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BACKGROUND: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. METHODS: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2-4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7-16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March-June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. RESULTS: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94-112), 5987 enrolled at study initiation (23rd November-22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71-1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84-1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83-1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0-100 scale; 95% CI 0.05-6.59), and no evidence of effects on other secondary outcomes. CONCLUSIONS: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT05024890.
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Salud Infantil , Higiene , Instituciones Académicas , Humanos , Etiopía , Niño , Femenino , Masculino , Adolescente , Saneamiento/métodos , Saneamiento/normas , Servicios de Salud Escolar , Diarrea/prevención & control , Diarrea/epidemiología , Abastecimiento de Agua/normasRESUMEN
Through the report of 4 cases of occupational heatstroke among sanitation workers working in high-temperature weather, this study analyzes the risk of occupational heatstroke among workers in the environmental sanitation industry working in high-temperature weather, and provides scientific suggestions for standardizing occupational health management, safeguarding the health rights and interests of workers, and preventing the occurrence of occupational heatstroke in summer. Through case analysis, we aim to raise high awareness of the occupational health of sanitation workers in the whole society, in order to provide a scientific and healthy working environment for sanitation workers and promote their physical and mental health.
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Golpe de Calor , Calor , Enfermedades Profesionales , Humanos , Golpe de Calor/etiología , Adulto , Calor/efectos adversos , Masculino , Exposición Profesional/efectos adversos , Salud Laboral , Femenino , Persona de Mediana Edad , SaneamientoRESUMEN
A group of helminthic and intestinal protozoa causes intestinal parasitic infections (IPIs), affecting more than 2.5 billion people worldwide. IPIs are diseases closely associated with poor hygiene and sanitation, concentrated in underdeveloped regions and among populations with low socioeconomic status. Consequently, most prevalence is in Sub-Saharan Africa and Asia, with local habits or risk factors that could affect its prevalence. The aim of this study was to determine how hygienic practices, sanitation, and local behavior of eating raw meat (hinasumba) contributed to the prevalence of IPI. A cross-sectional study was conducted in the Simalungun District of North Sumatera Province, involving 428 people of Batak Simalungun. There were 15 villages randomly selected across the district based on the local registry, which consequently, non-purposive sampling was conducted. Face-to-face interviews assessed various risk factors, such as demographic characteristics, water source, traditional raw meat consumption, or hinasumba as local risk factors, hygienic practices, and sanitation. The findings indicated that an overall prevalence rate of IPI was 42.9%, consisting of 87.5% with helminthic infection and 12.5% with protozoal infection. More than half of IPI cases were associated with Taenia sp. infections (21.8%), followed by hookworms' infections with a 6.1% positivity rate. Based on multivariate analysis, farming and consuming traditional delicacies, namely hinasumba, increased the likelihood of IPI occurrence among the population by 1.7 and 3 times, respectively. It can be concluded that the high prevalence of taeniasis in the study area was associated with local behavior and hinasumba consumption, which may contribute to determining the dominance of specific IPI species.
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Higiene , Parasitosis Intestinales , Saneamiento , Teniasis , Humanos , Estudios Transversales , Masculino , Prevalencia , Femenino , Indonesia/epidemiología , Adulto , Teniasis/epidemiología , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/parasitología , Persona de Mediana Edad , Factores de Riesgo , Adolescente , Adulto Joven , Niño , Anciano , Animales , Enfermedades Endémicas/estadística & datos numéricosRESUMEN
Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)-a national sanitation program initiated in 2014-and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011-2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000-70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.
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Mortalidad Infantil , Saneamiento , Cuartos de Baño , Humanos , India/epidemiología , Mortalidad Infantil/tendencias , Lactante , Cuartos de Baño/estadística & datos numéricos , Femenino , Masculino , Recién Nacido , Preescolar , Mortalidad del Niño/tendencias , Composición FamiliarRESUMEN
BACKGROUND: Indian subcontinent being an important region in the fight to eliminate cholera needs better cholera surveillance. Current methods miss most infections, skewing disease burden estimates. Triangulating serosurvey data, clinical cases, and risk factors could reveal India's true cholera risk. METHODS: We synthesized data from a nationally representative serosurvey, outbreak reports and risk factors like water, sanitation and the Multidimensional Poverty Index, to create a composite vulnerability index for assessing state-wise cholera risk in India. We tested 7,882 stored sera samples collected during 2017-18 from individuals aged 9-45 years, for vibriocidal antibodies to Vibrio cholerae O1 using a cut-off titre ≥320 defining as elevated titre. We also extracted data from the 2015-19 Integrated Disease Surveillance Programme and published cholera reports. RESULTS: Overall, 11.7% (CI: 10.4-13.3%) of the sampled population had an elevated titre of cholera vibriocidal antibodies (≥320). The Southern region experienced the highest incidence (16.8%, CI: 12.1-22.8), followed by the West (13.2%, CI: 10.0-17.3) and North (10.7%, CI: 9.3-12.3). Proportion of samples with an elevated vibriocidal titre (≥320) was significantly higher among individuals aged 18-45 years (13.0% CI: 11.2-15.1) compared to children 9-17 years (8.6%, CI 7.3-10.0, p<0.05); we found no differences between sex or urbanicity. Between 2015-2019, the Integrated Disease Surveillance Program (IDSP) reported 29,400 cases of cholera across the country. Using the composite vulnerability index, we found Karnataka, Madhya Pradesh, and West Bengal were the most vulnerable states in India in terms of risk of cholera. CONCLUSION: The present study showed that cholera infection is present in all five regions across India. The states with high cholera vulnerability could be prioritized for targeted prevention interventions.
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Cólera , Humanos , Cólera/epidemiología , Cólera/microbiología , India/epidemiología , Adolescente , Adulto , Niño , Adulto Joven , Femenino , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estudios Seroepidemiológicos , Vibrio cholerae O1/inmunología , Incidencia , Anticuerpos Antibacterianos/sangre , Brotes de Enfermedades , SaneamientoRESUMEN
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.
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Control de Infecciones , Mejoramiento de la Calidad , Bangladesh , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Higiene/normas , Calidad de la Atención de Salud , Saneamiento/normas , Infección Hospitalaria/prevención & control , Instituciones de Salud/normas , Personal de Salud , FemeninoRESUMEN
BACKGROUND: Inadequate water supply, poor sanitation and hygiene (WASH) facilities in schools, insufficient puberty education and a lack of hygienic menstrual hygiene management (MHM) items (absorbents) cause girls in developing countries like Ethiopia to view menstruation as shameful and uncomfortable. However, there was little evidence of female MHM practice and associated factors among secondary school girls in eastern Ethiopia. OBJECTIVE: To assess MHM practice and associated factors among secondary school girls in eastern Ethiopia. DESIGN: Institutional-based cross-sectional study design was conducted. METHODS: A total of 473 secondary schoolgirls were selected using a stratified sampling technique. Data were collected using a self-administered structured questionnaire, double-entered to Epidata version 3.1 and exported to SPSS version 26 for analysis. Descriptive analysis was computed using frequency, percentage, mean and standard deviations. Multivariable logistic regression was applied to assess the association of the school water, sanitation and hygiene facilities with MHM. Adjusted odd ratio (AOR) with its 95% confidence interval was computed to show the strength of the association between dependent and independent variables. The goodness of fit of the model was tested by the Hosmer-Lemeshow goodness of fit test. RESULTS: Out of 473 study participants, 72.93% of them (95% CI: 68.74-76.76) reported good MHM practices. The study also found that availability of continuous water supply (AOR = 2.40, 95% CI: (1.42-4.01)); types of toilet (AOR = 2.01, 95% CI: (1.20-3.40)), confined space (AOR = 3.02, 95% CI: (1.49-4.76)) and having females' toilets alone inside in the school (AOR = 2.70, 95% CI: (1.20-4.40)) were significantly associated with female students' good MHM practice. CONCLUSION: The survey revealed that some of the secondary schoolgirls practiced poor menstrual hygiene management (MHM), which needs further improvement. The study also found that the availability of continuous water supply in the school, types of toilet facility in the school, availability of private space to manage periods at school, learning about MHM in schools and availability of female toilets kept locked inside were factors significantly associated with MHM practice of students, which require integration of Zonal Health and education bureau to jointly work towards the improvement of school WASH facilities.
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Higiene , Menstruación , Saneamiento , Instituciones Académicas , Abastecimiento de Agua , Humanos , Femenino , Etiopía , Saneamiento/normas , Estudios Transversales , Adolescente , Higiene/normas , Abastecimiento de Agua/normas , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Estudiantes/estadística & datos numéricos , Cuartos de Baño/estadística & datos numéricos , Productos para la Higiene MenstrualRESUMEN
In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug-Dec 2019), endline (n = 262) (Jun-Sep 2022) and an in-depth front-end study (n = 12) (Oct-Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.
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Escherichia coli , Heces , Población Rural , Saneamiento , Cuartos de Baño , Fiji , Heces/microbiología , Humanos , Composición FamiliarRESUMEN
On 22 April 2024, a locally-acquired case of cholera was confirmed in Mayotte. Subsequently, local transmission resulted in eight outbreak clusters with 221 notified cases in densely populated neighbourhoods with limited or no access to drinking water. The last case was detected on 12 July. A case-area targeted intervention strategy was applied to contain the outbreak. However, improving access to drinking water and basic sanitation is crucial to prevent further exposure.
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Cólera , Brotes de Enfermedades , Vibrio cholerae , Humanos , Cólera/epidemiología , Francia/epidemiología , Vibrio cholerae/aislamiento & purificación , Adulto , Persona de Mediana Edad , Masculino , Adolescente , Femenino , Niño , Anciano , Agua Potable/microbiología , Preescolar , Adulto Joven , Lactante , SaneamientoRESUMEN
Introduction: on October 18, 2023, the Ministry of Health declared an outbreak of cholera in the Lusaka district. Public health interventions were implemented using a multisectoral approach in the Lusaka district and other hotspots in the country. We documented the multisectoral response efforts and their impacts on the cholera epidemic in the Lusaka district of Zambia. We highlighted the major challenges and their associated impacts on the epidemiologic patterns of disease in hotspot areas. Methods: we conducted a descriptive observational study of cholera response activities in the Lusaka district. We used quantitative and qualitative non-participant techniques using the Centers for Disease Prevention and Control's direct in-person observation tool in healthcare settings. We reviewed surveillance records to estimate the magnitude of the outbreak, and characterized cases by person, place, and time. We documented the response interventions and challenges using situation reports. Results: during the 2023 - 2024 cholera outbreak, Lusaka district was the most affected district with 13,122 cases and 498 deaths as of 12th February 2024. Despite having a well-established system for coordinating technical support and resource mobilization, inadequate sanitation and limited access to clean water remained potential risks for cholera outbreaks in Lusaka district. Conclusion: Lusaka district may have experienced one of the most severe cholera epidemics in the nation's history, as indicated by its rapid spread and increased mortality reported from both the community and treatment centers. A multisectoral coordination for improved sanitary systems, access to clean water, health education strategies, and vaccination campaigns contributed to the decline in cholera cases.
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Cólera , Brotes de Enfermedades , Salud Pública , Saneamiento , Cólera/prevención & control , Cólera/epidemiología , Zambia/epidemiología , Humanos , Brotes de Enfermedades/prevención & control , Saneamiento/normas , Saneamiento/métodosRESUMEN
BACKGROUND: Poor child feces management contributes to enteropathogen exposure and, consequently, is associated with diarrheal disease and negative impacts on child growth. Despite high latrine coverage, only 37% of Indian households safely dispose of their child's feces into a latrine or have the child use the latrine, with the lowest rate in the state of Odisha at 12%. We evaluated a behavior change and hardware intervention designed to improve caregiver safe disposal of child feces and child latrine use. METHODS: We conducted a cluster-randomized controlled trial among 74 villages in rural Odisha, India. Eligible villages previously participated in a water and sanitation infrastructure program. Following a baseline survey, half the villages were assigned to intervention and half to control. Caregivers of children < 5 years old from households with a latrine were eligible to participate. The intervention included five behavior change activities. Hardware was provided at the first activity, based on child age, to aid safe disposal and latrine training (wash basin and bucket with lid for children < 7 months old; latrine training mat platform with removable tray for children 7 to 48 months old). The primary outcome was caregiver reported 'safe disposal' as defined by the WHO/UNICEF Joint Monitoring Programme (JMP) which encompasses two behaviors: caregiver disposal of child's feces into a latrine and child latrine use. Safe disposal was measured four to six months after intervention delivery (endline). RESULTS: Endline analysis included 665 intervention caregivers (840 children) and 634 control caregivers (785 children). Prevalence of JMP-defined safe disposal was 1.16 times greater in the intervention arm compared to control (77.7% vs. 65.9%; prevalence ratio [PR] 1.16, 95% CI 1.04-1.29), with higher prevalence of caregiver safe disposal (18.6% vs. 13.6%; PR 1.46, 95% CI 1.12-1.92) but no significant difference in child latrine use (59.0% vs. 52.2%; PR 1.06, 95% CI 0.95-1.18). When restricted to children < 3 years old, JMP-defined safe disposal was 1.42 times greater (67.5% vs. 46.7%; PR 1.42 95% CI 1.21-1.67) with higher prevalence of both caregiver safe disposal (34.6% vs. 25.7%; PR 1.44, 95% CI 1.11-1.86) and child latrine use (32.9% vs. 20.9%; PR 1.41, 95% CI 1.08-1.83). CONCLUSIONS: The intervention increased JMP-defined safe disposal, with substantial improvements in both caregiver safe disposal and child latrine use among children < 3 years old. While future research is needed to demonstrate sustainability of these effects, our results suggest a potentially scalable intervention for improving child feces disposal and reducing disease. TRIAL REGISTRATION: This trial was retrospectively registered at ISRCTN15831099 on 18/02/2020, which was approximately two months after the first participant was recruited for the baseline survey on 02/12/2019.
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Heces , Población Rural , Cuartos de Baño , Humanos , India , Preescolar , Lactante , Cuartos de Baño/estadística & datos numéricos , Femenino , Masculino , Población Rural/estadística & datos numéricos , Cuidadores/educación , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Análisis por Conglomerados , Saneamiento/normas , AdultoRESUMEN
BACKGROUND: Inadequate menstrual hygiene management can result in physical, social, psychological, and educational challenges for schoolgirls. To address these issues, researchers have conducted intervention studies, but the impact on school attendance has varied. This review has systematically collected and evaluated evidence about the effects of menstrual hygiene interventions on schoolgirls. METHOD: A systematic search of the literature was done and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement). Both peer-reviewed journals and gray literature were searched using PubMed and Google Scholar. The search included individual, or cluster randomized controlled trials, and quasi-experimental studies, and covered the period from the date of indexing until January 3, 2023. RESULT: A review of sixteen trial studies showed that menstrual hygiene interventions have a positive effect on schoolgirls' school attendance, performance, and dropout rates, as well as on their menstrual knowledge, attitudes, practices, and emotional well-being. There was a low to medium risk of bias in most of the studies. Additionally, the literature overlooked the impact of interventions that involve parental and male engagement, interventions correcting community misperceptions about menstruation, and the impact of infrastructure improvements on water, sanitation, and hygiene. CONCLUSION: Interventions aimed at improving menstrual hygiene management can enhance schoolgirls' educational outcomes, and can improve their menstrual knowledge, attitudes, and practices by helping them manage their periods more effectively. Most interventions have focused on the provision of menstrual products and menstrual education but have neglected improvements in the physical environment at home and school and the social norms surrounding menstruation. Trial studies should take a holistic approach that considers the total socio-cultural environment in which menstrual hygiene management takes place, thus enabling stakeholders and policymakers to develop sustainable, long-term solutions to these problems.
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Higiene , Menstruación , Humanos , Femenino , Menstruación/psicología , Conocimientos, Actitudes y Práctica en Salud , Instituciones Académicas , Países en Desarrollo , Adolescente , Niño , SaneamientoRESUMEN
OBJECTIVES: Globally, billions of people do not have access to safely managed drinking water and sanitation services. Interventions to improve drinking water, sanitation and hygiene could reduce the incidence of diarrhoea in low- and middle-income countries. This study aimed to investigate the association between these services and the incidence of diarrhoea. STUDY DESIGN: Worldwide, ecological observational study, utilising cross-sectional data. METHODS: Data from the Global Burden of Disease Study 2019 and World Bank were used in this study. Diarrhoeal disease episodes were defined as three or more loose bowel movements within 24 h. Estimated Annual Percentage Change was used to quantify trends in disease incidence over a specific time interval. Quasi-Poisson Generalised Linear Model was introduced to analyse the influence of basic drinking water and sanitation services on the incidence of diarrhoea. Subgroup analyses were carried out to determine potential variations in the incidence of diarrhoeal diseases according to sex, age and sociodemographic index (SDI) region. RESULTS: Between 2000 and 2019, the incidence rate of global diarrhoea remained consistent, with regional variations linked to SDIs. A 1% increase in access to basic drinking water was associated with a 0.41% (95% confidence interval [CI], 0.33%-0.50%) increase in the age-standardised incidence rate of diarrhoea; meanwhile, a 1% increase in sanitation service usage was associated with a 0.47% (95% CI, 0.40%-0.54%) reduction in the age-standardised incidence rate of diarrhoea. The correlation differed across SDI regions. The use of safely managed drinking water was associated with a reduction in diarrhoeal disease rates, but the effect was non-significant in High SDI regions. Higher diarrhoeal disease incidence was seen in younger and older populations. Individuals in the age groups 55-59 years and 10-14 years showed the greatest association of water service usage with diarrhoea, while an increase in sanitation service usage was related to decreased diarrhoea rates in most age groups, excluding children aged 5-14 years. CONCLUSIONS: Emphasising initiatives to enhance water quality, elevate the standards of drinking water safety management, and strengthening related infrastructure development in global health policies and development plans could have a positive impact on overall global health. Such comprehensive interventions have the potential to not only prevent waterborne diseases but also elevate the general health status of societies worldwide.
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Diarrea , Agua Potable , Salud Global , Saneamiento , Humanos , Diarrea/epidemiología , Diarrea/prevención & control , Saneamiento/normas , Incidencia , Agua Potable/normas , Masculino , Preescolar , Femenino , Adolescente , Lactante , Niño , Adulto , Salud Global/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Estudios Transversales , Anciano , Abastecimiento de Agua/normas , Abastecimiento de Agua/estadística & datos numéricos , Recién NacidoRESUMEN
BACKGROUND: The sixth United Nations Sustainable Development Goal emphasises universal access to clean water, sanitation and hygiene (WASH) to ensure human well-being as a fundamental human right for sustainable development. In Zimbabwe, WASH reforms began more than a century ago from the preindependence to postindependence era. However, countries face pressing challenges in improving their related health outcomes. Therefore, this scoping review aims to explore WASH status and how it influences health outcomes in Zimbabwe. METHODS AND ANALYSIS: The leading databases to be searched for relevant sources published in English with an unrestricted search back until May 2024 include PubMed, EBSCO, SAGE, SpringerLink, Cochrane Library, ScienceDirect, Scopus, Web of Science and African Journals Online. A search string was developed for retrieving literature, and reports from key stakeholders in the WASH sector will be included in this study as grey literature. The study will employ a two-step screening process for identifying relevant literature incorporating Cohen's kappa coefficient statistics to estimate the inter-rater reliability between two independent reviewers using Mendeley and Rayyan software. The Strengthening the Reporting of Observational Studies in Epidemiology checklist for observational studies and the Consolidated Standards of Reporting Trials checklist for randomised controlled trials will be used for the quality checks. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide this study in terms of data collection, extraction and analysis from relevant literature. Data charting was used to present and interpret the findings. The entire process is scheduled to commence in June 2024, with the manuscript anticipated to be submitted to a journal in October 2024. ETHICS AND DISSEMINATION: This review will use only published data; therefore, no ethical clearance is required. The findings will be disseminated to relevant stakeholders through peer-reviewed journals, meetings, conferences, seminars and forums.
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Higiene , Saneamiento , Zimbabwe , Humanos , Saneamiento/normas , Higiene/normas , Proyectos de Investigación , Abastecimiento de Agua/normas , Literatura de Revisión como AsuntoRESUMEN
Slum areas in Ethiopia have high poverty status. In addition, they possess poor water and sanitation accesses such as unsafe drinking water, a lower number of sanitation facilities and poor hygienic conditions. These scenarios are important in the occurrence of diarrhea among under five children's. However, there are many studies conducted on diarrhea among under five children in Ethiopia, unfortunately, the majority usually didn't give enough coverage for the burden of diarrhea among under five children in slum areas. This study aimed to determine the prevalence of diarrhea and associated factors among under five children in slum areas of Gondar City. This community-based cross-sectional study was conducted in slum areas of Gondar City among under five children from March 28 to April 28, 2023. A multi-stage sampling technique was used to collect a sample of 836 through interview-administered methods using a structured data collection tool. The collected data was manually checked for completeness, coded, and entered into EPI Info version 7.1.5.2 software. It was then exported to Stata version 14.1 software for descriptive analysis, as well as bivariable and multivariable binary logistic regression analyses, to identify factors associated with diarrhea among under five children. The prevalence of diarrhea among under five children at 95% confidence interval was 24.64% (CI 21.71-27.56). Mothers/caretakers age < 25 years (AOR = 1.88, 95% CI 1.16-3.06), mothers/caretakers age between 28 and 31 years (AOR = 1.82, 95% CI 1.08-3.05), mothers/caretakers who had no formal education (AOR = 3.18, 95% CI 1.86-5.41), mothers/caretakers who had primary education (AOR = 1.67, 95% CI 1.09-2.57), income level between 4877 and 5643 Ethiopian Birr (AOR = 1.81, 95% CI 1.04-3.15), family size greater than five (AOR = 1.54, 95% CI 1.00-2.36), flies around the house (AOR = 2.27, 95% CI 1.38-3.73), playground not clean (AOR = 2.70, 95% CI 1.62-4.50), breastfed for ≥ 1 year (AOR = 0.63, 95% CI 0.41-0.97), mothers/caretakers who did not wash their hands before food preparation and eating (AOR = 2.31, 95% CI 1.39-3.58), mothers/caretakers who did not wash their hands after visiting latrine (AOR = 1.60, 95% CI 1.07-2.38) were significantly associated factors with diarrhea among under five children in slum areas of Gondar City. The study indicates that the prevalence of diarrhea was higher among under five children in slum areas of Gondar City. The Gondar City Administration Education Bureau should give great emphasis on improving mother's and caretaker's education. In addition, the Gondar City Administration Health Bureau should educate mothers and caretakers about breastfeeding, sanitation, and hygiene in the slum areas of Gondar City.
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Diarrea , Áreas de Pobreza , Humanos , Etiopía/epidemiología , Diarrea/epidemiología , Estudios Transversales , Femenino , Masculino , Prevalencia , Preescolar , Lactante , Adulto , Factores de Riesgo , Adulto Joven , Saneamiento , Recién NacidoRESUMEN
Background: Water, sanitation, and hygiene (WaSH) are crucial determinants of human health. However, the spatio-temporal trends in the global burden of disease attributable to unsafe WaSH remain poorly understood. This study aimed to estimate the disease burden attributable to unsafe WaSH from 1990 to 2019 using data from the Global Burden of Disease (GBD) Study 2019, providing new insights into the associated health conditions. Methods: We extracted data on deaths and disability-adjusted life years (DALYs) attributable to unsafe WaSH from 1990 to 2019 from the GBD 2019. The disease burden was evaluated by region, sociodemographic index (SDI), sex, age, risk factor, and specific disease. Results: Globally, unsafe WaSH was responsible for 1 656 887.37 (95% uncertainty interval (UI) = 1 198 864.94, 2 312 688.33) deaths in 2019, a 49% decrease from 1990. The global age-standardised DALY rate due to unsafe WaSH was 1244.29 (95% UI = 993.20, 1544.13) per 100 000 in 2019, a 66% reduction since 1990. Western sub-Saharan Africa had the highest age-standardised death rate (ASDR) and age-standardised DALY rate in both 1990 and 2019. Among the 21 regions studied, only high-income North America witnessed an increasing ASDR from 1990 to 2019. Countries and territories in low SDI regions had higher ASDRs and age-standardised DALY rates. U-shaped associations were observed between the estimated annual percentage change (EAPC) of ASDR, EAPC of age-standardised DALY rate, and SDI. Both rates were slightly lower in females, with the burden concentrated in those under five and over 80 years old. In 2019, unsafe water source and diarrhoeal diseases remained the leading risk factor and cause of unsafe WaSH-related disease burden, respectively. Conclusions: Despite substantial improvements in hygiene awareness and health education, unsafe WaSH persists as a significant global health risk and a major contributor to the burden of diarrhoeal diseases. Disparities across regions and age groups remain evident. Increased efforts are needed to raise awareness and strengthen water and sanitation infrastructure, particularly in low SDI settings, to mitigate the health risks associated with unsafe WaSH.
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Carga Global de Enfermedades , Salud Global , Desinfección de las Manos , Saneamiento , Humanos , Salud Global/estadística & datos numéricos , Femenino , Masculino , Adulto , Abastecimiento de Agua , Persona de Mediana Edad , Preescolar , Lactante , Adolescente , Niño , Anciano , Adulto Joven , Higiene , Años de Vida Ajustados por DiscapacidadRESUMEN
BACKGROUND: This paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia. METHODS: The Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time. RESULTS: The prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato-Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly. CONCLUSIONS: The reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method.
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Helmintiasis , Suelo , Etiopía/epidemiología , Helmintiasis/epidemiología , Helmintiasis/transmisión , Humanos , Suelo/parasitología , Masculino , Femenino , Prevalencia , Niño , Adolescente , Animales , Preescolar , Helmintos/clasificación , Helmintos/aislamiento & purificación , Helmintos/genética , Administración Masiva de Medicamentos , Adulto , Saneamiento , Adulto Joven , Antihelmínticos/uso terapéutico , Antihelmínticos/administración & dosificación , HigieneRESUMEN
Pit latrines are the most common household sanitation system in East African cities. Urbanisation reduces the space available for new latrines to be constructed when pits fill and they increasingly require emptying. But formal services that empty and transport sludge to safe disposal or treatment are often unaffordable to low-income households. Cross-subsidies have been suggested to fund services for low-income households but there are no academic studies assessing this funding mechanism. This study analyses empirical financial and operational data shared by a formal service provider in Kigali, Rwanda who is establishing a cross-subsidy model between corporate and high-income households, and low-income households in informal settlements. A semi-mechanical method is used to serve households which cannot be accessed from the road by an exhauster truck. We find that mechanical emptying is gross profitable when exhauster trucks are fully used, particularly large volume and corporate customers. Transferring sludge between vehicles for efficient transport reduces average cost. Cross-subsidies are found to be a viable funding method and a ten-fold increase in mechanical emptying by the service provider would generate 466,876 Int$ (2022 international dollars) gross profit to fund a cross-subsidy for all low-income households in Kigali which require semi-mechanical emptying. This study highlights the opportunities that city authorities have to organise funding to cross-subsidise emptying for low-income households. In addition, by using data from operational records rather than self-reported estimates the reliability of cost estimates is in improved. Further research is required to understand customer group size, demand and emptying frequencies to determine the structure of a citywide cross-subsidy.
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Cuartos de Baño , Rwanda , Cuartos de Baño/economía , Cuartos de Baño/estadística & datos numéricos , Humanos , Composición Familiar , Saneamiento/economía , Saneamiento/métodos , PobrezaRESUMEN
Freshwater pollution is a major concern in Ghana, directly impacting human health. However, the underlying drivers of exposure and risks are not comprehensively understood, emphasizing the severity and impact of these diseases. This study assessed the interaction between water and human health, specifically focusing on the risk factors for waterborne diseases and the drivers of water pollution among residents near the Tano River Basin, Ghana. A sample size of 400 households was selected from five communities within the basin based on their proximity to the Tano River. In addition, the study combined both spatial and non-spatial data sources to map potential flood zones for the basin. The study found that inadequate sanitation, poor hygiene practices, and contamination from illegal mining were the primary causative factors of waterborne diseases. Additionally, floods and improper waste management significantly contributed to disease outbreaks. The flood susceptibility analysis indicated that areas highly susceptible to flooding cover 21.2% of the basin, predominantly in the southern part. The results highlight the urgent need for comprehensive interventions to address the drivers of waterborne diseases. This study will contribute to the local authorities in developing plans to prevent waterborne diseases and mitigate their economic and public health impacts.
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Ríos , Enfermedades Transmitidas por el Agua , Ghana/epidemiología , Humanos , Enfermedades Transmitidas por el Agua/epidemiología , Factores de Riesgo , Inundaciones , Saneamiento , Contaminación del Agua/análisisRESUMEN
Two of the world's biggest sanitation initiatives are approaching their 10-year anniversaries, offering insights into challenges faced worldwide. Gary Humphreys reports.