COVID-19 water, sanitation, and hygiene response: Review of measures and initiatives adopted by governments, regulators, utilities, and other stakeholders in 84 countries

Water pollution and sanitation in Indonesia: a review on water quality, health and environmental impacts, management, and future challenges

As an archipelagic tropical developing country, Indonesia is characterized by vast expanses of rural and isolated areas. This review aims to discuss water pollution and sanitation's existing condition, health, and environmental impacts, alongside its management and challenges in Indonesia. The systematic review approach was utilized to ensure transparency and replicability, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Many water sources in Indonesia are contaminated by various pollutants such as heavy metals, microplastics, pesticides, and endocrine-disrupting chemicals (EDCs). Moreover, the existing water and wastewater treatment plants cannot completely remove pollutants, including bacteria that cause waterborne diseases. The lack of proper sanitation facilities, including toilets and latrines, is not only reported in rural areas but also in peri-urban regions of Indonesia. This situation forces many to rely on unimproved water sources, such as river water, for their daily use and engage in open defecation, which may increase the risk of direct exposure to waterborne contaminants. Insufficient sanitation has been linked to significant public health issues in Indonesia, including maternal health complications, childhood stunting, and an increased incidence of waterborne diseases such as diarrhea. Based on the findings of this review, Indonesia still needs to improve its sanitation and water treatment facilities, as well as reduce pollution of the aquatic environment. This condition not only illustrates the condition of water and sanitation in Indonesia but can also be used as an illustration of how developing countries face various pollution and sanitation problems during the massive development and industry.

The determinants of handwashing in humanitarian crisis setting during the COVID-19 pandemic: a multi-country analysis

The Wash'Em process was developed to improve the design of handwashing behaviour change programmes during outbreaks and humanitarian crises. It aims to rapidly create evidence-based, contextualized handwashing programmes. Wash'Em was widely used during the COVID-19 pandemic. This multi-country secondary data analysis compares data emerging from Wash'Em during the pandemic, to understand whether commonalities in programming constraints or the determinants of handwashing behaviour existed across countries. Wash'Em datasets (n = 38) were verified prior to inclusion in secondary data analysis; descriptively summarized and then statistical summaries of homogeneity were derived. Wash'Em was implemented as intended during the pandemic, typically taking a small number of humanitarian staff less than a week to complete. Most actors reported using the recommendations suggested by the process but did so within relatively short-term and poorly financed prevention programmes. Homogeneity in the responses to the Wash'Em tools was low indicating that the determinants of handwashing behaviour during the pandemic were predominantly shaped by pre-existing factors rather than the nature of the health threat. Hygiene programmes during outbreaks should avoid 'copying and pasting' interventions from one setting to another and instead make time to holistically understand the behavioural determinants in a specific context and develop programme activities that are designed to address these. Particular attention should be given to factors in the physical and social environment that may enable or constrain handwashing behaviour, pre-existing disease vulnerabilities and the secondary and non-health impacts of outbreaks. Wash'Em provides one feasible way of contextualizing handwashing interventions in outbreak or humanitarian settings.

Reduction in diarrhea cases following implementation of COVID-19 hand hygiene interventions in Ghana: A causal impact analysis

BACKGROUND

The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana.

METHODS

Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease.

RESULTS

A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001).

CONCLUSION

This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled.

Synthesising the evidence for effective hand hygiene in community settings: an integrated protocol for multiple related systematic reviews

INTRODUCTION

Despite evidence for the efficacy and effectiveness of hand hygiene in reducing the transmission of infectious diseases, there are gaps in global normative guidance around hand hygiene in community settings. The goal of this review is to systematically retrieve and synthesise available evidence on hand hygiene in community settings across four areas: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures.

METHODS AND ANALYSIS

This protocol entails a two-phased approach to identify relevant studies for multiple related systematic reviews. Phase 1 involves a broad search to capture all studies on hand hygiene in community settings. Databases, trial registries, expert consultations and hand searches of reference lists will be used to ensure an exhaustive search. A comprehensive, electronic search strategy will be used to identify studies indexed in PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary published in English from January 1980 to March 2023. The outcome of phase 1 will be a reduced sample of studies from which further screening, specific to research questions across the four key areas can be performed. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Quantitative and qualitative data will be extracted following best practices. We will assess all studies using the Mixed Method Appraisal Tool. All effect measures pertaining to review outcomes will be reported and a narrative synthesis of all studies will be presented including 'data-driven' descriptive themes and 'theory-driven' analytical themes as applicable.

ETHICS AND DISSEMINATION

This systematic review is exempt from ethics approval because the work is carried out on published documents. The findings of the reviews will be disseminated in related peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42023429145.

COVID-19 preparedness and response in rural and remote areas: A scoping review

This scoping review used the Arksey and O'Malley approach to explore COVID-19 preparedness and response in rural and remote areas to identify lessons to inform future health preparedness and response planning. A search of scientific and grey literature for rural COVID-19 preparedness and responses identified 5 668 articles published between 2019 and early 2022. A total of 293 articles were included, of which 160 (54.5%) were from high income countries and 106 (36.2%) from middle income countries. Studies focused mostly on the Maintenance of Essential Health Services (63; 21.5%), Surveillance, epidemiological investigation, contact tracing and adjustment of public health and social measures (60; 20.5%), Coordination and Planning (32; 10.9%); Case Management (30; 10.2%), Social Determinants of Health (29; 10%) and Risk Communication (22; 7.5%). Rural health systems were less prepared and national COVID-19 responses were often not adequately tailored to rural areas. Promising COVID-19 responses involved local leaders and communities, were collaborative and multisectoral, and engaged local cultures. Non-pharmaceutical interventions were applied less, support for access to water and sanitation at scale was weak, and more targeted approaches to the isolation of cases and quarantine of contacts were preferable to blanket lockdowns. Rural pharmacists, community health workers and agricultural extension workers assisted in overcoming shortages of health professionals. Vaccination coverage was hindered by weaker rural health systems. Digital technology enabled better coordination, communication, and access to health services, yet for some was inaccessible. Rural livelihoods and food security were affected through disruptions to local labour markets, farm produce markets and input supply chains. Important lessons include the need for rural proofing national health preparedness and response and optimizing synergies between top-down planning with localised planning and coordination. Equity-oriented rural health systems strengthening and action on rural social determinants is essential to better prepare for and respond to future outbreaks.

The End of Life Accompanied by COVID-19: A Qualitative Study on Changes in Behavior and Stigmatization of the Grieving Families in Peru (Part II)

The rapid spread of SARS-CoV-2 has led to changes in every aspect of life and death. In Peru, where the longest quarantine has occurred with suboptimal results, the rituals have been turned around, impacting the relatives in multiple aspects. Here, we used a qualitative approach to analyze unresolved grief, hygiene changes, and stigma through semi-structured, online (Google Meet) interviews with 15 participants aged 20-72, who had lost family members to COVID-19. The recorded and transcribed interviews were analyzed using reflexive thematic analysis. Most participants had unresolved grief due to the blocking of funeral rituals, which could predispose them to prolonged mourning. After the loss of relatives, hygiene measures will be improved to avoid infections and new deaths in every family, while most participants felt no stigma in their milieu, since their relatives accompanied them during the funeral, supporting them from afar. It is important that interventions are implemented to prevent the progression of grief by providing mental health opportunities for the bereaved.

Assessing health impact of COVID-19 and associated household socioeconomic factors in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System

Introduction

The COVID-19 pandemic had an unprecedented impact on the health and well-being of populations worldwide. Few studies have used household data to explore the health risks associated with COVID-19 in low-income and middle-income countries. This study assessed population vulnerability to COVID-19 by examining household socioeconomic factors related to COVID-19 health risks in Papua New Guinea (PNG).

Methods

Using household socioeconomic surveillance data from 2020, encompassing 37 880 residents living within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System, the study assessed COVID-19 health risks based on the socioeconomic demographic characteristics of the surveillance population. Multinomial logistic regression analyses were conducted to determine associated factors and to estimate predictors of COVID-19 health risks.

Results

Among the surveillance population, more than 9% reported experiencing COVID-19 health risks, including home-based quarantine (9.6%), centre-based quarantine (0.5%), positive COVID-19 test (0.1%), hospitalisation due to COVID-19 (0.3%) and death from COVID-19 (0.3%). People living in semimodern houses (OR 1.47 (95% CI 1.35 to 1.61)) (verse permanent houses), individuals living in houses with 1-2 bedrooms (OR 1.12 (95% CI 1.01 to 1.25)) (verse houses with 4+ bedrooms) and those belonging to the poorest wealth quintile (OR 1.16 (95% CI 1.024 to 1.314)) (verse the richest) were more susceptible to COVID-19 health risks. Protective factors against COVID-19 health risks included urban residence (OR 0.65 (95% CI 0.59 to 0.71)) (verse rurality), aged 0-4 years (OR 0.76 (95% CI 0.64 to 0.91)) (verse aged 55+ years), households with 7-8 members (OR 0.84 (95% CI 0.74 to 0.96)) (verse 10+ members), handwashing with soap (OR 0.3 (95% CI 0.28 to 0.33)) (verse without soap).

Conclusions

The study provides insights into the susceptibility to COVID-19 health risks across socioeconomic groups in PNG. These findings have implications for development of public health policies and interventions that can be extrapolated to similar settings for enhancing preparedness for future public health emergencies.

Responsiveness of water-sector regulation in Brazil to the Covid-19 pandemic: A view through the human rights lens

This paper provides an overview of the regulatory responses to Covid-19 from the regulatory authorities of Brazilian states. This paper aims to provide new insights into the operationalization of the human rights to water and sanitation in the Brazilian regulatory authorities' actions during a health emergency. We find that communities located in unserved areas were not mentioned in the regulatory responses, nor were people in vulnerable situations. Equity and non-discrimination principles were correlated more with economic measures. This study has also identified the absence of responses related to access to sanitation facilities, with normative contents related to the issue not appearing in the content analysis.

Fabrication of a bi-metallic metal organic framework nanocomposite for selective and sensitive detection of triclosan

Transition metal-ion based nanocomposites are widely used owing to their ease of synthesis and cost-effectiveness in the sensor development. In this study, we have synthesized bi-metallic (iron and zinc) metal organic framework (MOF) nanorods-nanoparticles (denoted as Fe₂Zn-MIL-88B) with a well-defined structure and characterized them. The bimetallic material nanocomposite (Fe₂Zn-MIL-88B, nafion (Nf), and multiwalled carbon nanotube (MWCNT)) was fabricated on the electrode (glassy carbon electrode (GCE) or screen printed carbon electrode (SPCE)) surface within 10 min at room temperature. The Fe₂Zn-MIL-88B/Nf/MWCNT@GCE showed an excellent electron transfer mechanism compared to a bare GCE and bare SPCE. The Fe₂Zn-MIL-88B based nanocomposite electrode triggers the oxidation of the environmental carcinogenic molecule triclosan (TCS). Under optimized conditions, the sensor has a limit of detection of 0.31 nM and high selectivity to TCS in the presence of other interfering agents. The sensor has a good day-to-day TCS detection reproducibility. Fe₂Zn-MIL-88B was stable even after 11 months of synthesis and detected TCS with similar sensitivity. The fabrication of the Fe₂Zn-MIL-88B/Nf/MWCNT nanocomposite was successfully translated from the GCE to SPCE. TCS was detected in human plasma and commercial products such as soaps, skin care products, shampoos, and tooth pastes.

Can Stringent Government Initiatives Lead to Global Economic Recovery Rapidly during the COVID-19 Epidemic?

This paper investigates the effectiveness of government measures implemented against COVID-19 and the factors influencing a country's economic growth from a global perspective. With the help of the data of the Government Response Stringency Index (GRSI), Google mobility, and confirmed COVID-19 daily cases, we conducted a panel model for 105 countries and regions from 11 March 2020 to 31 June 2021 to explore the effects of response policies in different countries against the pandemic. First, the results showed that staying in residential places had the strongest correlation with confirmed cases. Second, in countries with higher government stringency, stay-at-home policies carried out in the early spread of the pandemic had the most effective the impact. In addition, the results have also been strictly robustly analyzed by applying the propensity score matching (PSM) method. Third, after reconstructing a panel data of 47 OECD countries, we further concluded that governments should take stricter restrictive measures in response to COVID-19. Even though it may also cause a shock to the market in the short term, this may not be sustainable. As long as the policy response is justified, it will moderate the negative effect on the economy over time, and finally have a positive effect.

A Qualitative Evaluation of COVID-19 Preventative Response Activities in South Kivu, Democratic Republic of the Congo

OBJECTIVE

In this evaluation of COVID-19 preventative response programs in South Kivu, Democratic Republic of the Congo (DRC), we aimed to explore community understandings of COVID-19, assess operational successes and challenges of COVID response activities, and identify barriers to practicing COVID-19 preventative behaviors.

METHODS

Thirty-one semi-structured interviews were conducted from April to September 2021 in South Kivu, DRC, with community members (n = 16) and programmatic stakeholders (n = 15) (healthcare providers, government officials, and developmental and NGO staff engaged in COVID-19 response).

FINDINGS

Most community members were aware of COVID-19 and its global burden, but few were aware of local transmission in their area. Some community members attributed COVID-19 to actions of malevolent neighbors, miasma ("bad air"), or spirits. Awareness of COVID-19 preventative measures was widespread, largely because of radio and TV health promotion programs. Community members and programmatic stakeholders both said community-level non-compliance to COVID-19 preventative measures was high despite high awareness of preventative methods. Community members expressed concern that face masks distributed as part of preventative programs contained the COVID-19 virus. Programmatic stakeholders emphasized the need for broader health system strengthening with improved coordination, provision of resources to health facilities at the provincial level, and prioritization of research. Lessons learned from addressing Ebola were leveraged for COVID-19 health promotion, rapid training of healthcare personnel, and surveillance.

CONCLUSIONS

Community-informed approaches are needed for effective COVID-19 preventative response programs in South Kivu, DRC. Our study identified successes and challenges in COVID-19 response activities. Future research should assess the effectiveness of integrating preventive programs with COVID-19 vaccination efforts.

Chlorination in the pandemic times: The current state of the art for monitoring chlorine residual in water and chlorine exposure in air

During the COVID-19 pandemic, the use of chlorine-based disinfectants has surged due to their excellent performance and cost-effectiveness in intercepting the spread of the virus and bacteria in water and air. Many authorities have demanded strict chlorine dosage for disinfection to ensure sufficient chlorine residual for inactivating viruses and bacteria while not posing harmful effects to humans as well as the environment. Reliable chlorine sensing techniques have therefore become the keys to ensure a balance between chlorine disinfection efficiency and disinfection safety. Up to now, there is still a lack of comprehensive review that collates and appraises the recently available techniques from a practical point of view. In this work, we intend to present a detailed overview of the recent advances in monitoring chlorine in both dissolved and gaseous forms aiming to present valuable information in terms of method accuracy, sensitivity, stability, reliability, and applicability, which in turn guides future sensor development. Data on the analytical performance of different techniques and environmental impacts associated with the dominated chemical-based techniques are thus discussed. Finally, this study concludes with highlights of gaps in knowledge and trends for future chlorine sensing development. Due to the increasing use of chlorine in disinfection and chemical synthesis, we believe the information present in this review is a relevant and timely resource for the water treatment industry, healthcare sector, and environmental organizations.

Disinfection of corona and myriad viruses in water by non-thermal plasma: a review

Nowadays, in parallel to the appearance of the COVID-19 virus, the risk of viruses in water increases leading to the necessity of developing novel disinfection methods. This review focuses on the route of virus contamination in water and introduces non-thermal plasma technology as a promising method for the inactivation of viruses. Effects of essential parameters affecting the non-thermal discharge for viral inactivation have been exposed. The review has also illustrated a critical discussion of this technology with other advanced oxidation processes. Additionally, the inactivation mechanisms have also been detailed based on reactive oxygen and nitrogen species.

Impact of COVID-19 on paediatric admissions to a Chinese hospital: a single-centre retrospective chart review

OBJECTIVE

To explore the impact of the COVID-19 on the distribution, type and patterns of diseases in hospitalised children under local antiepidemic measures.

DESIGN

Retrospective chart review.

SETTING

Electronic medical records of patients hospitalised in the paediatric department of a tertiary hospital in South China from 21 January 2019 to 20 January 2021.

PARTICIPANTS

Records of 2139 patients.

OUTCOME MEASURES

Data were analysed before and during the COVID-19 pandemic. Disease characteristics were analysed based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Features of the length of hospital stay were investigated. Categorical variables involving more than three groups were analysed using an overall χ² test, followed by pairwise comparisons.

RESULTS

During the COVID-19 outbreak period, paediatric hospitalisation was reduced by 29.6%, from 1255 to 884. The proportions of infection-related diseases (36.3% (455 cases) vs 20.8% (184 cases)), respiratory system-related diseases (22.5% (283 cases) vs 9.4% (83 cases)); and endocrine, nutritional and metabolic diseases (17.1% (214 cases) vs 9.2% (81 cases)) decreased significantly, whereas that of musculoskeletal and connective tissue diseases increased from 11.0% (138 cases) to 20.1% (178 cases), thereby becoming the most common reason for hospitalisation. The proportions of diseases of the nervous system (12.4% (156 cases) to 18.8% (166 cases)) and mental and behavioural disorders (0.2% (3 cases) to 2.1% (19 cases)) increased significantly. The average length of hospital stay increased after the outbreak (7.57±6.53 vs 8.36±6.87).

CONCLUSION

The number of hospitalisation cases decreased during the COVID-19 period. The prominent decreases in hospitalisation associated with infections and respiratory system diseases were likely attributed to the improved epidemic prevention work, enhancement of people's health awareness and fear of possible exposure to COVID-19. Describing the impact of COVID-19 on disease patterns may provide a reference for resource planning during the pandemic.

Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review

The present narrative review aimed to analyze the impact of the COVID-19 pandemic on the sustainable development goals (SDGS). This information would allow a better comprehension of the actual state of the SDGS and a more efficient programming in future interventions. To achieve the objective of the study, a consensual and critical review was carried out using both primary sources, such as scientific articles, and secondary sources, such as bibliographic indexes, web pages and databases. The Sustainable Development Goals are a global call to action to end poverty, close the gender gap, protect the planet, and improve the lives of people around the world. In 2015, the United Nations General Assembly adopted 17 goals as part of the 2030 Agenda for Sustainable Development, which sets out a plan to achieve the goals in 15 years. However, the COVID-19 pandemic crisis has been a turning point in the achievement of these goals, due to all its consequences at the political, economic, and socio-cultural levels. This review can be used as a guide for future research and reviews in order to understand the status of each of the SDGs and what actions have been taken and proposed in the aftermath of the pandemic in recent years.

Rural Sanitation: Scenarios and Public Policies for the Brazilian Semi-Arid Region

Brazil’s primary sanitation sector has been neglected, especially concerning rural sanitation. Population dispersion and the difficulty of access in many rural communities bring more significant challenges to the universalization of the service and, consequently, vulnerabilities for the population. The present work builds a theoretical framework about the context of rural sanitation in Brazil, with history, weaknesses in the sector, the impact of COVID-19 and new technologies, and central public policies in the State of Pernambuco. It is known that COVID-19 has caused considerable challenges that, added to the obstacles to national sanitation, result in greater vulnerability to the population, especially for indigenous peoples, quilombolas, and diffuse rural communities. In the State of Pernambuco, certain policies, such as the One Million Rural Cisterns Program (P1MC), One Land and Two Waters Program (P1 + 2), Água Doce Program and Operação Pipa Program, significantly improved the quality of life of the rural population. However, these measures are not enough to remedy the sector’s shortcomings. Although alternative sanitation technologies bring hope to the sector, there is a long way to go towards the universalization of sanitation.

Stakeholder Perspectives on COVID-19 and Household Water Access in Vulnerable Communities in the Mekong Region

The COVID-19 pandemic has underlined the importance of safe access to sufficient clean water in vulnerable communities, renewing interest in water, sanitation and hygiene (WASH) programs and related targets under Sustainable Development Goal 6 (SDG 6). The purpose of this study was to better understand the obstacles to water access in vulnerable communities and identify ways they might be addressed in five countries in the Mekong Region (Cambodia, Laos, Myanmar, Thailand, Vietnam). To this end, qualitative interviews with 50 government officials and development or health experts were complimented with a quantitative survey of the experiences and views of individuals in 15 vulnerable communities. There were several key findings. First, difficulties in accessing sufficient clean water for drinking and hygiene persist in certain vulnerable communities, including informal urban settlements, remote minority villages, and migrant worker camps. Second, limited rights, high prices, and remote locations were common obstacles to household access to improved water sources. Third, seasonal differences in the availability of clean water, alongside other disruptions to supply such as restrictions on movement in COVID-19 responses, drove households towards lower quality sources. Fourth, there are multiple threats to water quality from source to consumption that should be addressed by monitoring, treatment, and watershed protection. Fifth, stakeholder groups differ from each other and residents of vulnerable communities regarding the significance of water access, supply and quality difficulties, and how they should be addressed. The paper ends with a set of program suggestions addressing these water-related difficulties.

An examination of water, sanitation, and hygiene (WASH) accessibility and opportunity in urban informal settlements during the COVID-19 pandemic: Evidence from Nairobi, Kenya

This research examines water, sanitation, and hygiene (WASH) accessibility and opportunity in Kibera and Mathare during the COVID-19 pandemic in 2021. Kibera and Mathare are two of the largest urban informal settlements in Nairobi (the capital city of Kenya) as well as Sub-Saharan Africa. Accessibility indicates how easily a person can reach WASH facilities from their home by walking. Opportunity represents how many WASH options a person has near their home. We utilize the data on water and toilet facilities collected by GroundTruth Initiative in partnership with Map Kibera Trust (local community partners) between February and April 2021 - amid the COVID-19 pandemic. By conducting quantitative geospatial analysis, we illustrate WASH accessibility and related issues that were not evident in previous studies: (1) 77.4% of people living in Kibera have limited WASH facility accessibility or opportunity; (2) 60.6% of people living in Mathare have limited WASH facility accessibility or opportunity; (3) there is a clear geographic pattern in WASH facility accessibility and opportunity; and (4) overall accessibility and opportunity is better in Mathare than in Kibera. This study is one of the first studies to examine WASH accessibility and opportunity in urban informal settlements during the COVID-19 pandemic by utilizing the current data and quantitative geospatial methods. Based on the results, we discuss important public health policy implications for people living in urban informal settlements to improve their WASH facility accessibility and opportunity during the COVID-19 pandemic.

Access to and challenges in water, sanitation, and hygiene in healthcare facilities during the early phase of the COVID-19 pandemic in Ethiopia: A mixed-methods evaluation

BACKGROUND

Inadequate water, sanitation, and hygiene (WASH) in healthcare facilities (HCFs) have an impact on the transmission of infectious diseases, including COVID-19 pandemic. But, there is limited data on the status of WASH facilities in the healthcare settings of Ethiopia. Therefore, this study aimed to assess WASH facilities and related challenges in the HCFs of Northeastern Ethiopia during the early phase of COVID-19 pandemic.

METHODS

An institution-based cross-sectional study was conducted from July to August 2020. About 70 HCFs were selected using a simple random sampling technique. We used a mixed approach of qualitative and quantitative study. The quantitative data were collected by an interviewer-administered structured questionnaire and observational checklist, whereas the qualitative data were collected using a key-informant interview from the head of HCFs, janitors, and WASH coordinator of the HCFs. The quantitative data were entered in EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The quantitative data on access to WASH facilities was reported using WHO ladder guidelines, which include no access, limited access, and basic access, whereas the qualitative data on challenges to WASH facilities were triangulated with the quantitative result.

RESULTS

From the survey of 70 HCFs, three-fourths 53 (75.7%) were clinics, 12 (17.2%) were health centers, and 5 (7.1%) were hospitals. Most (88.6%) of the HCFs had basic access to water supply. The absence of a specific budget for WASH facilities, non-functional water pipes, the absence of water-quality monitoring systems, and frequent water interruptions were the major problems with water supply, which occurred primarily in clinics and health centers. Due to the absence of separate latrine designated for disabled people, none of the HCFs possessed basic sanitary facilities. Half (51.5%) of the HCFs had limited access to sanitation facilities. The major problems were the absence of separate latrines for healthcare workers and clients, as well as female and male staffs, an unbalanced number of functional latrines for the number of clients, non-functional latrines, poor cleanliness and misuse of the latrine. Less than a quarter of the HCFs 15 (21.4%) had basic access to handwashing facilities, while half 35 (50%) of the HCFs did not. The lack of functional handwashing facilities at expected sites and misuse of the facilities around the latrine, including theft of supplies by visitors, were the two most serious problems with hygiene facilities.

CONCLUSION

Despite the fact that the majority of HCFs had basic access to water, there were problems in their sanitation and handwashing facilities. The lack of physical infrastructure, poor quality of facilities, lack of separate budget to maintain WASH facilities, and inappropriate utilization of WASH facilities were the main problems in HCFs. Further investigation should be done to assess the enabling factors and constraints for the provision, use, and maintenance of WASH infrastructure at HCFs.

SARS-CoV-2 RNA surveillance in large to small centralized wastewater treatment plants preceding the third COVID-19 resurgence in Bangkok, Thailand

Wastewater surveillance for SARS-CoV-2 RNA has been a successful indicator of COVID-19 outbreaks in populations prior to clinical testing. However, this has been mostly conducted in high-income countries, which means there is a dearth of performance investigations in low- and middle-income countries with different socio-economic settings. This study evaluated the applicability of SARS-CoV-2 RNA monitoring in wastewater (n = 132) to inform COVID-19 infection in the city of Bangkok, Thailand using CDC N1 and N2 RT-qPCR assays. Wastewater influents (n = 112) and effluents (n = 20) were collected from 19 centralized wastewater treatment plants (WWTPs) comprising four large, four medium, and 11 small WWTPs during seven sampling events from January to April 2021 prior to the third COVID-19 resurgence that was officially declared in April 2021. The CDC N1 assay showed higher detection rates and mostly lower Ct values than the CDC N2. SARS-CoV-2 RNA was first detected at the first event when new reported cases were low. Increased positive detection rates preceded an increase in the number of newly reported cases and increased over time with the reported infection incidence. Wastewater surveillance (both positive rates and viral loads) showed strongest correlation with daily new COVID-19 cases at 22-24 days lag (Spearman's Rho = 0.85-1.00). Large WWTPs (serving 432,000-580,000 of the population) exhibited similar trends of viral loads and new cases to those from all 19 WWTPs, emphasizing that routine monitoring of the four large WWTPs could provide sufficient information for the city-scale dynamics. Higher sampling frequency at fewer sites, i.e., at the four representative WWTPs, is therefore suggested especially during the subsiding period of the outbreak to indicate the prevalence of COVID-19 infection, acting as an early warning of COVID-19 resurgence.