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Objective This study aims to assess the current status of sanitation facilities across primary healthcare institutions in China, offering valuable insights for improving sanitary facilities in middle-income settings. Methods Data were draw from the ACACIA project (March 2021-April 2023) across seven provinces in China. A total of 2139 visits were made to 1167 primary healthcare institutions. Unannounced standardized patients (USPs) were utilized to covertly assess the sanitation facilities during clinical visits. Results Toilet sanitation facilities were available in 70.4% of visits. 95% had access to piped water. The probability of having a handwashing sinks in toilet and examination room is 79.2% and 50.8%. Significant regional disparities were observed, with southern regions exhibiting higher facility coverage compared to northeastern regions. Public primary healthcare institutions have more sanitary facilities than private ones. Higher-tier institutions have higher rates of sanitary facilities. Regarding quality, adverse event rates show minimal differences between clinic-level and center-level institutions. And the urban institutions is obviously better than that in rural areas. Conclusions China’s policy initiatives have improved sanitation facilities within primary healthcare institutions, but gaps persist in essential components and maintenance. Continued efforts are needed to enhance sanitation infrastructure to meet higher standards and ensure comprehensive coverage. The study’s insights can inform both domestic and global strategies for improving healthcare sanitation, contributing to the achievement of international health goals. Future research should focus on identifying barriers to sanitation improvements and developing targeted interventions to standardize sanitary facilities in primary healthcare settings.

In most low- and middle-income countries, due to financial constraints and improper management practices, the expansion of conventional centralized systems to enhance wastewater management services is not practical. Despite the fact that the majority of the world population has met the Millennium Development Goals 7c (MDG7c) targets, more than 2.5 billion are still using unimproved sanitation facilities and affecting the safety of drinking water and public health. Because of this problem, a novel approach on ‘Non-Sewered Sanitation’ with decentralized treatment systems is being recognized as a promising alternative to accomplish the Sustainable Development Goal No. 6 (SDG6) targets on ‘Safe Water and Sanitation’ and bringing health benefits to the people. This study aimed to investigate the current status of access to improved sanitation facilities in relation to the MDG7c and SDG6 in Thailand and comparing with other countries, including the effects of unsafely managed fecal sludge (FS) on the prevalence of diarrhea and liver fluke infections. The prevailing constraints and weaknesses were identified, and effective sanitation management measures to accomplish SDG6 targets were recommended. Based on data collected from 20 cities located in the north and northeastern regions of Thailand during the period of 2015–2020, the sanitation facilities data on conventional centralized systems and FS management facilities that affect the prevalence of diarrhea and liver infections were analyzed and interpreted using statistical and response surface methodology techniques. The findings showed that most of the surveyed cities have achieved the MDG7c targets, but 70% of the FS generated from on-site sanitation systems are still unsafely managed, caused by limited expansion of sewage systems for wastewater collection and conveyance (with inadequate operation and maintenance) as well as the financial constraints, especially in areas outside of urban neighborhoods. The effective sanitation management practices to accomplish the SDG6 targets were proposed such as increasing the capacity of sanitation facilities to be 55,000 m3/day/30,000 households, designing appropriate FS collection program and treatment technology, and providing more awareness programs for safe sanitation management and health risk protection.

Background: Improved sanitation facilities offer numerous advantages, ranging from the reduction of diarrheal illnesses and helminth infections to the improvement of psychosocial well-being. At the household level, attaining universal access to improved sanitation facilities demands a thorough understanding of the factors that influence their adoption and use. As a result, the purpose of this study was to assess the availability and utilization of improved sanitation facilities, as well as the factors that influence the adoption and proper use of such a facility among households in the Gedeb district of Southern Ethiopia. Methods: A community-based cross-sectional household survey was conducted from March to April 2019. A systematic random sampling technique was used to select 630 households at random. A pre-tested questionnaire was used to collect the respondents’ self-reported data, which comprised socio-demographic, home characteristics, behavioral, and environmental elements. The factors related to the availability and utilization of improved sanitation facilities were identified using multivariable logistic regression. Result: Improved sanitation facilities were present in 172 (27.3%) of the 630 households surveyed, with 111 (64.5%) of them being used properly. The availability of improved sanitation was associated with educational status [AOR = 2.73, 95% CI (1.59, 4.67)], upper wealth quintile [AOR = 2.18, 95% CI (1.21, 3.93)], ever hearing educational messages about latrines [AOR = 3.9, 95% CI (1.86, 8.18)], favorable attitude toward latrine construction [AOR = 2.81, 95% CI (1.67, 4.74)], and receiving support during construction [AOR = 3.78, 95% CI (2.15, 6.65)]. Furthermore, utilization was associated with the absence of children under the age of 5, knowledge of sanitation-related diseases, and a positive attitude toward latrine use. Conclusion: Both the availability of improved sanitation facilities and the rate at which they were used properly fell far short of the National Hygiene and Environmental Health Strategy’s goals. This study contributes to the body of knowledge on how to improve the availability of improved sanitation in Ethiopia.

Background Access to adequate sanitation remains a global challenge, with nearly 4.2 billion people lacking hygienic facilities. This issue is particularly acute in low and middle-income countries, where it is associated with various communicable diseases. In India, regional disparities in sanitation access persist, especially in economically backward areas. Therefore, this study examines to assess the health implications of shared sanitation facilities with various socio-economic factors. Data and methods Data for this study were collected from 635 households across 10 villages in West Bengal using a structured questionnaire and a purposive sampling technique. In this study, we have employed binary logistic regression models to examine the association between shared sanitation facilities and various socioeconomic factors. Findings The study revealed that 95.12% of households had access to sanitation facilities within their premises. However, 4.88% of households still practiced open defecation and 7.40% of households share their sanitation facilities. Regression analysis showed that households with > 8 members were 5.30 times more likely to share facilities than those with 1–4 members ( p  < 0.05). Muslim-headed households were 1.68 times more likely to share facilities than Hindu-headed households ( p  < 0.10), while illiterate households were 1.23 times more likely than highly educated ones ( p  < 0.05). Middle-income households were 27% less likely to share than low-income households ( p  < 0.10), and semi-pucca houses were 14% less likely than kutcha houses ( p  < 0.10). The study also revealed Shared sanitation was also linked to higher prevalence of waterborne diseases in villages with poor social infrastructure. Conclusion Despite high sanitation coverage, shared sanitation facilities and open defecation remain prevalent in the region. Socioeconomic factors, particularly education, income, and household size, significantly influence sanitation practices. Therefore, targeted interventions are crucial to minimize the health risks. Prioritizing education on hygiene practices, improving economic conditions to facilitate private facility construction, and enhancing social infrastructure are essential strategies. Graphical abstract

Populations in peri-urban communities of Sub-Saharan Africa frequently depend on shallow aquifers and on-site sanitation facilities concurrently. Routinely, domestic wells end up too close to toilet facilities, risking groundwater contamination. For coastal communities, saltwater intrusion adds to the risk of groundwater contamination. This study assessed both risks in five peri-urban communities of Cape Coast, Ghana. Groundwater samples collected from 40 domestic wells were analyzed for physicochemical and microbial constituents. Multivariate statistics including hierarchical cluster analysis (HCA) and principal component analysis (PCA) were used to classify and link contaminants to potential sources. Results indicate high enteric bacteria contamination in 98% of the samples, as well as high enrichment in physicochemical constituents, tied largely to impacts of on-site sanitation facilities. We found that wells located within 25 m of septic tanks/toilet facilities contained higher contaminant loads than those without such facilities within 25 m of their locations. Similarly, for wells located close to point sources, the closer the water table is below the land surface (within 2 m), the higher the contaminant loads. Lastly, using molar ratios of Cl − /HCO 3 − and Na + /Cl − with R-mode HCA, the study isolated a few wells, located within 2 km of the coastline, that are experiencing effects of saltwater intrusion. Overall, this study provides useful information for aiding groundwater quality mitigation policy, and the baseline data for aiding future investigations in the study area. It also has broader policy implications for other peri-urban settings throughout Ghana and the entire Sub-Saharan Africa.

Water and sanitation facilities in schools are directly linked to the attainment of Sustainable Development Goal (SDG) 6; however, these facilities are often grossly inadequate in both quality and quantity in public primary schools (PPS) in developing countries. This study examined the existing water and sanitation facilities in PPS in Oyo State, Nigeria, to identify disparities. Using ANOVA, variables extracted from the 2020 Oyo State Annual School Census report were analyzed and mapped to reveal spatial distribution at the local government level. Five water sources and 4 types of sanitation facilities were identified. Significant variations were observed across local government types (urban, semi-urban & rural, and rural) with respect to enrollment (P = .000), total number of toilets (P = .033), PPS with wells (P = .002), PPS with no water source (P = .001), PPS with flush toilets (P = .001), and PPS with other toilet types (P = .011). With sanitation facility availability below 20%, open defecation is likely to be prevalent in these schools. For the well-being of the pupils and the entire population of the state, the government needs to prioritize the provision of potable drinking water and improved sanitation facilities in PPS, while considering the need for facilities to be gender sensitive.

Environmental health studies and practices tend to prioritise health and hygiene, with environmental sanitation, which encompasses behaviour and sanitation facilities, representing a significant concern in environmental health risks. Nevertheless, numerous studies have demonstrated that the physical components of buildings exert an impact on environmental health status. The purpose of this article is to demonstrate that the physical components of buildings influence environmental health risks and they can be incorporated as additional variables in the development of a more precise, valid, and comprehensive environmental health risk assessment model. In this study, a multistage random sampling technique was employed to obtain a total sample of 400 households. This study is a second-order construct that was measured formatively using an embedded two-stage approach. The findings of this study indicate that the physical component of the building has a significant effect on environmental health risks. This is indicated by the path coefficient value of 0.249. The most influential components are bedroom windows, floor type, ceiling, wall type, roof type, living room windows, occupancy density, temperature, humidity, and temperature. By identifying these neglected health risk factors, governments, health institutions, and communities can develop more effective and efficient strategies for mitigating environmental health risks.

Based on the panel data of water and latrine improvement in rural China from 2003 to 2016, this paper explores the spatiotemporal evolution pattern of rural sanitation facilities and analyzes the spatial heterogeneity of influencing factors of rural sanitation facilities by using the Geographically Weighted Regression (GWR) model. The conclusions are as follows: the gap between the western and the eastern regions of China is gradually narrowing; the spatial differences of rural environmental sanitation facilities in provinces were obvious, showing high-high and low-low agglomeration types. Additionally, years of education per capita, population density, and government investment all have a significant positive impact on the improvement of water and latrines. And the proportion of the minority population has a significant negative impact on the improvement of water. The net income per capita, traffic density, and residential investment per capita are significantly positively correlated with the improvement of water and latrines. But the difference is that the impact on the improvement of water is an obviously east-west band and decreases successively, and the impact on the improvement of latrines shows a dual pattern of polarization between north and south.

PurposeThe main aim of this study is to provide a methodology for assessing the social impacts related to water consumption in life cycle assessment (LCA). Methods for the environmental assessment of water use in LCA have already been developed. However, the impacts of water consumption from a social life cycle perspective, which are also site-dependent, still need to be addressed. According to a sustainability concept, freshwater sources should be assessed by considering the social and economic, as well as the environmental impacts.MethodsFor the life cycle inventory (LCI) modelling, blue water flows from production processes are separated into direct process water and indirect water from energy production. Primary data, published studies and the GaBi 6© software’s Database serve as sources for this study. Risk of access to unimproved drinking water (RADW) and risk of access to unimproved sanitation facilities (RASA) are the social indicators selected for consumed water based on published data and according to the guidelines for social life cycle assessment (S-LCA). In the automobile industry, the social assessment is applied in the production stage of a conventional vehicle instrument panel. In order to show the influence of site-dependent aspects on these social indicators, three production sites (China, Germany and South Africa) are compared. The inventory is also used for an environmental assessment based on water stress indices (WSI), thereby confirming the compatibility of both social and environmental assessments.Results and discussionResults showed that the instrument panel manufactured in China is the most water-intensive alternative. Indirect water was the main driver for water consumption in all processes. The hotspots of water consumption are found in the supply chain processes, where isocyanate production embraces the most water-intensive processes. China is the country where the water consumed in the production processes by the manufacturer led to the highest risk of accessing unimproved drinking water and sanitation, i.e. not protected from contamination, for the local community. Of all processes, the amount of water consumed by the energy production processes was the highest. Thus, the instrument panel manufactured in China led to the highest environmental impact as well.Conclusions and recommendationsA feasible and practicable method for a social risk assessment of freshwater consumption for automotive products is proposed. This contributes to the method development leading towards a comprehensive life cycle sustainability assessment (LCSA) of freshwater. The approach provides valid indicators for decision makers. Furthermore, the social assessment is implemented in an industrial product with a simplified supply chain. It has been shown that the social assessment is consistent with an existing environmental assessment, this being a first practical step for a sustainability assessment of water use for the automobile industry. The proposed method should be integrated in commercialised databases for assessments of an entire vehicle in order to facilitate its implementation. In addition, the economic pillar needs to be included for a comprehensive LCSA of water use. Further case studies should allow for a finer granularity in regional assessment, if required for the decision makers.

Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh. From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste. Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people. A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators.