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Objective: This mixed-methods study aims to develop and validate a comprehensive hygiene tool from a One Health perspective to document the assessment of hygiene at the human-animal interface. Methods: This mixed-methods study consisted of two components: a narrative review of the development of tool, followed by validation. The tool development was conducted in two phases. Phase 1 was a literature review, while phase 2 focused on the development and validation. Results: Tool version 1 consisted of 37 questions to assess personal hygiene practices among 16 households with livestock. Face validity, content validity, and multi-rater kappa scores were used to validate tool version 1. The questions with kappa score exceeding 0.74 were retained for further test. A total of 29 questions were obtained and incorporated into tool version 2, which was subsequently employed to evaluate the personal hygiene practices among 62 households with stock. The median total scores for 16 households and 62 households were 10.5 (range: 6-16) and 16 (range: 10-22), respectively. Conclusions: Many studies have assessed hygiene practices among livestock farmers, yet none used a validated assessment tool. Thus, this validated tool will facilitate the measurement of hygiene in human-animal interactions.

Clean water and sanitation are essential for human development. Governments, international and national aid organizations have implemented water, sanitation, and hygiene (WASH) projects worldwide, notably in low- and middle-income countries. However, the majority of such projects experience failure. As a result, 2.4 billion people worldwide are deprived of improved WASH services. Research revealing how WASH projects can be sustained and which factors need to be considered is crucial. Despite the gap and its importance, existing studies on the sustainability assessment of WASH projects are limited. This study attempted to assess and compare the sustainability of WASH projects in Myanmar that used the Community Led Total Sanitation (CLTS) and Participatory Hygiene and Sanitation Transformation (PHAST) approaches with the "Sustainability Check" developed by The United Nations Children's Fund (UNICEF). This research also evaluated the extent to which WASH projects contributed to the Myanmar National WASH Strategy. The study results show that both CLTS and PHAST project operations fully met the sustainability standards regarding accessibility and intra-village equity. Other sustainability indicators, such as water quality, use of sanitation facilities, and handwashing facilities, were at or above 85% and had already met the 2025 national targets. In contrast, handwashing practices have reached the 2030 national targets. The findings revealed that technical factors, institutional factors (at the community level), social, financial, and sanitation factors contributed to WASH project sustainability. The results also highlight the need for strengthening collaboration with local government to ensure that communities receive post-implementation support from local authorities, to encourage community participation and foster sense of ownership, to empower community-based bodies for O&M and monitoring of water and sanitation facilities, to integrate appropriate behavioral change activities, and to align with the National WASH Strategy. This study would be beneficial for WASH practitioners to ensure the inclusion of factors that support sustainability in the execution of future WASH projects. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections are prevalent in low- and middle-income countries and may be reduced through proper hand hygiene (HH) adherence during patient care. We produced and distributed alcohol-based hand rub (ABHR) to 19 public primary- and secondary-level healthcare facilities in Quetzaltenango, Guatemala, and carried out HH observations to assess healthcare workers' (HCWs) HH adherence, and to identify factors associated with this practice. HH adherence was defined as washing hands with soap and water or using ABHR. Observations were conducted before (2021, baseline) and after (2022, follow-up) ABHR distribution to evaluate the evolution of HH practices over time. Bivariate comparisons and mixed-effects logistic regression models were used to explore associations between HH adherence and the following independent variables: healthcare facility level, type of contact performed, timing of HH performance, occupational category of HCW and materials present (e.g., water, soap, ABHR). We observed 243 and 300 patient interactions among 67 and 82 HCWs at each time point, respectively. HH adherence was low for both observation periods (40% at baseline and 35% at follow-up). HCWs were more likely to adhere to HH during invasive contacts, after patient contact, and if the HCW was a physician. HH adherence varied by scenario, which underscores the importance of addressing multiple determinants of behaviour change to improve adherence. This requires interventions implemented with a multi-modal approach that includes both increasing access to HH materials and infrastructure, as well as HH education and training, monitoring and feedback, reminders, and promoting a HH safety culture. [ABSTRACT FROM AUTHOR]

This article discusses a study that developed and validated a hygiene assessment tool for human-animal interactions in rural areas. The tool consists of 37 questions that cover various aspects of hygiene, including personal hygiene, livestock hygiene, and shelter cleanliness. The study highlights the importance of assessing hygiene in human-animal interactions and the need for a validated assessment tool in this area. The document emphasizes the interconnectedness of human, animal, and environmental health and the need to address hygiene practices in settings where humans and animals interact. [Extracted from the article]

Objectives: Innovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low‐income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub‐county and HCF level. Methods: At baseline (pre‐intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in‐charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference‐in‐difference analysis compared changes from baseline to endline in patient‐reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient‐reported acceptability following use of SaTo pan versus non‐SaTo pan latrines within intervention HCFs. Results: Patient‐reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient‐reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between‐arm difference‐in‐difference was not significant. Enumerator‐observed odour declined in intervention latrines (32%–14%) compared with controls (36%–51%, difference‐in‐difference ratio: 0.32, 95% confidence interval: 0.12–0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient‐reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported. Conclusions: Our results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed. [ABSTRACT FROM AUTHOR]

Abstract Background Many people who menstruate in low- and middle-income countries struggle to manage their menstruation safely, hygienically, and with dignity. This is exacerbated in humanitarian settings with limited access to menstrual products and safe, private spaces for changing, washing, and disposing of menstrual products. To address these challenges, Youth Development Labs (YLabs) used a human-centered design approach to co-design the Cocoon Mini, a safe, physical structure for managing menstruation in the Bidi Bidi Refugee Settlement in Uganda. Methods The study comprised five phases, including background research, design research, rough prototyping, live prototyping, and a pilot study. A total of 340 people, including people who menstruate, male community members, and community stakeholders, participated in interviews, focus groups, and co-design sessions. Solution prototypes were created, evaluated, and iterated upon in each successive project phase. The final intervention design, the Cocoon Mini, was evaluated qualitatively for feasibility and acceptability during a three-month pilot using structured interviews with 109 people who menstruate utilizing Cocoon Mini structures, 64 other community members, and 20 Cocoon Mini supervisors. Results Results showed widespread desirability and acceptability of the Cocoon Mini among people who menstruate and other community members. Overall, 95% (104/109) of people who menstruate stated the space had made menstrual health management easier, primarily by providing designated waste bins, solar lights, and additional water sources. The Cocoon Mini provided an increased sense of physical and psychological safety in knowing where to privately manage menstruation. Furthermore, the Cocoon Mini demonstrated that an intervention could be run and maintained sustainably at the household level in humanitarian contexts, without continued external stakeholder intervention. Each Cocoon Mini structure costs approximately $360 USD to build and maintain and serves 15–20 people who menstruate, leading to a cost per person of $18-$24. Furthermore, attaching an incinerator to the structure for easier and quicker disposal of waste bin contents (compared to transporting full waste bins elsewhere) costs $2110 USD. Conclusions People who menstruate lack access to safe, private spaces for menstrual health and product disposal in humanitarian settings. The Cocoon Mini provides a solution for the safe and effective management of menstruation. Customizing and scaling up dedicated menstrual health spaces should be considered a high-priority intervention in humanitarian settings.

This study conducted an in-depth systematic review of literature to explore the context of water, sanitation and hygiene (WaSH) sustainability and resilience in refugee communities. Our results indicate growing concerns, given the two-decade waiting period for refugees to achieve repatriation/integration into host communities, and the bulk of their accommodation is largely in the Global South. This makes the sustainability of WaSH increasingly complex and depends on understanding the roles and interdependences among the factors in each specific refugee camp, and recognizes that it is not 'one-size-fits-all' solutions and the sustainability of one camp might not be suitable for other camps. [ABSTRACT FROM AUTHOR]

Background: Many people who menstruate in low- and middle-income countries struggle to manage their menstruation safely, hygienically, and with dignity. This is exacerbated in humanitarian settings with limited access to menstrual products and safe, private spaces for changing, washing, and disposing of menstrual products. To address these challenges, Youth Development Labs (YLabs) used a human-centered design approach to co-design the Cocoon Mini, a safe, physical structure for managing menstruation in the Bidi Bidi Refugee Settlement in Uganda. Methods: The study comprised five phases, including background research, design research, rough prototyping, live prototyping, and a pilot study. A total of 340 people, including people who menstruate, male community members, and community stakeholders, participated in interviews, focus groups, and co-design sessions. Solution prototypes were created, evaluated, and iterated upon in each successive project phase. The final intervention design, the Cocoon Mini, was evaluated qualitatively for feasibility and acceptability during a three-month pilot using structured interviews with 109 people who menstruate utilizing Cocoon Mini structures, 64 other community members, and 20 Cocoon Mini supervisors. Results: Results showed widespread desirability and acceptability of the Cocoon Mini among people who menstruate and other community members. Overall, 95% (104/109) of people who menstruate stated the space had made menstrual health management easier, primarily by providing designated waste bins, solar lights, and additional water sources. The Cocoon Mini provided an increased sense of physical and psychological safety in knowing where to privately manage menstruation. Furthermore, the Cocoon Mini demonstrated that an intervention could be run and maintained sustainably at the household level in humanitarian contexts, without continued external stakeholder intervention. Each Cocoon Mini structure costs approximately $360 USD to build and maintain and serves 15–20 people who menstruate, leading to a cost per person of $18-$24. Furthermore, attaching an incinerator to the structure for easier and quicker disposal of waste bin contents (compared to transporting full waste bins elsewhere) costs $2110 USD. Conclusions: People who menstruate lack access to safe, private spaces for menstrual health and product disposal in humanitarian settings. The Cocoon Mini provides a solution for the safe and effective management of menstruation. Customizing and scaling up dedicated menstrual health spaces should be considered a high-priority intervention in humanitarian settings. [ABSTRACT FROM AUTHOR]

Abstract Background Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units. Methods Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7–17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011–2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis. Results Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983–0.996; RR 0.988, CI 95 % 0.977–0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979–0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982–0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models. Conclusions Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.

This study sought to coalesce sector knowledge on the use of systems approaches for sustainable water, sanitation, and hygiene (WASH) service delivery in low-income countries. To accomplish this objective, we remotely convened a panel of WASH sector experts within a multiround survey to identify, characterize, and prioritize the necessary attributes of WASH systems approaches. The first survey round asked experts to comment on the conceptual differences between traditional approaches and systems approaches to WASH. Emerging within responses from the first survey round were attributes of WASH systems (i.e., factors, actors) and attributes of WASH systems approaches (i.e., flexible, scalable). A three-round Delphi survey was then administered to reach consensus on these emerging attributes. By the final round of the Delphi, consensus was reached on every attribute of WASH systems, indicating alignment between the experts on the fundamental characteristics and implications of WASH systems. Consensus was also reached on the majority of attributes of WASH systems approaches, including the inherent interconnected and complex nature of WASH systems. However, consensus was not achieved on attributes related to mapping WASH system interconnections, convening stakeholders in collective action, and the appropriateness and feasibility of applying systems approaches at scale. This indicates a need for future research that explores practical and scalable tools and techniques to map and evaluate WASH system interactions, and ways to engage relevant actors in these approaches to collectively apply systems knowledge. [ABSTRACT FROM AUTHOR]

Competing Interests: Potential of competing interest. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robert Skov reports a relationship with European Society of Clinical Microbiology and Infectious Diseases that includes: board membership.

In the context of commonly limited research on the subject, this study intended to (i) identify the types, magnitude and impacts of disasters in the char land communities in Bangladesh, and (ii) unfolded their water, sanitation and hygiene practices. A quantitative research approach was employed for this study, where a survey method was used. Data were collected through a face-to-face structured interview from 392 household heads in 32 char lands from three north-west districts in Bangladesh. The results claimed that the char people were faced all common disasters that damaged their properties and increased low livelihoods and health problems. Though the households used safe water in all purposes, they had to depend on government, community or sharing water. They had to go a far way to collect water and that was a matter of the women security. The sanitation and hygiene facilities were found very poor in the char areas. The findings would be a useful guideline to the policymakers, Ministry of Health and Family Welfare, health workers and development practitioners. [ABSTRACT FROM AUTHOR]

Background: Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units.Methods: Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7-17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011-2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis.Results: Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983-0.996; RR 0.988, CI 95 % 0.977-0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979-0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982-0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models.Conclusions: Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group. [ABSTRACT FROM AUTHOR]

Abstract Background Schistosomiasis is a water-based disease transmitted by trematodes belonging to the genus Schistosoma. The aim of this study was to assess the relationship between the prevalence of schistosomiasis and access to water, sanitation and hygiene (WASH) and environmental and socioeconomic factors in the city of Korhogo, northern Côte d'Ivoire. Methods A cross-sectional study including 728 randomly selected households was conducted in Korhogo in March 2015. The heads of the households were interviewed about access to WASH and environmental and socioeconomic factors. All children abed between 5 and 15 years living in the households were selected to provide stool and urine samples for parasitological diagnosis of Schistosoma mansoni and Schistosoma haematobium infection. The relationship between infection with S. mansoni and potential risk factors was analysed by a mixed logistic regression model with ‘household’ as a random factor. Likelihood ratio tests were used to identify factors that were significantly associated with a Schistosoma spp. infection. Results The overall prevalence of schistosomiasis among school-aged children in Korhogo was 1.9% (45/2341) composed of 0.3% (3/1248) S. haematobium and 3.5% (42/1202) S. mansoni. Due to the low prevalence of S. haematobium infection, risk factor analysis was limited to S. mansoni. Boys were 7.8 times more likely to be infected with S. mansoni than girls. Children between 10 and 15 years of age were 3.8 times more likely to be infected than their younger counterparts aged 5-10 years. Moreover, living in a house further away from a water access point (odds ratio [OR] = 0.29, 95% confidence interval [CI]: 0.13–0.70) and abstaining from swimming in open freshwater bodies (OR = 0.16, 95% CI: 0.04–0.56) were significantly associated with decreased odds of S. mansoni infection. The socioeconomic status did not appear to influence the prevalence of S. mansoni. Conclusions A strategy to reduce the incidence of schistosomiasis should focus on health education to change the behaviour of populations at risk and encourage communities to improve sanitation and infrastructure in order to reduce contact with surface water.

Background: It has been suggested that specific interventions delivered through the education sector in low- and middle-income countries might improve children's health and wellbeing. This cluster-randomised controlled trial aimed to evaluate the effects of a school garden programme and complementary nutrition, and water, sanitation and hygiene (WASH) interventions on children's health and nutritional status in two districts of Nepal.Methods: The trial included 682 children aged 8-17 years from 12 schools. The schools were randomly allocated to one of three interventions: (a) school garden programme (SG; 4 schools, n = 172 children); (b) school garden programme with complementary WASH, health and nutrition interventions (SG+; 4 schools, n = 197 children); and (c) no specific intervention (control; 4 schools, n = 313 children). The same field and laboratory procedures were employed at the baseline (March 2015) and end-line (June 2016) surveys. Questionnaires were administered to evaluate WASH conditions at schools and households. Water quality was assessed using a Delagua kit. Dietary intake was determined using food frequency and 24-h recall questionnaire. Haemoglobin levels were measured using HemoCue digital device and used as a proxy for anaemia. Stool samples were subjected to a suite of copro-microscopic diagnostic methods for detection of intestinal protozoa and helminths. The changes in key indicators between the baseline and end-line surveys were analysed by mixed logistic and linear regression models.Results: Stunting was slightly lowered in SG+ (19.9 to 18.3%; p = 0.92) and in the control (19.7 to 18.9%). Anaemia slightly decreased in SG+ (33.0 to 32.0%; p < 0.01) and markedly increased in the control (22.7 to 41.3%; p < 0.01), a minor decline was found in the control (43.9 to 42.4%). Handwashing with soap before eating strongly increased in SG+ (from 74.1 to 96.9%; p = 0.01, compared to control where only a slight increase was observed from 78.0 to 84.0%). A similar observation was made for handwashing after defecation (increase from 77.2 to 99.0% in SG+ versus 78.0 to 91.9% in control, p = 0.15).Conclusions: An integrated intervention consisting of school garden, WASH, nutrition and health components (SG+) increased children's fruit and vegetable consumption, decreased intestinal parasitic infections and improved hygiene behaviours.Trial Registration: ISRCTN17968589 (date assigned: 17 July 2015). [ABSTRACT FROM AUTHOR]

Abstract The water, sanitation and hygiene (WaSH) sector has witnessed the development of multiple tools for multidimensional monitoring. Hierarchical and composite indicator (CI)–based conceptual frameworks provide one illustrative example. However, this approach does not address the existing interrelationship of the indicators they comprise. Bayesian networks (BNs) are increasingly being exploited to assess WaSH issues and to support planning and decision-making processes. Here, we aim to evaluate the validity, reliability and feasibility of BNs in replicating an existing CI-based conceptual framework. We adopt a data-driven approach and propose a semi-automatic methodology. As a pilot study, we used the regional monitoring initiative Rural Water Supply and Sanitation Information System (SIASAR). Data from two different countries are processed and analysed to calibrate and validate the model and the method. The major findings show: i) the model inference capacity improves when structure is provided to the networks (according to the CI-based framework); ii) key components that explain a pre-defined objective variable are reduced and quantified (implying important advantages in data updating); and iii) interlinkages among these components can be identified (which might enhance multi- and trans-disciplinary actions). We conclude that BNs accurately replicate the CI-based conceptual framework, with great potential for a wider application. Graphical abstract Unlabelled Image Highlights • We replicate hierarchical composite indicators by exploiting Bayesian networks. • A data-driven and semi-automatic method is provided for this purpose. • Providing network inner structure improves model inference capacity. • This method allows key factors that explain the objective variable to be identified. [ABSTRACT FROM AUTHOR]

Improving access to water, sanitation and hygiene (WASH) can help to eliminate the root cause of waterborne disease transmission. WASH has the potential to function as a sustained and effective mechanism for controlling enteric diarrheal disease (EDD) over the long term. To address this question, we formulate a mathematical model to study the impact of WASH services on reducing the transmission of waterborne diseases. The model is analyzed using the stability theory of differential equations in order to determine the threshold condition in disease control. We utilize optimal control theory to find the right balance in WASH interventions, ensuring a decrease in waterborne disease over a specific planning period. The total number of EDD cases is minimized when there are specific financial restrictions. To analyze the outcomes, we employed numerical simulations and conducted a sensitivity analysis on different weights in the cost index. Furthermore, we compared the numerical simulations of the optimal solutions and performed multiple regression analyses to gain insights into the impact of control strategies. Our findings reveal that wastewater and sewage treatment (WST) control has the most significant impact. When multiple controls are necessary, WST and drinking water supply (DWS) control provide the most effective combination. These results have significant implications for controlling infectious diseases, especially in developing countries where budgets are typically limited. Implementing these strategies could potentially reduce disease transmission and improve public health outcomes. • Two mathematical models are formulated to explore the most effective strategies for minimizing enteric diarrheal disease (EDD) cases within given budget constraints. • Optimal control theory is applied to explore the right balance in WASH interventions, ensuring a decrease in waterborne disease over a specific planning period. • When multiple controls are necessary, WST and drinking water supply (DWS) control provide the most effective combination in minimizing the spread of waterborne diseases. [ABSTRACT FROM AUTHOR]

Both intestinal schistosomiasis and giardiasis are co-endemic throughout many areas of sub-Saharan Africa, significantly impacting the health of millions of children in endemic areas. While giardiasis is not considered a neglected tropical disease (NTD), intestinal schistosomiasis is formally grouped under the NTD umbrella and receives significant advocacy and financial support for large-scale control. Although there are differences in the epidemiology between these two diseases, there are also key similarities that might be exploited within potential integrated control strategies permitting tandem interventions. In this review, we highlight these similarities and discuss opportunities for integrated control of giardiasis in low and middle-income countries where intestinal schistosomiasis is co-endemic. By applying new, advanced methods of disease surveillance, and by improving the provision of water, sanitation and hygiene (WASH) initiatives, (co)infection with intestinal schistosomiasis and/or giardiasis could not only be more effectively controlled but also better understood. In this light, we appraise the suitability of a One Health approach targeting both intestinal schistosomiasis and giardiasis, for if adopted more broadly, transmission of both diseases could be reduced to gain improvements in health and wellbeing.

In the era of the Sustainable Development Goals, for which one of the aims is to provide universal access to safe water, sanitation and hygiene (WASH) services, it is crucial to target and prioritize those who remain unserved. Multi-criteria decision analysis (MCDA) models can play an important role in WASH planning by supporting priority-setting and policy-making. However, in order to avoid misleading assumptions and policy decisions, data uncertainty — intrinsic to the available collection methods — must be integrated into the decision analysis process. In this paper, we present two approaches to incorporating data uncertainty into MCDA models (MAUT and ELECTRE-III). We use WASH planning in rural Kenya as a case study to illustrate and compare the two approaches. The comparison focuses on the way these two models handle uncertainty in the available data. The analysis shows that, while both methods incorporate data uncertainty in a considerably different manner, they lead to similar prioritization settings. [ABSTRACT FROM AUTHOR]

Environmental enteropathy (EE) is characterised by subclinical inflammation and hyperpermeability of the small intestine, hypothesised to be caused by recurrent ingestion of faecal bacteria. It has been suggested that EE may be a contributor to malnutrition and growth delays seen in children living in unsanitary conditions. We measured putative faecal EE markers myeloperoxidase (MPO) (ng/mL) and alpha-1-antitrypsin (AAT) (mg/g) in stool samples collected from 133 children aged 1-5 years in 16 communities enrolled in the WASH for WORMS randomised controlled trial in Timor-Leste. Samples were collected two years after a community-wide water, sanitation and hygiene (WASH) intervention that was integrated with regular deworming. Mixed effects multivariable linear regression models were used to examine the impact of the study intervention and of various WASH and infection-related factors on EE biomarkers. Children who lived in communities that received both the WASH intervention and deworming had similar AAT values as those who lived in communities that received only deworming (regression coefficient -0.14, p = 0.583), but they had a trend towards lower MPO values (coeff -0.51, p = 0.055). Younger children showed significantly higher MPO levels (coeff: -0.29, p = 0.002). No WASH variables or parasitic infections were associated with AAT levels. Household water being stored in covered containers was associated with lower MPO levels (coeff -1.75, p = 0.046). We found little evidence that a community-based WASH intervention had an impact on EE over a two-year period. [ABSTRACT FROM AUTHOR]

Gender-based violence resulting from water, sanitation and hygiene (WASH) insecurity is a major public health problem. WaSH gender-based (WaSH-GBV) is a spatio-temporal experience and has disproportionate health and wellbeing impacts on women and girls. However, the global community of WaSH practitioners and policymakers is yet to adequately address women's vulnerability to violence in relation to WaSH access. Informed by the feminist political ecology of health framework, we conducted in-depth interviews (n = 27, 16 women and 11 men) with Ghanaian immigrants to Canada to explore perceptions of WaSH experiences over lifecourse. Results revealed that participants' perceptions and experiences of GBV are both socially and context dependent, organized around four dimensions: structural, physical, psychological, and sexual. These muti-scalar dimensions of diasporans' WaSH experiences and perceptions in Ghana are discussed along with their implications for policy and practice, specifically in enhancing health equity and water security. • We used feminist political ecology of health framework for a broader understanding of WaSH-GBV. • Four dimensions of WaSH-GBV were identified including psychosocial, physical, structural and sexual violence. • WaSH-GBV is socially constructed in place. • While WaSH-GBV may occur in one place, the psychosocial impacts are not bound to that place and time. • WaSH-GBV is a significant barrier to achieving the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Women's use of water differs from men in essentially one aspect: in cleansing the body of menstrual blood. The pledge of the water, sanitation and hygiene (WASH) sector to place ‘women at the centre’ of development has in recent years, therefore, come to focus on menstruation. International development agencies have begun to push the agenda of menstrual hygiene management (MHM), but their use of a medical approach requires critical rethinking. This article argues that through MHM lessons, menstruation is medicalised to construct new and repressive expectations of normality for the female body. A medical construction also poorly accommodates the natural biological process of menstruation within the gamut of existing sociocultural practices. Consequently, menstruation becomes associated with the perceived need for not only sanitisation of the female body of the rural poor, but also to turn it into a working body that is able to ceaselessly and ‘normally’ perform its productive and reproductive chores. I note that the success of medicalisation relies upon the separation of the body from its purported waste, the menstrual blood. Once menstruation is confined to a pathological condition, treatable only by public agents such as doctors and commercially produced goods such as sanitary napkins, a defining essence of womanhood is thereby dissociated from the female body. [ABSTRACT FROM PUBLISHER]

This paper draws on sanitation innovations in Blantyre (Malawi), Chinhoyi (Zimbabwe), Dar es Salaam (Tanzania) and Kitwe (Zambia) driven by slum(1)/shack dweller federations to consider what an inclusive approach to sanitation would involve. This includes what is possible for low-income households when there is little or no external support, no piped water supply and no city sewers to connect to. The paper discusses low-income households’ choices in situations where households can only afford US$ 3–4 per month for sanitation (for instance between communal, shared and household provision). It also considers the routes to both spatial and social inclusion (including the role of loan finance in the four cities) and its political underpinnings. In each of the four cities, the community engagement in sanitation intended from the outset to get the engagement and support of local authorities for city-wide sanitation provision. [ABSTRACT FROM PUBLISHER]

This paper explores how communities in Chinhoyi, Zimbabwe have used community-led mapping and enumerations(1) to build partnerships with local government to support the development and co-production of innovative pro-poor city-wide sanitation strategies as part of the SHARE City-Wide Sanitation Project. This action research project is being conducted in four cities across sub-Saharan Africa: Chinhoyi (Zimbabwe), Kitwe (Zambia), Blantyre (Malawi) and Dar es Salaam (Tanzania). This programme of work responds to the failure of conventional approaches to urban sanitation to meet the needs of low-income urban communities in sub-Saharan Africa. Over three years it has supported Shack/Slum Dwellers International affiliates to develop and test pro-poor sanitation strategies that can be adopted and driven by networks of community organizations and residents’ associations, and supported by public authorities and private providers. [ABSTRACT FROM PUBLISHER]

The global community of water, sanitation and hygiene (WASH) researchers, practitioners and policy makers has to date inadequately addressed the challenge of vulnerability to violence in relation to access to water and sanitation in development and humanitarian emergency contexts. Reasons may include the lack of valid and reliable documentation of girls’, boys’, women’s, and men’s experiences of violence while accessing water and/or sanitation facilities; the sensitivity of the topic, with secrecy around individuals’ experiences of violence and their sanitation needs further hindering the collection of reliable data; the complexity of understanding the gendered dimensions of vulnerability to violence, with girls and women at least anecdotally reported to be more likely to experience violence in relation to WASH; and the likelihood that many WASH practitioners lack training in gender and violence, affecting their ability to deliver adequate programming and evaluation. In an effort to encourage increased action and learning on the intersection of gender, violence and WASH, a review of the existing evidence and practice was conducted. Findings indicate the need for more systematic, reliable, and ethically conducted monitoring and learning on this topic to build a more solid evidence base, while also refining key principles for improved policy and programming. [ABSTRACT FROM PUBLISHER]

This paper describes how lack of access to adequate sanitation facilities affects the lives of adolescent girls in urban poor India. It draws specifically on the experiences of four adolescent girls, each living in one of four settlements in Bengaluru, India, and conversations with a larger group of girls. Findings reveal that where sanitation facilities are sorely lacking, adolescent girls face many deprivations (education, free time, privacy and independent mobility) and risks (sexual harassment and assault, health risks, etc.), and that this inadequacy can be a structural pathway for cyclical gender-based disempowerment and injustice. [ABSTRACT FROM PUBLISHER]

The Tijuana River watershed is binational, flowing from Tijuana, Mexico into San Diego and Imperial Beach, USA. Aging sewage and stormwater infrastructure in Tijuana has not kept pace with population growth, causing overflows into this watershed during major rainfall or equipment failures. The public health consequences of this impaired watershed on the surrounding communities remain unknown. Here, we performed untargeted metagenomic sequencing to better characterize the sewage contamination in the Tijuana River, identifying potential pathogens and molecular indicators of antibiotic resistance in surface waters. In 2019-2020, water samples were collected within 48 h of major rainfall events at five transborder flow sites and at the mouth of the river in the US portion of the Tijuana River and estuary. After filtration, DNA was extracted and sequenced, and sequences were run through the Kaiju taxonomic classification program. A pathogen profile of the most abundant disease-causing microbes and viruses present in each of the samples was constructed, and specific markers of fecal contamination were identified and linked to each site. Results from diversity analysis between the sites showed clear distinction as well as similarities between sites and dates, and antibiotic-resistant genes were found at each site. This serves as a baseline characterization of microbial exposures to these local communities.

Abstract: Strategic planning and appropriate development and management of water and sanitation services are strongly supported by accurate and accessible data. If adequately exploited, these data might assist water managers with performance monitoring, benchmarking comparisons, policy progress evaluation, resources allocation, and decision making. A variety of tools and techniques are in place to collect such information. However, some methodological weaknesses arise when developing an instrument for routine data collection, particularly at local level: i) comparability problems due to heterogeneity of indicators, ii) poor reliability of collected data, iii) inadequate combination of different information sources, and iv) statistical validity of produced estimates when disaggregated into small geographic subareas. This study proposes an improved approach for water, sanitation and hygiene (WASH) data collection at decentralised level in low income settings, as an attempt to overcome previous shortcomings. The ultimate aim is to provide local policymakers with strong evidences to inform their planning decisions. The survey design takes the Water Point Mapping (WPM) as a starting point to record all available water sources at a particular location. This information is then linked to data produced by a household survey. Different survey instruments are implemented to collect reliable data by employing a variety of techniques, such as structured questionnaires, direct observation and water quality testing. The collected data is finally validated through simple statistical analysis, which in turn produces valuable outputs that might feed into the decision-making process. In order to demonstrate the applicability of the method, outcomes produced from three different case studies (Homa Bay District –Kenya–; Kibondo District –Tanzania–; and Municipality of Manhiça –Mozambique–) are presented. [Copyright &y& Elsevier]

This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment ( p = 0.024). CTBF results found a similar result, although this was not statistically significant ( p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment ( p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.