Towards safe drinking water and clean cooking for all

Safe drinking water, sanitation, and hygiene (WASH) are fundamental to improving standards of living for people. The improved standards made possible by WASH include, among others, better physical health, protection of the environment, better educational outcomes, convenience time savings, assurance of lives lived with dignity, and equal treatment for both men and women. Poor and vulnerable populations have lower access to improved WASH services and have poorer associated behaviors. Improved WASH is therefore central to reducing poverty, promoting equality, and supporting socioeconomic development. Drinking water and sanitation were targets in the Millennium Development Goals (MDGs) for 2015; under the Sustainable Development Goals (SDGs) for the post-2015 period, Member States of the United Nations (UN) aspire to achieve universal access to WASH by 2030. The Human Right to Safe Drinking Water and Sanitation (HRTWS) was adopted in 2010 under a UN resolution calling for safe, affordable, acceptable, available, and accessible drinking water and sanitation services for all.The scope of WASH services included in this chapter is shown in table 9.1. The focus is on services at the household and institutional level and on services for personal rather than productive uses.This chapter summarizes global evidence on current WASH coverage and effects of intervention options, and it recommends areas for research and policy. Evidence comes from published synthesized evidence, such as systematic reviews and meta-analyses, evidence papers, and literature reviews. When those sources were not available, evidence was compiled from the next best sources of published research, thus using accepted criteria of the hierarchy of evidence for studies on health effectiveness. Unpublished and grey literature was used where no peer-reviewed published evidence exists.This chapter is structured as follows: Progress in improving drinking water, sanitation, and hygiene coverage Impacts of poor WASH, thereby summarizing the evidence on the continued decline in mortality from diarrheal disease and the emerging evidence on the long-term developmental and cognitive effects of inadequate WASH on children Effectiveness of interventions, thereby examining the health effects of specific WASH interventions, the approaches to service delivery, and the key role of broader institutional policy in accelerating and sustaining progress Intervention costs, efficiency, and sustainability, thereby assessing the socioeconomic returns of improved WASH and considering the requirements for populations to have continued access to WASH services Challenges, opportunities, and recommendations. This chapter uses the World Health Organization (WHO) classification of superregions as follows: Africa, the Americas, South-East Asia, Europe, Eastern Mediterranean, and Western Pacific.

BackgroundMental disorders, particularly depression and post-traumatic stress disorder, are common long-term psychological outcomes in emergency contexts arising from conflicts, natural disasters, and other challenging environmental conditions. In emergencies, people suffer not only from the lack of external resources such as drinking water and food but also from poor mental health. Mental disorders can substantially impair daily activities in vulnerable individuals. However, water, sanitation, and hygiene (WASH) behaviors are daily activities that require effort, time, and strong internal motivation. Therefore, questions arise: whether there is a relationship between mental health and safe water behaviors, and if so, whether the motivational drivers of these behaviors are affected by mental health.MethodsOur cross-sectional study conducted face-to-face interviews with 638 households in rural Malawi. We used a quantitative questionnaire based on the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach to measure motivational psychosocial factors. Mental health was assessed using the validated Chichewa version of the Self-Reporting Questionnaire (SRQ-20). Results. Almost a third of the respondents reported poor mental health. We found significant negative association between mental health and self-reported safe water collection (p = .01, r = −.104) but not between safe water transportation and storage behavior. The moderation analysis revealed significant interaction effects of mental health with some psychosocial factors and therefore on WASH behaviors. Poor mental health changed the influence of three psychosocial factors—perceived others’ behavior, commitment, and remembering—on safe drinking water collection behavior. The influence on water transportation and storage behavior of the perceived severity of contracting a disease, the belief that transporting and storing water requires substantial effort, and others’ approval depended on the mental health condition of the respondent.ConclusionsThese results imply that populations with a significant proportion of individuals with poor mental health will benefit from interventions to mitigate mental health before or parallel to behavioral change interventions for WASH. Specific population-level interventions have been shown to have a positive effect on mental well-being, and they have been successfully applied at scale. This research is especially relevant in emergency contexts, as it indicates that mental health measures before any WASH interventions will make them more effective.

This study assessed the situation of safe drinking water, health and hygiene conditions, and knowledge about waterborne diseases among the teachers and students of 153 selected government and private schools in District Chiniot, Pakistan. The methodology relied on questionnaires and discussion with the school teachers and students. In the survey sample, a total of 153 schools of Tehsil Lalian, District Chiniot, were included. While, total 306 Head Teachers and students of the selected schools including 153 head teachers (males 34 and females 119) and 153 students (boys 62 and girls 91), were interviewed for data collection. The quantitative and qualitative data on the issues related to safe drinking water, WASH (water, sanitation and hygiene) facilities, and waterborne diseases were collected and analyzed using SPSS (Statistical Package for the Social Sciences). The study revealed that the main sources of drinking water in the schools were hand pumps (73%) and about 80% schools have sufficient quantity of available water throughout year. More than 90% head teachers and 92% students reported that water has no smell and color but it has a specific taste. About 86% head teachers and 38% students were not satisfied with existing drinking water services. As reported by 100% respondents, schools have toilets, while 95% students confirmed that students waste water in the schools. Students were asked about the disposal of used water in their schools and in their homes. In response, 23% students said that used water was properly disposed in their schools, while only 10% students told that used water was properly disposed in their homes. 100% teachers and students have knowledge about the diseases caused by drinking unsafe water, but sometimes they don’t take care in using water. About 68% head teachers told that no water treatment methods were used by the people in the area. Lack of knowledge and affordability were the main reasons for not using the water treatment methods. The need for promotion of knowledge among the teachers and students on use of safe drinking water and to improve health and hygiene conditions in schools and homes was also emphasized.

Transition from cooking with traditional biomass to clean cooking is a persistent challenge in Malawi. The underlying technologies in clean cooking are improved cookstove. Improved cook stoves are designed to reduce fuel consumption per meal and to curb smoke emissions experienced in traditional three-stone cookstove. However, promotion adoption and utilisation of clean cooking requires coordinated policy and regulatory framework. This study analysed the Malawi policy regulatory framework on clean cooking by benchmarking with relevant literature. The following policy gaps were identified: (i) the lack of clear cookstove rating by Malawi Bureau of Standards; (ii) uncomplimentary policies and regulations in the energy and forestry sectors on clean cooking fuels and technologies; (iii) the lack of empirical data on adoption and utilisation of clean cooking technologies and fuels in Malawi; (iv) predicaments in adopting and using international standards for testing cookstoves; and (v) the value chain of improved cookstoves and other forms of clean cooking fuels and technologies that is not adequately analysed. Coordinated development and harmonious implementation of clean cooking regulations in the key sectors of energy and forestry can promote adoption and utilisation of clean cooking methods and technologies in Malawi.

Background:Research often suffers from overspecialization, a practice nurtured in academia and reinforced by funders. Indeed, investigators in household air pollution (HAP) and water, sanitation and hygiene (WaSH), working in poor parts of the world, rarely interact despite having similar training and using similar methods to evaluate interventions in the same vulnerable populations. Disappointing results from recent trials of improved cookstoves and traditional approaches to WaSH suggest the need for alternative approaches.Objectives:We argue that bringing these two areas together would improve the effectiveness and efficiency of interventions to reduce the massive disease burden associated with HAP and poor WaSH, including pneumonia and diarrhea, the leading killers of young children in low-income countries.Results:HAP and WaSH face similar challenges in designing, implementing, and securing the sustained and exclusive use of scalable interventions such as clean fuel and water.Discussion:Research can advance greater coordination of these areas by demonstrating their interactions and wider impacts on well-being as well as the potential for programmatic synergies. Integrated solutions to clean households and communities can benefit from the contribution in multiple disciplines, including economics and policy analysis; business and finance; engineering and technology; lab sciences, environmental health, and biomedical sciences; and behavioral and implementation sciences.Conclusion:There are compelling reasons to overcome the artificial and unproductive segregation of HAP and WaSH. Researchers should encourage integration by expanding the scope of their collaborations and projects. Policy makers, funders, and implementers can help by supporting comprehensive solutions, encouraging innovation, and requiring rigorous evaluations of their effects. https://doi.org/10.1289/EHP4752

The poor practice of Water, Sanitation, and Hygiene (WASH) supports the spread of disease burdens causing high U-5 children mortality rates in developing countries like Nigeria. Knowledge, perception, attitude and other influencing factors become important in determining WASH practices. This study, guided by the Health Belief Model, assessed the knowledge, perception, and attitude of mothers of U-5 children in Lagos urban slums to WASH behaviour messages in order to understand their WASH practices. The cross-sectional study involved 361 mothers of U-5 children in selected Lagos urban slums. Applying cluster sampling and purposive sampling techniques, the study used a pre-tested structured questionnaire through interviews to collect data on knowledge, perception, attitude, and practice of WASH. IBM SPSS Version (26) was used to analyse the data collected, and the presentation was in percentages, tables and charts. The main objective was analysed using path analysis of the structural equation model (SEM) and logistic regression model. Only 15.2% used improved water sources, 44.3% stored drinking water safely, and 10.3% did not treat home drinking water. Open defecation was high (61.8%); Only 22.4% washed their hands with water and soap at critical times; 36.6% disposed of waste into the river and canal; open dumpsites (33.8%), and 29.6% used waste to fill marshy areas in the environment. The majority (90%) favourably perceived the susceptibility of children to the dangers of unsafe drinking water. The mothers positively perceived the benefits of good WASH practice for children’s health, but (31.1%) had low knowledge of the severity of the risk resulting from poor WASH. The mothers’ positive perceptions did not necessarily reflect in their WASH practices. Age, level of education, marital status, and occupation significantly influenced the respondents’ WASH practice. Economic reasons and limited WASH facilities were barriers, while contributions of community leaders were supportive. Study recommendations include; the provision of WASH facilities and more WASH behaviour education for mothers through participatory communication approaches. The WASH behaviour sensitisation model should be reviewed to have a distinct identity from routine immunization programmes; to enable mothers to understand WASH messages better.

Attributes of drinking water, sanitation, and hygiene associated with microbiological water quality of stored drinking water in rural schools in Mozambique and Uganda.

Improved water, sanitation and hygiene (WASH) are significant in preventing diarrhea morbidity and mortality caused by protozoa in low- and middle-income countries. Due to the intimate and complex relationships between the different WASH components, it is often necessary to improve not just one but all of these components to have sustainable results. The objective of this paper was to review the current state of WASH-related health problems caused by parasitic protozoa by: giving an overview and classification of protozoa and their effect on people’s health, discussing different ways to improve accessibility to safe drinking water, sanitation services and personal hygiene behavior; and suggesting an institutional approach to ensure improved WASH. The findings indicate that Giardia and Cryptosporidium are more often identified during waterborne or water-washed outbreaks and they are less sensitive than most of the bacteria and viruses to conventional drinking water and wastewater treatment methods. There are various institutions of control and prevention of water-related diseases caused by protozoa in developed countries. Unfortunately, the developing regions do not have comparable systems. Consequently, the institutional and systems approach to WASH is necessary in these countries.

Safe drinking water is crucial for human health. However, global challenges such as limited access to WASH (Water Sanitation, and Hygiene) services, water scarcity, and inequities in clean water distribution contribute to poor hygiene and the spread of waterborne diseases, such as diarrhea, dysentery, and cholera. These challenges are particularly prevalent in rural areas of developing countries. This cross-sectional study assessed the microbiological contamination and associated risk factors in drinking water from 270 rural households. The findings were compared to Rwanda's national drinking water quality standards. Overall, 56.7% of water samples met the national pH standards. However, only 21.9% met the microbiological safety criteria for drinking water. Factors significantly associated with the quality of stored drinking water included age of the household head (p = 0.041), education level (p = 0.047), water source (p = 0.018), and water treatment practices (p = 0.023). Logistic regression indicated that older adults were 3.38 times more likely to use unsafe drinking water (95% CI: 1.24–9.24; p = 0.018). These findings highlight the need for regular monitoring of household drinking water quality and the implementation of WASH interventions, such as the treatment of drinking water, to ensure access to safe drinking water.

Context Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and dignity and helps to create resilient communities living in healthy environments. WHO and UNICEF, through the WHO/UNICEF Joint Monitoring Programme (JMP), produce internationally comparable estimates of progress on drinking water, sanitation and hygiene (WASH) and are responsible for monitoring the Sustainable Development Goal (SDG) targets related to WASH. Since the establishment of the SDGs, the JMP has published global baseline reports on WASH in households (2017), WASH in schools (2018) and WASH in health care facilities (2019), and a progress update on households (2019). Objectives To put the European findings in a global perspective regarding school toilets. Results Findings from the last report published under this JMP (2021) will be presented, updating national, regional and global estimates for WASH in schools up to the year 2019, with a special focus on the implications for ensuring the safety of students and school staff during and after the coronavirus disease 2019 (COVID-19) pandemic. Using service ladders to benchmark and compare progress across countries on WASH in schools by tracking progress towards a basic level of service, as the indicator used for global monitoring of SDG targets related to WASH in schools, we will see that situations are contrasted. Globally 63% of schools had a basic sanitation service in 2019, while it is the case of 99% of schools in Europe and Northern America. The differences are of the same level regarding basic drinking water service in schools (respectively 69% vs. 99%), as well as for basic hygiene (resp. 57% vs. 98%). Conclusions Those results illustrate the paradox that existence of a given facility, access and use are not equivalent and need to be explored further.

Consumption of clean and dirty cooking fuels in ghanaian households: The role of financial inclusion

In Memoriam: Kirk R. Smith.

Introduction: The literature suggests that children living in the areas with widespread opendefecation, lack of access to safe drinking water and provision of hand hygiene are exposed to a higher level of microbial contamination. These conditions often keep children undernourished, diminishes their cognitive skills leading to intergenerational poverty. Methods: Using the individual and household data from Indian Human Development Survey 2012 (IHDS II), the study used binary logistic model to analyse the impact of household-based water, sanitation and hygiene (WASH) and health outcome of the children in the Empowered Action Group (EAG) states of India. Results: The study suggested that having access to safe water, the chances of being not stunted are 20 per cent lower compared to the children accessing unsafe water. Similarly, children who have a household toilet and practice better hand hygiene, have 20 per cent higher chances of being not stunted against open defecating children and children who do not practice hand-hygiene habits. Other than WASH, the children’s demographic traits of being at a higher age, being female over male, indicated a significantly higher odds of being stunted. Conclusion: The empirical findings suggests that WASH has the ability to guide the child related policies with concrete approaches. Since the three components of the WASH are interdisciplinary it is suggested that combined WASH intervention have massive personal

The use of clean cooking fuels is crucial for enhancing public health and environmental sustainability. However, in many low-income regions, including North-Western Nigeria, the reliance on unclean fuels remains high, contributing to adverse health outcomes and environmental degradation. This study assesses the utilization of clean energy and identifies household factors influencing the adoption of clean cooking fuels among households in North-Western Nigeria, while analysing disparities across states. Data from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed, focusing on the household recode (HR) file, resulting in a sample of 9,509 households across Kebbi, Sokoto, Zamfara, Katsina, Kano, Jigawa, and Kaduna state. Descriptive statistics and bivariate analysis were employed to assess the proportion of households using clean versus unclean cooking fuels and to identify sociodemographic factors associated with clean fuel usage. The analysis revealed that approximately 95% of households relied on unclean fuels, such as wood, kerosene, and charcoal, while only 5% used clean fuels, including electricity and liquefied petroleum gas (LPG). Significant variations were observed among the states, with Kano having the highest proportion of clean fuel usage at 8.87%, while Sokoto had the lowest at 0.42%. Wealth, educational attainment, and urban residence were strong predictors of clean fuel use. These findings underscore the urgent need for targeted interventions to promote the adoption of clean cooking fuels in North-Western Nigeria, addressing barriers to usage and improving access to clean energy sources to enhance public health and environmental sustainability.

IntroductionHousehold drinking water can be contaminated by diarrheagenic enteropathogens at numerous points between the source and actual consumption. Interventions to prevent this contamination have focused on preventing exposure to human waste through interventions to improve drinking water, sanitation and hygiene (WASH). In many cases though, the infectious agent may be of zoonotic rather than human origin suggesting that unsafely managed animal waste may contribute to the contamination of household drinking water and the associated diarrheal disease burden.MethodsA cross-sectional household survey of 800 households was conducted across three informal peri-urban neighborhoods of Kisumu, Kenya, collecting stored drinking water samples, administering a household survey including water, sanitation and hygiene infrastructure and behaviors, and recording domestic animal presence and ownership. We used multivariate logistic regression to assess the association of traditional WASH factors and domestic animal presence and ownership on microbial contamination of household drinking water.ResultsThe majority of households sampled had fecally contaminated drinking water (67%), defined by the presence of any colony forming units of the fecal indicator bacteria enterococci. After adjustment for potential confounders, including socio-economic status and water and sanitation access, both household animal ownership (aOR 1.31; CI 1.00–1.73, p = 0.05) and the presence of animal waste in the household compound (aOR 1.38; CI 1.01, 1.89, p = 0.04) were found to be significantly associated with household drinking water contamination. None of the conventional WASH variables were found to be significantly associated with household drinking water contamination in the study population.ConclusionsWater, sanitation, and hygiene strategies to reduce diarrheal disease should consider the promotion of safe animal contact alongside more traditional interventions focusing on the management of human waste. Future research on fecal contamination of unsafe household drinking water should utilize host-specific markers to determine whether the source is human or animal to prepare targeted public health messages.