Urinary incontinence in children aged 5 to 12 in an emergency setting: lessons learned in Ethiopia

This scoping study aimed to be the first to explore the number of children aged 5 to 12 in an emergency setting (Tukaley village, Ethiopia) wetting themselves, and demand for support to manage self-wetting in the home. A survey asked 524 children about their latrine behaviours; and 312 adult caregivers about the latrine behaviours of the children aged 5 to 12 they care for. Few adult caregivers (1 per cent) indicated that children were self-wetting during the day and/or night, and only one child indicated self-wetting (during the day). Yet the survey revealed demand from adult caregivers for household items typically used to manage involuntary self-wetting. This could suggest self-wetting is occurring, but there is a reluctance to disclose it. Given the impact of self-wetting on the lives of children and their adult caregivers, it would be unethical for it not to be considered when developing emergency programmes across sectors including the water, sanitation, and hygiene sector. With further research and modifications to the survey, it could provide greater clarity on the number of children self-wetting and the scale of demand for support to inform emergency programme design.

Editorial: Knowing when and how to disengage humanitarian response

The machinery of international humanitarian response, once triggered and functioning in a country, has a life of its own. A multiplicity of United Nations agencies and international non-governmental organizations set up their programmes. The various sector- or subject-focused ‘clusters’, established to strengthen pre-emergency preparedness and operational coordination once an emergency has occurred, are activated. Humanitarian response plans are published, and appeals for funds made.

Sanitation Challenge for Ghana (SC4Gh): motivating local authorities through innovation prizes to achieve SDG6

As part of the UK Government-funded Ideas to Impact programme, the Sanitation Challenge for Ghana (SC4Gh) ran from 2015 to 2019 aiming to incentivize local authorities in Ghana to prioritize resources to improve municipal sanitation services towards the achievement of Sustainable Development Goal (SDG) 6. The paper reviews the overall results of the SC4Gh and discusses selected results for the Metropolitan, Municipal, and District Assemblies (MMDAs) involved. The most notable outcome was that MMDAs involved were able to make significant improvements across the sanitation value chain with limited technical support and no upfront external donor funding. Another important outcome was the empowering aspect of the prize process which enabled MMDAs to innovate their plans based upon their own ideas to improve sanitation services. The prize process was an unprecedented opportunity for MMDAs throughout the country to participate in an international programme, resulting in encouraging results particularly from smaller, less well-resourced MMDAs in remote parts of Ghana who secured prizes in both stages of the Challenge.

How socio-demographic and mass media factors affect sanitary item usage among women in rural and urban India

Our study’s objective is to examine the various socio-demographic and mass media factors of sanitary item usage among rural and urban women in India. We have used data from the Indian version of the Demographic and Health Survey, conducted in 2015–16 for this study, with a sample of 247,833 women in the age group of 15 to 24 years. Binary logistics regression was performed separately for urban and rural women to understand the various determinants of sanitary item usage. We found that three-quarters of women in urban areas use sanitary items compared to half of the women in rural areas. Indian women in rural areas appear to be at a considerable disadvantage compared to their urban counterparts with regard to sanitary item usage. Factors determining sanitary item usage did not vary between urban and rural areas. However, education, wealth, mass media, and toilet facility were the major factors in understanding the improvement in sanitary item usage in urban and rural areas. At the policy level, there is need to focus on (a) disseminating knowledge about menstrual hygiene management (MHM) practices and provisioning of sanitary items; and (b) providing exposure to traditional media channels to potentially reduce the social stigma associated with these issues and bring critical conversations to the forefront, especially among the socio-economically disadvantaged groups.

Menstrual hygiene management in disasters: the concerns, needs, and preferences of women and girls in Vanuatu

In disaster settings, women and girls face additional challenges in safely managing menstruation with confidence and dignity. Assessing women’s and girls’ needs and preferences at country level prior to a disaster assists Red Cross National Societies with preparedness planning and development of local menstrual hygiene management (MHM) kits for pre-positioning. This study, conducted in Vanuatu, examined the experiences, concerns, needs, and preferences of women and girls in managing menstruation in disasters. Participants trialled one of four different sanitary products included in a MHM kit. Absorbency, security of fit, and odour were the main determinants of product acceptability. Water supply and safe disposal options influenced the preference for either reusable or disposable products. Access to sanitary products, distribution processes, water supply, and privacy were key concerns. Detailed recommendations within this paper will support the Vanuatu Red Cross in decision making and programming for MHM in disaster preparedness and response.

The Bishesta campaign: a menstrual hygiene management intervention for people with intellectual impairments and their carers

This paper describes the components of the Bishesta campaign: a behaviour change intervention for menstrual hygiene management (MHM), targeting young people with intellectual impairments, and their carers in Nepal. The campaign uses two fictitious characters: Bishesta (a young person with an intellectual impairment) and Perana (her carer), and consists of three group training modules. ‘Period packs’, designed to make MHM behaviours attractive and easy to adopt, are given to the young people. Packs include storage bags, a bin, and stories about Bishesta menstruating and learning to manage as independently as possible, with Perana’s support. Carers receive a calendar to track the young person’s menstrual cycle. A Bishesta doll, with removable clothes, underwear, and a miniature ‘period pack’ is used in training to demonstrate MHM. Evaluation findings show the intervention is feasible at small scale, so further research on how to scale up the intervention in an evidence-based way is required.

Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda

Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5–2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Venturi doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friendly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products was challenging. Where solid chlorine tablets were locally rarely available, the costs of liquid chlorine options were high (27–162 per cent of the water price).

Integrating sanitation and climate change adaptation: lessons learned from case studies of WaterAid’s work in four countries

The links between climate change and sanitation are frequently overlooked in the WASH sector. This paper examines experiences of WaterAid in Bangladesh, Burkina Faso, India, and Madagascar where there was some consideration of the impacts of climate change on sanitation. Climate resilience was often not considered explicitly, however, with work instead framed around weather-related threats that are now increasingly frequent and severe. In these case studies, sanitation and climate integration involved adapting on-site sanitation hardware to physical impacts on infrastructure, while some social aspects of climate resilience were also considered. Integration took place primarily at the project level, while climate change consideration seemed absent from wider planning and decision-making. Aside from these case studies, most of WaterAid’s sanitation work does not seem to incorporate climate change. It is recommended that climate resilience is integrated into each stage of sanitation programming, with a more systematic consideration of its potential impacts.

Intervention mapping as a framework for planning the implementation of urine diversion toilets and Ecosan education in a community school in Kavre, Nepal

Use of human excreta as fertilizer is not a new concept. However, with the use of the modern water-flush toilet, human excreta becomes mixed with water and causes environmental pollution. To reemphasize the nutritional value of human urine in the field, a urine diversion toilet was constructed in a community school situated in Kavre, Nepal. The purpose of establishing the urine diversion toilet is to improve hygiene outcomes through promoting proper sanitation and transforming the school community’s regular practice and attitudes towards urine as a resource. To ensure effective implementation of the urine diversion toilets, intervention mapping was used as a guiding framework. The aim of this paper is to document how the urine diversion toilet was planned and implemented in the school and how the urine diversion toilet was connected with the curriculum to address concerns regarding water, sanitation, and hygiene with a focus on sustainability through intervention mapping. This study highlights the benefits of intervention mapping as a systematic and step-by-step process for the planning and implementation of the urine diversion toilet. This study also highlights the benefits of connecting urine diversion toilets with school gardening, and engaging with local government and other stakeholders about the value of the approach.