Search Results (330)

Inadequate hygiene knowledge and poor sanitation practices remain key challenges to safe learning environments in South Africa, with 462 million learners attending schools without basic handwashing facilities and many schools failing to meet sanitation standards. Although national policies and infrastructure investments have improved water, sanitation, and hygiene (WASH) services in some schools, access and behaviours remain uneven across socio-economic contexts. This study evaluated knowledge, attitudes, and practices (KAP) related to WASH among 1200 learners from 40 high schools in Durban using a cross-sectional design and interviewer-administered questionnaires. Data were analysed using descriptive statistics, Pearson correlations, ANOVA, and multiple regression. The study addressed the research question: To what extent do learners’ knowledge and attitudes predict hygiene practices across socio-economic contexts? It was hypothesised that higher knowledge and more positive attitudes would significantly predict improved hygiene practices. Results showed that while 74.6% reported handwashing after toilet use, only 39.3% consistently used soap. Knowledge of disease transmission through unsafe water was 35.4%, although overall attitudes were positive. Learners from higher-quintile schools had significantly better KAP scores than those from lower quintiles (p < 0.001). Both knowledge (β = 0.232, p < 0.001) and attitudes (β = 0.266, p < 0.001) were significant predictors of learners’ hygiene practices. Significant group differences were also observed by gender (t = 18.032, p = 0.001) and district (t = −3.895, p = 0.001). These findings highlight persistent WASH gaps and inequities across schools, underscoring the need for integrated interventions that strengthen both hygiene education and school infrastructure to achieve Sustainable Development Goal 6. Full article

Antimicrobial resistance (AMR), mostly resulting from the widespread use of antimicrobials in healthcare, veterinary, and agriculture, poses a significant challenge to global health. Healthcare facilities are hotspots of AMR due to high antibiotic consumption and the presence of highly susceptible populations. Moreover, there may be a dynamic exchange in AMR between healthcare infrastructures, human populations, animals, and the environment. To address these challenges, this review presents a One Health perspective, emphasizing the complex interconnections among many ecosystems. Furthermore, the development and dissemination of AMR in the healthcare environment, via surfaces and hands, have been critically investigated. Some of the neglected aspects that contribute to AMR, such as ventilation and wastewater, have also been addressed. The natural environment plays a crucial role as a reservoir for antimicrobial resistance genes (ARGs). The expected increase in AMR in the coming years will not only pose a challenge to public health but also to food security and environmental health. Hospitals should install advanced systems for treating wastewater to reduce the discharge of antimicrobials. Hospitals should also combine full water, sanitation, and hygiene (WASH) protocols with infection prevention and control (IPC) methods. These efforts are aimed at preventing infections and protecting public health and the environment. Other measures include advancing research to understand transmission pathways, increasing surveillance, reducing contamination in healthcare settings, implementing national plans for stewardship, and globally sharing resources and targets to reduce AMR. Full article

Background: Access to water, sanitation, and hygiene (WASH) services is internationally recognized as a fundamental human right and an essential determinant of health. Yet, many healthcare facilities in sub-Saharan Africa face persistent WASH deficits, undermining safe and effective care delivery. Aim: To explore how water (in)accessibility influences patient healthcare experiences and patient–provider relationships in Yendi Hospital, a major referral facility in northern Ghana. Methods: Using a qualitative design, we gathered data from patients (n = 21), caregivers (n = 11), and nurses (n = 11) through in-depth interviews, participant observation, and a focus group to document their lived experiences and perceptions. We transcribed and inductively coded the data for thematic analysis. Results: Our key findings reveal that water inaccessibility is not solely an infrastructural issue but also a pervasive challenge with profound implications for care delivery. Patients and caregivers often leave the hospital to bathe at home, resulting in missed ward rounds, delayed reviews, and/or refusal of admission. Nurses described how water inaccessibility disrupted clinical routines and strained relationships with patients and caregivers. These dynamics eroded trust, rapport, and professional morale, while exacerbating inequities in healthcare access and outcomes. Conclusions: This study underscores that addressing water challenges in the hospital is imperative not only for infection control but also for fostering equity, patient rights, and institutional resilience. We argue that policy interventions to strengthen WASH systems are urgently required to advance progress toward Sustainable Development Goal 6. Full article

Background: Sustainable sanitation underpins Sustainable Development Goal (SDG) 6.2, which mandates safe, equitable services and the elimination of open defecation by 2030. Rural South African communities continue to face significant Water, Sanitation and Hygiene (WASH) challenges driven by economic, environmental and governance constraints. Methods: An explanatory sequential mixed-methods design was conducted in King Sabata Dalindyebo Local Municipality, Eastern Cape. Quantitative data comprised household surveys (n = 246) and structured observations of VIP latrines (n = 50). Qualitative data were gathered from 20 semi-structured interviews with community representatives and four focus groups (n = 32). Results: While 63% of households owned VIP latrines, only 22% of the inspected facilities were in good working condition and 20% were abandoned; 58% required major maintenance. Major barriers to sustainable sanitation included limited financial capacity, structural damage related to a high-water table, gendered safety risks, and low community engagement in sanitation planning and maintenance. Conclusions: Achieving SDG 6.2 in rural South Africa requires co-productive governance that integrates infrastructure maintenance with community leadership. Recommended actions include delegated WASH committees, targeted subsidies for vulnerable households, routine gender and safety audits, and enforcement of environmental protection measures to secure long-term sanitation sustainability. Full article

Background: Diarrheal disease (DD) remains a major public health challenge and is the leading cause of malnutrition and the second leading cause of death among children under five globally. Although DD can be caused by a wide range of pathogens, its primary drivers are often linked to unimproved sanitation, limited access to clean drinking water, and poor hygiene practices. Low- and middle-income countries, particularly those in South Asia, experience the highest burden. These regions are also increasingly vulnerable to climate change and land use/cover changes, which may further exacerbate DD risk. However, the relative influence of environmental and social drivers at localized scales is not well understood. This gap presents a critical opportunity to identify scalable, data-informed interventions that address environmental determinants of health in the context of a changing climate. Methods: To investigate these dynamics, we analyzed 21,779 records from the Demographic and Health Surveys (DHS) for Bangladesh, integrating them with remotely sensed data on forest cover change, temperature, and rainfall. Using Random Forest machine learning models, we assessed the relative importance of both environmental and socio-demographic variables at household and regional (village) levels. Results: The results show that DD risk varies across scales: household-level outcomes are primarily associated with socio-demographic characteristics, while regional-level outcomes are more strongly influenced by environmental and geographic features, including precipitation, elevation, and proximity to water bodies. Conclusions: These findings underscore the importance of scale-sensitive approaches when assessing environmental health risks and developing climate-adaptive public health strategies. Full article

Access to safe water and sanitation remains a pressing challenge in Sub-Saharan Africa. Rapid urbanisation, fragile governance, and increasing climate hazards continue to undermine the sustainability of WASH (Water, Sanitation and Hygiene) services. This study examines whether Mozambique’s normative and institutional framework effectively supports sustainable urban WASH service delivery in Beira, the country’s second-largest city. Combining a critical policy review with six semi-structured interviews involving institutional actors and community leaders, the research employs a qualitative, phenomenological design to explore the interaction between national frameworks and local practices. Findings reveal five interrelated dimensions shaping sustainability: governance coordination, infrastructure robustness and maintenance, community participation, climate resilience, and financial viability. Although post-disaster investments and recent policy reforms have led to improvements, significant challenges persist. These include overlapping institutional mandates, underdeveloped preventive maintenance systems, limited recognition and support for community-led initiatives, fragmented climate adaptation efforts, and strong dependence on external funding. The study also reveals how historical legacies, particularly colonial-era governance structures, continue to shape water and sanitation delivery. By integrating policy analysis with local perspectives, the paper contributes to debates on WASH sustainability in African cities, particularly in climate-vulnerable secondary urban centres. It highlights the need for systemic reforms that clarify institutional roles, institutionalise maintenance practices, formalise community engagement, embed nature-based adaptation strategies, and strengthen financial transparency. These changes are essential if Beira, and similar cities across sub-Saharan Africa, are to achieve Sustainable Development Goal 6 under mounting climate pressure. Full article

Fecal sludge (FS) requires effective management to mitigate environmental and public health risks and enable resource recovery. This study evaluated the effects of microwave (MW) treatment on FS characteristics and subsequent anaerobic digestion (AD) performance. MW treatment raised FS temperatures to ~96 °C, reducing FS volume by 50% and inducing three thermal phases. Soluble chemical oxygen demand (sCOD) showed a multi-phase pattern, with a maximum solubilization of 29.8% during initial heating due to the solubilization of proteins and carbohydrates. Scanning electron microscopy (SEM) revealed morphological changes, while Fourier transform infrared (FTIR) spectroscopy confirmed that core functional groups remained unchanged. MW-pretreated FS enhanced AD performance, achieving a 17% increase in cumulative methane yield, alongside 18% and 33% improvements in organic loading and methane production rates, respectively. MW treatment influenced the phase distribution of digestate components, showing a shift in nutrient portioning towards the liquid fraction. These results suggest that integrating MW pretreatment into FS management systems can improve energy recovery, reduce treatment costs, and support resource-efficient sanitation solutions. Full article

Background: Soil-transmitted helminth (STH) infections, including ascariasis, trichuriasis, and hookworm disease, are among the most common neglected tropical diseases (NTDs) globally. This study evaluates the disease burden of STH in China from 1990 to 2021 and projects trends to 2035. Methods: Data from the Global Burden of Disease 2021 database were utilized to analyze the prevalence and disability-adjusted life years (DALYs) of STH infections in China from 1990 to 2021. The estimated annual percentage change (EAPC) was calculated to assess trends over time, and a Bayesian age-period-cohort model was used to project the disease burden up to 2035. Results: From 1990 to 2021, the prevalence and DALYs of STH infections decreased significantly by 85.08% and 98.01% in China, respectively. The age-standardized prevalence rate (ASPR) of STH infections dropped from 34,073.24/10⁵ to 4981.01/10⁵ with an EAPC of −6.62% [95% confidence interval (CI): −7.40%, −5.83%], and the age-standardized DALY rate (ASDR) decreased from 1.77/10⁵ to 0.18/10⁵, with an EAPC of −14.05% (95% CI: −15.04%, −13.06%). Trichuriasis contributed to 78.85% of the total ASPR for STH, whereas hookworm disease accounted for 51.14% of STH’s ASDR. The highest disease burden due to STH peaked in the 5–9 years age group, with prevalence of 8030.05/10⁵ [95% uncertainty interval (UI): 5356.86/10⁵–11,662.62/10⁵] and DALYs rate of 2.99/10⁵ (95% UI: 1.56/10⁵−4.87/10⁵). The projected ASDR and ASPR of trichuriasis rose to 0.55/10⁵ and 5362.50/10⁵ by 2035. Conclusions: China has achieved remarkable reductions in the burden of STH infections over the past three decades. However, the predominance between the species has changed. The projected rebound in trichuriasis underscores the importance of sustained control efforts. To achieve the 2030 elimination target outlined in the WHO NTDs roadmap, it is crucial to integrate precision epidemiology with ongoing water, sanitation, and hygiene initiatives, targeted chemotherapy and health education. Full article

Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017–2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities—such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure—could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology. Full article

Chad, one of the poorest Sub-Saharan Central African countries, has one of the worst global diarrhea burdens. Project 21 seeks to enhance community health in the rural town of Béré, Chad but it is lacking. The study aims to determine diarrhea outcomes and associated factors, such as drinking water, malaria, sanitation and hygiene resources and practices, in Béré. A survey questionnaire was administered by trained community health workers using a random sampling method. The respondents (n = 484) are predominantly Nangtchéré (87%) evangelical (63%) males (88%) aged between 40–59 years old (43%) with secondary school education level (37%) or 8 years of school on average, from nuclear families (78%) with seven members on average, and of medium housing standard (56%). Drinking water treatment, transport and storage (p < 0.001), malaria related factors (p < 0.001), sanitation and hygiene practices (p < 0.001), children diarrhea experience, and treatment (p < 0.001) are predictors of diarrhea outcomes in adults. Also, factors related to drinking water transport, treatment and storage (p < 0.001), malaria (p < 0.001), health advice source (p < 0.001), sanitation and hygiene (p < 0.001), adult diarrhea experiences, and treatment (p < 0.001) are predictors of children diarrhea outcomes. Future interventions targeting the above factors are warranted. Full article

Access to microbiologically safe water in preschool educational settings constitutes a pressing public health challenge, particularly in rural areas with deficient infrastructure. Repeated exposure to enteropathogens present in contaminated water has been associated with acute gastrointestinal infections, environmental enteropathy, and disruptions in the intestinal microbiota of young children. Motivated by this concern, the present study evaluates the microbiological quality of water in 32 public preschool facilities in the municipality of Matehuala, San Luis Potosí—18 urban and 14 rural—by analyzing the presence of aerobic mesophilic bacteria (AMB), total coliforms (TC), fecal coliforms (FC), and helminth eggs. The assessment was conducted in accordance with Mexican standards NOM-092-SSA1-1994 and NOM-230-SSA1-2002 and supplemented with the World Health Organization’s guidelines for drinking-water quality. The findings revealed a marked territorial disparity: 100% of rural schools that relied on rooftop water tanks exceeded permissible limits for TC, and 35.7% tested positive for FC. In contrast, all urban schools—supplied through piped water systems—complied with current regulations. Statistical analysis (Mann–Whitney U test, p < 0.05) confirmed significant differences in microbiological contamination based on geographic location and type of water supply. In all FC-positive cases, a lack of sewage infrastructure and inadequate sanitation practices in storage containers were documented. These results demonstrate that formal access to water does not ensure its microbiological safety, particularly in settings with poor structural conditions. The study underscores the urgent need to implement point-of-use water treatment technologies, establish regular microbiological monitoring protocols, and provide training for educational staff in water hygiene practices. Full article

This paper provides a comprehensive bibliographic and bibliometric review of water, sanitation, and hygiene (WASH) in global urban areas, employing the Proknow-C methodology. The study categorizes WASH into four main themes: sustainability, urban areas, indicators and index, and urban planning, allowing for a detailed analysis of several multidimensional aspects. The review underscores the importance of providing basic infrastructure to adopt an integrated, sustainable, and socially inclusive approach, showcasing the resilience and adaptability of the WASH sector in tackling the dynamic challenges of urbanization. It is noticeable that the WASH area has undergone significant development, moving from a focus primarily on infrastructure to a more holistic approach. In general, the WASH framework is globally characterized by high irregularity/inequality in provision and access. The relationship between urban vulnerabilities and WASH is very clear, but also multifaceted and complex, and there is a crucial need to combine behavior change with infrastructure development while addressing economic challenges and prioritizing investments in WASH. The improvement of WASH conditions in urban areas should focus the interplay between urban development policies and the provision of WASH services, while focusing also on the role of multi-sectoral collaboration, stakeholder engagement, and policy implementation in overcoming barriers to effective WASH delivery. Full article

Period poverty is a broad and complex issue that intersects with various areas, including health, education, infrastructure, and human rights, among others, affecting countless women and girls around the world. Despite remarkable technological, social, and economic advances this century, menstruation remains a taboo subject, which leads to widespread misinformation and stigma. Prejudice and a lack of access to knowledge and essential sanitation resources, such as clean water, hygiene products, and safe private spaces, heighten the vulnerability of those affected. Integrated and multisectoral approaches that involve legislature, health, education, and sanitation are necessary to face this public health issue effectively. These efforts involve developing and implementing comprehensive plans that unite government, society, and the private sector. Some examples of these actions include making information about menstruation and menstrual health available in schools, cutting taxes on feminine hygiene products, improving basic sanitation, building decent public restrooms, and providing free sanitary pads in schools and workplaces. These initiatives have the potential to promote menstrual health and dignity, ensuring that people who menstruate can manage their periods in healthy, safe, and supportive environments. This review aims to shed light on menstrual poverty in Brazil as a global issue and a human rights violation, especially when it comes to the rights to health, education, and dignity. It stresses that efforts to end this social stigma and align with the 2030 Agenda, which seeks to eliminate poverty and inequality worldwide, and provides a plan of action to tackle this stigma. Full article