Explore the vast range of titles available.

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.

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. 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. 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. 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.

Access to safe sanitation facilities remains a critical public health concern, especially in rapidly urbanizing countries like Ghana. This study investigates the determinants of household toilet ownership among property owners in three urban districts in Ghana. Using a cross-sectional survey design, data were collected from 1,256 property owners selected through a multi-stage stratified sampling procedure. Logistic regression analysis revealed that toilet ownership is significantly associated with the age and education level of property owners, community classification, building characteristics, and household income. Older property owners were more likely to own toilets (OR = 1.014 per year increase), as were those with higher education levels (OR = 1.752 for secondary, OR = 4.489 for tertiary education). Medium-class communities (OR = 2.013) completed buildings (OR = 2.625), and those constructed with sandcrete (OR = 12.755) were more likely to have toilets. Higher household income (OR = 1.00) correlated positively with toilet ownership. We conclude that enforcing building regulations requiring toilet facilities in all properties is crucial for improving sanitation in urban Ghana. Additionally, innovative sanitation financing interventions that subsidize the costs of sanitation facilities can be effective in addressing financial barriers and increasing household toilet ownership.

This study explores the critical roles of Operation and Maintenance (O&M) in influencing sanitation service levels, as outlined by the Joint Monitoring Program (JMP), in schools across Kampala City. In consideration of access, technology, and condition of sanitation facilities, the JMP classifies sanitation services in schools as basic, limited and no service levels. A cross-sectional study approach and systematic random sampling techniques were used to collect data from 274 schools (selected from 852) using checklists and questionnaires. Results show that 62% and 38% of the schools are operating at limited and basic sanitation service levels respectively. No school was at the \"no service\" level. Binary logistic regression identified toilet technology, flushing method, cleanliness, and special sanitation budgets as significant O&M factors (P < 0.005). The logistic regression model predicted sanitation levels with 67% accuracy (Chi-Square = 52.251, P < 0.001, Cox and Snell R  = 0.18, Nagelkerke R  = 0.245). Results indicate that schools with waterborne toilets are less likely to operate at limited-service levels compared to those with pit latrines (Odds Ratio (OR) = 0.272, P-value = 0.018). Schools that maintained clean toilets and had dedicated sanitation budgets were more likely to achieve basic sanitation service levels, with odds ratios of 2.109 (P-value = 0.012) and 3.603 (P-value = 0.001), respectively. Implementation of privacy promoting activities have a gain index of 135% which is potentially enough to improve basic sanitation coverage from 38 to 75% of schools in Kampala City. These findings emphasize the importance of improved sanitation technologies, proper maintenance practices, and financial investment all aimed at sustaining improved sanitation service provision. This study provides empirical evidence on factors influencing service levels in Kampala City schools.

Pit latrines are one of the most common human excreta disposal systems in low-income countries, and their use is on the rise as countries aim to meet the sanitation-related target of the Millennium Development Goals. There is concern, however, that discharges of chemical and microbial contaminants from pit latrines to groundwater may negatively affect human health. Our goals were to a) calculate global pit latrine coverage, b) systematically review empirical studies of the impacts of pit latrines on groundwater quality, c) evaluate latrine siting standards, and d) identify knowledge gaps regarding the potential for and consequences of groundwater contamination by latrines. We used existing survey and population data to calculate global pit latrine coverage. We reviewed the scientific literature on the occurrence of contaminants originating from pit latrines and considered the factors affecting transport of these contaminants. Data were extracted from peer-reviewed articles, books, and reports identified using Web of ScienceSM, PubMed, Google, and document reference lists. We estimated that approximately 1.77 billion people use pit latrines as their primary means of sanitation. Studies of pit latrines and groundwater are limited and have generally focused on only a few indicator contaminants. Although groundwater contamination is frequently observed downstream of latrines, contaminant transport distances, recommendations based on empirical studies, and siting guidelines are variable and not well aligned with one another. In order to improve environmental and human health, future research should examine a larger set of contextual variables, improve measurement approaches, and develop better criteria for siting pit latrines.

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana’s ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.

Globally, and in Ghana, a lot of people do practice open defecation as well as share toilet facilities with other households. Meanwhile, open defecation in particular, is associated with numerous negative health and economic effects. To this end, a number of empirical studies have been conducted on the determinants of access to sanitation facilities among households in Ghana. Nonetheless, while financial inclusion (sustainable ways of ensuring easier accessibility to cheap and useful financial products and services among individuals/firms) can enhance the ability of households or individuals to afford toilet facilities, hence, could help in curbing open defecation and sharing of toilet facilities among households, the previous studies on Ghana did not pay attention to it. This study therefore uses data from the 7 th round of the Ghana Living Standards Survey (GLSS7) to examine the association of financial inclusion with open defecation and sharing of toilet facilities among households in Ghana. The binary logit regression is used as the empirical estimation technique. The results show that, financial inclusion in general is associated with lesser likelihood of open defecation and sharing of toilet facilities among households in Ghana after controlling for welfare quintile, urban or rural residence and other covariates. Moreover, while informal financial inclusion is statistically insignificant, formal financial inclusion is found to be associated with reduced open defecation and sharing of toilet facilities among households. Thus, in the attempt to eliminate open defecation as well as reduce the sharing of toilet facilities among households in Ghana, conscious efforts should be devoted towards enhancing formal financial inclusion.

This study examined sociocultural and economic factors determining open defecation in the Wa Municipality, Ghana. The study employed a mixed method approach involving questionnaire administration to 367 households systematically selected from 21 communities, observation, and eight key informant interviews. The mixed logit model was used to determine the factors that significantly influence open defecation. The findings revealed that 49.8% of households had no form of toilet facility at home and were either using communal/public toilets or practicing open defecation. Several sociocultural and economic reasons account for this. But for these households, having a toilet facility at home does not seem to be a priority. Six factors (education, household size, occupation, income, traditional norms, and beliefs and ownership of a toilet facility) were positively significant in determining open defecation. Fundamental to many of the significant factors is households’ capacity to finance construction of home toilets. In addition to finding new and innovative approaches to public education, the principle of credit financing, that incorporates community-led initiatives, may be considered in assisting households to construct home toilets.

This study aimed to investigate the association between sanitary toilets and health poverty vulnerability among rural western Chinese adults aged 45 years and older. Using data from the ’Rural Household Health Inquiry Survey’ conducted in 2022, a three-stage feasible generalized least squares method was employed to calculate health poverty vulnerability. Propensity score matching (PSM) and mediation effect analysis were used to assess the association between sanitary toilets and health poverty vulnerability among rural western Chinese adults aged 45 years and older and the mechanisms underlying this impact. This study revealed that the use of sanitary toilets was significantly associated with decreased health poverty vulnerability in adults over 45 years of age. Heterogeneity analysis revealed that this effect was more pronounced among males (β = -0.0375, P <0.05), those aged 60–74 years (β = -0.0476, P <0.05), and households with middle income (β = -0.0590, P <0.01). Mediation effect analysis identified total household income (a×b = -0.0233, P <0.05), household size (a×b = -0.0181, P <0.01), number of household laborers (a×b = -0.0107, P <0.01), and registered poor households (a×b = -0.0081, P <0.01) as the mediating factors between sanitary toilets and health poverty vulnerability. The provision of sanitary toilets has been instrumental in mitigating health-related poverty among middle-aged and elderly people residing in rural areas. By improving household livelihood capital, the vulnerability of these individuals to health-related poverty can be significantly reduced.

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)—a national sanitation program initiated in 2014—and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011–2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR ( p  < 0.05), and 6.8 lower U5MR ( p  < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000–70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.