Pruss-Ustun A et al., 2014. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 19: 894ā905.
Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JMC, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 42ā52.
Waddington H, Snilstveit B, 2009. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. J Dev Effect 1: 295ā335.
Bartram J, Cairncross S, 2010. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 7 : e1000367.
Emerson PM et al., 2004. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet 363: 1093ā1098.
Brown J, Hien VT, McMahan L, Jenkins MW, Thie L, Liang K, Printy E, Sobsey MD, 2012. Relative benefits of on-plot water supply over other āimprovedā sources in rural vietnam. Trop Med Int Health 18: 65ā74.
Kumpel E, Nelson KL, 2014. Mechanisms affecting water quality in an intermittent piped water supply. Environ Sci Technol Lett 48: 2766ā2775.
Howard G, Bartram J, 2003. Domestic Water Quantity, Service Level and Health. Geneva, Switzerland: World Health Organization.
Cronk R, Slaymaker T, Bartram J, 2015. Monitoring drinking water, sanitation, and hygiene in non-household settings: priorities for policy and practice. Int J Hyg Environ Health 218: 694ā703.
UN Committee on Economic, Social and Cultural Rights. General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the covenant). 2011; E/C. 12/2000/4.
Meier B, Kayser GL, Amjad U, Bartram J, 2013. Implementing an evolving human right through water and sanitation policy. Water Policy 15: 116ā133.
Steinmann P, Bratschi MW, Lele P, Chavan U, Sundaram N, Weiss M, Juvekar SK, Hirve S, 2015. Availability and satisfactoriness of latrines and hand washing stations in health facilities, and role in health seeking behavior of women: evidence from rural Pune district, India. J Water Sanit Hyg Dev 5: 474ā482.
Bazzano AN, Oberhelman RA, Potts KS, Gordon A, Var C, 2015. Environmental factors and WASH practices in the perinatal period in Cambodia: implications for newborn health. Int J Environ Res Public Health 12: 2392ā2410.
Benova L, Cumming O, Gordon BA, Magoma M, Campbell OMR, 2014. Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania. PLoS One 9: e106738.
Leslie HH, Fink G, Nsona H, Kruk ME, 2016. Obstetric facility quality and newborn mortality in Malawi: a cross-sectional study. PLoS Med 13: e1002151.
Bartram J, Cronk R, 2015. Water, sanitation and hygiene in health care facilities: status in low- and middle-income countries and way forward. Geneva, Switzerland: World Health Organization.
Kayser G, Moriarty P, Fonseca C, Bartram J, 2013. Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: a review. Int J Hyg Environ Health 10: 4812ā4835.
World Health Organization, 2017. Safely Managed Drinking Water: Thematic Report on Drinking Water 2017. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2016. Improved and Unimproved Water Sources and Sanitation Facilities. Available at: https://www.wssinfo.org/definitions-methods/watsan-categories/2016. Accessed July 12, 2017.
Bain R, Cronk R, Wright J, Yang H, Slaymaker T, Bartram J, 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 11 : e1001644.
Guedes ZBL, OriĆ” HF, Britto NPB, Neto JWS, Silveira JW, Lopes AEC, 2004. Controle sanitario da agua consumida nas unidades de saude do municipio de fortaleza, CE. Higiene Alimentar 18: 28ā31.
Mosley LM, Sharp DS, Singh S, 2004. Effects of a tropical cyclone on the drinking-water quality of a remote pacific island. Disasters 28: 405ā417.
Lee EJ, Schwab KJ, 2005. Deficiencies in drinking water distribution systems in developing countries. J Water Health 3: 109ā127.
Potter A, Klutse A, Snehalatha M, Batchelor C, Uandela A, Naafs A, Fonseca C, Moriarty P, 2010. Assessing Sanitation Service Levels. The Hague, The Netherlands: IRC, International Water and Sanitation Centre.
HernĆ”ndez JE, MejĆa CR, Cazali IL, Arathoon EG, 1996. Nosocomial infection due to vibrio cholerae in two referral hospitals in guatemala. Infect Control Hosp Epidemiol 17: 371ā372.
Swaddiwudhipong W, Peanumlom P, 2010. A case of nosocomial cholera during a community outbreak in a thai-myanmar border area. J Med Assoc Thai 93: 1112ā1114.
Ethiopian Public Health Institute, Federal Ministry of Health Ethiopia, ICF International, 2014. Ethiopia Service Provision Assessment Plus (SPA+) Survey 2014 Key Findings. Addis Ababa, Ethiopia: Ethiopian Public Health Institute.
Boyce JM, Pittet D, 2002. Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control practices advisory committee and the hicpac/shea/apic/idsa hand hygiene task force. Am J Infect Control 30: S1āS46.
World Health Organization, 2009. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge, Clean Care is Safer Care. Geneva, Switzerland: WHO.
Allegranzi B, Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, 2011. Burden of endemic health-careassociated infection in developing countries: systematic review and meta-analysis. Lancet 377: 228ā241.
Allegranzi B, Pittet D, 2009. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 73: 305ā315.
Blencowe H, Cousens S, Mullany LC, Lee AC, Kerber K, Wall S, Darmstadt GL, Lawn JE, 2011. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and delphi estimation of mortality effect. BMC Public Health 11 (Suppl 3):S11.
Bartram J, Cronk R, Montgomery M, Gordon B, Neira M, Kelley E, Velleman Y, 2015. Lack of toilets and safe water in health-care facilities. Bull World Health Organ 93: 210.
Lawn J, Mongi P, Cousens S, 2006. Africaās newbornsācounting them and making them count. In: Opportunities for Africaās Newborns: Practical Data, Policy and Programmatic Support for Newborn Care in Africa. Geneva, Switzerland: World Health Organization, 11ā22. Available at: http://www.who.int/pmnch/media/publications/aonsection_I.pdf. Accessed July 10, 2017.
UN Department of Economic and Social Affairs, 2014. World Urbanization Prospects, the 2014 Revision: Percentage Urban and Urban Agglomerations by Size Class. Available at: https://esa.un.org/unpd/wup/Maps/CityDistribution/CityPopulation/CityPop.aspx. Accessed July 13, 2017
Lehmann U, Dieleman M, Martineau T, 2008. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res 8: 19.
WHO/UNICEF Joint Monitoring Programme, 2014. Progress on Drinking Water and Sanitation: 2014 Update. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2015. JMP Green Paper: Global Monitoring of Water, Sanitation and Hygiene Post-2015. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2016. Monitoring WASH in Health Care Facilities: Core Indicators and Questions.Available at: http://www.who.int/water_sanitation_health/monitoring/coverage/wash-in-hcf-core-questions.pdf?ua=1. Accessed July 13, 2017.
WHO/UNICEF Joint Monitoring Programme, 2006. Core Questions on Drinking-Water and Sanitation for Household Surveys. Geneva, Switzerland: WHO.
MEASURE DHS, 2012. DHS Model Questionnaires. Available at: http://www.measuredhs.com/What-We-Do/Questionnaires.cfm. Accessed July 13, 2017.
Stauber C, Miller C, Cantrell B, Kroell K, 2014. Evaluation of the compartment bag test for the detection of Escherichia coli in water. J Microbiol Methods 99: 66ā70.
Aquagenx LLC, 2013. Compartment bag test: instructions for use.
World Health Organization, 2011. Guidelines for Drinking-Water Quality, 4th edition. Geneva, Switzerland: WHO.
The American Association for Public Opinion Research, 2008. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
Shields K, Bain R, Cronk R, Wright J, Bartram J, 2015. Association of supply type with fecal contamination of source water and household stored drinking water in developing countries: a bivariate meta-analysis. Environ Health Perspect 123: 1222ā1231.
Langley J, 2002. From soap and water, to waterless agents: update on hand hygiene in health care settings. Can J Infect Dis 13: 285ā286.
Jumaa P, 2005. Hand hygiene: simple and complex. Int J Infect Dis 9: 3ā14.
Patrick D, Findon G, Miller T, 1997. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect 119: 319ā325.
De Wandel D, Maes L, Labeau S, Vereecken C, Blot S, 2010. Behavioral determinants of hand hygiene compliance in intensive care units. Am J Crit Care 19: 230ā239.
Erasmus V, Daha T, Brug H, Richardus JH, Behrendt MD, Vos MC, van Beeck EF, 2010. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 31: 283ā294.
Kostyla C, Bain R, Cronk R, Bartram J, 2015. Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review. Sci Total Environ 514: 333ā343.
Sreenivasan N, Gotestrand SA, Ombeki S, Oluoch G, Fischer TK, Quick R, 2015. Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza province, Kenya, 2008. Epidemiol Infect 143: 873ā880.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 297 | 297 | 75 |
Full Text Views | 1744 | 341 | 4 |
PDF Downloads | 1108 | 202 | 4 |
Safe and sufficient water, sanitation, and hygiene (WaSH) prevent the spread of disease in health-care facilities (HCFs). Little research has been conducted on WaSH in HCF in sub-Saharan Africa. We carried out a cross-sectional study of WaSH in 1,318 randomly selected rural HCF (hospitals, health centers, health posts, and clinics) in regions throughout Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Methods included questionnaires with head doctors and nurses to document WaSH access, continuity, quality, quantity and reliability, and analysis of drinking water samples for Escherichia coli. We found that fewer than 50% of rural HCFs had access to improved water sources on premises, improved sanitation, and consistent access to water and soap for handwashing (Ethiopia [7%), Kenya [30%], Mozambique [29%], Rwanda [50%], Uganda [30%], and Zambia [21%]). Adequate hand hygiene reduces disease transmission and health-care-acquired infections, but fewer than 25% of HCF in each country reported that a combination of water, soap, and hand-drying materials were always available. Our research points to a lack of basic WaSH services in rural HCFs in regions of sub-Saharan Africa, which poses a threat to the health of patients and health-care workers in these settings.
Financial support: This study was funded by a grant to the Water Institute at the University of North Carolina at Chapel Hill by World Vision, Inc. (Federal Way, WA). World Vision did not influence the research design, the conduct of the research, or the writing of this paper.
Authorsā addresses: Amy Guo and Jamie Bartram, Department of Environmental Sciences and Engineering, Water Institute, University of North Carolina, Chapel Hill, NC, E-mails: aguo@live.unc.edu and jbartram@unc.edu. J. Michael Bowling, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, E-mail: jbowling@email.unc.edu. Georgia Kayser, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, E-mail: gkayser@ucsd.edu.
Pruss-Ustun A et al., 2014. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 19: 894ā905.
Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JMC, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 42ā52.
Waddington H, Snilstveit B, 2009. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. J Dev Effect 1: 295ā335.
Bartram J, Cairncross S, 2010. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 7 : e1000367.
Emerson PM et al., 2004. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet 363: 1093ā1098.
Brown J, Hien VT, McMahan L, Jenkins MW, Thie L, Liang K, Printy E, Sobsey MD, 2012. Relative benefits of on-plot water supply over other āimprovedā sources in rural vietnam. Trop Med Int Health 18: 65ā74.
Kumpel E, Nelson KL, 2014. Mechanisms affecting water quality in an intermittent piped water supply. Environ Sci Technol Lett 48: 2766ā2775.
Howard G, Bartram J, 2003. Domestic Water Quantity, Service Level and Health. Geneva, Switzerland: World Health Organization.
Cronk R, Slaymaker T, Bartram J, 2015. Monitoring drinking water, sanitation, and hygiene in non-household settings: priorities for policy and practice. Int J Hyg Environ Health 218: 694ā703.
UN Committee on Economic, Social and Cultural Rights. General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the covenant). 2011; E/C. 12/2000/4.
Meier B, Kayser GL, Amjad U, Bartram J, 2013. Implementing an evolving human right through water and sanitation policy. Water Policy 15: 116ā133.
Steinmann P, Bratschi MW, Lele P, Chavan U, Sundaram N, Weiss M, Juvekar SK, Hirve S, 2015. Availability and satisfactoriness of latrines and hand washing stations in health facilities, and role in health seeking behavior of women: evidence from rural Pune district, India. J Water Sanit Hyg Dev 5: 474ā482.
Bazzano AN, Oberhelman RA, Potts KS, Gordon A, Var C, 2015. Environmental factors and WASH practices in the perinatal period in Cambodia: implications for newborn health. Int J Environ Res Public Health 12: 2392ā2410.
Benova L, Cumming O, Gordon BA, Magoma M, Campbell OMR, 2014. Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania. PLoS One 9: e106738.
Leslie HH, Fink G, Nsona H, Kruk ME, 2016. Obstetric facility quality and newborn mortality in Malawi: a cross-sectional study. PLoS Med 13: e1002151.
Bartram J, Cronk R, 2015. Water, sanitation and hygiene in health care facilities: status in low- and middle-income countries and way forward. Geneva, Switzerland: World Health Organization.
Kayser G, Moriarty P, Fonseca C, Bartram J, 2013. Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: a review. Int J Hyg Environ Health 10: 4812ā4835.
World Health Organization, 2017. Safely Managed Drinking Water: Thematic Report on Drinking Water 2017. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2016. Improved and Unimproved Water Sources and Sanitation Facilities. Available at: https://www.wssinfo.org/definitions-methods/watsan-categories/2016. Accessed July 12, 2017.
Bain R, Cronk R, Wright J, Yang H, Slaymaker T, Bartram J, 2014. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 11 : e1001644.
Guedes ZBL, OriĆ” HF, Britto NPB, Neto JWS, Silveira JW, Lopes AEC, 2004. Controle sanitario da agua consumida nas unidades de saude do municipio de fortaleza, CE. Higiene Alimentar 18: 28ā31.
Mosley LM, Sharp DS, Singh S, 2004. Effects of a tropical cyclone on the drinking-water quality of a remote pacific island. Disasters 28: 405ā417.
Lee EJ, Schwab KJ, 2005. Deficiencies in drinking water distribution systems in developing countries. J Water Health 3: 109ā127.
Potter A, Klutse A, Snehalatha M, Batchelor C, Uandela A, Naafs A, Fonseca C, Moriarty P, 2010. Assessing Sanitation Service Levels. The Hague, The Netherlands: IRC, International Water and Sanitation Centre.
HernĆ”ndez JE, MejĆa CR, Cazali IL, Arathoon EG, 1996. Nosocomial infection due to vibrio cholerae in two referral hospitals in guatemala. Infect Control Hosp Epidemiol 17: 371ā372.
Swaddiwudhipong W, Peanumlom P, 2010. A case of nosocomial cholera during a community outbreak in a thai-myanmar border area. J Med Assoc Thai 93: 1112ā1114.
Ethiopian Public Health Institute, Federal Ministry of Health Ethiopia, ICF International, 2014. Ethiopia Service Provision Assessment Plus (SPA+) Survey 2014 Key Findings. Addis Ababa, Ethiopia: Ethiopian Public Health Institute.
Boyce JM, Pittet D, 2002. Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control practices advisory committee and the hicpac/shea/apic/idsa hand hygiene task force. Am J Infect Control 30: S1āS46.
World Health Organization, 2009. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge, Clean Care is Safer Care. Geneva, Switzerland: WHO.
Allegranzi B, Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, 2011. Burden of endemic health-careassociated infection in developing countries: systematic review and meta-analysis. Lancet 377: 228ā241.
Allegranzi B, Pittet D, 2009. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 73: 305ā315.
Blencowe H, Cousens S, Mullany LC, Lee AC, Kerber K, Wall S, Darmstadt GL, Lawn JE, 2011. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and delphi estimation of mortality effect. BMC Public Health 11 (Suppl 3):S11.
Bartram J, Cronk R, Montgomery M, Gordon B, Neira M, Kelley E, Velleman Y, 2015. Lack of toilets and safe water in health-care facilities. Bull World Health Organ 93: 210.
Lawn J, Mongi P, Cousens S, 2006. Africaās newbornsācounting them and making them count. In: Opportunities for Africaās Newborns: Practical Data, Policy and Programmatic Support for Newborn Care in Africa. Geneva, Switzerland: World Health Organization, 11ā22. Available at: http://www.who.int/pmnch/media/publications/aonsection_I.pdf. Accessed July 10, 2017.
UN Department of Economic and Social Affairs, 2014. World Urbanization Prospects, the 2014 Revision: Percentage Urban and Urban Agglomerations by Size Class. Available at: https://esa.un.org/unpd/wup/Maps/CityDistribution/CityPopulation/CityPop.aspx. Accessed July 13, 2017
Lehmann U, Dieleman M, Martineau T, 2008. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res 8: 19.
WHO/UNICEF Joint Monitoring Programme, 2014. Progress on Drinking Water and Sanitation: 2014 Update. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2015. JMP Green Paper: Global Monitoring of Water, Sanitation and Hygiene Post-2015. Geneva, Switzerland: WHO.
WHO/UNICEF Joint Monitoring Programme, 2016. Monitoring WASH in Health Care Facilities: Core Indicators and Questions.Available at: http://www.who.int/water_sanitation_health/monitoring/coverage/wash-in-hcf-core-questions.pdf?ua=1. Accessed July 13, 2017.
WHO/UNICEF Joint Monitoring Programme, 2006. Core Questions on Drinking-Water and Sanitation for Household Surveys. Geneva, Switzerland: WHO.
MEASURE DHS, 2012. DHS Model Questionnaires. Available at: http://www.measuredhs.com/What-We-Do/Questionnaires.cfm. Accessed July 13, 2017.
Stauber C, Miller C, Cantrell B, Kroell K, 2014. Evaluation of the compartment bag test for the detection of Escherichia coli in water. J Microbiol Methods 99: 66ā70.
Aquagenx LLC, 2013. Compartment bag test: instructions for use.
World Health Organization, 2011. Guidelines for Drinking-Water Quality, 4th edition. Geneva, Switzerland: WHO.
The American Association for Public Opinion Research, 2008. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
Shields K, Bain R, Cronk R, Wright J, Bartram J, 2015. Association of supply type with fecal contamination of source water and household stored drinking water in developing countries: a bivariate meta-analysis. Environ Health Perspect 123: 1222ā1231.
Langley J, 2002. From soap and water, to waterless agents: update on hand hygiene in health care settings. Can J Infect Dis 13: 285ā286.
Jumaa P, 2005. Hand hygiene: simple and complex. Int J Infect Dis 9: 3ā14.
Patrick D, Findon G, Miller T, 1997. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect 119: 319ā325.
De Wandel D, Maes L, Labeau S, Vereecken C, Blot S, 2010. Behavioral determinants of hand hygiene compliance in intensive care units. Am J Crit Care 19: 230ā239.
Erasmus V, Daha T, Brug H, Richardus JH, Behrendt MD, Vos MC, van Beeck EF, 2010. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 31: 283ā294.
Kostyla C, Bain R, Cronk R, Bartram J, 2015. Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review. Sci Total Environ 514: 333ā343.
Sreenivasan N, Gotestrand SA, Ombeki S, Oluoch G, Fischer TK, Quick R, 2015. Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza province, Kenya, 2008. Epidemiol Infect 143: 873ā880.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 297 | 297 | 75 |
Full Text Views | 1744 | 341 | 4 |
PDF Downloads | 1108 | 202 | 4 |