A new measure of hygiene inequality applied to urban-rural comparison

Spatiotemporal characteristics and socioeconomic inequalities in water, sanitation, and hygiene access in China from 2000 to 2020: analysis of data from three national censuses

BACKGROUND

Access to water, sanitation, and hygiene (WASH) facilities presents a significant global public health challenge. This study aims to investigate the temporal and spatial characteristics of WASH access in mainland China, as well as the socioeconomic equity, using data from national censuses.

METHODS

We analyzed households' data from three national censuses spanning 2000 to 2020 to examine the characteristics of safe water, sanitary toilets, and hygiene bathing facilities over time. Spatial clustering of WASH facilities in 2020 was assessed using Moran's I analysis. Socioeconomic disparities in WASH access across provinces were quantified using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII).

RESULTS

Between 2000 and 2020, access to safe water in China increased significantly from 45.7% to 91.3%, access to sanitary toilets rose from 18.7% to 78.5%, and access to hygiene bathing facilities climbed from 26.0% to 88.4%, reflecting continuous improvements in WASH access. Urban areas consistently outperformed rural areas, and the eastern region showed higher access rates compared to the central and western regions. Spatial analysis revealed statistically significant clustering of sanitary toilets and hygiene bathing facilities at the provincial level in 2020. Equity analysis indicated a notable improvement in the fairness of WASH access over the past two decades, with decreases observed in both SII and RII metrics.

CONCLUSION

Mainland China has made substantial strides in enhancing WASH access over the last 20 years, accompanied by significant improvements in provincial equity. However, persistent regional disparities underscore the need for targeted financial support to rural, central, and western regions to further enhance WASH accessibility.

The Acari Hypothesis, IV: revisiting the role of hygiene in allergy

Allergy and its manifestations were first appreciated in the 1870 s. Today, the mechanism by which specific substances elicit allergic reactions remains poorly understood. This is problematic from a healthcare perspective because the prevalence of allergic disease and its societal costs are substantial. Regarding mechanistic understanding of allergy, a new proposal, The Acari Hypothesis, has been forwarded. The Hypothesis, borne from consideration of alpha-gal syndrome, postulates that acarians, i.e., mites and ticks, are operative agents of allergy. By way of their pathogenic payloads and salivary pattern recognition receptor(s), acarians potentiate in human hosts the generation of IgE against acarian dietary elements. Those elements account for most, if not all, known human allergens. Inasmuch as acarian-human interactions occur on human epithelial surfaces, it is to be expected factors that influence the presence and/or operation of acarians on those surfaces influence the expression of allergic diseases. In this report, it is proposed that two adaptations of catarrhine primates, i.e., Old World monkeys, apes and humans, evolved to deter acarian species: firstly, the expansion of eccrine glands across the entirety of body surface area, and, secondly, the secretion of sweat by those glands. Contemporary hygienic practices that reduce and/or disrupt the operation of eccrine glands are likely responsible for the increase in allergic disease seen today.

From the global to the subnational scale: Landing the compositional monitoring of drinking water and sanitation services

Monitoring of access to water and sanitation services is stipulated in Sustainable Development Goals (SDG) 6.1 and 6.2, respectively. The monitoring is carried out with a global, regional and country vision. However, in most developing countries, decentralization of services in water and sanitation management has tended to the sub-national level or has shared responsibilities between national and sub-national governments. Management at the subnational level becomes more important, since everything that is done there will impact the objectives and goals of the country. However, little or nothing progress has been made in harmonizing global indicators with those at the subnational level. Therefore, in this study we have proposed a way to disaggregate information and form WASH ladders at the subnational level. The results show using disaggregated data to interpolate models at the subnational level requires overcoming three main points: the validation of the data through statistical methods, interpolation techniques that go according to the compositional characteristics of the data and the incorporation of the uncertainty of the data into the model results. It also shows that subnational behavior is heterogeneous, which a general analysis does not capture correctly, i.e., there is a masking effect of subnational trends that the country's trend does not represent. However, these have been exceptional cases in some specific categories. Finally, the applicability of non-linear models is contrasted in a broader context, an issue that is still under discussion for its application to global monitoring. This study also provides a way to disaggregate information from the global to the sub-national level, allowing any sector analyst to replicate the methodology in a broader context.