Search Results (312)

Safe and adequate water supply, sanitation, and hygiene (WASH) in schools are prerequisites within the right to basic education. WASH facilities across schools in developing nations, particularly in Africa, are unsatisfactory and expose children to risks of disease and infection. This study aims to gather insights into the WASH status of secondary schools in Ibadan, Nigeria, to develop a sustainable water management framework for schools. A concurrent mixed-method design (questionnaires and interviews) was adopted to benchmark water management in schools and inform the design of a framework. Results reveal a wealth of issues and concerns that include infrastructure challenges accessing reliable and safe water supplies, rundown and unhygienic toilet/urinal facilities, and dilapidated sinks/taps, plus resource challenges, such as an absence of tissue paper and soap. These issues are exposing schoolchildren to unnecessary health risks, further supported by reported illnesses and reduced school attendance. Based on these findings, and guided by the UN SDG#6 targets, a water improvement framework has been created and validated by school officials. The framework identifies both short-term and long-term guidance/actions to improve water management in schools across Sub-Saharan Africa. These form crucial steps toward better WASH, building healthier communities and enhancing educational environments and outcomes for schoolchildren. Full article

Wastewater-based epidemiology (WBE) has historically proven to be a powerful surveillance tool, particularly during the SARS-CoV-2 pandemic. Effective WBE depends on the sensitive detection of pathogens in wastewater. However, determining the process limit of detection (PLOD) of WBE through a comprehensive evaluation that accounts for pathogen concentration, nucleic acid extraction, and molecular analysis has rarely been documented. We prepared dilution series with known concentrations of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 in surface water and wastewater. Pathogen concentration was performed using Nanotrap particles with the KingFisher™ Apex robotic platform, followed by nucleic acid extraction. Quantitative real-time PCR (qPCR) and digital PCR (dPCR) were used to detect the extracted nucleic acids of the pathogens. The PLODs and recovery efficiencies for each of the four pathogens in surface water and wastewater were determined. Overall, the observed PLODs for S. Typhi, V. cholerae, and rotavirus in surface water and wastewater were approximately 3 log₁₀ loads (2.1–2.8 × 10³/10 mL) using either qPCR or dPCR as the detection method. For SARS-CoV-2, the PLOD in surface water was 2.9 × 10⁴/10 mL with both RT-qPCR and dPCR, one log₁₀ higher than the PLODs of the other three pathogens. In wastewater, the PLOD for SARS-CoV-2 was 2.9 × 10⁴/10 mL using RT-qPCR and 2.9 × 10³/10 mL using dPCR. The mean recovery rates of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 for dPCR in both surface water and wastewater were below 10.4%, except for S. Typhi and V. cholerae in wastewater, which showed significantly higher recoveries, from 26.5% at 4.6 × 10⁵/10 mL for S. Typhi to 58.8% at 4.8 × 10⁵/10 mL for V. cholerae. Our study demonstrated that combining qPCR or dPCR analysis with automated Nanotrap particle concentration and nucleic acid extraction using the KingFisher™ platform enables the sensitive detection of S. Typhi, V. cholerae, rotavirus, and SARS-CoV-2 in surface water and wastewater. Full article

The Roma population is one of Europe’s largest ethnic minorities, often living in inadequate living conditions, worse than those of the majority population. They frequently lack access to essential services, even in high-income countries. This lack of basic services—particularly in combination with proximity to (stray) animals and human and solid waste—significantly increases environmental health risks, and leads to a higher rate of endoparasitic infections. Our study sheds light on the living conditions and health situation in Roma communities in Slovakia, focusing on the prevalence of intestinal endoparasitic infections across various settlement localisations. It highlights disparities and challenges in access to safe drinking water, sanitation, and hygiene (WASH) and other potentially disease-exposing factors among these marginalised populations. This study combines a comprehensive review of living conditions as per national data provided through the Atlas of Roma communities with an analysis of empirical data on parasitological infection rates in humans, animals, and the environment in settlements, applying descriptive statistical methods. It is the first study in Europe to provide detailed insights into how living conditions vary and cause health risks across Roma settlements, ranging from those integrated within villages (inside, urban), to those isolated on the outskirts (edge, sub-urban) or outside villages (natural/rural). Our study shows clear disparities in access to services, and in health outcomes, based on where people live. Our findings underscore the fact that (i) place—geographical centrality in particular—in an already challenged population group plays a major role in health inequalities and disease exposure, as well as (ii) the urgent need for more current and comprehensive data. Our study highlights persistent disparities in living conditions within high-income countries and stresses the need for greater attention and more sensitive targeted health-promoting approaches with marginalised communities in Europe that take into consideration any and all of the humans, ecology, and animals affected (=One Health). Full article

The unprecedented development of coastal cities in West Africa is marked by anarchic urbanization accompanied by ineffective environmental management, leading to water pollution. This study is conducted in the southern districts of Lomé, Togo, an area built on sandbars where inappropriate attitudes, behaviors, and inadequate hygiene and sanitation practices prevail. The objective of this study is to characterize the quality of groundwater in the study area. Bacteriological and physicochemical analyses were carried out on 11 wells in 10 districts in the southern districts during the four seasons of the year. The analysis shows that the groundwater is polluted in all seasons. Nitrate concentrations exceed 50 mg/L in 65% of the samples, while chloride levels surpassed 250 mg/L in 18% of the cases. Regardless of the season, the dominant facies is sodium chloride and potassium chloride. In all districts, the analysis of microbiological parameters including total germs (30 °C, 100/mL), total coliforms (30 °C, 0/mL), Escherichia coli (44 °C, 2/250 mL), fecal streptococci (0/100 mL), and anaerobic sulfite reducers (44 °C, 2/20 mL) reveals values exceeding the European Union standards (2007). Groundwater contamination is facilitated by the sandy nature of the soil, which increases its vulnerability to various pollutants. Togo continues to experience cholera outbreaks, aggravated by poor sanitation infrastructure and limited vaccination coverage. Public health efforts are directed toward improving sanitation and raising awareness about waterborne and non-communicable diseases. Full article

This study aimed to apply the integrated WASH assessment tool and assess the performance of WASH services in three Internally Displaced Person (IDP) camps in Rakhine State, Myanmar. The tool was applied in a unique non-household setting that is vulnerable to annual storms and storm-induced flooding, while also facing the complexity of political and social constraints. The assessment focused on nine components of the tool: water, sanitation, hygiene, financial, institutional, environmental impacts, technical, social, and climate change. Afterwards, the overall WASH services performance of the three IDP camps was determined. The assessment revealed good performance in water, financial, institutional, and social components across all camps. However, environmental impact, technical, and climate change components showed the need for improvement due to recurrent climate hazards, and their impacts on WASH facilities, such as latrine destruction, saltwater intrusion into handpumps, and increased diarrhea cases. Based on the findings, the study recommends constructing disaster-resilient latrines, reinforcing handpumps with watertight materials, elevating wellheads to prevent contamination, and forming emergency response teams with appropriate training. Overall, Ohn Taw Gyi (South) and Kaung Doke Khar (2) camps had a good level of WASH performance with a 6.38 sum of net scores of components (SAS), and with 6.06 SAS, respectively. Thet Kae Pyin camp had a moderate level of performance with 5.35 SAS. The application of the assessment tool provided valuable data to support evidence-based decision-making. It serves as a useful resource for WASH professionals, humanitarian organizations, and local governments to evaluate service performance and ensure sustainable service provision in their areas. Full article

Environmental health services in healthcare facilities are important, but coverage gaps remain. The World Health Organization and UNICEF developed the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) to assess and improve environmental health services in healthcare facilities. Over 70 countries have adopted it. However, there is little evidence of its effectiveness. This systematic review evaluates whether WASH FIT improves environmental health services and associated health outcomes and impacts. We extracted data from 31 studies on inputs, activities, outputs, outcomes, and impacts associated with WASH FIT and summarized findings using a logic model framework. Twenty-three studies reported quantitative outputs for environmental health services. Of these, only nine reported longitudinal changes in these outputs throughout WASH FIT implementation. Six studies reported quantitative outcomes; the remainder described outcomes qualitatively or not at all. No studies directly measured impacts or evaluated WASH FIT against a rigorous control group. We found that available evidence was insufficient to evaluate WASH FIT’s effectiveness. Further effort is needed to identify the inputs and activities required to implement WASH FIT and to draw specific links between changes in outputs, outcomes, and impacts. Opportunities exist to improve evidence by more comprehensively reporting WASH FIT assessments and exploiting data on health impacts within health management information systems. Full article

Background: Adequate water, sanitation, and hygiene (WaSH) are critical to maintaining good health and hygiene. However, health is a function of many health determinants, and WASH services alone may not be sufficient to improve health outcomes. Objective: To identify whether the presence of WaSH services is associated with fewer children under five years of age experiencing symptoms of diarrhea in Katoma, Geita, Tanzania. Method: A cross-sectional study was conducted to collect health data, demographics, and other variables, such as WASH, food insecurity, education of the mother, vaccination data, and household income data, for 452 households with children under five. Surveys were completed in-person through interviews. Health outcome data included being sick with diarrhea or symptoms. Data analysis was performed using SAS OnDemand for Academics. Multivariate logistic regression and mixed-effects logistic regression models were employed to determine the association between the covariates and sickness of inclusion children and all the children involved in the study, respectively. Results: The findings suggest that WASH services alone do not have a significant impact on diarrhea, but other determinants of health, including the education of the mother, showed a significant impact on health outcomes among children with at least one WASH service. These demographic variables were also associated with lower food insecurity and poverty. The findings highlight the need to (1) include other covariates when analyzing WASH data to understand health outcomes; and (2) improve education attainment for women to maximize health benefits for their children. Full article

Stunting is a major global health concern, particularly in low- and middle-income countries, due to its persistently high prevalence. It often originates from chronic malnutrition during the critical first 1000 days of life. Maternal and child nutrition are critical determinants of a child’s growth and development. This article aimed to explore the impact, causes, and evidence-based strategies to accelerate the reduction of stunting incidence worldwide. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025 using the keyword “Stunting”, “Causes of stunting”, “Stunting Impact”, “Stunting Intervention”, and “Stunting Prevention”. The findings highlight the multifactorial causes of stunting, including maternal malnutrition, inadequate breastfeeding and complementary feeding, poor sanitation, and socioeconomic factors. Stunting is associated with impaired linear growth, cognitive deficits, gut dysbiosis, endocrine disruption, anemia, and increased risk of chronic diseases later in life. Addressing stunting demands multisectoral strategies focusing on maternal and child nutrition, infection prevention, improved WASH (Water, Sanitation, and Hygiene) practices, and socioeconomic support. The evidence presented may guide policy development and targeted interventions to prevent stunting and its long-term effects. Full article

Background and Objectives: Hepatitis A is an infectious disease caused by the hepatitis A virus (HAV), which is transmitted via the fecal–oral route, either through the consumption of contaminated food and water or through direct contact with an infected individual. The incidence of HAV is closely associated with socioeconomic factors, access to clean drinking water, sanitation safety, and hygiene. This study aimed to determine HAV seroprevalence and shifting endemicities of hepatitis A virus infection. The seroprevalence and endemicity status were assessed based on the age at the midpoint of population immunity (AMPI). Materials and Methods: A cross-sectional seroprevalence study was conducted in two contrasting areas (urban vs. rural) in Bandung, Indonesia. All participants underwent serological testing for anti-HAV IgG using a chemiluminescent microparticle immunoassay (CMIA) and participated in questionnaire interviews. Socioeconomic status was assessed using the Water/sanitation, Assets, Maternal education, and Income (WAMI) index. All statistical analyses were performed using SPSS 18, with a p-value of <0.05 considered significant. Results: A total of 1280 participants were tested (640 living in urban areas; 640 living in rural areas). The total prevalence of HAV seropositivity was 50.5% (95% confidence interval [CI]: 47.7–53.3%), with prevalences of 46.1% (95% CI: 42.5–54.4%) across urban sites and 54.7% (95% CI: 50.7–58.6%) across rural sites. The AMPI was within the 20–24-year age group, with an age point of 22 years, classified as an intermediate HAV endemicity status. Conclusions: the study found a shift in HAV endemicity status from low to intermediate, supporting the need for large-scale national hepatitis A vaccination in Indonesia. Full article

This paper examines the financial health risks that private sector water, sanitation, and hygiene (WASH) businesses in rural Vietnam face. It investigates the challenges faced by water operators and sanitation suppliers involved in donor-funded development projects aimed at supporting poor and vulnerable households. Through surveys and focus group discussions with 15 suppliers who worked in public–private partnerships, this research examines the financial risk factors affecting water and sanitation suppliers and their impact on financial viability through two case studies. For water operators, the risks primarily involve infrastructure management, operational costs, and revenue instability. In the sanitation sector, risks center around fluctuating material prices, limited business expansion capital, and household affordability. This study highlights the dual role of government and donor subsidies, which enhance service accessibility but potentially distort market dynamics. It also underscores the need for targeted financial and policy interventions, including better access to microfinance, regulatory improvements, and human resource development. The findings aim to inform strategies for government, donors, and private sector actors in similar WASH development contexts to enhance financial sustainability, ensuring inclusive WASH services in underserved areas. This paper contributes to policy discussions by proposing mechanisms to balance public–private collaboration while fostering market resilience and equitable access to WASH services in emerging economies similar to that of Vietnam. Full article

This study aimed to assess the water quality, prevalence of waterborne diseases, and hygiene practices in selected Union Councils (UCs) of Abbottabad District. A small number of studies on water contamination and its effects on health have been carried out by various researchers and government organizations in Abbottabad. Considering how much time has passed since the last study, this one will provide up-to-date information on water quality and disease prevalence, taking into account any developments or patterns over the last ten years. The areas of high and low prevalence of waterborne diseases were identified based on secondary data from district hospitals. The high-prevalence area included UC Nawanshehr, UC Mirpur, and UC Sherwan, while the low-prevalence area comprised UC Bakot, UC Moolia, and UC Tearch. Water samples were collected from these UCs and analyzed for physical parameters (pH, turbidity, TDS, EC, and temperature) as well as biological parameters (E. coli, Salmonella typhi, and Vibrio cholera) to assess the drinking water quality. Questionnaires were also administered to gather information on water supply, storage, treatment, disease prevalence, and hygiene practices. The findings indicated that all physical parameters fell within the permissible limits; however, all water samples were found to be contaminated with biological agents. UC Mirpur and UC Bakot exhibited the highest disease prevalence rates of 55% and 33%, respectively. Correlation analysis revealed strong positive correlations (correlation coefficients of 1, 0.8, and 0.5) between the presence of E. coli, Salmonella typhi, and Vibrio cholera and disease prevalence. The questionnaire data revealed that the main sources of water supply were tube wells, small streams, and water pumps, with minimal water treatment practices. The water treatment level was, however, noted to be far below expectations, even with the required hygiene practices being followed in all Union Councils. Above all, these findings indicate the necessity to promote best practices for water treatment in the studied UCs and inform efforts to improve drinking water quality at the population level. Public health measures need to focus on improving access to safe drinking water sources, appropriate water treatment, and hygiene. The identified findings from this study nurture innovative affordable solutions that can lead to decreased waterborne diseases and enhanced public health protections in the Abbottabad District. Full article

Rural and remote communities often face significant challenges maintaining their health and well-being. In developing countries, these challenges are further compounded by (1) limited access to clean water, (2) ineffective sanitation, (3) low education and literacy levels and (4) low awareness of the role of personal hygiene practices in reducing communicable disease transmission. Existing health education materials distributed within such communities are often presented in a traditional written format, making them inaccessible to people with low literacy levels. Therefore, recent evidence supports an alternative health communication approach through the use of picture-based materials. This study has assessed the effectiveness of a cartoon-based pictorial educational tool (CBPET) in communicating key messages about hygiene and bacteria contained within the environment and bodily fluids. The CBPET that was developed was tested in a Tanzanian village, representative of a community with low literacy and a resource-poor setting. The CBPET was found to effectively deliver key health promotion messages to the local community. Developing healthcare education in a universal language format based on pictures or cartoons could be the way forward. Full article

This study examined the link between traditional practices, water stewardship, and cholera outbreaks in three rural Nigerian communities (Enugu, Delta, and Ondo States) in 2020. A sample of 180 participants, representing different socio-economic backgrounds, was surveyed using a mixed-methods approach. Knowledge-based pre-test and post-test measures were employed to assess changes in the understanding of cholera transmission, prevention, and water infrastructure. Chi-square and logistic regression analyses were applied to examine the relationship between socioeconomic status, trust in traditional water sources, and cholera knowledge. Educational seminars were conducted, followed by six months, before administering the post-test to the same population. Key findings revealed that 47% of respondents washed animals in water sources, 42% did not treat their water, and 53% were unaware of cholera-reporting practices. The post-test results showed that 80% of participants could correctly identify cholera symptoms following educational interventions (p < 0.001). Water, sanitation, and hygiene (WaSH) program awareness was significantly associated with reduced cholera incidence (p = 0.005), while certain cultural practices, such as washing slaughtered animals in main water sources, were associated with increased cholera (p < 0.002). This study highlights the need for increased awareness of source water quality, better stewardship, and trust-building efforts to provide culturally appropriate interventions in mitigating these outbreaks. Full article

This study provides the first comprehensive investigation of Blastocystis sp. contamination in the drinking well and coastal water sources in Guinea-Bissau, a region grappling with severe water quality challenges. Of the forty-five water samples analyzed (34 well and 9 coastal water sources), Blastocystis sp. was detected in five (11%, 95% CI: 3.71–24.05) of the wells, which serve as a critical and primary drinking source for local communities. The detection of human-associated Blastocystis sp. subtype (ST)2 and ST3 raises concerns about the potential of fecal contamination as a transmission route for Blastocystis sp., underscoring the public health risks associated with an inadequate WASH (water, sanitation, and hygiene) infrastructure. These findings highlight the urgent need for improved water management and further research on waterborne parasitic infections in resource-limited settings. Full article

This study assessed the status of water, sanitation, and hygiene (WASH) services at (49) selected primary schools in uMfolozi Local Municipality, which is situated in the province of Kwa-Zulu Natal in South Africa. Data were collected using an observational checklist tool and by conducting a walk-through survey to inspect the conditions of sanitary facilities, observe the hand-washing practices of the school learners, and analyse the accessibility to safe drinking water in school premises. The data were analysed with the Statistical Package for Social Science Version 29. This study revealed that there is easy access to safe drinking water in all but one school. The dependability of the water supply seemed to be one of the most urgent problems in every school, even though all of them have some kind of drinking water infrastructure on their grounds. Municipal water (n = 25, 36%) and rainwater (n = 25, 36%) were the most common type of water used in schools compared to borehole (n = 15, 22%) and tanker truck water (n = 4, 6%). Schools must have a reserved water supply because of the inconsistent supply of municipal water, and because rainwater is a seasonal harvest while borehole water may be affected by factors like load-shedding. The UNICEF-described ratio of one tap or disperser per fifty learners suggests that the water taps in the schoolyard were insufficient in some schools (n = 25, 36%). Rainwater is collected through a gutter system in the school building roofs and stored in 5000–10,000 Jojo tanks. Borehole water is pumped into Jojo tanks at an elevated position where it is stored, and learners receive the water through taps connected to the borehole tanks. During an emergency when there is no water supply from other sources, tanker trucks are hired to fill tanks that are also used to store rainwater. The borehole and rainwater quality appeared to be clear, but water treatment had not been performed, and the microbial quality was unknown. This shows that the Sustainable Development Goal (SGD) 6, clean water and sanitation, is still far from being met. According to national norms and standards for domestic water and sanitation services, people who do not use water treatment or purification techniques fall in the ‘no service’ category and contribute to the water backlog. Pit latrines (n = 46, 94%) and flush toilet (n = 3, 6%) were found to be the only convenient toilet systems used. The number of toilets is not sufficient according to the guidelines. There are (n = 46, 94%) of the schools in the study area using pit latrine due to insufficient or no water supply. In 89.8% of primary schools, sanitation facilities are in working condition in terms of repair and hygiene, while 10.2% are not usable in terms of hygiene, and these are mostly boy’s toilets. All schools (n = 46, 94%) that have flush toilets is because they received sponsorship from non-government stakeholders that funded them in achieving piped water systems that permit the functionality of flush toilets. For the purposes of this study, hygiene was evaluate based on the items found in toilets and handwashing practices. The hygiene aspects of toilets included tissues, cleanness, and toilet seat. For handwashing practices we looked the number of washing basins, the colour of water, and having soaps to use. In the schools that did provide handwashing facilities, some of the toilets were broken, there was no water, or there was no drainage system in place to allow them to function. However, according to the school act, the handwash basins should be inside the facilities. A total of (n = 7, 14%) of handwash basins were inside the toilets. Only (n = 2, 4%) of schools had handwashing facilities which were Jojo tanks with taps near toilets, which were outside of the toilet, with no soap provided. Additionally, (n = 40, 82%) of learners used drinking points for handwashing, which can possibly transmit microbes among them. The findings revealed that, in general, (n = 32, 64%) of school toilets were clean, while, in general, the girls’ toilets were cleaner than the boys’ toilets. In all the schools, the cleaning services were from the people who were involved in school nutrition. In conclusion, there were water sources available for access to water inside schools; however, the situation can be improved by increasing the number of water source points. Pit latrines were the main used toilets, which were in a majority of the schools, and did not have the necessary terms for hygiene such as handwashing basin, tissues, and others. The lack of the main aspect, i.e., access to water and sanitation items, results in an impact on hygiene to learners as they will fail to practice proper hygiene. However, improvement can still be made by keeping the boys’ toilets clean while increasing the number of handwashing basins inside the toilets, so that they do not use taps outside the toilets. Schools should work towards meeting the required number of handwashing basins to increase access to handwashing facilities. Full article