Water, Sanitation and Hygiene in Nepal and International Travellers' Travel-Health Experiences.

BACKGROUND: Tourism is one of the main sectors in Nepal, contributing in its economic growth. It is influenced by various factors including the situation of water, sanitation and hygiene and water, sanitation and hygiene practices. For travelers, poor water, sanitation and hygiene provisions are considered risk factors for different food and water-borne diseases. This study aims to describe the perceptions of international travelers regarding their experiences on WASH facilities or practices, and how it influences their health, and travel experiences. METHODS: This is a cross-sectional pilot study conducted among 150 international travelers in Nepal. The travelers were selected conveniently from the Kathmandu valley. The data on different water, sanitation and hygiene related variables, travelers' health and travel experiences were collected using semi-structured questionnaire. The quantitative data was entered into SPSS for descriptive analysis and qualitative data was transcribed through thematic analysis. RESULTS: Of 150 international travelers, about 2/3rd of the travelers had inadequate perception of water, sanitation and hygiene condition. Nearly 23% of them experienced gastrointestinal symptoms, including diarrhea in the past week during their visit. Among those travelers who experienced gastrointestinal symptoms, 21.4% of them reported of their travel plans being affected. CONCLUSIONS: Perception and experience with water, sanitation and hygiene facilities was found inadequate among international travelers visiting Nepal. Such facilities seem to have affected the travelers' health (nearly a quarter of them experienced gastrointestinal symptoms, including diarrhea) and their travel plan. Hence, this pilot study demonstrates that there is an urgent need to improve the water, sanitation and hygiene facilities in the travel and tourism sector of Nepal.

Effects of sanitation and hygiene perceptions on international travelers' health, travel plans and trip experiences in India.

Background: International travelers often experience travelers' diarrhea. However, there is paucity of data on whether self-reported gastrointestinal symptoms influence travelers' perceptions of adequacy of sanitation and hygiene services encountered during travel, and to what degree their travel plans, and overall trip experience are impacted. Methods: A cross-sectional face-to-face survey was conducted amongst international travelers in India. Data collected included socio-demographics, travel characteristics, self-reported occurrence and frequency/severity of gastrointestinal symptoms, perceptions of sanitation and hygiene encountered, and adverse effects of symptoms on travel plans and trip experiences. Chi-square tests and logistic regression were performed to describe differences and associations between categorical variables. Results: Of the 300 international travelers surveyed, 46.3% experienced diarrhea. At least two thirds of travelers perceived the quality of sanitation (67.0%) and hygiene (70.0%) encountered to be inadequate. Perceptions of inadequate sanitation (adjusted OR = 3.0; 95% CI 1.7-5.5) and poor hygiene (adjusted OR = 7.7; 95% CI 4.1-15.5) were higher among travelers who experienced diarrhea. Additionally, both higher likelihood of travel plans being affected (adjusted OR = 10.7; 95% CI 5.1-23.6) and adverse impacts on overall trip experience (adjusted OR = 2.8; 95% CI 1.4-5.8) were reported among those who experienced diarrhea. Conclusions: More than two thirds of travelers surveyed in India experienced inadequate sanitation and hygiene services, with perceptions influenced by occurrence and frequency of diarrhea. Self-reported diarrhea was also associated with adverse effects on travel plans and overall trip experience. While these results may seem intuitive, they have important implications and suggest that improving sanitation and hygiene standards in India could potentially enhance tourism.