Influence of Water, Sanitation, and Hygiene Practices on Common Infections among Under-Five Children in Longido and Monduli Districts of Arusha, Tanzania

In-house environmental factors and childhood acute respiratory infections in under-five children: a hospital-based matched case-control study in Bangladesh

BACKGROUND

Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality among children under five globally, particularly in regions like South Asia and sub-Saharan Africa. Bangladesh has made substantial progress in reducing child mortality, yet pneumonia remains a significant contributor to under-five deaths. This study aimed to investigate the association between in-house environmental factors and childhood ARI, considering factors such as household crowding, smoking, and sanitation facilities.

METHODS

This case-control study was conducted at a tertiary-level children's hospital in Dhaka, Bangladesh, from March to September 2019. The study included children aged 6-59 months. Cases were children with ARI symptoms, while controls were children without such symptoms. Rigorous matching by age and gender was employed to ensure comparability. Data were collected through structured questionnaires, and bivariate and conditional logistic regression analyses were performed.

RESULTS

Several household environmental factors were significantly associated with childhood ARIs. Children from overcrowded households (AOR = 2.66, 95% CI = 1.52-4.71; p < 0.001), those using unclean cooking fuels (OR = 2.41, 95% CI: 1.56, 3.73; p = < 0.001), those exposed to in-house smoking (AOR = 1.74, 95% CI = 1.01, 3.05; p = 0.04) and those with unimproved sanitation facilities faced higher odds (AOR = 4.35, 95% CI = 2.14-9.26) of ARIs. Additionally, preterm birth and higher birth order were associated with an increased risk of ARI. In contrast, exclusive breastfeeding was a protective factor.

CONCLUSION

In-house environmental factors, including sanitation, crowding and in-house smoking, significantly influence childhood ARIs. Additionally, birth order and preterm birth play a crucial role. Promoting exclusive breastfeeding is associated with a lower ARI risk among under-five children in Bangladesh. These findings can guide interventions to reduce ARIs in low-income regions, particularly in South Asia.

Occupational Health Sufferings of Child Waste Workers in South Asia: A Scoping Review

Background: Child labor remains a health hazard, affecting the mental, physical, and emotional well-being of children. Children engage in waste management through various channels while constantly working to create a healthier and cleaner environment and exposing themselves to numerous health risks. Thus, this scoping review aims to explore the occupational injuries, health hazards, and sufferings of child waste workers in South Asia. Methods: Following the PRISMA guidelines, a scoping review of available relevant scientific literature was completed to comprehensively analyze the extent of child waste workers’ health suffering. Online databases PubMed, SCOPUS, and Google Scholar were searched for predefined criteria. Collected references were screened with Rayyan web tools and Endnote. Based on study inclusion criteria, a thematic synthesis was performed on the findings of 12 articles. Results: This study’s findings provided deep insights into the most prevalent occupational health sufferings among child waste workers, as depicted in the available literature. Prevalence of injuries like cuts and wounds was found predominant. These injuries are caused by the collection, transportation, dumping, and recycling of waste. Respiratory, musculoskeletal, and skin diseases are more prevalent among child waste worker children than in control groups of the same socioeconomic backgrounds. A higher chance of genetic or neuro-degenerative disorder and DNA mutation indicates a long-term effect on the children working in the waste management sector. Psychological sufferings were the least explored, although very common among child laborers. MPD (Minor Psychiatric Disorder) was very high among waste workers. Regarding healthcare-seeking behavior, traditional methods are preferable rather than formal health facilities. More research is required in this area due to a lack of evidence on the health problems of child waste workers. Conclusions: Occupational hazards were myriad among child waste workers. Though many children are involved in waste management, they are typically excluded from mainstream child protection and support systems, making them more exposed to occupational harassment and injury. Policymakers should design specific programs for these vulnerable groups considering the issues below, i.e., provide protective equipment such as facemasks, gloves, footwear, and rag sorting tools to safeguard them from physical damage and illness, ensure access to health care, to school, and provide basic nutrients to them. Furthermore, the authorities should think of alternative income generating programs for these groups of children.

Complementary feeding pattern and its determinants among mothers in selected primary health centers in the urban metropolis of Ekiti State, Nigeria

The incidence of malnutrition in the first two years of life has been directly linked with inappropriate complementary feeding practices along with high infectious disease levels. This study was therefore aimed to assess the complementary feeding pattern among mothers of children aged zero to two years in selected health centres in Ado Ekiti, the capital of Ekiti State, Nigeria. The study was cross-sectional in design. One hundred and thirty-five mothers were selected from two health centres within Ado-Ekiti for this study. A semi-structured interviewer-administered questionnaire was used to collect information from the mothers. The questionnaire included questions that assessed the mothers’ socio-demographic characteristics and complementary feeding pattern. Most (62.5%) infants were introduced to complementary foods at 3–5 months old and water (43.3%) at 3 months of age. The main food item given to the infants on commencement of complementary feeding was formula food (45.9%) followed by fermented cereal gruel (37%). The timing of introduction for different food items revealed that in contrast to the use of fermented cereal gruel (23.8%), fewer children were introduced to iron-rich foods (15.1%) and fruits (11%) at 6 months to a year old. Mother’s knowledge of ideal age for the introduction of complementary feeding (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\chi }^{2}=$$\end{document}χ2= 20.547; p < 0.001) associated significantly with the age of introduction of complementary feeding. More than three-fifth (62.5%) of the respondents had commenced complementary feeding to their infants between 3 and 5 months while an excess of two-fifth (43.3%) of the respondents started giving their children water to drink at 3 months of age. Nurses and nutritionists in primary health care centers should take the lead role in educating mothers about the need for exclusive breastfeeding for the first 6 months of life and appropriate complementary feeding for ages 6–24 months.

Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania: A Community-Based, Cross-Sectional Analysis

Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18−0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27−0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24−0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52−0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65−1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.

Evaluation of Water, Sanitation, and Hygiene, Behavioral Aspects, Household State for the Diarrhea Prevalence among Students in the Valley of Sinabung Volcano, North Sumatera, Indonesia

Diarrhea stands as a result of the inter-variable relationships, including behavior, environmental aspect, and household states. The study aimed to conduct an epidemiologic survey of diarrhea prevalence and several existing risk factors of diarrhea. A community-based surveillance and in-depth interview were conducted following the JMP ladder service for WASH and government regulation and it enrolled 135 children of a public primary school, SDN 040494, and households in the Valley of Sinabung Volcano, North Sumatera, Indonesia between June and October 2019. There were only two lowest categories of each WASH (Water, Sanitation and Hygiene) indicator. Multivariate analysis has also demonstrated a high likelihood of diarrhea among the population in limited settings for hygiene (p-value 0.012, AOR 7.892 95%CI 2.485, 25.064) and low daily income (p-value 0.015, AOR 3.079 95%CI 1.148, 8.260). Improvement of hygienic practices is mandatory as well as preventing volcanic eruption implications to the economy of the local community.

Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders

BACKGROUND

Despite aspects of the SAFE strategy for reducing trachoma in Tanzania have been somewhat successful, the disease still persists in marginalised communities even with repeated trachoma control interventions. This study aims to understand the facilitators and barriers associated with implementing trachoma control programmes in these communities, from the perspective of non-governmental organisations (NGOs).

METHODS

Participants were the representatives of NGOs who had knowledge and experience in the implementation of trachoma control programmes. Data was collected using in-depth, semi-structured interviews guided by a topic guide, which was updated after each interview using a constant comparative method. Interviews were audio-recorded and then transcribed verbatim. Thematic analysis was done inductively. Codes were generated from the transcripts and then clustered into themes.

FINDINGS

The context within marginalised communities often acted as a perceived barrier to successful implementation of control programmes. This included poor environmental cleanliness, lack of trust, poor disease knowledge and traditional lifestyles. Community values could either be a facilitator or a barrier, depending on the scenario. The anatomical location of the disease and the poor understanding of the disease progression also served as barriers. Considerations affecting decision-making among NGO's include financial feasibility, community needs and whether the quality of the intervention could be improved. NGOs felt that the collaboration and the opportunity to learn from other organisations were beneficial aspects of having different actors. However, this also resulted in variability in the effectiveness of interventions between districts.

CONCLUSION

NGOs should focus on behaviour change and health education that is tailored to marginalised communities and seek innovative ways to implement trachoma intervention programmes whilst being minimally intrusive to the traditional way of life. Partners should also implement ways to ensure high quality programmes are being provided, by increasing staff accountability and compensating volunteers fairly.

Water, sanitation and hygiene (WaSH) practices and diarrhoea prevalence among children under five years in a tribal setting in Palghar, Maharashtra, India

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

Several studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

Sanitation and Hygiene Practices in Small Towns in Tanzania: The Case of Babati District, Manyara Region

Formative research findings from the fast-growing Babati town were used to assess the prevalence of sanitation and hygiene practices among individuals and institutions and associated factors. A cross-sectional study involving household surveys, spot-checks, focus group discussions, in-depth interviews, and structured observations of behaviors showed that 90% of households have sanitation facilities, but 68% have safely managed sanitation services. The most common types of household sanitation facilities were pit latrines with slab (42%) followed by flush/pour flush toilets (32%). Therefore, the management of wastewater depends entirely on onsite sanitation systems. The majority of households (70%) do not practice proper hygiene behaviors. Thirteen percent of the households had handwashing stations with soap and water, handwashing practice being more common to women (38%) than men (18%). The reported handwashing practices during the four critical moments (handwashing with soap before eating and feeding, after defecation, after cleaning child’s bottom, and after touching any dirt/dust) differed from the actual/observed practices. Households connected to the town’s piped water supply were more likely to practice handwashing than those not directly connected. Sanitation and hygiene behaviors of the people in the study area were seen to be influenced by sociodemographic, cultural, and economic factors. The conditions of sanitation and hygiene facilities in public places were unsatisfactory. There is an urgent need to ensure that the sanitation and hygiene services and behaviors along the value chain (from waste production/source to disposal/end point) are improved both at the household level and in public places through improved sanitation services and the promotion of effective hygiene behavior change programs integrated into ongoing government programs and planning.

Hygienic Practice during Complementary Feeding and Associated Factors among Mothers of Children Aged 6–24 Months in Bahir Dar Zuria District, Northwest Ethiopia, 2019

Introduction. Breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore food is needed. Microbiologically contaminated food is particularly harmful for children <2 years of age. There is scanty of information on hygienic practice and associated factors during complementary feeding among mothers of children aged 6 to 24 months in the country, particularly in the study setting. Objective. The study was aimed to assess hygienic practices and associated factors during complementary feeding among children aged 6 to 24 months in Bahir Dar Zuria District, Northwest Ethiopia. Methods. A community-based cross sectional study was conducted from March 20 to April 20, 2019. A multistage sampling technique was used to select the study participants. Data were collected using the structured interviewer administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with hygienic practice during complementary feeding. Data were entered by using Epi Data version 3.1, and then it was exported to SPSS version 21 for analysis, and at 95% CI, p value <0.05 was considered statistically significant. Result. Among 604 respondents, 235 (38.9%) of study participants had good hygienic practice during complementary feeding. Access to media (AOR: 8.8, 95% confidence interval (CI): 3.8–20.3), private latrine ownership (AOR: 4.11, 95% CI: 1.90–8.49), presence of hand washing facility at doorstep (AOR: 6.75 95% CI: 3.16–14.41), and residence of the study participants (AOR: 85.42, 95% CI: 1.94–15.2) were significantly associated with good hygienic practice of mothers during complementary feeding. Conclusion. Majority of mothers had poor hygienic practice during complementary feeding. Attitude of mothers, access to media, household private latrine ownership, presence of handwashing facility, and residence of the study participants were significantly associated with hygiene practice of mothers during complementary feeding. The health sector should train mothers on good hygiene practices during complementary feeding.

Field application of the Micro Biological Survey method for the assessment of the microbiological safety of different water sources in Tanzania

Access to safe water is stated within human rights as essential for life, as water can be a source of severe enteric infections threatening human health, in particular children from Developing Countries. Along with reference methods, need is pressing for alternative methods to flank reference ones to improve water safety on-site monitoring and in the absence of scientific facilities or even electricity supply. The Micro Biological Survey (MBS) method has already been successfully applied to water safety assessment in Developing Countries. A total of 18 water samples were collected from different sources (rivers, dug wells, tap water) within the Rukwa Region, Tanzania, and underwent analysis for Total Coliforms following the MBS method. Globally, rivers showed more frequently contamination, followed by dug wells, tap water and tanks. Results demonstrate the need for continuous monitoring of water sources, even in difficult frameworks lacking electric supply, to help improve control over water quality, possibly using alternative methods to simplify existing protocols.