Unsafe drinking water and poor sanitation and hygiene lead to deterioration of the child health condition in low-and middle-income countries. This study aimed to evaluate the nutritional and health status of children living in an urban slum and to clarify the factors contributing to undernutrition and diarrhea prevalence by focusing on water, sanitation, and hygiene from three viewpoints: household environments, child personal hygiene practices, and knowledge and awareness. The study was conducted at a preschool and two elementary schools in the densely populated area of Bandung, Indonesia. Participants were 228 pairs of children and their caretakers. The survey involved 1) anthropometric measurements (height and weight), 2) handwashing observation using a checklist, and 3) questionnaires. On multivariate logistic regression analysis, not using a towel for handwashing practices (adjusted odds ratio [AOR] = 2.37; 95% confidence interval [CI] = 1.13-4.96) was significantly associated with an increased risk of stunting. Regarding household environments, children from households using tap water as drinking water were significantly associated with an increased risk of stunting and thinness compared with households using tank water (AOR = 2.26; 95% CI = 1.03-4.93; and AOR = 2.88; 95% CI = 1.13-7.35, respectively). Moreover, children from households using open containers for water storage were significantly associated with an increased risk of diarrhea (AOR = 5.01; 95% CI = 1.08-23.15). Therefore, drinking water management at home and proper personal hygiene practices of children are important for maintaining and promoting child health in urban Indonesian slums.
Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards allin-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.
objective Globally, the challenge of handwashing with soap (HWWS) still exists despite the importance of HWWS being shown previously. This study aimed to evaluate faecal contamination on the hands of children and to find factors related to faecal contamination from handwashing techniques, HWWS, knowledge and awareness of water, sanitation, and hygiene (WASH), and a comprehensive WASH index.methods The study was conducted at two elementary schools with 169 children in a densely populated area of Bandung, Indonesia. The survey involved handwashing observation using a checklist, hand bacteria sampling and questionnaires.results Most children (98.7%) had faecal contamination. Girls had significantly fewer Escherichia coli than boys (P < 0.05). Ability in handwashing techniques, HWWS, and knowledge and awareness of WASH were poor in the lower grades. Escherichia coli counts were negatively correlated with handwashing technique (r = À0.171, P < 0.05), HWWS (r = À0.225, P < 0.01) and the WASH index (r = À0.205, P < 0.05).conclusions Proper handwashing technique and HWWS at appropriate times can reduce faecal contamination. Moreover, it is important that both grade-based and gender-based handwashing education be considered in elementary school education.
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