Water, Sanitation, and Hygiene in Rural Health-Care Facilities: A Cross-Sectional Study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia

Amy Guo The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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J. Michael Bowling Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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Jamie Bartram The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;

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Georgia Kayser The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina;
Department of Family Medicine and Public Health, School of Medicine, The University of California, San Diego, California

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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.

Author Notes

Address correspondence to Georgia Kayser, Department of Family Medicine and Public Health, School of Medicine, The University of California, San Diego, 9500 Gilman Drive, 0628, La Jolla, CA 92093-0628. E-mail: gkayser@ucsd.edu

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.

Authors’ 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.

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