Water, Sanitation And Hygiene Research Articles

Roles of Women Engagement in Managing WASH Projects in Rural Areas: A Case Study of Mufindi District, Tanzania

Women’s participation in managing Water, Sanitation, and Hygiene (WASH) projects is crucial for the sustainability and success of these initiatives, yet remains significantly limited, particularly in rural areas. This cross-sectional study, conducted with 163 participants, explores the challenges and opportunities surrounding women’s roles in WASH project management, focusing on their participation, the influence of cultural practices, and the availability of capacity-building programs to support women's leadership. Findings show that while women engage in community outreach and planning, their leadership and decision-making roles are restricted by traditional gender roles and patriarchal norms. A lack of training programs further limits their leadership potential. Additionally, the study highlights a severe shortage of training programs aimed at empowering women to assume leadership roles in WASH management, particularly in rural areas where access to these resources is most limited. The study recommends gender-sensitive policies and expanded training initiatives to promote women’s inclusion and leadership in WASH management, essential for achieving sustainable outcomes.

Pathways through which water, sanitation, hygiene, and nutrition interventions reduce antibiotic use in young children: a mediation analysis of a cluster-randomized trial.

Low-cost, household-level water, sanitation, and hygiene (WASH) and nutrition interventions can reduce pediatric antibiotic use, but the mechanism through which interventions reduce antibiotic use has not been investigated. We conducted a causal mediation analysis using data from the WASH Benefits Bangladesh cluster-randomized trial (NCT01590095). Among a subsample of children within the WSH, nutrition, nutrition+WSH, and controls arms (N=1,409), we recorded caregiver-reported antibiotic use at ages 14 and 28 months and collected stool at age 14 months. Mediators included caregiver-reported child diarrhea, acute respiratory infection (ARI), and fever; and enteric pathogen carriage in stool measured by qPCR. Models controlled for mediator-outcome confounders. The receipt of any WSH or nutrition intervention reduced antibiotic use in the past month by 5.5 percentage points (95% CI 1.2, 9.9) through all pathways, from 49.5% (95% CI 45.9%, 53.0%) in the control group to 45.0 % (95% CI 42.7%, 47.2%) in the pooled intervention group. Interventions reduced antibiotic use by 0.6 percentage points (95% CI 0.1, 1.3) through reduced diarrhea, 0.7 percentage points (95% CI 0.1, 1.5) through reduced ARI with fever, and 1.8 percentage points (95% CI 0.5, 3.5) through reduced prevalence of enteric viruses. Interventions reduced antibiotic use through any mediator by 2.5 percentage points (95% CI 0.2, 5.3). Our findings bolster a causal interpretation that WASH and nutrition interventions reduced pediatric antibiotic use through reduced infections in a rural, low-income population. Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases.

From the Ground Up: Stakeholder Perspectives on Housing Interventions to Reduce Environmentally Mediated Infections.

Housing conditions are intrinsically linked to human health, with inadequate housing potentially increasing exposure to environmentally mediated pathogens. Housing interventions that aim to improve housing and reduce environmentally mediated infections, such as finished floors and housing upgrades for vector-borne diseases, remain relatively under-explored as health interventions. This study explored facilitators of and barriers to funding, implementing, and scaling up housing improvements as health interventions to reduce environmentally mediated infectious diseases. Sixteen key informants (KIs) with direct experience in implementing or working within housing interventions and environmentally mediated infectious diseases in low- and middle-income countries were interviewed using a semi-structured interview format. KIs had diverse backgrounds, including academics researching housing interventions, housing policy advisors, and practitioners implementing housing interventions. A thematic analysis approach was used to identify key themes in interview transcripts, highlighting patterns, commonalities, and variations in participants' responses. KIs emphasized the multi-dimensional impacts of housing interventions that are intrinsically linked to Sustainable Development Goals (SDGs), including physical and mental health, as well as environmental, social, and economic dimensions. Moreover, a pronounced shortage of funding and financial systems to address housing interventions was highlighted, alongside the urgent need for more rigorous evidence and cost-benefit analyses. Furthermore, the imperative to raise awareness of the significance of housing and the critical importance of strong collaboration across sectors and stakeholders were stressed. Emphasizing the necessity for project-based and context-specific housing policies, the interviews revealed that contextualizing interventions to their specific setting and fostering community involvement are essential for successful implementation and scale-up. Housing interventions play a pivotal role in mitigating environmentally mediated diseases. These interventions can complement existing strategies like water, sanitation, and hygiene (WASH) interventions, ensuring comprehensive approaches to healthy housing and sustainable development goals amidst climate change.

Addressing barriers to improved water, sanitation, and hygiene (WASH) access for the promotion of healthy ageing among older persons in Ghana

Addressing barriers to improved water, sanitation, and hygiene (WASH) access for the promotion of healthy ageing among older persons in Ghana

Ethnicity and access to water, sanitation, and hygiene in Bangladesh: a study using MICS data and policy reviews.

Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. Reducing inequalities and ensuring universal access to WASH are essential to achieving the agenda of sustainable development. We aimed to measure access to WASH among ethnic minority populations in Bangladesh and understand the situation and factors affecting WASH practices among them. Additionally, we reviewed policy related to WASH to highlight the inequality faced by ethnic minority populations. We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multilevel mixed-effect logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling selected covariates. Furthermore, we systematically reviewed Bangladesh's WASH-related policies and programs. While 98.5% of Bengalis had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 87%, 45%, 31%, and 45% less access to water (aOR = 0.13, p ≤ 0.001), sanitation (aOR = 0.55, p ≤ 0.001), and handwashing (aOR = 0.69, p ≤ 0.05), and WASH facilities aOR = 0.55, p ≤ 0.001), respectively. Among the policies of Bangladesh, only one identified action for WASH rights of ethnic minorities. The government should identify the issues of WASH among ethnic minorities and represent them adequately in policies to achieve the aim of 'leaving none behind' of sustainable development goals.

Evaluating water, sanitation, and hygiene in schools of Bangladesh: progress toward SDG compliance

ABSTRACT The availability of safe water, sanitation, and hygiene (WASH) facilities in schools is essential for a healthy learning environment and achieving sustainable development goals (SDGs) 4 and 6. Despite its importance, comprehensive studies on drinking water quality, sanitation, and hygiene in schools are scarce. This study explicitly assessed the WASH services and gaps in 43 educational institutions, located in Tongi, Bangladesh, through field and laboratory investigations. Thirteen physicochemical and bacteriological parameters were analyzed, and water quality was classified using an Integrated Water Quality Index (IWQI). Hygiene and sanitation were evaluated through observations and data from school administrators on water sources, toilets, handwashing facilities, and solid waste management. Results showed that WASH services exceeded the national average, but all schools had dangerously high Escherichia coli levels (mean: 43.95 CFU/100 mL) in drinking water, posing health risks. Additionally, 89.72% of samples showed elevated manganese levels, 35% had high iron, and 41.86% had increased conductivity. About 35% of water was unsuitable for drinking based on IWQI. Schools lacked the capacity to monitor WASH quality, especially drinking water. A strategic framework for safe WASH facilities is recommended. The findings can lead the policymakers to prioritize the improvements in WASH facilities for attaining SDG 6.

Housing infrastructure and women in care: COVID-19 experiences from urban informal settlements of Khulna, Bangladesh

Urban informal settlements in the Global South, home to over a billion people, face significant challenges due to limited space and inadequate Water, Sanitation, and Hygiene (WASH) and Solid Waste Management (SWM) infrastructure. These deficiencies significantly impact women's ‘triple care role’—reproductive, productive, and community caregiving responsibilities—within their families, society, and the economy, exacerbated by the COVID-19 pandemic. This study aimed to explore how inadequate infrastructure in three informal settlements in Khulna, Bangladesh, influenced women's caregiving roles during the pandemic and their responses. Through semi-structured interviews with 24 women community leaders, who served as front-line workers during COVID-19, and supporting fieldwork, we discovered that women adapted by modifying their habits and the spatial layouts of their homes for isolation. Although some improvements were noted in WASH and SWM conditions, significant challenges remained, particularly in temporary housing, household adaptability, and reproductive responsibilities Despite facing informal employment, financial constraints, and food insecurity, women showed resilience through leadership, socio-political networking, and community initiatives. This study underscores the urgent need for adaptive infrastructure planning to improve living conditions in informal settlements, with a focus on proactive management of both spatial and non-spatial resources to enhance adaptation in resource-scarce contexts.

Swachh Bharat Mission Gramin: Uptake and challenges in rural Coimbatore

ABSTRACT Introduction: Water, sanitation, and hygiene (WASH)-related infectious diseases contribute to approximately 5% of the global disease burden. Despite sanitation being a human right, 673 million people worldwide had limited access to toilets. To tackle the same, Swachh Bharat Mission-Gramin (SBM-G) was launched in 2014 to facilitate the construction of over 100 million individual household latrines (IHHLs) across India. However, literature evidence on acceptance of SBM-G in Tamil Nadu, particularly in Coimbatore, is scarce. Objectives: The primary objective was to investigate the utilisation of the SBM-G scheme and its associated factors in rural Coimbatore. Materials and Methods: In 2022, a mixed-methods study incorporating quantitative (using a purpose-designed questionnaire) and qualitative (using in-depth interviews and focus group discussions) components was conducted among 60 SBM-G beneficiaries in Kovai Medical Center and Hospital Institute of Health Sciences and Research (KMCH IHSR)’s rural field practice area. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) v23 and qualitative data using manual thematic content analysis. Results: Before IHHL construction, 93.7% of respondents practiced open-air defecation (OAD). The issues perceived with OAD were distance (28.8%) and privacy concerns (12.5%). After SBM-G implementation, 78.3% reported using the IHHL ‘all the time’, reflecting a substantial shift in behaviour. Most respondents received financial aid within about six months (INR 8,000), often in a single instalment. The majority had constructed their IHHLs before 2015. The expenditures incurred varied significantly, with 58.3% spending extra costs ranging between INR 10,000 and 30,000. Water supply to households significantly influenced IHHL usage. Conclusion: While rural villagers appreciate the SBM-G financial assistance for IHHLs, concerns about the inadequacy of the sanctioned amount for proper piped water supply and septic tanks persist. Nonetheless, there is a clear demonstration of positive behavioural change, marked by reduced OAD and increased IHHL usage.

Access to water, sanitation and hygiene facilities by women with disabilities in Zimbabwe’s Harare Metropolitan Province during COVID-19

This study was conducted in three low-income areas of Harare Metropolitan Province in Zimbabwe to understand how women with disabilities accessed water, sanitation, and hygiene (WASH) facilities during COVID-19. Qualitative data were collected through structured interviews and focus group discussions involving 104 purposively sampled women with disabilities. Key informant interviews were held with seven representatives of organisations working with persons with disabilities in Harare. Findings indicated that overt discrimination against women with disabilities increased as households struggled to access WASH facilities. These women risked gender harassment from community boreholes ‘marshals’, and urogenital infections resulting from unhygienic menstruation management practices. Poor waste disposal and water reticulation systems restricted high water, sanitation and hygiene standards required to fight the pandemic. The study recommends the full implementation of the national disability policy and the constitutional provisions to safeguard the rights of women with disabilities in times of crises.

Relationship Between Household Water Sanitation and Hygiene Behaviors and Diarrhea Between 2010-2020 in Rwanda

Rwanda has made considerable progressive policy efforts to significantly reduce diarrhea among children under 5 years old, especially since 2010. This cross-sectional study aimed to assess the relationship between household water sanitation and hygiene (WASH) behaviors and diarrhea among children under 5 years old between 2010 and 2020. We used secondary data from the 2010, 2015, and 2020 Rwanda Demographic Health Surveys. We used descriptive statistics, pairwise comparisons, and linear regression designs to assess (a) the prevalence of household WASH behaviors across districts, regions, urban areas, and rural areas, (b) the variation of household WASH behaviors over time, and (c) the relationship between household WASH behaviors and diarrhea in children under 5. The study findings show (a) no statistically significant variation in handwashing, (b) a statistically significant decrease in water treatment (µ = 13.230, 95%CI [8.609; 17.851], <em>p</em> < .001) and in safe water storage (µ = 4.430, 95%CI [2.400; 6.460], <em>p</em> < .001), and (c) a statistically significant increase in the use of clean toilets (µ = 12.197, 95%CI [8.158; 16.235], <em>p</em> < .001) between 2010 and 2020. The study results did not show a statistically significant relationship between WASH behaviors (handwashing, water treatment, safe water storage, and use of clean toilets) and diarrhea among children under 5 years old.

Persistent transmission of soil-transmitted helminths despite 16 years of uninterrupted Mebendazole- and ivermectin-based preventive chemotherapy in the Lomie Health District (East Region, Cameroon): The emergency of complementary control strategies.

The control of the Soil-Transmitted Helminths (STH) infections primarily relies on the school-based Preventive Chemotherapy (PCT) with mebendazole. Given the efficacy of ivermectin on STH, the control of the latter is expected to be potentialized in areas where ivermectin is also distributed for onchocerciasis and/or lymphatic filariasis control/elimination. This study aimed to assess the prevalence and intensity of STH in the Lomie Health District where annual school-based deworming campaigns and community-directed treatments with Ivermectin have been underway for almost two decades. A quantitative cross-sectional study was conducted in 10 schools of the Lomie Health District, East Region, Cameroon. Stool samples were collected from school-aged children and analysed using the Kato-Katz technique. Semi-structured questionnaires were administered to enrolees to assess compliance with water, sanitation, and hygiene (WASH). Of the 491 children (median age: 9 years; IQR: 7-10) enrolled, 83.9% (95% CI: 80.3-87.1) were infected with at least one STH species. Trichuris trichiura was the predominant species (78.5%), and no hookworm was found. The prevalence trend slightly decreased between 1987 and 2010 (~8%) and remained unchanged since 2010 (p-value = 0.05). Overall, 46.8% and 41.8% of children were heavy-to-moderately infected with Ascaris lumbricoides and T. trichiura. Poor hand hygiene (OR: 2.24, 95% IC: 1.4-3.4, p-value = 0.0002) and the use of river as a source of drinking water (OR: 14.8, 95% IC: 6.9-33.3, p-value = 0.0001) were the main risk factors associated with the STH infection in Lomie Health District. The persistent high prevalence and intensity of STH infection despite 16 years of mebendazole-based PCT and expected collateral impact of ivermectin mass distribution, points to plausible implementation gaps, poor compliance to WASH or sub-optimal efficacy of the anthelminthics used. This study highlights the need to further assess the cause of the persistent high prevalence and implement context-adapted control measures in order to curb STH transmission.

Community engagement enhances undergraduate civil engineering capstone design projects

Abstract Over the past several decades numerous studies have shown the value of community engagement in global water, sanitation, and hygiene (WASH) programs. Engaging and collaborating with communities through the design process enables wider community acceptance and ownership of WASH interventions, ensures a more functional and impactful design, and opens the door for co-benefits of these systems. Accounting for a range of dimensions within a community is critical to creating WASH designs that provide the most benefits. Undergraduate engineering curriculums focus on design, but often do not explicitly account for the social, environmental, and economic elements that affect the success, efficacy, and sustainability of a design. There is increasing emphasis on educating engineers on sustainability and systems thinking so they are equipped to solve complex, multidisciplinary problems. To understand how social, environmental, and economic elements fit into engineering design and how to create sustainable WASH interventions, undergraduate engineering students benefit from participating in WASH design projects that engage and collaborate with communities. This perspective highlights the value of community engagement with partners in Uganda in teaching water resources and environmental engineering design to undergraduate civil engineering students.

Implementing a pragmatic randomised controlled trial in a humanitarian setting: lessons learned from the TISA trial

IntroductionHigh-quality evidence is crucial for guiding effective humanitarian responses, yet conducting rigorous research, particularly randomised controlled trials, in humanitarian crises remains challenging. The TISA (“traitement intégré de la sous-nutrition aiguë”) trial aimed to evaluate the impact of a Water, Sanitation and Hygiene (WASH) intervention on the standard national treatment of uncomplicated Severe Acute Malnutrition (SAM) in children aged 6–59 months. Implemented in two northern Senegalese regions from December 22, 2021, to February 20, 2023, the trial faced numerous challenges, which this paper explores along with the lessons learned.MethodsThe study utilised trial documentation, including field reports, meeting minutes, training plans, operational monitoring data and funding proposals, to retrace the trial timeline, identify challenges and outline implemented solutions. Contributions from all TISA key staff—current and former, field-based and headquarters—were essential for collecting and interpreting information. Challenges were categorised as internal (within the TISA consortium) or external (broader contextual issues).ResultsThe TISA trial, executed by a consortium of academic, operational, and community stakeholders, enrolled over 2000 children with uncomplicated SAM across 86 treatment posts in a 28,000 km2 area. The control group received standard outpatient SAM care, while the intervention group also received a WASH kit and hygiene promotion. Initially planned to start in April 2019 for 12 months, the trial faced a 30-month delay and was extended to 27 months due to challenges like the COVID-19 pandemic, national strikes, health system integration issues and weather-related disruptions. Internal challenges included logistics, staffing, data management, funding and aligning diverse stakeholder priorities.Discussion and conclusionDespite these obstacles, the trial concluded successfully, underscoring the importance of tailored monitoring, open communication, transparency and community involvement. Producing high-quality evidence in humanitarian contexts demands extensive preparation and strong coordination among local and international researchers, practitioners, communities, decision-makers and funders from the study’s inception.Trial registrationClinicaltrials.gov NCT04667767.

A multi-country survey on sanitation systems in underserved urban settlements in the Melanesian Pacific region

Safe and enduring water, sanitation, and hygiene (WASH) for all is the key target of Sustainable Development Goal 6. Despite progress in global WASH monitoring to support SDG 6, significant data gaps persist, especially in urban informal settlements in the Melanesian Pacific Region. This study aimed to improve understanding of existing sanitation systems, residents’ preferences, and climate hazard exposure in these areas. Household surveys were conducted with 393 households in Suva (Fiji) and Port Vila (Vanuatu). Water availability for sanitation was high in Suva (99%) and Port Vila (70%), with noted improvements in sanitation superstructure. However, dry pits without slabs remain significant (15%) in Port Vila. The preference for water-based systems highlights the need for a resilient sanitation service chain, including adequate faecal sludge management, which was problematic in both locations. Reports of climate-driven hazard damage were more frequent in Vanuatu, with one in three respondents reporting impacts on their sanitation services.

From the Ground Up: Stakeholder Perspectives on Housing Interventions to Reduce Environmentally Mediated Infections.

Housing conditions are intrinsically linked to human health, with inadequate housing potentially increasing exposure to environmentally mediated pathogens. Housing interventions that aim to improve housing and reduce environmentally mediated infections, such as finished floors and housing upgrades for vector-borne diseases, remain relatively under-explored as health interventions. This study explored facilitators of and barriers to funding, implementing, and scaling up housing improvements as health interventions to reduce environmentally mediated infectious diseases. Sixteen key informants (KIs) with direct experience in implementing or working within housing interventions and environmentally mediated infectious diseases in low- and middle-income countries were interviewed using a semi-structured interview format. KIs had diverse backgrounds, including academics researching housing interventions, housing policy advisors, and practitioners implementing housing interventions. A thematic analysis approach was used to identify key themes in interview transcripts, highlighting patterns, commonalities, and variations in participants' responses. KIs emphasized the multi-dimensional impacts of housing interventions that are intrinsically linked to Sustainable Development Goals (SDGs), including physical and mental health, as well as environmental, social, and economic dimensions. Moreover, a pronounced shortage of funding and financial systems to address housing interventions was highlighted, alongside the urgent need for more rigorous evidence and cost-benefit analyses. Furthermore, the imperative to raise awareness of the significance of housing and the critical importance of strong collaboration across sectors and stakeholders were stressed. Emphasizing the necessity for project-based and context-specific housing policies, the interviews revealed that contextualizing interventions to their specific setting and fostering community involvement are essential for successful implementation and scale-up. Housing interventions play a pivotal role in mitigating environmentally mediated diseases. These interventions can complement existing strategies like water, sanitation, and hygiene (WASH) interventions, ensuring comprehensive approaches to healthy housing and sustainable development goals amidst climate change.

Effects of health education intervention on menstrual hygiene knowledge and practices among the adolescent girls of Pokhara Metropolitan, Nepal.

Poor menstrual hygiene practices are one of the major public health problems in Nepal. Due to persistent taboos and socio-cultural constraints, adolescent girls are often unaware of scientific facts, knowledge, and practices related to menstrual hygiene. This paper aims to assess the effects of health education intervention on menstrual hygiene knowledge and practices among adolescent girls in Pokhara Metropolitan, Nepal. A true experimental study was conducted in two government basic schools in Pokhara Metropolitan, Nepal. The study population was adolescent girls who had attended the menarche. Firstly, a pretest with the help of a self-administered questionnaire was done to find out the socio-demographic information, knowledge and practices of menstrual hygiene. Next, health education sessions were conducted among the intervention group. Finally, after one month of intervention, a post-test was conducted among the intervention and non-intervention group. Data analysis was done through descriptive and inferential statistics. The findings showed significant improvement in the knowledge and practice level of adolescent girls on menstrual hygiene after health education intervention. Participants in the intervention group showed a significant increase in knowledge scores from 10.0% to 67.0%, while the non-intervention group remained unchanged at 7.5%. Good menstrual hygiene practices scores in the intervention group increased significantly from 22.5% to 67.0%, whereas the non-intervention group saw a slight rise from 20.0% to 22.5%. Regarding observed practice scores in menstrual hygiene, significant improvement was observed in the intervention group (45.0% to 100.0%) in contrast to the non-intervention group (25.0% to 27.5%). This study highlights the crucial role of school health education interventions in promoting menstrual hygiene among adolescent girls. It emphasizes the importance of comprehensive educational programs tailored to early teenage girls, addressing timing, content, and delivery methods alongside ensuring the availability of Water, Sanitation and Hygiene (WASH) facilities.

Water, sanitation, and hygiene (WASH) factors associated with stunting among under-fives: A hospital-based cross-sectional study in Banda Aceh, Indonesia

Water, sanitation, and hygiene (WASH) factors associated with stunting among under-fives: A hospital-based cross-sectional study in Banda Aceh, Indonesia

Post-war status of water supply, sanitation, hygiene and related reported diseases in Tigray, Ethiopia: A community-based cross-sectional study

Water, sanitation and hygiene (WASH) associated diseases remain a global public health issue and linked with Sustainable Development Goal 6. In November 2020, a war broke out in Tigray, Ethiopia, resulting in a negative health consequence. The post war status of WASH and its associated diseases are not documented. The aim of this study was to assess the status of drinking water, sanitation and hygiene practices and the prevalence of WASH-associated diseases in Tigray, Ethiopia following the war. A community-based cross-sectional study was conducted in 24 randomly selected accessible districts of Tigray, Ethiopia. A standardized questionnaire was used to collect data from households in the study. Data was collected from 2338 households. Descriptive statistics and binary logistic regression were used to analyze the data. The average age of respondents was 28.7 years (SD = 6.2). The majority of respondents 2030 (86.8%) were married and 1698 (72.6%) were rural residents. Nearly one third of the respondents were uneducated and around 40% have either radio or TV as means of communication. More than half (55.2%) of the respondents had a family size of over 5.A quarter (25%, 95% CI: 23.3, 26.8) of study participants had access to a basic water supply. Less than a tenth (7.7%, 95% CI: 6.6, 8.8) of households had access to basic sanitation. Basic hand washing was available in 2% of households. Malaria, diarrhoea, skin infection and eye infection were the common reported disease in the community. Marital status, family size, place of residence and liquid waste management were the most important predictors of reported diseases.Access to basic water, sanitation and hygiene services was low, and the prevalence of malaria, diarrhoea and skin infections was higher. There were differences in WASH services and reported diseases according to zone and place of residence (urban-rural). Post war, improved access to basic water, sanitation and hygiene services is recommended to prevent WASH-associated diseases in Tigray, Ethiopia. Furthermore, the prevention oriented policy of the country needs better implementation to reduce preventable diseases and ensure better health status in the community.

The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana

ABSTRACT Water, sanitation and hygiene practices (WASH) have been a major challenge facing many basic schools in Ghana for many decades. The school authority have made a number of complaints to the Ghana government through the Ministry of Education in relation to the inadequate potable water, sanitation facilities and hygiene practices in basic schools which the government has remained silent on. The aim of this study was to assess the level of implementation of Water, sanitation and hygiene practices in basic schools in the Sunyani East Education Directorate. Both qualitative and quantitative data were collected using questionnaires and interviews. The results indicate that hygiene and sanitation facilities available in schools under study included urinals, toilets, handwashing materials and solid waste disposal facilities. It was revealed that wooden slap pit latrine toilet was present in all schools except Methodist school which has cemented slaps. There were absence of toilet rolls, tap facilities and hand washing soap in all schools visited. The pupils fetched water from neighbouring houses and used it. The study recommends that the Parent-Teacher Association, School Management Committee, District Education Directorate and Ghana Education Service should team up to provide these essential facilities to basic schools in Sunyani East.

Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study

Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh’s 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.