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The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

Unsafe hospital wastewater (HWW) is a significant concern, especially in low-and middle-income countries (LMICs) where the health impact is often underreported. Socio-technical systems (STS) theory, which examines the interplay between social and technical elements within complex systems, is widely used in developed countries but rarely applied in LMIC hospitals. STS theory was employed to evaluate the social and technical aspects of HWW treatment and management in Dhaka City, alongside a comprehensive assessment of WWT processes. A mixed-methods approach was used, combining quantitative (structured observations) and qualitative interviews. Structured observations assessed the availability and functionality of WWT systems in selected hospitals. The fieldworkers conducted 30 key-informant interviews across 13 hospitals, including 21 respondents from government and nine from private hospitals. The respondents were cleaners, key health professionals, and public works department (PWD) engineers. We also analyzed relevant government reports and policies. Among the hospitals surveyed, 10 had some form of WWT system, while the remaining three lacked any treatment infrastructure. Of those with WWT, seven utilized anaerobic baffled reactors and three had septic tanks. Interviews revealed that hospital authorities prioritize patient care and medical equipment maintenance over WWT, with limited understanding among hospital staff regarding WWT. PWD-engineers reported frequent staff shortages and bureaucratic delays, affecting the efficiency of WWT system repairs and desludging. Our study identified significant gaps in WWT in Dhaka hospitals, including the limited use of adequate treatment technologies, poor wastewater management knowledge, and many systems in disrepair, leading to hazardous liquid being discharged directly into the environment. The STS approach highlighted the need for policy formulation for HWW regulation, government leadership, adequate financing, technical assistance, and staff capacity building. Addressing these issues comprehensively can lead to safer and more sustainable wastewater management practices in HCFs, ultimately benefiting public health and the environment. [ABSTRACT FROM AUTHOR]

In this article, we argue for the utility of evaluative personas to address common challenges associated with analyzing qualitative data and to support actionable evaluation insights. Personas are fictional composite characters representing subgroups within a broader population. To explore the value of persona development in evaluation, a team of researchers and practitioners applied a persona-based approach to midline evaluation of a gender mainstreaming activity within a sanitation program. Fourteen personas were identified from 199 micro-narratives of change, through thematic analysis and natural-language processing. The personas were used to communicate evaluation insights and as a frame to strengthen gender mainstreaming practice. Our case highlights the value of personas for (1) providing a feasible means to analyze complex textual data sets, (2) producing engaging content that promotes evaluative program reflections, and (3) creating profiles for designing future activities. We reflect on opportunities for other programs to use personas in their evaluations. [ABSTRACT FROM AUTHOR]

Author(s): Juliet Willetts *, Jess MacArthur, Naomi Carrard In July 2023, the Joint Monitoring Programme (JMP) released a progress report on household drinking water, sanitation, and hygiene (WASH) (2000-2022) with [...]

Sanitation approaches in low-income urban areas are predominately on-site sanitation, with septic tanks promoted as an improved sanitation solution. While a septic tank system is designed to contain sludge in the tank and discharge effluent to a soil infiltration system, in many urban contexts effluent from tanks discharge directly to open drains or surface waters. This research addresses the paucity of data on pathogen removal and discharge from septic tanks as operated in low-income contexts and the significance of this public health hazard. This study assessed the performance and risks of "septic tanks" discharging to open drains in a low-income neighbourhood in Dhaka, Bangladesh, considering the influence of usage and tank operation on concentrations of Norovirus GII, Salmonella Typhi, Vibrio cholerae, Giardia, Shigella and E. coli in the effluent and receiving drains. While 66% of septic tanks were functioning within design limits, multiple pathogens were detected in all effluent samples, with a mean concentration of 7.6 log10 MPN/100mL for E. coli and 4.2–5.6 log10 genome copies/100mL for pathogens, excluding S. Typhi which was not detected. Children's exposure to septic tank discharge in drains could result in an 18% risk of illness from Norovirus GII and 3% from Giardia annually. The pathogen reduction between the estimated septic tank inflows and measured effluent concentration ranged from 1.3 log10 MPN reduction for E. coli to 2.2 log10 genome copies reduction for Giardia. Increased coverage of septic tanks was significantly associated with reduced concentrations of Shigella in open drains compared to direct discharge from toilets, with increased reduction for septic tanks operating within design standards. Implementing septic tanks without sub-surface infiltration or treatment of effluent is a major concern. The potential health risk of exposure to septic tank effluent warrants increased attention to appropriate technical design, effluent management and alternatives such as networked sanitation. [ABSTRACT FROM AUTHOR]

A participatory citizen approach was established to monitor microbial water quality in household self-supply in Bekasi, Indonesia, and evaluated using a conceptual framework for context analysis, process evaluation and impact assessment (CPI). Households tested their self-supplied water for Escherichia coli presence every two weeks for six months, accompanied by pre- and post-monitoring surveys. The approach provided reliable water quality results, and increased awareness of water quality; however, nearly half of the households dropped out of the monitoring and increased awareness did not translate into actions that improved water quality within the study period. Contamination rates ranged from 11% to 70% at source and from 15% to 44% at point-of-use. Household-led testing could fulfil an important monitoring role in self-supply contexts, however it may have little impact on the drinking water safety unless accompanied by support to improve source protection and strengthen household water treatment and storage practices. [ABSTRACT FROM AUTHOR]

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