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South Africa and Botswana are middle-income countries in the southern part of the African continent. They are also the two of the most developed countries in the region, where socio-economic situation is better than in many other parts of the African continent. The progression of the Millennium Development Goals (MDGs) in these two countries can be seen as the setting stage for the disaster risk management understanding in the African region in the 21st century. This is done in this article for disaster risk management and waterborne diseases or water, sanitation, and hygiene (WASH) conditions in Botswana and South Africa. The authors used an open-source on the mortality in children under 5 to develop a proxy indicator for disaster risk from WASH. This dependent variable is correlated with the access to improved water and sanitation sources or facilities, and the expected lifespan at birth of the South African population. The latter indicators are used as independent variables in correlations, and they are seen as expressions of vulnerability determinants in the WASH context in South Africa and Botswana. Results indicate that the strongest prevention of the death rates from the WASH-related diseases comes from the overall status of the healthcare system in Botswana and South Africa. Socio-economic parameter played limited to no role in the determination of the diarrhoeal disease disaster risk in both the studied countries. Contribution: Access to improved drinking water sources and improved sanitation facilities played a partial role as a controlling factor in determining the WASH-related death rates. The overall functioning of the healthcare system is the most dominant factor in the disaster risk from WASH in South Africa and Botswana.

Background: Sustainable development Goal (SDG) 6 is to “ensure availability and sustainable management of water and sanitation for all”. This study aimed to estimate the proportion of households with access to improved drinking water source and improved sanitation facilities and identify predictors of access to improved drinking water source and improved sanitation facilities. Methodology: We used data from the National Family Health Survey (NFHS-5). Improved sources of drinking water and Improved sanitation facilities were stratified by different socio demographic variables. Multivariate logistic regression was performed to estimate the determinants of Improved sources of drinking water and Improved sanitation facilities. Results: The national level proportion of households’ access to improved drinking water was 93.7% (95%CI 93.6%-93.8%) and access to Improved sanitation facilities was 78.8% (95%CI 78.7%-78.9%). The household related factors which had strong association with greater access to improved drinking water and sanitation facilities were households’ residing in urban areas, wealth index of richest, residing in pucca houses, nuclear families and household with female as Head of the family (Hof). Conclusions: Improvement in access is to be ensured among rural areas, households with poor wealth index and north, central, west and east states for achievement of SDG 6 by 2030.

Access to improved drinking water and sanitation has been declared a fundamental right by the UN General Assembly. However, around 25 and 50% of the global population lacked access to safely managed drinking water and improved sanitation in 2020, respectively. India, the second most populous country in the world, has around 3.7 and 31% of its population without access to improved drinking water and sanitation, respectively. This paper explores the factors determining a household's access to improved drinking water and sanitation in India, using India Human Development Survey (IHDS) II data. The results indicate that urban households with bigger family sizes, with fewer rooms, married but uneducated household heads, belonging to forward castes, were more likely to have access to improved drinking water. Similarly, households with married female heads, belonging to forward castes, small household sizes, older aged heads with primary education, from Non-EAG (Empowered Action Group) states, located in urban areas, earning higher incomes and having more rooms were more likely to have access to improved sanitation. Findings suggest subsidized improved water and sanitation services and an increase in public investment to make these facilities affordable for poor rural households. HIGHLIGHTS A considerable share of the global population remains deprived of safe drinking water and sanitation.; There is an urgent need to understand the factors influencing their access as any policy intervention aiming to improve sanitation and drinking water problem must first identify the population at risk.; Studies on the determinants of access to improved drinking water and sanitation in the Indian context are limited.;

Abstract Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Sanitation programming success depends on users being satisfied with the proposed sanitation system and bathroom design. Past studies have described some households being dissatisfied with their current bathrooms and unwilling to accept a new bathroom because it is not modern; however, few studies have investigated how households define modern. To best support households in adopting improved sanitation infrastructure, or infrastructure that hygienically separates human waste from human contact, there is a need to understand characteristics associated with modern bathrooms and if modern encompasses more than the sanitation infrastructure. This study systematically identified characteristics associated with modern bathrooms across multiple sanitation infrastructure types. 305 households near Cascas, Peru, an area with diverse bathroom designs that have unimproved and improved sanitation infrastructure access, were surveyed to capture perceptions of modern. Results demonstrate that households often perceive a modern bathroom as one with a sitting-style toilet, a sink, and a shower. Most households did not associate sanitation infrastructure type with their definition of modern; however, all modern bathrooms had improved sanitation infrastructure. Future work should expand and test this definition of modern in other contexts to support future adoption of improved sanitation. HIGHLIGHTS Few studies have been conducted to explore household perceptions of modern bathrooms.; In this context, households most often associated a sitting-style toilet, a shower, and a sink with a modern bathroom.;

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage. [ABSTRACT FROM AUTHOR]

Waterborne diseases (i.e., diarrhea, dracunculiasis, dysentery, typhoid fever, malaria, scabies, ringworm, cholera, hepatitis B, streptococci, and onchocerciasis) are linked to a significant disease burden worldwide. This work has thus established a relationship between access to improved sanitation, potable water supply, and waterborne disease occurrence in Ondo State, Nigeria, by analyzing the data sourced from the Federal Ministry of Water Resources, Federal Republic of Nigeria. The results showed that there was water scarcity (< 42% access) in the southern part of Ondo State. There was inadequate access to improved sanitation (< 30% access) in both the southern and northern parts of the State. Meanwhile, Southern Ondo State had the highest (> 320%) prevalence of waterborne diseases. There also existed a negatively moderate correlation: a substantial relationship between the access to a potable water supply (APW) (%) and the occurrence of waterborne diseases (WBD) (%) in Ondo State and between the occurrence of WBD (%) and improved sanitation (IS) (%) in the State. There existed a low correlation: definite but small relationship between the percentage of people with APW and the percentage of people with IS (%). This study has used the multiple linear regression model to develop a relationship equation using WBD as a dependent variable and APW and IS as independent variables. The first twelve elements (or LGAs) of Ondo State were used for modeling, while the last six were used to validate the results obtained. Equations generated were validated through residuals by observing the conditions of homoscedasticity, normality, and autocorrelation. The Nash–Sutcliffe efficiency was estimated to be about 80%. The spatial variability analysis was also done using inverse distance weighting. Therefore, it can be said that the modeled equation was quite good in predicting past and future waterborne diseases in Ondo State. [ABSTRACT FROM AUTHOR]

Introduction: provision of adequate sanitation is among the common strategies of preventing sanitation-related diseases. However, provision of sanitation facilities may only be a sustainable solution if the population's behavior changes and positive perception is embraced. This paper highlights the influence of social factors on adoption of sanitation practices. Methods: convergent mixed methods design was employed. Quantitative data was gathered using structured questionnaires from 100 household heads selected using cluster and simple random techniques. Logistic regression analysis was performed to explore factors that influenced adoption of sanitation practices. Qualitative data was gathered from a purposively selected focus group and analyzed thematically. Results: many (57%) of the participants were males. The average age for participants was 39 years, standard deviation (SD)=0.20. From the multivariable regression analysis with adjusted odds, household heads being aged 18-33 years (OR 1.76, 95% CI: 0.62-3.02, p=0.015) and safety of latrines (OR 1.72, 95% CI: 0.70-5.15, p<0.001) was associated with increased open defecation chances; whereas being a female (OR 0.16 95% CI: 0.06-1.81, P=0.01), availability of open spaces near households (OR 0.12, 95% CI: 0.05-1.13, p=0.30), and mason skills (OR 0.29, 95% CI: 0.13-1.65) were associated with reduced likelihood of open defecation practices. Further, being a female (OR 1.06, 95% CI: 0.18-3.16, p=0.043), having knowledge on safe sanitation (OR 1.01, 95% CI: 0.74-3.08, p=0.02), engaging skilled masons for toilet construction (OR 1.299, 95% CI: 1.01-8.95, p=0.005) and financial stability (OR 1.95, 95% CI: 0.98-23.40, P=0.032<0.001) were positively associated with adoption of improved toilets. Conclusion: the sanitation status in the study area was mainly poor due to the influence of multiple factors like gender, absence of toilets, knowledge on safe sanitation, poverty, mason skills and toilet location in relation to safety. The findings showed the need for innovative planning approaches based on the social aspects of communities for progress in sanitation standards in rural areas. Such approaches should adhere to the sanitation hardware versus software components of communities to promote active utilization of the available toilets, construction of improved toilets and reduction of open defecation. [ABSTRACT FROM AUTHOR]

A primary goal of the WASH sector is to facilitate transitions from open defecation to improved sanitation. Many residents of low-income countries desire improved sanitation but lack the resources to obtain or maintain access to toilets. For such persons, describing the goal as ‘behavior change’ implies a deficiency in mindset, failing to capture contextual factors affecting sanitation access. Furthermore, household circumstances affect movement both up and down the sanitation ladder, a phenomenon that the sector tends to overlook. This study, based on interviews with 308 former subscribers to Haitian container-based-sanitation service EkoLakay, tracks household sanitation access at four points in time: prior to subscribing, during the subscription period, immediately upon unsubscribing, and at the time of interview. We describe this movement through time as the ‘sanitation arc’. Prior to subscribing, households were more likely to practice open defecation or rely on non-household sanitation, and less likely to have private improved sanitation than the average urban Haitian. This distribution is reversed among former subscribers. Nearly half of former subscribers, however, could not afford continuous access to EkoLakay; 80% of involuntary terminations resulted in loss of access to private improved sanitation, and over one-third of these households reverted to open defecation. HIGHLIGHTS Measuring behavior change omits perspective on resource availability.; Movement on the sanitation ladder is not always upward.; The ‘sanitation arc’ describes household movement up and down the sanitation ladder over time.; Many households rely on container-based sanitation for sanitation while amassing means to invest in permanent infrastructure.; Households with economic challenges revert to open defecation when no alternative sanitation is available.;

BackgroundAccess to water, sanitation, and hygiene is an important element for communicable disease control including the existing COVID-19 pandemic. This is due to the growing water demand and decreasing water availability, because of shrinking resources, increased urbanization, and pollution. This problem is higher, particularly among least developed countries like Ethiopia. This study, therefore, aimed at investigating the level of improved water sources and sanitation as well as their predictors in Ethiopia using EMDHS-2019.MethodMini Ethiopian Demographic and Health Surveys 2019 database survey was used in this study. Data collection took place over 3 months, from 21 March 2019 to 28 June 2019. A total of 9,150 households were selected for the sample, of which 8,794 were engaged. Among involved households, 8,663 were successfully interviewed at a response rate of 99%. The dependent variables measured in this study were improved drinking water sources and sanitation facilities. Due to the nested nature of DHS data, multilevel binary logistic regression analysis was done using Stata-16.ResultsThe majority (72.62%) of household heads were men, and 69.47% of participants were from rural areas. Close to half (47.65%) of study participants did not have any form of formal education, while the lowest proportion (9.89%) of them had higher education. Approximately 71.74 and 27.45% of the households have accessed improved water sources and sanitation, respectively. Based on the final model results, wealth index, educational status, and having a television individual-level variables while community-level poverty, community-level education, community-level media exposure, and place of residence were statistically significant predictors of getting improved water source and sanitation.ConclusionThe level of access to improved water sources is moderate but it lacks progress, while access to improved sanitation was lower. Based on these findings, great improvements should be made in providing access to an improved water source and sanitation facilities in Ethiopia. Based on these findings, great improvements should be made in providing access to improved water source and sanitation facilities in Ethiopia.

South Africa and Botswana are middle-income countries in the southern part of the African continent. They are also the two of the most developed countries in the region, where socio-economic situation is better than in many other parts of the African continent. The progression of the Millennium Development Goals (MDGs) in these two countries can be seen as the setting stage for the disaster risk management understanding in the African region in the 21st century. This is done in this article for disaster risk management and waterborne diseases or water, sanitation, and hygiene (WASH) conditions in Botswana and South Africa. The authors used an open-source on the mortality in children under 5 to develop a proxy indicator for disaster risk from WASH. This dependent variable is correlated with the access to improved water and sanitation sources or facilities, and the expected lifespan at birth of the South African population. The latter indicators are used as independent variables in correlations, and they are seen as expressions of vulnerability determinants in the WASH context in South Africa and Botswana. Results indicate that the strongest prevention of the death rates from the WASH-related diseases comes from the overall status of the healthcare system in Botswana and South Africa. Socio-economic parameter played limited to no role in the determination of the diarrhoeal disease disaster risk in both the studied countries., Contribution: Access to improved drinking water sources and improved sanitation facilities played a partial role as a controlling factor in determining the WASH-related death rates. The overall functioning of the healthcare system is the most dominant factor in the disaster risk from WASH in South Africa and Botswana., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Despite efforts to achieve universal access to safe drinkable water and improved sanitation, many Africans still lack access to these social services. There are also disparities between urban and rural areas in access to these services in Africa. If sustained, this adverse trend could undermine the achievement of the United Nations' Sustainable Development Goal 6 to ensure access to safe drinkable water and sanitation for all by 2030. This paper examines the effect of globalization on access to clean water and improved sanitation in Africa over the 1990–2015 period. Based on the panel corrected standard errors estimator, the results show that overall globalization improves access to water and improved sanitation while increasing disparities between urban and rural areas in access to improved sanitation. Among the sub-indexes of globalization, social globalization enhances access to drinkable water and improved sanitation for the total, urban and rural population. However, social globalization widens the urban-rural gap in access to improved sanitation while its effect on disparities in access to drinkable water is not significant. Economic globalization reduces the share of the population with access to improved sanitation while its effects on access to drinkable water and the urban-rural disparities in access in both social services are not statistically significant. Finally, some differences are found when distinguishing between de facto and de jure aspects of globalization. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

Access to safe drinking water and improved sanitation is a fundamental human right and basic ingredient of public health. However, one of the major problems faced by developing countries in the twenty-first century is the lack of access to these facilities. Punjab, the most populous province of Pakistan with more than 50% of the country's population, is no exception. Keeping in view its importance, the current study is an effort to investigate important determinants of access to safe drinking water and improved sanitation in Punjab to ensure the provision of these services to the masses. Multiple Indicator Cluster Survey Household data from 2017 to 2018 has been used for analysis. The results of a logistic regression model revealed that household media exposure, education level of household head, household wealth status, and ethnic background of the household head are some of the important determinants of household access to safe drinking water. For household access to improved sanitation, along with these factors, the role of social norms and place of residence are also important. Particularly, the role of social norms is very profound. Findings from the study suggest that efforts should be made to provide readily available media access, household education level needs to be enhanced, policies should be made to raise the living standard of the poorest households, and the social norm for the use of improved sanitation needs to be promoted. HIGHLIGHTS In the wake of COVID-19, the importance of water, sanitation, and hygiene has been increased manifold.; There is dire need to understand the important factors that contribute to access to safe water and improved sanitation.; Currently, there are hardly any studies in Punjab (Pakistan) on this matter, so the current study is an effort to fill this gap.;

Globally, over 2.5 billion people are still without access to improved sanitation. Almost a third of the world’s population suffers on a daily basis from a lack of access to a clean and functioning toilet. People are obliged to defecate in the open due to a lack of toilet facilities. Poor usage of latrines and excreta disposal are contributing factors to a high number of morbidity and mortality, especially among under-five children. Health improvement comes from proper sanitation facilities, not simply because of their mere physical presence. Therefore, this study assessed latrine utilisation and associated factors among households in Holte town of Derashe, especial Woreda, southern Ethiopia. A cross-sectional study was conducted on 356 households using an interviewer-administered questionnaire and checklist. An SPSS software Version.23 was used for analysis, and descriptive statistics and association among factors were finally calculated. From total respondents, 316 (88.76%) were using Latrine for 24 hours (good utilisation), 29 (8.1%) daily and the remaining 11 (3.0%) rarely (poor utilisation). Family members in each household were identified as using Latrine together. From the study respondents who have under-five children, 189 (53.1%) of the households do not allow their children to use Latrine. In conclusion, there is somewhat good latrine utilisation but poor hand washing practice after visiting Latrine in the study area. So, strengthening health information dissemination, appropriate technical support, and multi-sectorial collaboration should be key factors to improve the proper utilisation of latrines and handwashing practices.

Efforts to eradicate open defecation and improve sanitation access are unlikely to achieve health benefits unless interventions reduce microbial exposures. This study assessed human fecal contamination and pathogen exposures in rural India, and the effect of increased sanitation coverage on contamination and exposure rates. In a cross-sectional study of 60 villages of a cluster-randomized controlled sanitation trial in Odisha, India, human and domestic animal fecal contamination was measured in community tubewells and ponds (n = 301) and via exposure pathways in homes (n = 354), using Bacteroidales microbial source tracking fecal markers validated in India. Community water sources were further tested for diarrheal pathogens (rotavirus, adenovirus and Vibrio cholerae by quantitative PCR; pathogenic Escherichia coli by multiplex PCR; Cryptosporidium and Giardia by immunomagnetic separation and direct fluorescent antibody microscopy). Exposure pathways in intervention and control villages were compared and relationships with child diarrhea examined. Human fecal markers were rarely detected in tubewells (2.4%, 95%CI: 0.3-4.5%) and ponds (5.6%, 95%CI: 0.8-10.3%), compared to homes (35.4%, 95%CI: 30.4-40.4%). In tubewells, V. cholerae was the most frequently detected pathogen (19.8%, 95%CI: 14.4-25.2%), followed by Giardia (14.8%, 95%CI: 10.0-19.7%). In ponds, Giardia was most often detected (74.5%, 95%CI: 65.7-83.3%), followed by pathogenic E. coli (48.1%, 95%CI: 34.8-61.5%) and rotavirus (44.4%, 95%CI: 34.2-54.7%). At village-level, prevalence of fecal pathogen detection in community drinking water sources was associated with elevated prevalence of child diarrhea within 6 weeks of testing (RR 2.13, 95%CI: 1.25-3.63) while within homes, higher levels of human and animal fecal marker detection were associated with increased risks of subsequent child diarrhea (P = 0.044 and 0.013, respectively). There was no evidence that the intervention, which increased functional latrine coverage and use by 27 percentage points, reduced human fecal contamination in any tested pathway, nor the prevalence of pathogens in water sources. In conclusion, the study demonstrates that (1) improved sanitation alone may be insufficient and further interventions needed in the domestic domain to reduce widespread human and animal fecal contamination observed in homes, (2) pathogens detected in tubewells indicate these sources are microbiologically unsafe for drinking and were associated with child diarrhea, (3) domestic use of ponds heavily contaminated with multiple pathogens presents an under-recognized health risk, and (4) a 27 percentage point increase in improved sanitation access at village-level did not reduce detectable human fecal and pathogen contamination in this setting.

While the state of sanitation in Pakistan has improved in the last decade, a significant proportion of its population is still using inadequate sanitation or no toilet facility at all. Open defecation has decreased over the years; however, it has been replaced by poor quality sanitation in rural areas that might still cause diarrhoea and undernutrition. The research regarding inadequate sanitation in Pakistan, especially in terms of the sanitation ladder, remains limited. The present research thus fills this research gap by assessing the impact of different types of sanitation on the prevalence of stunting and underweight (moderate as well as severe) among under-five children in Pakistan using the nationally representative micro survey, Pakistan Demographic and Health Survey (2017-18). The sanitation ladder comprises of piped to sewer (highest level, base) followed by flush to septic tank, flush to pit latrine, other improved, unimproved sanitation, and open defecation. In order to estimate the adjusted and unadjusted odds ratios of the determinants, this research uses logistic regressions are used to estimate adjusted and unadjusted odds ratios of the determinants. We show that toilets connected to piped sewerage network are rare in the rural areas of Pakistan and a large segment of the rural population is still practicing open defecation. The logistic regressions show that piped sewerage network and flush to septic tanks are associated with lowest odds (both adjusted and unadjusted) of stunting and underweight among under-five children. In multivariate regressions, pit latrines are associated with even higher adjusted odds of severe and moderate and severe stunting as well as underweight among under-five children, showing that poor quality pit latrines may bring the source of faecal contamination to the doorstep of the households. Therefore, interventions targeting reduction in open defecation should promote good quality toilets for sustainable long-term improvements in child health. [ABSTRACT FROM AUTHOR]

Globally, over 2.5 billion people are still without access to improved sanitation. Almost a third of the world's population suffers on a daily basis from a lack of access to a clean and functioning toilet. People are obliged to defecate in the open due to a lack of toilet facilities. Poor usage of latrines and excreta disposal are contributing factors to a high number of morbidity and mortality, especially among under-five children. Health improvement comes from proper sanitation facilities, not simply because of their mere physical presence. Therefore, this study assessed latrine utilisation and associated factors among households in Holte town of Derashe, especial Woreda, southern Ethiopia. A cross-sectional study was conducted on 356 households using an interviewer-administered questionnaire and checklist. An SPSS software Version.23 was used for analysis, and descriptive statistics and association among factors were finally calculated. From total respondents, 316 (88.76%) were using Latrine for 24 hours (good utilisation), 29 (8.1%) daily and the remaining 11 (3.0%) rarely (poor utilisation). Family members in each household were identified as using Latrine together. From the study respondents who have under-five children, 189 (53.1%) of the households do not allow their children to use Latrine. In conclusion, there is somewhat good latrine utilisation but poor hand washing practice after visiting Latrine in the study area. So, strengthening health information dissemination, appropriate technical support, and multi-sectorial collaboration should be key factors to improve the proper utilisation of latrines and handwashing practices. [ABSTRACT FROM AUTHOR]

Ensuring access to improved water and sanitation remains a public health challenge in Ethiopia. Exploring access to improved drinking-water supply and sanitation will help to track the progress towards achieving the Sustainable Development Goals. The aim of this study was to explore geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. A total of 16,650 households from 643 enumeration areas of the recent Ethiopian Demographic and Health Survey 2016 data were extracted and included in the analysis. World Health Organization recommended definitions were used to measure indicators of improved drinking water and sanitation at enumeration areas. SaTScan™ software was used for spatial analysis using enumeration areas as centers for exploring geographical variations of improved water and sanitation. Absolute and relative inequalities were used to quantify regional inequalities in access to improved water and sanitation. Nationwide access to improved drinking water and sanitation in Ethiopia was 49.6% (95% CI: 48.4–50.7) and 6.3% (5.8–6.8), respectively, with large variations between and within regions (using the categories and definitions that were in effect for monitoring coverage in 2016). Access to improved drinking water ranged from 28.5% in Somali Region to 95.3% in Addis Ababa city whereas access to improved sanitation ranged from 1.7% in Amhara Region to 24% in Dire Dawa city. Households lacking access to improved water and sanitation were clustered in northern (Amhara Region) and southern (Southern Nations, Nationalities, and Peoples' Region) parts of Ethiopia. Most enumeration areas had very low level of access to improved drinking water and/or sanitation. This analysis demonstrated the existence of geographical variations and inequalities in access to improved drinking water and sanitation in Ethiopia. Therefore strategies to improve access for safe drinking water and sanitation should consider geographical variations and inequalities at a subnational scale.

Abstract Objective Access to improved sanitation facilities is critical to the health and well-being of individuals and communities. However, globally, over 2.5 billion people live without access to safe sanitation facilities and more than 40% of the world population, do not use a toilet, but defecate in the open or in unsanitary places. In Ghana, only 14% of the population have access to improved sanitation facilities with great disparities between rural (8%) and urban (19%) dwellers. This paper sought to examine the determinants of access to improved sanitation facilities by households among rural dwellers in two districts in southern Ghana. Results This study, which involved 16,353 household heads from the Dodowa Health and Demographic Surveillance System, found that sanitation facilities used by households were significantly influenced by age, gender, level of education, occupation, marital and socioeconomic status of household heads. It further revealed that a large proportion (85.94%) of the study participants did not have access to improved sanitation facilities. The study therefore recommends that the national sanitation laws must strictly be enforced to ensure each household in Ghana has decent and hygienic toilet facility.

Background: With the rapid expansion of urban population, provision of safe water and basic sanitation is becoming a challenge; especially in slums. This is adversely affecting the health of the people living in such areas. Objectives: The study was conducted to measure the proportion of households using improved drinking water and sanitation facilities and to determine the association between diarrhea in under-five children with water and sanitation facilities. Methods: A community-based, cross-sectional study was conducted among 796 slum households in Siliguri from January to March 2016 by interviewing one member from each household using a predesigned and pretested questionnaire based on the WHO/UNICEF Joint Monitoring Program Core questions on drinking water and sanitation for household surveys. Results: A majority 733 (92.1%) of slum households used an improved drinking water source; 565 (71%) used public tap. About two-thirds (65.7%) household used improved sanitation facilities. About 15.8% households had reported diarrheal events in children in the previous month. Unimproved drinking water sources (AOR = 4.13; 1.91, 8.96), houses without piped water supply (AOR = 4.43; 1.31, 15.00), and latrines located outside houses (AOR = 3.61; 1.44, 9.07) were significantly associated with the diarrheal events in children. Conclusion: The utilization of improved drinking water source was high but piped water connection and improved sanitary toilet used was low. Association between diarrheal events and type of drinking water sources and place of sanitation might suggest fecal contamination of water sources. Awareness generation through family-centered educational programs could improve the situation.

This study describes the results of a series of laboratory experiments on aimed at developing of a protocol for the use of fly ash as a pit additive in the ventilated improved pit latrines (VIPs) in South Africa. Model VIP vaults were prepared in the laboratory and filled with synthetic faecal sludge; and dosed with fly ash in amounts ranging from 5 to 20 % (w/w). The maximum leachable chemical oxygen demand (COD) accounted for 3.2 % of the total organic matter, while the maximum leachable ammonium accounted for 1.4 % of the leachable ammonium present in the synthetic faecal sludge. All phosphate in the synthetic faecal material was leachable. Mixing of the 20 % dose of fly ash into the synthetic faecal sludge resulted a minimum 98.9 % reduction (or about two log units) in the faecal coliform concentration after 28 days of incubation. As a result, addition of fly ash can decrease microbial threats to public and environmental health threats from the VIP faecal wastes, but can cause environmental contamination with phosphate. The fly ash dose and the duration of the faecal sludge treatment require further optimisation. Relationship between the chemical composition of the fly ash used as an additive to stabilise the VIP faecal sludge and the leaching of phosphorus from the sludge will also have to be investigated further. [ABSTRACT FROM AUTHOR]

Objective: This study aims to characterize household trends in access to improved water sources and sanitaton in Chi Linh Town, Hai Duong Province, Vietnam, and to identify factors affecting those trends. Method: Data were extracted from the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) database from 2004–2014, which included household access to improved water sources, household access to improved sanitation, and household demographic data. Descriptive statistical analysis and multinominal logistic regression were used. The results showed that over a 10-year period (2004–2014), the proportion of households with access to improved water and improved sanitation increased by 3.7% and 28.3%, respectively. As such, the 2015 Millennium Development Goal targets for safe drinking water and basic sanitation were met. However, 13.5% of households still had unimproved water and sanitation. People who are retired, work in trade or services, or other occupations were 1.49, 1.97, and 1.34 times more likely to have access to improved water and sanitation facilities than farming households, respectively (p < 0.001). Households living in urban areas were 1.84 times more likely than those living in rural areas to have access to improved water sources and improved sanitation facilities (OR =1.84; 95% CI = 1.73–1.96). Non-poor households were 2.12 times more likely to have access to improved water sources and improved sanitation facilities compared to the poor group (OR = 2.12; 95% CI = 2.00–2.25). More efforts are required to increase household access to both improved water and sanitation in Chi Linh Town, focusing on the 13.5% of households currently without access. Similar to situations observed elsewhere in Vietnam and other low- and middle- income countries, there is a need to address socio-economic factors that are associated with inadequate access to improved water sources and sanitation facilities.

Within the domain of public health, commonalities exist between the sanitation and cookstove sectors. Despite these commonalities and the grounds established for cross-learning between both sectors, however, there has not been much evidence of knowledge exchange across them to date. Our paper frames this as a missed opportunity for the cookstove sector, given the capacity for user-centred innovation and multi-scale approaches demonstrated in the sanitation sector. The paper highlights points of convergence and divergence in the approaches used in both sectors, with particular focus on behaviour change approaches that go beyond the level of the individual. The analysis highlights the importance of the enabling environment, community-focused approaches and locally specific contextual factors in promoting behavioural change in the sanitation sector. Our paper makes a case for the application of such approaches to cookstove interventions, especially in light of their ability to drive sustained change by matching demand-side motivations with supply-side opportunities. Abbreviation: DALY: Disability-adjusted life year; CHC: Community Health Club; CLTS: Community-Led Total Sanitation; HAP: Household air pollution; BM-WASH: Integrated Behavioural Model for Water, Sanitation and Hygiene; ICS: Improved cookstove; LPG: Liquefied petroleum gas; NBA: Nirmal Bharat Abhiyan; NGO: Non:governmental organisation; OD: Open defecation; ODF: Open defecation free; HAST: Participatory Hygiene and Sanitation Transformation; RANAS: Risks, Attitudes, Norms, Abilities and Self-regulation RCT: Randomised controlled trial; (Sani) FOAM: Focus, Opportunity, Ability and Motivation; SBM: Swachh Bharat Mission; TSC: Total Sanitation Campaign; WASH: Water, Sanitation and Hygiene [ABSTRACT FROM AUTHOR]

Objective: Access to improved sanitation facilities is critical to the health and well-being of individuals and communities. However, globally, over 2.5 billion people live without access to safe sanitation facilities and more than 40% of the world population, do not use a toilet, but defecate in the open or in unsanitary places. In Ghana, only 14% of the population have access to improved sanitation facilities with great disparities between rural (8%) and urban (19%) dwellers. This paper sought to examine the determinants of access to improved sanitation facilities by households among rural dwellers in two districts in southern Ghana. Results: This study, which involved 16,353 household heads from the Dodowa Health and Demographic Surveillance System, found that sanitation facilities used by households were significantly influenced by age, gender, level of education, occupation, marital and socioeconomic status of household heads. It further revealed that a large proportion (85.94%) of the study participants did not have access to improved sanitation facilities. The study therefore recommends that the national sanitation laws must strictly be enforced to ensure each household in Ghana has decent and hygienic toilet facility. [ABSTRACT FROM AUTHOR]

Background: To my knowledge, there was no systematic study so far that analysed the extent of the impact of improved sanitation on infant mortality in the African context with long years of full-fledged longitudinal data. Aim: The aim of this study was to empirically examine the extent to which improved sanitation explains the observed differences in infant mortality under 5 years of age across African countries. Setting: The study covered a panel of 33 countries from north, south, east, west and central Africa for the years 1994–2013. Methods: The study first conducted Durbin–Wu–Hausman specification test and then used fixed effect model. In addition, Praison–Winsten regression with corrected heteroscedasticity was employed to verify the consistency of the results that were revealed in using fixed effect estimation method. Results: The study revealed that a 1% increase in access to improved sanitation would reduce infant mortality by a rate of about two infant deaths per 1000 live births. Also, the study confirmed that a significant decline in infant mortality rate was highly linked to improvements in education, health and sustainable economic growth. Conclusion: The findings have wide implications especially for African countries for which decreasing infant mortality is one of the most crucial priorities in the continent to reverse the current deep-rooted challenges related to human capital formation.