Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity amongst the slum population lead to differential experiences in Water, Sanitation, and Hygiene (WASH) and housing access. This scoping review provides evidence of the interconnection of WASH and housing and presents barriers to access and the consequences thereof for slum dwellers. It does so while considering the social stratification amongst urban slum dwellers and their lived experiences. A systematic search of journal articles was conducted in November 2022 in PubMed, Scopus, and Web of Science. A total of 33 papers were identified which were full text reviewed and data extracted. Infrastructure, social and cultural, socio-economic, governance and policy and environmental barriers emerged as general themes. Barriers to WASH and housing were more frequently described concerning women and girls due to gender norms within WASH and the home. Barriers to WASH lead to compromised health, socio-economic burdens, and adverse social impacts, thus causing residents of slums to navigate their WASH mobility spatially and over time. Insights from this review underscore the need for an intersectional approach to understanding access inequalities to WASH and housing.

UNASSIGNED: Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as school-age children (SAC).This paper complements the published results of the parasitological survey (prevalence and intensity of STH) conducted in selected Aeta and Ata-Manobo communities.
UNASSIGNED: This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies.
UNASSIGNED: Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation.Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conducted separately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation.Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016).
UNASSIGNED: The characteristics of the STH control strategies and the target populations are interrelated factors that influence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drug shortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceived harm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and school-based MDA programs also affected engagement of SAC.IP communities are special settings where geographic isolation, peace and order situation as well as water supply need to be considered to help ensure access to STH control strategies, high MDA coverage, and improvements in WASH leading to desired outcomes.
UNASSIGNED: Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated.

Childhood stunting is a significant public health concern in Bangladesh. This study analysed the data from the Healthy Village programme, which aims to address childhood stunting in southern coastal Bangladesh. The aim was to assess childhood stunting prevalence over time and explore the risk factors in the programme areas. A cross-sectional, secondary data analysis was conducted for point-prevalence estimates of stunting from 2018 to 2021, including 132,038 anthropometric measurements of under-five children. Multivariate logistic regression analyses were conducted for risk factor analysis (n = 20,174). Stunting prevalence decreased from 51% in 2018 to 25% in 2021. The risk of stunting increased in hardcore poor (aOR: 1.46, 95% CI: 1.27, 1.68) and poor (aOR: 1.50, 95% CI: 1.33, 1.70) versus rich households, children with mothers who were illiterate (aOR: 1.25, 95% CI: 1.09, 1.44) and could read and write (aOR: 1.35, 95% CI: 1.16, 1.56) versus mothers with higher education, and children aged 1-2 years compared with children under one year (aOR: 1.32, 95% CI: 1.20, 1.45). The stunting rate was halved over three years in programme areas, which is faster than the national trend. We recommend addressing socioeconomic inequalities when tackling stunting and providing targeted interventions to mothers during the early weaning period.

BACKGROUND: Diarrhoea is a preventable disease affecting children under five years disproportionately. Globally, thousands of children die from diarrhoea related diseases each year, most deaths occuring in sub-Saharan Africa where Ghana is located. Coastal communities bear the greatest brunt due to poor sanitary conditions. We assess the prevalence of diarrhoea in selected coastal communities along the eastern coast of Ghana.
METHODS: We conducted a cross-sectional study in Mumford, Opetekwei, Anyako, Anyauni and Ateteti communities in the Central, Greater Accra and Volta region respectively. We interviewed households with children under five years on the occurrence of diarrhoea and health seeking practices. We also used a checklist to assess the sanitary conditions of the household. Frequencies and proportions were generated. We determined significant differences using modified Poisson regression models at p < 0.05. Results were presented in tables and text.
RESULTS: The prevalence ratio of diarrhoea was 36% (95% CI 33-40%). Most cases were from Anyako community. All interviewed households in Mumford and Opetekwei used improved water sources whiles 94% in Atetetio used improved water sources. Children who were fully vaccinated had 32% lower prevalence of diarrhoea compared to those who were not (aPR: 0.68, 95% CI 0.55-0.84).
CONCLUSIONS: Diarrhoea prevalence was high inspite of the reported use of improved water sources and sanitation facilities by majority of households in the communities. Fully vaccinated children had a relatively lower prevalence of diarrhoea compared to children who were not fully vaccinated. We recommend in-depth analysis of the use of water and sanitation facilities in these settings to understand the reasons for the observed diarrhoea prevalence.

Objectives: This systematic review and meta-analysis aimed to: i) determine the pooled prevalence of acute diarrhea; and ii) synthesize and summarize current evidence on factors of acute diarrheal illnesses among under-five children in Ethiopia. Methods: A comprehensive systematic search was conducted in PubMed, SCOPUS, HINARI, Science Direct, Google Scholar, Global Index Medicus, Directory of Open Access Journals (DOAJ), and the Cochrane Library. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological quality of each included article was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for cross-sectional and case-control studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of diarrheal illnesses. Heterogeneity and publication bias were assessed using I2 test statistics and Egger\'s test, respectively. The statistical analysis was done using STATA™ software version 14. Results: Fifty-three studies covering over 27,458 under-five children who met the inclusion criteria were included. The pooled prevalence of diarrhea among under-five children in Ethiopia was found to be 20.8% (95% CI: 18.69-22.84, n = 44, I2 = 94.9%, p < 0.001). Our analysis revealed a higher prevalence of childhood diarrhea in age groups of 12-23 months 25.42% (95%CI: 21.50-29.35, I2 = 89.4%, p < 0.001). In general, the evidence suggests that diarrheal risk factors could include: i) child level determinants (child\'s age 0-23 months, not being vaccinated against rotavirus, lack of exclusive breastfeeding, and being an under-nourished child); ii) parental level determinants {mothers poor handwashing practices [pooled odds ratio (OR) = 3.05; 95% CI:2.08-4.54] and a history of maternal recent diarrhea (pooled OR = 3.19, 95%CI: 1.94-5.25)}; and iii) Water, Sanitation and Hygiene (WASH) determinants [lack of toilet facility (pooled OR = 1.56, 95%CI: 1.05-2.33)], lack handwashing facility (pooled OR = 4.16, 95%CI: 2.49-6.95) and not treating drinking water (pooled OR = 2.28, 95% CI: 1.50-3.46). Conclusion: In Ethiopia, the prevalence of diarrhea among children under the age of five remains high and is still a public health problem. The contributing factors to acute diarrheal illnesses were child, parental, and WASH factors. A continued focus on improving access to WASH facilities, along with enhancing maternal hygiene behavior will accelerate reductions in diarrheal disease burden in Ethiopia.

The final point-of-drinking water (FPODW) exposure to Vibrio and waterborne pathogens remains a misaim surveillance target. Therefore, the current study purposed to estimate the global and regional prevalence of Vibrio pathogens in FPODW. Vibrio-FPODW data derived from integrated databases per PRISMA protocol were fitted to a random-intercept-logistic mixed-effects and meta-regression models. The global FPODW Vibrio prevalence was 5.13% (95%CI: 2.24-11.30) with 7.76% (6.84-8.78) cross-validated value. Vibrio prevalence in different FPODW varied with the highest in unclassified (13.98%, 3.98-38.95), household stored (6.42%, 1.16-28.69), municipal (4.39%, 1.54-11.90), and bottled (1.06%, 0.00-98.57) FPODW. Regionally, FPODW Vibrio prevalence varied significantly with highest in Africa (6.31%, 0.49-47.88), then Asia (4.83%, 2.01-11.18). Similarly, it varied significantly among income classification with the highest from low-income (8.77%, 0.91-50.05), then lower-middle-income (6.16%, 2.75-13.20), upper-middle-income (0.23%, 0.00-82.04), and 0.94% (0.19-2.72) in high-income economies. Among the WHO region, it varied significantly from 1.41% (0.17-10.45) in Eastern Mediterranean, 6.31% (0.49-47.88) in Africa to 8.86% (3.85-19.06) in South-East Asia and declining among SDI-quintiles from 11.64% (3.29-33.83) in Low-SDI, 10.59% (4.58-22.61) in High-middle-SDI to 0.26% (0.01-9.09) in Middle-SDI. FPODW Vibrio prevalence was 7.31% (2.94-17.03) in the low-GHSIG, followed by 4.55% (0.00-100.00) in the upper-GHSIG, and 2.21% (0.31-14.24) in middle-GHSIG; rural (4.18%, 0.06-76.17) and urban (5.28%, 2.35-11.44) settings. Also, sample size, SDI, SDI-quintiles, and nation significantly explained 14.12%, 10.91%, 30.35%, and 87.65% variance in FPODW Vibrio prevalence, respectively as a univariate influence. Additionally, 11.90% variance in FPODW Vibrio prevalence explained mortality rate attributed to unsafe WASH services. In conclusion, the study revealed a substantial high FPODW prevalence of Vibrio calling for initiative-taking and intentional surveillances of waterborne pathogens at the neglected stage across nations in order to achieve sustainably the SDG 3.

UNASSIGNED: More than 3300 rural Alaska Native homes lack piped water, impeding hand hygiene. During the COVID-19 pandemic, the Alaska Native Tribal Health Consortium and the Centers for Disease Control and Prevention partnered with 10 Tribal communities and regional Tribal health organizations to install a low-cost, intermediate-technology water and sanitation system, the Miniature Portable Alternative Sanitation System (Mini-PASS). We assessed the impact of the Mini-PASS handwashing station on handwashing, other water-related uses, and problems encountered over time.
UNASSIGNED: In this pre-postintervention study, we conducted semi-structured interviews by telephone seasonally with representatives of 71 households with the Mini-PASS from February 2021 through November 2022 to assess the impact of the units on water use and health.
UNASSIGNED: Before Mini-PASS installation, all participating households primarily used washbasins for handwashing. Postintervention, more than 70% of households reported using the Mini-PASS as their primary handwashing method in all 3 follow-up intervals (3, 6-9, and 12 months postintervention). The proportion of households using the handwashing station for other household tasks increased during 12 months, from 51.4% (19 of 37) at 3 months postintervention to 77.8% (21 of 27) at 12 months postintervention. Although approximately 20% to 40% of households reported problems with their handwashing station during the 12 months postintervention, a large proportion of interviewees (47% to 60%) said they were able to conduct repairs themselves.
UNASSIGNED: Households in rural Alaska quickly adopted the Mini-PASS for hand hygiene and other needs and were largely able to troubleshoot problems themselves. Further research evaluating the impact of improved handwashing behaviors facilitated by the Mini-PASS should be conducted.

UNASSIGNED: Access to safe drinking water, sanitation, and hygiene (WASH) facilities is crucial for health and human rights, impacting nutrition and weight.
UNASSIGNED: Multiple Indicators Cluster Survey (MICS) 2017-18 has been used in this study to examine the association between WASH and underweight, alongside other factors. Analysis included descriptive statistics, association tests, logistic regression, and population-attributable fractions (PAF).
UNASSIGNED: According to results child were 1.8, 1.1 and 1.04 times less likely to be underweight if they had access to improved source of drinking water, improved sanitation and hygiene facilities respectively. The likelihood of child being underweight reduces by 1.4, 1.89, 2.01 and 2.55 times if the household wealth status increases from poorest to second, middle, fourth and richest wealth quintiles, respectively. As the mothers\' education level increases from no schooling to primary, middle, secondary, and higher level, the possibility of child being underweight reduces by 1.22, 1.24, 1.60 and 2.01 times, respectively. Moreover, the likelihood of a child being underweight decreases as the education level of the household head improves. If maternal age is less than 20 or more than 35 years the likelihood of the child being underweight is increased by 1.074 and 1.121 times, respectively. A child is 1.1 times more likely to be underweight if birth spacing is less than 2 years. A child\'s risk of being underweight decreases by 1.1 times if they have not experienced diarrhea. A child who has never been breastfed has 1.3 times higher risk of being underweight. The results of Population Attributable Fraction (PAF) indicate that holding the other factors constant, approximately 36.46% burden of underweight was preventable by access to improved drinking water, sanitation, and hygiene practices.
UNASSIGNED: Comprehensive strategy is needed that focuses on improving access to safe drinking water, sanitation infrastructure, and hygiene behaviors.

BACKGROUND: Undernutrition among children younger than 5 years is a subtle indicator of a country\'s health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services.
OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India.
METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators.
RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions.
CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.

Combined water, sanitation, and handwashing (WSH) interventions could reduce fecal contamination along more transmission pathways than single interventions alone. We measured Escherichia coli levels in 3909 drinking water samples, 2691 child hand rinses, and 2422 toy ball rinses collected from households enrolled in a 2-year cluster-randomized controlled trial evaluating single and combined WSH interventions. Water treatment with chlorine reduced E. coli in drinking water. A combined WSH intervention improved water quality by the same magnitude but did not affect E. coli levels on hands or toys. One potential explanation for the limited impact of the sanitation intervention (upgraded latrines) is failure to address dog and livestock fecal contamination. Small ruminant (goat or sheep) ownership was associated with increased E. coli levels in stored water and on child hands. Cattle and poultry ownership was protective against child stunting, and domesticated animal ownership was not associated with child diarrhea. Our findings do not support restricting household animal ownership to prevent child diarrheal disease or stunting but do support calls for WSH infrastructure that can more effectively reduce household fecal contamination.