COVID-19 and informal settlements - implications for water, sanitation and health in India and Indonesia.

Informal settlements are home to over 1 billion people worldwide and are characterised by high population densities and poor environmental conditions. The authors identify the impact of COVID-19 on existing water and sanitation practices and potential pathways for the transmission of COVID-19 in informal settlements in India and Indonesia. In the short term, there is an urgent need for mobile and contactless hand washing, washing/bathing facilities and toilets. In the long term, COVID-19 provides an opportunity to invest in centralised water and sanitation networked solutions appropriate for high-density settings to integrate those settlements into cities and improve environmental conditions and health in these cities.

Stability of SARS-CoV-2 on the Army Combat Uniform and Recommendations for Cleaning.

SARS-CoV-2 is the virus responsible for the disease that is known as COVID-19. While there have been numerous studies detailing the survival rates of SARS-CoV-2 on various materials, there are currently no published data regarding whether this virus is stable on standard military uniforms. Consequently, there are no standard operating procedures for washing uniforms once exposed to the virus. This study aimed to determine whether SARS-CoV-2 could be removed from Army combat uniform material by washing with a commercially available detergent and tap water. Washing the fabric with detergent followed by a rinse step with tap water effectively removes detectable viral particles. Importantly, it was found that washing with hot water alone was not effective. Therefore, it is recommended that military personnel wash their uniforms with detergent and water as soon as possible after exposure to SARS-CoV-2; hot water should not be used as a substitute for detergent.

One Health: navigating plague in Madagascar amidst COVID-19.

BACKGROUND: Africa sees the surge of plague cases in recent decades, with hotspots in the Democratic Republic of Congo, Madagascar, and Peru. A rodent-borne scourge, the bacterial infection known as plague is transmitted to humans via the sneaky bites of fleas, caused by Yersinia pestis. Bubonic plague has a case fatality rate of 20.8% with treatment, but in places such as Madagascar the mortality rate can increase to 40-70% without treatment. MAIN TEXT: Tragedy strikes in the Ambohidratrimo district as three lives are claimed by the plague outbreak and three more fight for survival in the hospitals, including one man in critical condition, from the Ambohimiadana, Antsaharasty, and Ampanotokana communes, bringing the total plague victims in the area to a grim to five. Presently, the biggest concern is the potential plague spread among humans during the ongoing COVID-19 pandemic. Effective disease control can be achieved through training and empowering local leaders and healthcare providers in rural areas, implementing strategies to reduce human-rodent interactions, promoting water, sanitation and hygiene practices (WASH) practices, and carrying out robust vector, reservoir and pest control, diversified animal surveillance along with human surveillance should be done to more extensively to fill the lacunae of knowledge regarding the animal to human transmission. The lack of diagnostic laboratories equipped represents a major hurdle in the early detection of plague in rural areas. To effectively combat plague, these tests must be made more widely available. Additionally, raising awareness among the general population through various means such as campaigns, posters and social media about the signs, symptoms, prevention, and infection control during funerals would greatly decrease the number of cases. Furthermore, healthcare professionals should be trained on the latest methods of identifying cases, controlling infections and protecting themselves from the disease. CONCLUSIONS: Despite being endemic to Madagascar, the outbreak's pace is unparalleled, and it may spread to non-endemic areas. The utilization of a One Health strategy that encompasses various disciplines is crucial for minimizing catastrophe risk, antibiotic resistance, and outbreak readiness. Collaboration across sectors and proper planning ensures efficient and consistent communication, risk management, and credibility during disease outbreaks.

Association between sociodemographic characteristics and knowledge and practice of COVID-19 measures among households in Mombasa and Kilifi County, Kenya.

BACKGROUND: Coronavirus disease 2019 (COVID-19), declared a global pandemic by the World Health Organization (WHO), is a severe acute respiratory disease. The Kenyan Ministry of Health (MoH) put in place measures that included mandatory face masking, hand and cough hygiene and social and physical distancing to reduce disease transmission and increase prevention efforts. The primary objective of this study was to determine how sociodemographic characteristics affect knowledge and practice of the above measures. METHODS: A cross-sectional study was conducted to assess water, sanitation and hygiene practices for the prevention and control of COVID-19 in Kilifi and Mombasa Counties, Kenya. Data collection was accomplished through a mobile data collection tool. Principal component analysis was used to create a wealth index using data on asset ownership and housing characteristics. Bloom cut-off points of 80-100%, 60-79% and ≤59% were used to determine knowledge and practice. RESULTS: Of the 612 households, 339 (55.4%) were from Kilifi County and 273 (44.6%) were from Mombasa County. A total of 431 (70.4%) were female and the mean age of the household members was 38.2±14.8 y.Almost all (99.2%) respondents were aware of COVID-19, with 60% knowing prevention, symptoms and persons at a higher risk of contracting the virus. Females had the highest knowledge of COVID-19 and were likely to practice prevention and control measures, unlike males. Age was significant (p<0.05) with knowledge and practice. CONCLUSIONS: The sociodemographic characteristics of populations play a key role in behavioural aspects as far as prevention and control of COVID-19 are concerned. There is a need for partnerships between the MoH and county governments to put in place a multisectoral community approach to advance feasible behavioural interventions among targeted populations towards combating the spread of COVID-19.

One-step and wash-free multiplexed immunoassay platform based on bioinspired photonic barcodes

Multiplex, rapid and accurate virus quantification plays a great value in biomedical detection. Here, a novel one step, wash-free immunoassay platform based bioinspired PhC barcodes for multiplexed virus quantification was explored. PhC barcodes were decorated with PDA by self-polymerization of DA, thus this nanocomposite hybridized PhC barcodes facilitated the adsorption of FITC labelled antibodies and quenched itself photoluminescent, allowing a fast responsive composite platform. In the presence of target analyte, the FITC-labelled detection antibody was released from the surface of PDA decorated microcarrier to specifically bind to the target analyte, thus recovered the photoluminescence. In addition, the PhC microcarrier was enabled to carry out various color barcode for different targets detection though tuning internal periodic structures. Based on these excellent performances of the nanocomposite barcode, this method can not only capture H1N1, H5N1, SARS-CoV-2 simultaneously with rapid, accuracy but also accomplish multiplex quantification detection with high-sensitivity. Furthermore, our developed platform was also achieved with high-sensitivity and high-specificity through the verification of clinical samples, thus laying out a new avenue for multiplex virus detection in clinical diagnosis. © 2023

Condition of water, sanitation and hygiene (WaSH) in Ghana's basic schools: Empirical evidence from Wa municipality

Access to functional water, sanitation and hygiene (WaSH) systems is a necessity for safe health and a fundamental determinant of human well-being. As a result, constant monitoring, tracking and bridging of the gaps in access to WaSH is a global public health requirement. Developing countries are currently disadvantaged in this era of the COVID-19 outbreak, particularly in the area of school-based WaSH. This study assesses the present condition and challenges hindering access to school-based WaSH in the Wa Municipality. Primary data involving 145 health teachers were sourced using survey questionnaires and supported with ocular assessment. Results show that basic schools in the Wa Municipality currently have in place some sort of WaSH facilities, thereby meeting the availability criteria to a large extent. However, these schools do not meet the remaining standards – functionality, accessibility, maintenance and quality of services, education and prac-tices. The major factors affecting the sustainable operationalisation of the school-based WaSH are poor maintenance and inadequate funding of WaSH infrastructure. The school-based WaSH in Ghana requires rapt policy attention if the quest to attain Sustainable Development Goal 6 by 2030 is to be achieved. © 2023 The Authors.

COVID-19 Among Omani Pilgrim Returnees From the Ashura Mass Gathering.

Background The annual Ashura pilgrimage is a mass Islamic gathering during which millions of worshippers converge in the city of Karbala in Iraq. We report on the incidence of the coronavirus disease 2019 (COVID-19) in Omani pilgrims returning from Karbala in the month of Muharram (August) 2021 during the COVID-19 pandemic. Methodology This is a retrospective study using an electronic, self-completed, and Arab-language survey, composed of 17 questions, that was distributed to all pilgrims returning from Karbala. Participation was voluntary, and consent with confidentiality was obtained. Data on the demographics including sex, COVID-19 vaccination record, type of vaccine, duration of stay, compliance with wearing a face mask, using hand sanitization, and polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus before the departure from Oman, upon the return to Oman, and on the eighth post-quarantine day were collected. The responses were collected from the period between August 28, 2021, and September 25, 2022. Statistical association and analysis were performed using the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). Results Out of 250 pilgrims, 139 responded to the survey. Fifty-two participants (37.4%) were males, and 87 (63.6%) were females. None of the pilgrims had positive SARS-CoV-2 PCR results before their departure from Oman. Only four pilgrims (2.9%) were detected positive on PCR by the end of a compulsory quarantine on the eighth day after arrival to Oman. No hospital admissions were recorded. The vast majority of the pilgrims were vaccinated with two doses of COVID-19 vaccination, while some few pilgrims were not vaccinated at all. Most of the pilgrims were also compliant with mask wearing, and just over half the pilgrims were compliant with hand sanitization. No significant statistical association was found between contracting SARS-CoV-2 virus infection and taking SARS-CoV-2 vaccination, the number of vaccination doses, having had COVID-19 before, wearing a mask, or compliance with hand sanitization. Conclusion The incidence of COVID-19 cases among pilgrims returning from Iraq during the COVID-19 pandemic was low. No significant difference was noted between pilgrims vaccinated and compliant with the protective measures and those who were not vaccinated or compliant. Herd immunity could be a possible explanation for the low incidence of COVID-19 infection. Larger studies are needed to investigate the incidence of COVID-19 in Ashura pilgrims.

Stepping into the Void: Lessons Learned from Civil Society Organizations during COVID-19 in Rio de Janeiro.

Brazil experienced some of the highest rates of COVID-19 globally. This was complicated by the fact that 35 million of its citizens have limited access to water, a primary resource necessary to stem the spread of infectious diseases. In many cases, civil society organizations (CSOs) stepped into this void left by responsible authorities. This paper explores how CSOs in Rio de Janeiro helped populations struggling with access to water, sanitation, and hygiene (WASH) during the pandemic, and what coping strategies are transferable to similar contexts. In-depth interviews (n = 15) were conducted with CSO representatives in the metropolitan region of Rio de Janeiro. Thematic analysis of the interviews revealed that COVID-19 exacerbated pre-existing social inequities among vulnerable populations, undermining their ability to protect their health. CSOs provided emergency relief aid but faced the counterproductive actions of public authorities who promoted a narrative that diminished the risks of COVID-19 and the importance of non-pharmacological interventions. CSOs fought this narrative by promoting sensitization among vulnerable populations and partnering with other stakeholders in networks of solidarity, playing a vital role in the distribution of health-promoting services. These strategies are transferrable to other contexts where state narratives oppose public health understandings, particularly for extremely vulnerable populations.

Peri-urban schools of Kinshasa before and during COVID-19: an evaluation of water, handwashing facilities, and girl students' hand hygiene practices

The COVID-19 pandemic has led communities, including Kinshasa peri-urban schools, to reinforce WASH-related practices as a key com-ponent in preventing the spread of COVID-19. This study aimed to determine the institutional and behavioural changes in adolescent girl students' handwashing practices before and during the COVID-19 pandemic. A cross-sectional study was performed, observing the hand hygiene of adolescent girl students, and assessing WASH facilities at schools, chosen from a sample previously selected in the study area. The results indicate significant increases in the prevalence of water points in schools from 10.9 to 22.5%, of handwashing facilities from 43 to 60.1% of schools with an average number of handwashing facilities from one to two, and the prevalence of school WASH brigades from 4.8 to 11.8% of schools. There was also a significant increase in schools receiving funds, and other support for WASH, respectively, from 24.9 to 70.3%, and from 17 to 45.9%, while the proportion of adolescent girl students washing their hands after using the toilet and before eating significantly increased from 6 to 28.4%. However, to improve the current WASH picture, and succeed in curtailing the spread of COVID-19 and related impacts, additional efforts to enhance handwashing practice and WASH items' coverage are expected. © 2023 The Authors.

Human rights, COVID-19, and barriers to safe water and sanitation among people experiencing homelessness in Mexico City

Access to safe water, sanitation, and hygiene (WASH) are human rights and play a fundamental role in protecting health, which has been particularly evident during the SARS-CoV2 (COVID-19) pandemic. People experiencing homelessness face frequent violations of their human rights to water and sanitation, negatively affecting their health and dignity and ability to protect themselves from COVID-19. This research aimed to identify barriers to safe water, sanitation and hygiene access for people experiencing homelessness in Mexico City during the COVID-19 pandemic. A survey of 101 respondents experiencing homelessness was conducted using mobile data collection tools in collaboration with El Caracol A.C., an NGO that contributes to the visibility and social inclusion of homeless people in Mexico. We report findings according to the following themes: general economic impacts of COVID-19;experiences with reduced access to WASH services due to COVID-19, challenges in accessing hand washing to follow COVID-19 public health advice;and coping mechanisms used to deal with reductions in access to WASH. We discuss the broader implications of the findings in terms of realization of the human rights to water and sanitation (HRtWS), and how people experiencing homelessness are left behind by the existing approaches to ensure universal access to water and sanitation under SDG 6. Copyright © 2023 Liera, Dickin, Rishworth, Bisung, Moreno and Elliott.

Knowledge Evaluation of Hand Hygiene and Infectious Diseases in Lebanon

Background: Hand washing, also known as hand hygiene, is a simple procedure used for cleaning and cleansing hands for eliminating soil, dirt, and germs including microorganisms such are bacterial or viral particles. In the absence of water and soap, cinder can be used as an alternative method for cleaning hands. Hand hygiene is an essential part that needs to be carefully fol-lowed in the infection control protocols. With the expanding loads of Health-Care Associated Infections (HCAIs) and the increasing levels of both treatment complexity and severity of illness synchronized by multi-drug resistant (MDR) pathogen infections, health care practitioners are fo-cusing on the basic and most essential facts of disease prevention by implementing the basic and simple cleaning measures including hand hygiene measures. According to healthcare facilities, many scientific evidences support the observation that hand hygiene or handwashing if properly im-plemented, can decrease and eliminate the risk factors of cross-transmission infections. Method(s): The data was collected using a self-administrated survey, which included 10 questions, constructed using the monkey survey website. The survey was sent by email and collected from 100 participants of different ages. Result(s): Our results indicated that the majority of our population under study is considered healthy, representing good educational levels. Conclusion(s): The majority revealed advanced knowledge and understanding about the key aspects for hand washing procedures.Copyright © 2021 Bentham Science Publishers.

Water, women and disability: Using mixed-methods to support inclusive WASH programme design in Vanuatu.

BACKGROUND: Adequate access to water, sanitation and hygiene (WASH) is imperative for health and wellbeing, yet people with disabilities, people with incontinence and people who menstruate often experience unmet WASH requirements. METHODS: In 2019 we completed a mixed-methods study in two provinces of Vanuatu, (SANMA and TORBA). The study comprised 1) a population-based disability survey using the Washington Group Short-Set 2) a nested case-control study to explore associations between WASH, disability and gender, and 3) an in-depth qualitative assessment of the experiences of WASH users with additional requirements: people with and without disabilities who menstruate, or experience incontinence. FINDING: 11,446 households (response rate 85%) were enrolled into the survey. All-age disability prevalence across the two provinces was 2.6% (95% Confidence Interval 2.5-2.8), increasing with age. 814 people with, and 702 people without disabilities participated in the case-control study. People with disabilities were statistically more likely to experience barriers in seven of eight intra-household indicators. WASH-related stigma, reliance on informal caregivers, and under-resourcing of WASH personnel were critical issues for people who menstruate or experience incontinence. INTERPRETATION: People with disabilities, people with incontinence and people who menstruate in Northern Vanuatu face continued challenges in accessing safe, affordable and appropriate WASH that meets their requirements. Outputs from this study have supported progression towards gender and disability-inclusive WASH programming in the area and highlighted the value of mixed-methods research. FUNDING: The research was funded by the Australian Government's Water for Women fund and donations from the Australian public.

Towards a participatory framework for improving water & health outcomes: A case study with Maasai women in rural Tanzania.

Rural communities in sub-Saharan Africa (SSA) are disproportionately burdened by a pervasive lack of access to safe drinking water. Widespread programmatic failure in the water, sanitation, and hygiene (WaSH) sector has resulted in particularly slow progress in alleviating these challenges in the region. Drawing from decolonial and participatory methodological scholarship, this research demonstrates how geographically and demographically specific, locally controlled, and long-term educational programming can improve health and wellness outcomes when associated with a technological intervention. Specifically, consultations between January 2015 and August 2018 were followed by an iterative and community-driven program development process between January and July 2019. Fifty Maasai women were subsequently recruited to participate and were provided with a point-of-use water treatment technology in August 2019. These women engaged in a series of three 14-week WaSH education programs over an 18-month evaluation period. Results showed that 38% of participants reported regular diarrhea at baseline, decreasing to 8%, 0%, and 3% immediately after each of the three WaSH education programs were provided at 3, 12, and 18 months. Interim measurements taken between WaSH programs showed 35% of participants (at 6 months) and 5% of participants (at 15 months) reporting regular diarrhea. A trend of improvement was thus observed over the study period, though the increase in reported diarrhea at 6 months demonstrates the need for long-term commitment on the part of WASH practitioners when engaging with end users to achieve sustained change. Further, this research highlights the importance of participatory program development and pedagogical approaches in WaSH interventions, where local control of study objective determination and implementation, combined with consistent and long-term engagement, can facilitate sustained technology use and associated reductions in diarrhea.

Water, Sanitation and Hygiene (WASH) in Japanese elementary schools: Current conditions and practices.

BACKGROUND: Water, sanitation, and hygiene (WASH) is the foundation for preventing infectious diseases, as the current COVID-19 pandemic has shown. WASH is essential for school health, yet there have been very few papers published on WASH in Japanese schools. The objective of this review is to describe the current conditions and practices in Japanese elementary schools using an international framework for WASH in schools and identify implications for handwashing promotion in other areas. METHODS: This research was based primarily on a literature review. Information on common WASH practices was also collected through an international workshop attended by school health experts. RESULTS: There is a rigorous legal foundation for ensuring the physical infrastructure and quality control of a safe water supply in Japanese schools. Water quality is monitored regularly by Yogo teachers and school pharmacists. Strategic locations and an abundance of water supply infrastructure facilitate handwashing behavior. Hygiene promotion activities by Yogo teachers and student's health committees play a major role in increasing awareness, while health education classes provide minimal but necessary knowledge on handwashing with soap. Flush toilets are the standard, but there is still a demand for improvement of toilet facilities. Children's participation in daily cleaning of school toilets contributes to students understanding the importance of cleanliness. CONCLUSIONS: Drawing from the Japanese example, WASH in schools' interventions are suggested to include laws and policies, a designated teacher, and children's participation to sustain both infrastructure and hygiene promotion.

Biopolymer Coating Imparts Sustainable Self-Disinfecting and Antimicrobial Properties to Fabric: Translated to Protective Gears for the Pandemic and Beyond.

The global pandemic of COVID-19 and emerging antimicrobial drug resistance highlights the need for sustainable technology that enables more preparedness and active control measures. It is thus important to have a reliable solution to avert the present situations as well as preserve nature for habitable life in the future. One time use of PPE kits is promoting the accumulation of nondegradable waste, which may pose an unforeseen challenge in the future. We have developed a biocompatible, biodegradable, and nonirritating nanoemulsion coating for textiles. The study focused on coating cotton fabric to functionalize it with broad spectrum antimicrobial, antibiofilm, and anti-SARS-CoV-2 activity. The nanoemulsion comprises spherical particles of chitosan, oleic acid, and eugenol that are cross-linked to fibers. The nanoemulsion caused complete destruction of pathogens even for the most rigid biofilms formed by drug resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans on the surface of the coated fabric. The secondary coat with beeswax imparts super hydrophobicity and 20 wash cycle resistance and leads to enhanced barrier properties with superior particulate filtration, bacterial filtration, and viral penetration efficiency as compared to an N95 respirator. The coated fabric qualifies as per standard parameters like breathability, flammability, splash resistance, and filtration efficiency for submicrometer particles, bacteria, and viruses. The scaleup and bulk manufacturing of the coating technology on fabric masks complied with standards. The consumer feedback rated the coated mask with high scores in breathability and comfortability as compared to an N95. The strategy promises to provide a long-term sustainable model compared to single use masks and PPE that will remain a nondegradable burden on the ecosystem for years to come.

Wastewater surveillance of SARS-CoV-2 in Bangladesh: Opportunities and challenges.

The ongoing pandemic of the coronavirus disease 2019 (COVID-19) is a public health crisis of global concern. The progression of the COVID-19 pandemic has been monitored in the first place by testing symptomatic individuals for SARS-CoV-2 virus in the respiratory samples. Concurrently, wastewater carries feces, urine, and sputum that potentially contains SARS-CoV-2 intact virus or partially damaged viral genetic materials excreted by infected individuals. This brings significant opportunities for understanding the infection dynamics by environmental surveillance. It has advantages for the country, especially in densely populated areas where individual clinical testing is difficult. However, there are several challenges including: 1) establishing a sampling plan and schedule that is representative of the various catchment populations 2) development and validation of standardized protocols for the laboratory analysis 3) understanding hydraulic flows and virus transport in complex wastewater drainage systems and 4) collaborative efforts from government agencies, NGOs, public health units and academia.

How much can we rely on a scrambled COVID-19 vaccine? It is not the only way out!

The COVID-19 pandemic has engulfed the world in the blink of an eye and created a state of panic. Vaccine is one of the suggested ways to counter the menace. Smallpox was an ideal vaccine candidate yet, it took about 182 years to eradicate. Vaccines are associated with incidents of mishap like the 'Cutter incident'. COVID-19 vaccine has a political, commercial angle to it, with at least 62 vaccine candidates in the pipeline. Potential obstacles in development of vaccines are mutations in strains of SARS-CoV-2, lack of details of biological properties of the virus and incomplete information of pathogenicity, lack of suitable animal models. The potential side effects of the vaccine are eosinophilic infiltration, increased infectivity following challenge infections, antibody-dependent enhancement of infections. The general public has to stop anticipating that a vaccine is nearby and believe that for now, vaccine is face mask, hand wash, and social distancing and hope that either the virus goes weak or an effective vaccine arrives rather early than late. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.

Rise of Informal Slums and the Next Global Pandemic.

Informal slums are growing exponentially in the developing world and these will serve as the breeding ground for a future global pandemic. Virtually every sustainable development goal is unmet in slums around the globe thus we must act now to divert a global humanitarian crisis.

Qualities of transformative leaders in WASH: A study of gender-transformative leadership during the COVID-19 pandemic

IntroductionEqual access to water, sanitation and hygiene (WASH) for all requires leadership that prioritises and drives inclusion. Inclusive WASH also presents opportunities to advance equality more widely, with WASH a pathway to meaningful participation and empowerment for diverse groups. The concept of gender-transformative leadership-which connects ideas of leadership to transformative models of gender equality in development theory that challenge prevailing power structures-is a relevant lens for exploring inclusive WASH. This article shares findings and reflections from a positive deviance study that aimed to investigate gender-transformative leadership in the WASH sector to explore (i) the factors shaping gender-transformative leadership and the characteristics of gender-transformative leaders;(ii) actions taken by gender-transformative leaders;(iii) the types of outcomes achieved;and (iv) ways to strengthen gender-transformative leadership. MethodsThe study was undertaken during the COVID-19 pandemic and consisted of interviews with 19 leaders in Bhutan, Lao People's Democratic Republic, and Nepal. We developed a conceptual framework which considers leaders' (i) personal values and traits;(ii) leadership styles;(iii) actions;and (iv) outcomes, influenced by a range of (v) enabling factors and barriers. ResultsLeaders' personal values and traits included a strong learning orientation, social justice values, humility, courage, and altruism. Leadership styles were primarily empathetic, with leaders guided by a mission to lead by example and pursue equality in their professional and personal lives. Exploration of actions and outcomes revealed a range of inclusion-oriented WASH activities responding to pandemic-related challenges, with associated potential outcomes in shifting norms. However, validation of outcomes was not possible due to the study timeframe and complexity of tracing complex social change in a positive deviance study reliant on self-reporting. Analysis of enablers and barriers to gender-transformative leadership respectively emphasized the importance of educational opportunities and the persistence of traditional gender norms. ConclusionFindings contribute to the body of knowledge on gender-transformative leadership, being the first study to connect this concept to WASH. Future research could build further evidence by applying the conceptual framework to analyze additional contexts or sectors, and by more fully articulating and validating outcomes in terms of their potential for gender-transformative leadership to drive equality both in and beyond WASH.