scholarly journals Status of Water, Sanitation and Hygiene in Healthcare Facilities in the Greater Kampala Metropolitan Area, Uganda.

2020 ◽  
Author(s):  
Denis Kayiwa ◽  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
John Bosco Isunju ◽  
John C. Ssempebwa ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Waste Management ◽  
Water Supply ◽  
Metropolitan Area ◽  
Healthcare Services ◽  
Health Care Facilities ◽  
Quality Analysis ◽  
Sanitation And Hygiene ◽  
Significant Difference ◽  
The Status

Abstract Background: Improved Water, Sanitation and Hygiene (WASH) services in Health Care Facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of hospital acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on the status of WASH in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the status of WASH within HCFs in the GKMA in order to inform policy and WASH programming.Methods: A cross-sectional study was conducted in 60 HCFs. The status of WASH in the study facilities was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. The relationships between WASH status and HCF characteristics were assessed using Fishers’ exact tests.Results: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH status respectively. About 48.3% (28/58) had a limited water supply status, 84.5% (49/58) had limited sanitation status, 50.0% (29/58) had limited environmental cleanliness status, 56.9% (33/58) had limited hand hygiene status and 51.7% (30/58) had limited waste management status. Overall, there were significant differences in water supply status by ownership of the HCF and level of HCF. There was a significant statistical difference in WASH status between public and private not for profit facilities (p = 0.021). A significant difference was also observed in WASH status between hospitals and lower levels HCFs (p = 0.004). Conclusion: Majority of the HCFs in the GKMA had limited access to all WASH service domains i.e. water supply, sanitation, hand hygiene, environmental cleanliness and healthcare waste management. We recommend deliberate increased investments in WASH for healthcare services, especially for sanitation and hand hygiene provisions which were in the poorest state. Improvements in WASH conditions will not only minimize the risk of transmission of HAIs but also associated costs.

scholarly journals Assessment of water, sanitation and hygiene service availability in healthcare facilities in the greater Kampala metropolitan area, Uganda

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Denis Kayiwa ◽  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
John Bosco Isunju ◽  
John C. Ssempebwa ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Waste Management ◽  
Metropolitan Area ◽  
Health Centre ◽  
Quality Analysis ◽  
Management Service ◽  
Public Health Importance ◽  
Healthcare Facilities ◽  
Sanitation And Hygiene ◽  
Health Care Waste

Abstract Background Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability and status of WASH services within HCFs in the GKMA in order to inform policy and WASH programming. Methods A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%). Conclusions Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

scholarly journals Assessment of Water, Sanitation and Hygiene Services in Healthcare Facilities in the Greater Kampala Metropolitan Area, Uganda

2020 ◽  
Author(s):  
Denis Kayiwa ◽  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
John Bosco Isunju ◽  
John C. Ssempebwa ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Waste Management ◽  
Metropolitan Area ◽  
Health Centre ◽  
Quality Analysis ◽  
Management Service ◽  
Public Health Importance ◽  
Healthcare Facilities ◽  
Sanitation And Hygiene ◽  
Health Care Waste

Abstract Background: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.Methods: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).Conclusions: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs are largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

scholarly journals Assessment of Water, Sanitation and Hygiene Service Availability in Healthcare Facilities in the Greater Kampala Metropolitan Area, Uganda

2020 ◽  
Author(s):  
Denis Kayiwa ◽  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
John Bosco Isunju ◽  
John C. Ssempebwa ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Waste Management ◽  
Metropolitan Area ◽  
Health Centre ◽  
Quality Analysis ◽  
Management Service ◽  
Public Health Importance ◽  
Healthcare Facilities ◽  
Sanitation And Hygiene ◽  
Health Care Waste

Abstract Background: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.Methods: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software. Results: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).Conclusions: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs are largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

scholarly journals Assessment of Water, Sanitation and Hygiene Service Availability in Healthcare Facilities in the Greater Kampala Metropolitan Area, Uganda

2020 ◽  
Author(s):  
Denis Kayiwa ◽  
Richard K. Mugambe ◽  
Jane Sembuche Mselle ◽  
John Bosco Isunju ◽  
John C. Ssempebwa ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Waste Management ◽  
Metropolitan Area ◽  
Health Centre ◽  
Quality Analysis ◽  
Management Service ◽  
Public Health Importance ◽  
Healthcare Facilities ◽  
Sanitation And Hygiene ◽  
Health Care Waste

Abstract Background: Improved Water, Sanitation and Hygiene (WASH) in Healthcare facilities (HCFs) is of significant public health importance. It is associated with a reduction in the transmission of healthcare acquired infections (HAIs), increased trust and uptake of healthcare services, cost saving from infections averted, increased efficiency and improved staff morale. Despite these benefits, there is limited evidence on availability of WASH services in HCFs in the Greater Kampala Metropolitan Area (GKMA). This study assessed the availability of WASH services within HCFs in the GKMA in order to inform policy and WASH programming.Methods: A cross-sectional study was conducted in 60 HCFs. Availability of WASH services in the study HCFs was assessed using a validated WASH Conditions (WASHCon) tool comprising of structured interviews, HCF observations and microbial water quality analysis. Data were analysed using Stata 14 software and R software.Results: Overall, 84.5% (49/58) and 12.1% (7/58) of HCFs had limited and basic WASH service respectively. About 48.3% (28/58) had limited water service, 84.5% (49/58) had limited sanitation service, 50.0% (29/58) had limited environmental cleanliness service, 56.9% (33/58) had limited hand hygiene service, and 51.7% (30/58) had limited waste management service. About 94.4% of public HCFs had limited WASH service compared to only 68.2% of private not for profit facilities. More health centre IIIs, 92.5% and health centre IVs (85.7%) had limited WASH service compared to hospitals (54.5%).Conclusions: Our findings indicate that provision of water, sanitation, hand hygiene, environmental cleanliness, and health care waste management services within HCFs is largely hindered by structural and performance limitations. In spite of these limitations, it is evident that environmental cleanliness and treatment of infectious waste can be attained with better oversight and dedicated personnel. Attaining universal WASH coverage in HCFs will require deliberate and strategic investments across the different domains.

scholarly journals What it takes to save lives: An assessment of water, sanitation, and hygiene facilities in temporary COVID-19 isolation and treatment centers of Southern Ethiopia: A mixed-methods evaluation

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256086
Author(s):  
Aiggan Tamene
Keyword(s):  
Health Care ◽  
Hand Hygiene ◽  
Rural Areas ◽  
Health Care Facilities ◽  
Infection Prevention And Control ◽  
Southern Ethiopia ◽  
Limited Information ◽  
Sanitation And Hygiene ◽  
Significant Difference ◽  
Care Facilities

Background Quality water, sanitation, and hygiene facilities act as barricades to the transmission of COVID-19 in health care facilities. These facilities ought to also be available, accessible, and functional in temporary treatment centers. Despite numerous studies on health care facilities, however, there is limited information on the status of WASH facilities in such centers. Methods The assessment of health care facilities for the COVID-19 response checklist and key informant interviews, were used for data collection. 35 treatment centers in Southern Ethiopia were surveyed. Eightkey informants were interviewed to gain an understanding of the WASH conditions in the treatment centers. The Quantitative data was entered using EPI-INFO 7 and exported to SPSS 20 for analysis. Results are presented using descriptive statistics. Open Code 4.02 was used for the thematic analysis of the qualitative data. Results Daily water supply interruptions occurred at 27 (77.1%) of the surveyed sites. Only 30 (85.72%) had bathrooms that were segregated for personnel and patients, and only 3 (3.57%) had toilets that were handicapped accessible. 20(57.2%) of the treatment centers did not have a hand hygiene protocol that satisfied WHO guidelines. In terms of infection prevention and control, 16 (45.71%) of the facilities lacked adequate personal protective equipment stocks. Between urban and rural areas, there was also a significant difference in latrine maintenance, hand hygiene protocol design and implementation, and incineration capacity. Conclusion The results reveal crucial deficiencies in the provision of WASH in the temporary COVID-19 treatment centers. Efforts to improve WASH should offer priority to hygiene service interventions to minimize the risk of healthcare-acquired infections. The sustainable provision of hygiene services, such as hand washing soap, should also be given priority.

scholarly journals Neglected scenario of sanitation in schools of Sunsari district of Nepal: Critical sphere for public health consideration

2017 ◽  
Vol 13 (2) ◽  
pp. 114-124
Author(s):  
Pramila Rai ◽  
R B Sah ◽  
R Rijal ◽  
PK Pokharel
Keyword(s):  
Public Schools ◽  
Water Supply ◽  
School Environment ◽  
Simple Random Sampling ◽  
Vital Role ◽  
Septic Tank ◽  
Sanitation And Hygiene ◽  
The Status ◽  
Sound Environment ◽  
Equal Right

Background: Provision of adequate water supply, sanitation facilities, hygiene and waste management in schools reduces the disease burden among children, staff and their families. Every child has equal right to grow in a safe and sound environment. However, levels of water supply, sanitation and hygiene are unacceptable in many schools worldwide.Method: Study included forty schools comprising twenty public and twenty private schools of Sunsari district selected by simple random sampling method. The status of school environment and sanitation were assessed by using observation and interview method using observation checklist, questionnaires and photographs.Result: Two public schools were completely devoid of sanitary facilities though toilet facility was present physically. Students couldn’t use toilet due to lack of water in one school due to theft of tube well and septic tank of the toilet was full in another school. Other remaining schools didn’t have satisfactory, clean and proper sanitary facilities. Only few schools had convenient hand washing point.Conclusion: Sanitation facilities were in neglected state evidenced by unavailability of sanitation facilities even though that was physically present and the sanitation facilities were in pitiable condition including cleanliness, water supply. All the stakeholders including school management, supervisors, parents, teachers, students should be ready to play vital role on their own. Lack of one toilet affects no. of students and people of surrounding area and raises of risk of soil transmitted diseases so this situation demands attention of authorities and other stakeholders.Health Renaissance 2015;13(2): 114-124

scholarly journals Psychological impacts of the COVID-19 pandemic on one-month postpartum mothers in a metropolitan area of Japan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Youji Takubo ◽  
Naohisa Tsujino ◽  
Yuri Aikawa ◽  
Kazuyo Fukiya ◽  
Momoko Iwai ◽  
...  
Keyword(s):  
Mental Health ◽  
Metropolitan Area ◽  
Depression Scale ◽  
Significant Difference ◽  
The Status ◽  
Self Harm ◽  
Post Hoc ◽  
Maternity Health ◽  
Postpartum Mothers ◽  
The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has recently become the most important issue in the world. Very few reports in Japan have examined the impact of the COVID-19 pandemic on peripartum mental health. We examined the status of postpartum mental health before and during COVID-19 pandemic from a consecutive database in a metropolitan area of Japan. Methods The subjects were women who had completed a maternity health check-up at a core regional hospital in Yokohama during the period from April 1, 2017, to December 31, 2020. We collected the subjects’ scores for the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale (MIBS) at 1 month postpartum. The subjects were divided into four groups (three Before COVID-19 groups and a During COVID-19 group). MANOVA and post-hoc tests were used to determine mental health changes in the postpartum period among the four groups. Results The Before and During COVID-19 groups contained 2844 and 1095 mothers, respectively. There were no significant difference in the total scores of the EPDS and MIBS among the four groups. However, the EPDS items related to anxiety factors were significantly higher and the EPDS items related to anhedonia and depression factors (excluding thoughts of self-harm) were significantly lower in the During COVID-19 group. Conclusion The EPDS scores changed in connection with the COVID-19 pandemic. Anxiety, which represent hypervigilance, was significantly higher and anhedonia and depression were significantly lower in the During COVID-19 group. Our results may reflect COVID-19-related health concerns and a lack of social support caused by the COVID-19 pandemic.

scholarly journals The Status of International Collaboration in Writing Specialised Articles on Water Pollution, Air Pollution and Solid Waste Management

2020 ◽  
Author(s):  
Aram Tirgar ◽  
Zahra Aghalari ◽  
Mika Sillanpää
Keyword(s):  
Water Pollution ◽  
Air Pollution ◽  
Waste Management ◽  
Environmental Health ◽  
Solid Waste ◽  
International Collaboration ◽  
Solid Waste Management ◽  
T Test ◽  
Significant Difference ◽  
The Status

Abstract BackgroundConducting research and writing articles in the three specialised fields of environmental health, air pollution, water pollution and solid waste management through collaboration between Iranian and international researchers lead to information exchange, science advancement and environmental problem-solving. This study therefore aimed to determine the status of international collaboration in writing specialised articles on water and air pollution and solid waste management.MethodsThis descriptive cross-sectional study was conducted over twelve years (2008-2019) by reviewing all articles published in the fields of air pollution, water pollution and solid waste management in five specialised environmental health journals. All articles were downloaded after visiting the journal site. The full text of the articles was reviewed and articles that matched the purpose of the study were included in it. Data were collected using a researcher-made checklist. The information included in the checklist was the number of articles published and the status of the authors' participation in terms of number, gender, country and continent in each of the fields of water pollution, air pollution and solid waste management. Statistical analysis of data was performed using a T-test. VOS viewer software was used to visualise the data and chart the extent of the international authors' involvement with Iranian researchers from different continents and countries.ResultsA review of 1,679 articles in 135 editions of five specialised environmental health journals revealed that 883 of the articles were in the fields of water and air pollution and solid waste management and 123 of the articles were written by international researchers. The top continents concerning collaboration in writing articles with Iran were Asia, Africa and Europe, respectively, with 70, 22, and 19 articles. In all three fields, India had the highest scientific participation with Iran. The gender distribution of the authors in these 123 articles with the participation of international authors showed that of the 406 authors, 35.7% were female and 65.3% were male and, for articles with just Iranian authors, 28.6% were female and 72.4% were male. The T-test for comparing the mean number of male and female authors in each article with and without the participation of international researchers showed no significant difference.ConclusionsBased on their findings and comparisons with other research on the amount of scientific contributions by international researchers in other countries, it was found that the extent of international participation in the compilation of articles on water pollution, air pollution and solid waste management was large. However, given the low proportion of European and American collaboration in articles, it seems necessary to adopt ways to attract more researchers from advanced countries in the fields of air pollution, water pollution and solid waste management.

scholarly journals Water supply, sanitation and hygiene interventions and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia: a comparative cross-sectional study

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Negasa Eshete Soboksa ◽  
Abebe Beyene Hailu ◽  
Sirak Robele Gari ◽  
Bezatu Mengistie Alemu
Keyword(s):  
Drinking Water ◽  
Water Supply ◽  
Cross Sectional Study ◽  
Major Public Health Problem ◽  
Sectional Study ◽  
Childhood Diarrhea ◽  
Cross Sectional ◽  
Sanitation And Hygiene ◽  
Jimma Zone ◽  
Significant Difference

Abstract Background Diarrhea is a major public health problem that disproportionately affects children in developing countries, including Ethiopia. Most of the diseases can be prevented through safe drinking water supply and provision of basic sanitation and hygiene. However, there is a paucity of information on childhood diarrhea related to interventions in kebeles (smallest administrative structure) where community-led total sanitation (CLTS) implemented and not implemented (non-CLTS). Thus, the aim of this study was to assess and compare the association of water supply, sanitation and hygiene interventions, and childhood diarrhea in CLTS implemented and non-implemented kebeles. Method A comparative cross-sectional study was conducted in Kersa and Omo Nada districts of Jimma Zone, Ethiopia from July 22 to August 9, 2018. Systematically selected 756 households with under-5 children were included in the study. Data were collected through interview using structured questionnaires. Water samples were collected in nonreactive borosilicate glass bottles. The binary logistic regression model was used; variables with a p value < 0.05 were considered as significantly associated with childhood diarrhea. Results The prevalence of childhood diarrhea in the past 2 weeks was 17.7% (95% CI: 13.9–21.5) in CLTS kebeles and 22.0% (95% CI: 17.8–26.2) in non-CLTS kebeles. The occurrence of childhood diarrhea, increased among children whose families did not treat drinking water at home compared to those who treated in both CLTS (AOR = 2.35; 95% CI: 1.02–05.98) and non-CLTS (AOR = 1.98; 95% CI: 0.82–4.78) kebeles. About 96% of households in CLTS and 91% of households in non-CLTS kebeles had pit latrine with and without superstructure. Children from families that used water and soap to wash their hands were 76% less likely to have diarrhea in CLTS kebeles (AOR = 0.76; 95% CI: 0.31–1.88) and 54% less likely to have diarrhea in non-CLTS kebeles (AOR = 0.54; 95% CI: 0.17–1.72) when compared to children from families who used only water. The odds of having diarrhea was 1.63 times higher among children whose families live in CLTS non-implemented kebeles compared to those children whose families live in CLTS implemented kebeles (AOR = 1.63; 95% CI: 0.98–2.68). Conclusions No significant difference was observed in the prevalence of childhood diarrhea between CLTS and non-CLTS kebeles.

scholarly journals Water, sanitation, and hygiene services in health care facilities in the Autonomous Province of Vojvodina, Serbia

2021 ◽  
Author(s):  
Sanja Bijelović ◽  
Valentina Grossi ◽  
Enkhtsetseg Shinee ◽  
Oliver Schmoll ◽  
Dragana Jovanović ◽  
...  
Keyword(s):  
Water Quality ◽  
Health Care ◽  
Drinking Water ◽  
Waste Management ◽  
Health Care Facilities ◽  
Service Levels ◽  
Environmental Cleaning ◽  
Sanitation And Hygiene ◽  
Care Facilities ◽  
Autonomous Province

Abstract Provision of safe water, sanitation, and hygiene (WASH) services in health care facilities is a priority at the global, national, and local levels. To inform improvements planning, conditions of WASH, waste management, and environmental cleaning were assessed in 81 facilities in the Autonomous Province of Vojvodina, Serbia, as part of a nationally representative survey in 2019. The survey included on-site checks, structured interviews, and drinking-water quality analysis. WHO/UNICEF indicators for WASH service levels and an advanced service level defined at the national level were applied. The results showed that all investigated facilities provided basic water services; 94% of facilities provided basic hygiene and waste management services; 58 and 2%, respectively, provided basic cleaning and sanitation services. Only 1% of investigated facilities met the basic level for all five WASH dimensions. Advanced service levels were only met for hygiene, waste management, and/or cleaning in 15–38% of facilities. In 33% of health care facilities, drinking-water quality was not in compliance with the national standards. The results revealed that there is a need for increased awareness and efforts to ensure basic provisions for sanitation, environmental cleaning, and drinking-water safety.

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