset and uncomfortable, and frightened to use the toilet at night; many children also indicated that they would be punished by their caregivers for self-wetting. Key informants indicated that caregivers have difficulty handling children's self-wetting due to a limited amount of clothing, pillows, and blankets, and difficulty cleaning these items. It was evident that the available toilets are often not appropriate and/or accessible for children. Children in the Rohingya camps appear to self-wet due to both the medical condition of UI and because the sanitation facilities are inappropriate. They are teased by their peers and punished by their caregivers. Although WASH and protection practitioners are unable to drastically alter camp conditions or treat UI, the lives of children who self-wet in these camps could likely be improved by increasing awareness on self-wetting to decrease stigma and ease the concerns of caregivers, increasing the number of child-friendly toilets and increasing the provision of continence management materials.

Progress in controlling the transmission of schistosome parasites in Southern Ethiopia: the Geshiyaro Project in the Wolaita Zone

BackgroundThis paper describes changes in the prevalence and intensity of schistosome parasite infections in a project integrating mass drug administration (MDA), water, sanitation, and hygiene (WaSH), and behavioral change interventions.MethodsThe Geshiyaro Project comprises three intervention arms. Arm 1 is subdivided into “Arm 1 pilot” (one district) and Arm 1 (four other districts), both receiving integrated community-wide MDA with intensive WaSH interventions. Arm 2 involves 17 districts with community-wide MDA interventions, while Arm 3 serves as a control with school-based MDA interventions in three districts. A total of 150 individuals, stratified by age group, were randomly selected from each of the 45 sentinel sites. Arm sizes were 584 (Arm 1 pilot), 1636 (Arm 1), 2203 (Arm 2), and 2238 (Arm 3). Statistical tests were employed to compare infection prevalence and intensity across the different arms.ResultsThe prevalence of schistosome parasite infection ranged from 0% to 2.6% and from 1.7% to 25.7% across districts, employing the Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) diagnostics, respectively. The mean infection intensity level showed no marked difference between baseline and follow-up surveys when measured by KK, except in Arm 2 (t = 6.89, P < 0.0001). Infection prevalence decreased significantly in Arm 1 (t = 8.62, P < 0.0001), Arm 2 (t = 6.94, P < 0.0001), and Arm 3 (t = 8.83, P < 0.0001), but not in Arm 1 pilot (t = 1.69, P = 0.09) by POC-CCA, when trace was considered positive. The decrease was significant only in Arm 1 (t = 3.28, P = 0.0001) and Arm 2 (t = 7.62, P < 0.0001) when the trace was considered negative in POC-CCA. Arm 2 demonstrated a significant difference in difference (DID) compared to the control group, Arm 3, regardless of whether trace in POC-CCA was considered positive (DID = 3.9%, df = 8780, P = 0.025) or negative (DID = −5.2, df = 8780, P = 0.0004).ConclusionsThe prevalence of schistosomiasis was low when employing the KK diagnostic but moderate in some locations by the POC-CCA diagnostic. The infection level had decreased across all arms of the Geshiyaro study at mid-term of the 7-year project, but further efforts are needed to reduce the rate of parasite transmission based on the POC-CCA diagnostic scores.Graphical

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.

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

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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

ABSTRACT Background: 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. Materials and Methods: 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 &lt; 0.05 was considered statistically significant. Results: 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. Conclusion: 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.

Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis

Quantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial source tracking markers (MSTM) and subsequent child health outcomes. In this individual participant data meta-analysis we searched we searched PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus for WASH intervention studies with a prospective design and concurrent control that measured enteropathogens or MSTM in environmental samples, or both, and subsequently measured enteric infections, diarrhoea, or height-for-age Z-scores (HAZ) in children younger than 5 years. We excluded studies that only measured faecal indicator bacteria. The initial search was done on Jan 19, 2021, and updated on March 22, 2023. One reviewer (AM) screened abstracts, and two independent reviewers (AM and RT) examined the full texts of short-listed articles. All included studies include at least one author that also contributed as an author to the present Article. Our primary outcomes were the 7-day prevalence of caregiver-reported diarrhoea and HAZ in children. For specific enteropathogens in the environment, primary outcomes also included subsequent child infection with the same pathogen ascertained by stool testing. We estimated associations using covariate-adjusted regressions and pooled estimates across studies. Data from nine published reports from five interventions studies, which included 8603 children (4302 girls and 4301 boys), were included in the meta-analysis. Environmental pathogen detection was associated with increased infection prevalence with the same pathogen and lower HAZ (ΔHAZ -0·09 [95% CI -0·17 to -0·01]) but not diarrhoea (prevalence ratio 1·22 [95% CI 0·95 to 1·58]), except during wet seasons. Detection of MSTM was not associated with diarrhoea (no pooled estimate) or HAZ (ΔHAZ -0·01 [-0·13 to 0·11] for human markers and ΔHAZ -0·02 [-0·24 to 0·21] for animal markers). Soil, children's hands, and stored drinking water were major transmission pathways. Our findings support a causal chain from pathogens in the environment to infection to growth faltering, indicating that the lack of WASH intervention effects on child growth might stem from insufficient reductions in environmental pathogen prevalence. Studies measuring enteropathogens in the environment should subsequently measure the same pathogens in stool to further examine theories of change between WASH, faecal contamination, and health. Given that environmental pathogen detection was predictive of infection, programmes targeting specific pathogens (eg, vaccinations and elimination efforts) can environmentally monitor the pathogens of interest for population-level surveillance instead of collecting individual biospecimens. The Bill & Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.

Occupational safety and health among fishing boat workers in Thailand

The Thai fishing industry has been under close scrutiny for conditions faced by fishing boat workers, yet data are scarce with regards to occupational safety and health (OSH) among its workers. The objectives of this study are to describe: i) water, sanitation, and hygiene (WASH) conditions, and; ii) OSH conditions faced by migrant fishing boat workers in Thailand. We conducted a mixed-methods study with a quantitative survey in 200 migrant fishing boat workers and focus group discussions with 11 workers and 6 stakeholders in southern Thailand. We analyzed quantitative and qualitative data using descriptive statistics and content analysis, respectively. Nearly all participants (95.0%) reported that drinking water on board was stored in a sealed container, but only 5.5% of participants reported that there was latrine on board for defecation. Nearly all participants reported proper storage of objects on board, although findings on maintenance varied. Use of personal protective equipment was scarce as equipments obstruct the workers’ movement. The findings highlighted areas where improvements in WASH and OSH are needed. However, caveats regarding potential information bias and lack of generalizability should be considered in the interpretation of the study findings.