Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.

Municipal water supply through truck-to-cistern systems is common in northern Canada. Household satisfaction and concerns about water services likely impact user preferences and practices. This case study explores household perspectives and challenges with regard to domestic access to water in a decentralized truck-to-cistern system. A case study was conducted in the Northern Village of Kangiqsualujjuaq, Nunavik (Quebec, Canada). A paper-based questionnaire was completed by 65 households (one quarter of the population). Many households (37%) reported not drinking tap water from the truck-to-cistern system. Chlorine taste was a frequently reported concern, with those households being significantly less likely to drink water directly from the tap (p = 0.002). Similarly, households that reported a water shortage in the previous week (i.e., no water from the tap at least once) (33%) were more likely to express dissatisfaction with delivered water quantity (rs = 0.395, p = 0.004). Interestingly, 77% of households preferred using alternative drinking water sources for drinking purposes, such as public tap at the water treatment plant, natural sources or bottled water. The study underscores the importance of considering household perspectives to mitigate the risks associated with service disruptions and the use of alternative sources for drinking purposes.

UNASSIGNED: Stunting is associated with disorders of the small intestines caused by environmental factors and poor hygiene practices. Prevention of stunting should be conducted in the first 1,000 days of life; namely, from conception until the child is two years old. This research aimed to analyze the relationship between environmental risk factors and maternal personal hygiene with the incidence of stunting in children aged 6-23 months.
UNASSIGNED: This study was conducted using a case-control design, with a total sample of 212 (106 cases and 106 controls) enrolled purposively. Data were collected through interviews using a questionnaire. The analysis used chisquare tests and multiple logistic regression.
UNASSIGNED: The results of multivariate analysis showed the independent variables that have a significant association on the incidence of stunting are access to safe drinking water and maternal hygiene practices. The external variables that have a significant relationship is birth length and feeding practice.
UNASSIGNED: Having no access to safe drinking water, not proper sanitation, and poor maternal hygiene practices have a higher risk of stunting in children aged 6-23 months. The implications of this research include the need for increased access to a safe environment and improvement of mother\'s behavior as essential efforts to prevent stunting.

The allocation of water in areas which face shortage of water especially during hot dry seasons is of utmost importance. This is normally affected by various factors, the management of which takes a lot of time and energy with efforts falling infertile in many cases. In recent years, scholars have been trying to investigate the applicability of fuzzy interval optimization models in attempts to address the problem. However, a review of literature indicates that in applicating such models, the dynamic nature of the problem has mostly been overlooked. Therefore, the aim of the present study is to provide a fuzzy interval dynamic optimization model for the allocation of surface and groundwater resources under water shortage conditions in West Azerbaijan Province, Iran. In so doing, an optimization model for the allocation of water resources was designed and then was validated by removing surface and groundwater resources and analyzing its performance once these resources were removed. The model was then applied in the case study of ten regions in West Azerbaijan Province and the optimal allocation values and water supply percentages were determined for each region over 12 periods. The results showed that the increase in total demand has the greatest effect while the increase in groundwater industrial demand has the least effect on the supply reduction rate. The increase of uncertainty up to 50% in the fuzzy interval programming would lead to subsequent increases in groundwater extraction by up to 19% and decreases in water supply by up to 10%. The increase of uncertainty in the fuzzy interval dynamic model would cause an increase in groundwater extraction to slightly more than 10% and a decrease in water supply to 0.05%. Therefore, implementing the fuzzy interval dynamic programming model would result in better gains and would reduce uncertainty effects. This would imply that using a mathematical model can result in better gains and can provide better footings for more informed decisions by authorities for managing water resources.

Acque Bresciane is a public company that manages the integrated water cycle for more than 580,000 inhabitants in the Province of Brescia, in the north of Italy, providing drinking water, waste water treatment, and sewer systems. Drinking water systems are supplied with different types of groundwater, springs, and surface water sources (from lakes and rivers) whose availability and quality can be affected by climate change events. A multidisciplinary team, in collaboration with the University of Milano Bicocca, developed a specific Water Safety Plan (WSP) risk matrix focusing on the evaluation of climate-related hazardous events and calculation of their likelihood of occurrence, also using thematic maps. Moreover, to reduce the residual risks, in the risk matrix, possible control measures are suggested, such as the activation of an emergency plan, the use of other water sources, storage tanks, and interconnection with other water distribution networks. This work shows a simple and effective tool that can be applied by drinking water utilities to evaluate climate-related catchment risks, using a WSP risk matrix, thematic maps, and possible control measures to reduce risks in terms of water quality and availability and to respond with resilience to changes.

UNASSIGNED: Cutaneous leishmaniasis (CL) is one of the main causes of vector-born diseases in younger population. To evaluate the association of environmental health factors on the odds of CL incidence, a case-control study was conducted in northeastern Iran.
UNASSIGNED: This study was conducted within 2020-2021 based on individual and household data from a tertiary referral center. Cases were patients diagnosed with CL by PCR method; controls were selected among the patients\' relatives, and information was obtained from a health registry system. Demographic and socioeconomic data of 1871 subjects, included age, sex, household information and environmental health factors. Multivariable models with environmental factors in various conditions and CL were separately fit by univariate and mixed multiple unconditional logistic regression.
UNASSIGNED: Participants included 617 cases (mean [SD] age, 13.62[13.72] years; 58.20% male) and 1264 controls (mean [SD] age, 16.45[15.44] years; 50.40% male). Results revealed that the use of well-water sources compared to surface water is significantly associated with CL (odds ratio [OR]=0.204; 95%CI, 0.13-0.33;P<0.001). Muddy houses, ruined buildings or wastelands and stagnant water, canals and rivers near the houses were also associated with CL (OR=3.85; 95%CI, 1.66-8.89; P=.002; OR=2.47; 95%CI, 1.76-3.47; P<.001). Besides, existence of pine tree was found to be a risk factor (OR=3.25; 95%CI, 2.12-4.99; P<.001) and similarly for the use of waste collection system (OR=4.43; 95%CI, 3.32-7.51; P<.001).
UNASSIGNED: Environmental factors related to houses were significantly associated with CL and may represent the modifiable risk factors of CL disease.

Humans are having an increasingly profound impact on the environment along with the advent of the Anthropocene. Ecological risk assessment (ERA) as a method to quantify ecological problems can provide support for decision-makers, and it is one of key issues to integrate ecosystem services into ERA. In this study, an ERA framework was proposed under the loss-probability paradigm from the perspective of ecosystem services risk bundles. The results showed that initiatives aimed at ecological protection in Shanxi Province had been effective, the number of watersheds with low-risk bundles increased significantly (from 16.09% to 34.49%) and the watersheds basically overlapped with key forestation areas. However, the effects of forestation activities may no longer be as significant as they once were, as the relationship between forestation and water supply was becoming increasingly contradictory. Meanwhile, the conflict between urban expansion and natural ecosystem protection was intensifying, habitat degradation risks were gradually polarized, and the risk bundles dominated by high carbon emission and habitat degradation were increasing significantly (from 15.88% to 33.54%). Strengthening the construction of urban green space and controlling the expansion of human activities may be the next focus of ecological conservation in Shanxi Province. This study enriched the ERA framework with an ecosystem services risk bundle approach.

Water scarcity has become one of the serious global challenges threatening urban water security. To systematically understand the utilization of water resources in cities, this study established a novel comprehensive accounting framework of urban water resources based on three dimensions: \"the entire city, sectoral level, and intersectoral interactions\". To make this accounting framework that can be applied to the majority of cities, a method for compiling input-output (IO) tables at the general prefecture-level city scale was proposed to obtain the needed core data. Dongguan, a prefecture-level city in Guangdong Province, China, known for its well-developed manufacturing industries but water scarcity, was chosen as a case study to test the effectiveness of the method. The results indicated the total water use in Dongguan decreased by 7.2% during 2012-2017, which benefited from steady economic growth. Besides, the \"agriculture\" sector has significantly higher direct water use coefficient than other sectors, while the indirect water use coefficient of the manufacturing sector exceeded the direct water use coefficient in 2017. In addition, there are two major virtual water flow paths among sectors in Dongguan, which are helpful to water conservation. The comprehensive water resources accounting framework proposed in this study for general prefecture-level cities is applicable to water resource management, enabling not only the optimization of water resource allocation in urban areas but also the reduction of environmental pollution and ecological damage. Nevertheless, it is still necessary to further optimize the compilation of IO tables and better support the formulation of specific water-saving measures in the future research by collecting more detailed industry data and import-export data. These results of this study can provide important practical reference information for water resource management in general-scale cities similar to Dongguan in the world.

Water is becoming an increasingly scarce resource due to growing multi-sector demand and the effects of climate change. During droughts, the proportional rule is the most widespread water allocation method applied in irrigation systems. However, this method fails to guarantee efficient water allocation or to provide a fair method of water allocation. This paper aims to verify whether by replacing the water allocation methods based on a proportional rule with methods based on a priority rule could improve the allocation of water resources and minimize the negative economic impacts of water shortages. The ultimate objective of this research is to design a water pricing scheme capable of guaranteeing efficient water reallocation during drought conditions. Therefore, an experiment was carried out for the largest irrigated area in southern Italy, covered by the Capitanata Reclamation and Irrigation board (CBC). A positive mathematical programming model was implemented in order to simulate the effects of the proposed mechanism. The findings show that priority mechanisms have the potential to improve overall economic efficiency in the event of water shortages. However, results also point to the need for optimal design of a differentiated water pricing scheme.

The energy required for various processes in the water cycle can have significant economic and environmental impacts. Therefore, efficient energy management in urban water supply systems is crucial for a sustainable operation. By installing energy recovery technologies in these facilities, it is possible to reap the benefits of the infrastructure design by saving energy. In this study, a new methodology to assess the energy recovery at the inlets of district metered areas is presented, considering the city of Murcia (Spain) as case study. This methodology is based on creating a detailed model of city water supply system and calibrating such model with an experimental campaign of measurements. Then, the assessment of the hydraulic potential recovery is analysed through two different energy estimators, one considering the minimum available net head and the other assuming a variable net head. Results show that there are several points where turbines could be installed, most of them recovering in between 1000-5000 kWh, which could be used to cover the yearly energy consumption of about 24-120 m2 of a school or 10-50 traffic lights of such area. Moreover, in some points it could be recovered up to 14500 kWh. Even though these values are not high, the energy recovered could be used for self-consumption of nearby electrical loads, at the time that reduces the pressure in the system, thus leading to leak reductions. Moreover, this kind of energy recovery does not reduce the potential of other proposals for upstream energy recovery, such as replacing pressure reduction valves with turbines instead. The scripts developed to apply the proposed methodology are available in EPANET-Octave file exchange for the researcher community.