WaterAid

ABSTRACT Mismanaged disposable diaper (DD) waste is widespread in many urban African cities. Proposed policy responses range from free DD provision to outright bans. However, African studies examining DD consumption, disposal, and benefits are scarce. This cross-sectional study aimed to assess socio-economic variation in DD consumption, inappropriate DD disposal, and perceived benefits for children's carers. A survey interviewing 440 carers of children aged 0–36 months attending health facilities in Greater Accra, Ghana and Kisumu, Kenya found 95.0 and 94.2% used DD, respectively. Median DD consumption in a child's first 36 months was significantly higher in the wealthiest households, respectively, compared to the poorest households (4,099 versus 2,800 DD and 2,876 versus 1,714 DD, p ¼ 0.015 and 0.001 in Greater Accra and Kisumu, respectively). In Greater Accra, 10.2% of households reported burning, burying, or dumping used DD in latrines or elsewhere, compared to 30.5% in Kisumu. Carers in all wealth quintiles consistently cited DD's convenience and hygiene benefits. This confirms widespread DD consumption among rich and poor households, posing disposal challenges for those lacking waste collection services. Given DD's likely time-saving and reported convenience benefits for children's carers, we recommend waste management programmes that separate DDs for safe disposal as opposed to outright bans.

Abstract Two billion people globally lack access to a basic toilet, and sanitation is a critical determinant of health and wellbeing. Evaluations of sanitation programmes typically measure disease or behaviour, and visual analogue scales (VAS) have not been used to measure users’ feelings about their level of sanitation. In this study, we assess the validity of a sanitation VAS numbered 0–10, with end-anchors best and worst imaginable sanitation. In Kumasi, Ghana, we surveyed 291 participants before and after uptake of a container-based sanitation service. In Maputo, Mozambique, we surveyed 424 participants from treatment groups of a prior trial. We assessed construct validity by testing hypothesised associations between VAS scores and toilet characteristics, and by respondents valuing three hypothetical sanitation states. We assessed responsiveness by comparing VAS with/without interventions. There was evidence (p < 0.05) for 60% of hypothesised associations in Ghana, and 100% in Mozambique. For responsiveness, there was a 3.4 point increase (2.1 SD) in VAS 10 weeks post- intervention in Ghana, and a 2.9 point difference (1.3 SD) in Mozambique. In valuation exercises, the mean was higher (p < 0.001) for the objectively better state. The sanitation VAS could be useful in economic evaluation, in valuing sanitation states or levels of service, to identify which improvements achieve quality of life gains most efficiently.

Abstract Background Despite the limited evidence, desludging operators remain at a heightened risk of work-related musculoskeletal disorders (WMSDs). This study established the prevalence and predictors of WMSDs among desludging operators in Uganda. Methods A digitalized structured questionnaire was used to collect cross-sectional data on musculoskeletal disorders and routine workplace activities from 303 desludging operators in Uganda. Data were analyzed using STATA version 15.0. Results The prevalence of WMSDs among desludging operators was 29.7%. The background characteristics associated with WMSDs included; attending safety training in the last 12 months (APR = 0.55, 95% CI: 0.31–0.98) and undertaking regular health check-ups (APR = 1.68, 95% CI: 1.16–2.44). The ergonomic factors associated with WMSDs were; working with a bent wrist (APR = 2.64, 95%CI: 1.54–4.52), working with hands above the head (APR = 0.40, 95% CI: 0.26–0.62), and pinching unsupported objects (APR = 0.87, 95% CI: 0.59–1.29). Psychosocial factors associated with WMSDs included; neither agreeing nor disagreeing about being able to influence the availability of equipment needed to do their work = 0.43, 95% CI: 0.20–0.94), having much influence over the amount of work done (APR = 1.75, 95% CI: 1.05–2.91), and sometimes feeling that everything done was an effort (APR = 1.71, 95% CI: 1.01–2.89). Conclusion The prevalence of WMSDs was high among desludging operators in Uganda. We recommend providing comprehensive training on occupational health and safety, with a specific focus on ergonomic hazards. In addition, personal protective equipment uses, regular exercise programs, and considerations for work pace, rest, and recovery opportunities should be prioritized to reduce the risk of WMSDs.

This paper describes the components of the Bishesta campaign: a behaviour change intervention for menstrual hygiene management (MHM), targeting young people with intellectual impairments, and their carers in Nepal. The campaign uses two fictitious characters: Bishesta (a young person with an intellectual impairment) and Perana (her carer), and consists of three group training modules. ‘Period packs’, designed to make MHM behaviours attractive and easy to adopt, are given to the young people. Packs include storage bags, a bin, and stories about Bishesta menstruating and learning to manage as independently as possible, with Perana’s support. Carers receive a calendar to track the young person’s menstrual cycle. A Bishesta doll, with removable clothes, underwear, and a miniature ‘period pack’ is used in training to demonstrate MHM. Evaluation findings show the intervention is feasible at small scale, so further research on how to scale up the intervention in an evidence-based way is required.

Abstract Background: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.Methods: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).Conclusions: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs are largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0–626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 μg l−1 (range < 0.5–7 μg l−1). The high percentage of Mn exceedances (14% ± 5.2% >400 μg l−1) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination.

In most countries, local governments bear primary responsibility for ensuring everyone has access to water and sanitation services. For the human rights to water and sanitation to move from recognition to realisation, they need to become part of the everyday practice of local authorities. Yet the potential for the human rights to water and sanitation to practically inform local efforts towards inclusive, sustainable service delivery has received limited attention to date, with human rights discourse more typically focusing on national and international levels or on building the capacity of rights holders to claim their rights from government. There is considerable opportunity to consider how human rights can constructively inform local government efforts to expand and improve services. This Communication article presents a novel approach to making human rights relevant and actionable for local authorities. Developed by a consortium of WASH-focused organisations and informed by design thinking, the Making Rights Real approach combines user-centred materials showing how human rights can inform local action, with a process of constructive engagement between civil society and local government professionals. The Making Rights Real approach has been applied in 12 countries by 37 civil society organisations to date. In this paper, we describe the development and features of the Making Rights Real approach, share initial results from its implementation, and reflect on the potential for the approach to catalyse transformational change towards local realisation of the human rights to water and sanitation.

Sustainable Development Goal (SDG) 6.2 sets an ambitious target of leaving no one without adequate sanitation by 2030. The key concern is the lack of local human and financial capital to fund the collection of reliable information to monitor progress towards the goal. As a result, national and local records may be telling a different story of the proportion of safely managed sanitation that counts towards achieving the SDGs. This paper unveils such inconsistency in sanitation data generated by urban authorities and proposes a simple approach for collecting reliable and verifiable information on access to safely managed sanitation. The paper is based on a study conducted in Babati Town Council in Tanzania. Using a smartphone-based survey tool, city health officers were trained to map 17,383 housing units in the town. A housing unit may comprise of two or more households. The findings show that 5% practice open defecation, while 82% of the housing units have some forms of sanitation. Despite the extensive coverage, only 31% of the faecal sludge generated is safely contained, while 64% is not. This study demonstrates the possibility of using simple survey tools to collect reliable data for monitoring progress towards safely managed sanitation in the towns of global south.

The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Programme consortium is a programme funded by the United Kingdom Department for International Development (DFID) that aims to contribute to achieving universal access to effective, sustainable, and equitable sanitation and hygiene worldwide. The capacity development component is an important pillar for this programme and different strategies were designed and implemented during the various phases of SHARE. This paper describes and reflects on the capacity-building strategies of this large multi-country research consortium, identifying lessons learnt and proposing recommendations for future global health research programmes. In the first phase, the strategy focused on increasing the capacity of individuals and institutions from low- and middle-income countries in conducting their own research. SHARE supported six PhD students and 25 MSc students, and organised a wide range of training events for different stakeholders. SHARE peer-reviewed all proposals that researchers submitted through several rounds of funding and offered external peer-review for all the reports produced under the partner’s research platforms. In the second phase, the aim was to support capacity development of a smaller number of African research institutions to move towards their independent sustainability, with a stronger focus on early and mid-career scientists within these institutions. In each institution, a Research Fellow was supported and a specific capacity development plan was jointly developed.Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans. The key lessons learnt were that research capacity-building programmes need to be driven by local initiatives tailored with support from partners. We recommend that future programmes seeking to strengthen research capacity should consider targeted strategies for individuals at early, middle and later career stages and should be sensitive to other institutional operations to support both the research and management capacities.