Sanitation ladder and undernutrition among under-five children in Pakistan

Unraveling the South Asian enigma: concurrent manifestations of child anthropometric failures and their determinants in selected South Asian countries

Malnutrition among children is pervasive in South Asia and there are also reports of overnutrition. To better understand this phenomenon, we need a composite measure. However, the existing measures such as CIAF (Composite Index of Anthropometric Failure) and its revised version have ignored the overnutrition aspect of the phenomenon. This study proposes an extended version of CIAF which also considers overnutrition. This new measure was compared with the existing measures by using data from 1990 to 2018 for three selected South Asian countries including Pakistan, India and Bangladesh. We also examined the effects of socioeconomic and environmental variables on the outcome variable. The results reveal that the new measure (ECIAF) is better at measuring the phenomena. The burden of overall malnutrition has been decreased in the region. However, an increase in the concomitant prevalence of wasting and underweight is observed in both Pakistan and India and stunting and overweight is observed only in India. Besides, political stability, prevalence of undernourishment, anemia in children, mother's education, household size, dependency ratio, air pollution and unimproved sanitation are significantly correlated with childhood malnutrition. The findings also testified to long-run cointegrating relationship among the variables.

Situational assessment for fecal sludge management in major cities of Pakistan

With enhanced focus on global sanitation, access to toilets at the household level is increasing in developing countries although the provision of sewer networks is not expanding at the same pace. This is resulting in the adaptation of on-site sanitation facilities to contain the fecal sludge. The fecal sludge generated by the on-site sanitation facilities requires emptying, treatment, and safe end-use or disposal. In this study, the sanitation situation and need for fecal sludge management was evaluated in major cities of Pakistan including Karachi (provincial capital), Lahore (provincial capital), and Islamabad (national capital). Primary and secondary data were collected from key informant interviews of the stakeholders, national and international reports, research, and review articles. Infographics on wastewater and fecal sludge from origin to disposal were developed using a shit flow diagram tool and enabling environment was evaluated with a modified service delivery assessment tool. The results indicate that sewerage network coverage exists for 60%, 63%, and 50% of the areas in Karachi, Lahore, and Islamabad respectively. The sewerage network in major cities is old, leaking, and insufficient, thus a limited amount of wastewater reaches the treatment plants. Total wastewater treatment in Karachi and Islamabad is 10% and 9% respectively whereas, in Lahore, there is no infrastructure for the same. The safe sanitation in Lahore (8%) and Islamabad (25%) is coming from on-site sanitation systems with fecal sludge buried safely onsite. National level sanitation programs exist in the country but are limited to reducing open defecation and containments of fecal sludge only. The inclusion of complete fecal sludge management related framework, guidelines, and policies can help achieve the goal of safe sanitation for all.

Water, Sanitation, and Hygiene Service Ladders and Childhood Diarrhea in Haramaya Demographic and Health Surveillance Site, Eastern Ethiopia

BACKGROUND

The WHO/UNICEF Joint Monitoring Program (JMP) service ladders are worldwide indicators for monitoring drinking water, sanitation, and hygiene elements of the sustainable development goal targets. However, evidence on how the prevalence of childhood diarrhea looks across the service ladders is limited. This study aimed to assess the relationship between WASH service ladders and the prevalence of childhood diarrhea in Haramaya Demographic and Health Surveillance site, Eastern Ethiopia.

METHODS

A cross-sectional study using a structured questionnaire, observational checklist, and water quality analysis was conducted on 535 households with children under 5 years of age. Poisson regression with a robust error variance estimator was used to investigate the relationship between dependent and independent variables.

RESULTS

The prevalence of diarrhea among under-five children in the surveillance site was 24.8% (95% CI: 22.3-27.6). The regression model revealed that water and sanitation service ladders were associated with childhood diarrhea. Childhood diarrhea was found to be 73% (APR = 0.27; 95% CI: 0.12-0.57) less common in families with a basic water service ladder than in households with a surface water service ladder. In addition, children in households with basic sanitation services had 83% (APR = 0.17; 95% CI: 0.05-0.56) lower diarrhea prevalence than children in households where open defecation was practiced.

CONCLUSION

The present study found that childhood diarrhea differed considerably among WASH service levels and continues to be a serious health problem at the surveillance site. This study also shows that much work is needed to improve WASH services.