Determinants of hygiene practices among mothers seeking delivery services from healthcare facilities in the Kampala metropolitan area, Uganda.

Our study aimed at assessing the determinants of hand hygiene and utilisation of bathing facilities in healthcare facilities (HCFs) in the greater Kampala metropolitan area, Uganda. Results indicate that 19.9% of the respondents wished to wash hands and failed while 39.3% faced challenges related to bathing. Failure to wash hands was associated with received information on hand washing (APR = 1.14, 95% CI: 1.06-1.24), using piped water (APR = 0.88, 95%CI: 0.78-0.98) or a well as the main water source at the HCF (APR = 1.21,95% CI: 1.03-1.42). Experiencing challenges of bathing was associated with accessing healthcare services at a hospital (APR = 0.89, 95% CI 0.81-0.97) and using public HCF (APR = 1.10, 95% CI: 1.01-1.120). There is urgent need to improve hand hygiene and bathing facilities though providing reliable water and soap.

Quantitative assessment of exposure to fecal contamination in urban environment across nine cities in low-income and lower-middle-income countries and a city in the United States.

BACKGROUND: During 2014 to 2019, the SaniPath Exposure Assessment Tool, a standardized set of methods to evaluate risk of exposure to fecal contamination in the urban environment through multiple exposure pathways, was deployed in 45 neighborhoods in ten cities, including Accra and Kumasi, Ghana; Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Atlanta, United States; Dhaka, Bangladesh; Lusaka, Zambia; Kampala, Uganda; Dakar, Senegal. OBJECTIVE: Assess and compare risk of exposure to fecal contamination via multiple pathways in ten cities. METHODS: In total, 4053 environmental samples, 4586 household surveys, 128 community surveys, and 124 school surveys were collected. E. coli concentrations were measured in environmental samples as an indicator of fecal contamination magnitude. Bayesian methods were used to estimate the distributions of fecal contamination concentration and contact frequency. Exposure to fecal contamination was estimated by the Monte Carlo method. The contamination levels of ten environmental compartments, frequency of contact with those compartments for adults and children, and estimated exposure to fecal contamination through any of the surveyed environmental pathways were compared across cities and neighborhoods. RESULTS: Distribution of fecal contamination in the environment and human contact behavior varied by city. Universally, food pathways were the most common dominant route of exposure to fecal contamination across cities in low-income and lower-middle-income countries. Risks of fecal exposure via water pathways, such as open drains, flood water, and municipal drinking water, were site-specific and often limited to smaller geographic areas (i.e., neighborhoods) instead of larger areas (i.e., cities). CONCLUSIONS: Knowledge of the relative contribution to fecal exposure from multiple pathways, and the environmental contamination level and frequency of contact for those "dominant pathways" could provide guidance for Water, Sanitation, and Hygiene (WASH) programming and investments and enable local governments and municipalities to improve intervention strategies to reduce the risk of exposure to fecal contamination.

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

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.

Performance of subsurface flow constructed wetland mesocosms in enhancing nutrient removal from municipal wastewater in warm tropical environments.

Nutrient-rich effluents from municipal wastewater treatment plants (WWTPs) have significantly contributed to eutrophication of surface waters in East Africa. We used vertical (VF, 0.2 m(2)) and horizontal (HF, 0.45 m(2)) subsurface flow (SSF) constructed wetland (CW) configurations to design single-stage mesocosms planted with Cyperus papyrus, and operating under batch hydraulic loading regime (at a mean organic loading rate of 20 g COD m(-2) d(-1) for HF and 77 g COD m(-2) d(-1) for VF beds). The aim of the investigation was to assess the performance of SSF CWs as hotspots of nutrient transformation and removal processes between the WWTP and the receiving natural urban wetland environment in Kampala, Uganda. C. papyrus coupled with batch loading enhanced aerobic conditions and high efficiency regarding the elimination of suspended solids, organic matter, and nutrients with significant performance (P < .05) in VF mesocosms. The mean N and P elimination rates (g m(-2) d(-1)) were 9.16 N and 5.41 P in planted VF, and 1.97 N and 1.02 P in planted HF mesocosms, respectively. The lowest mean nutrient elimination rate (g m(-2) d(-1)) was 1.10 N and 0.62 P found in unplanted HF controls. Nutrient accumulation in plants and sediment retention were found to be essential processes. It can be concluded that whereas the SSF CWs may not function as independent treatment systems, they could be easily adopted as flexible and technologically less intensive options at a local scale, to increase the resilience of receiving environments by buffering peak loads from WWTPs.

Buffering municipal wastewater pollution using urban wetlands in sub-Saharan Africa: a case of Masaka municipality, Uganda.

In many sub-Saharan Africa municipalities and cities, wastewater is discharged with limited or no treatment at all, thus creating public and environmental health risks. This study assessed the performance of a conventional municipal wastewater treatment plant (WWTP), based on effluent pollution flux, in Masaka Municipality, Uganda. Also, the downstream pollution attenuation through a natural wetland was analysed to ascertain its role in buffering the WWTP performance deficits. Generally, there was deficiency in WWTP performance, with 100% failure over a five-year assessment period, for example, the mean effluent biochemical oxygen demand (BOD)5 and chemical oxygen demand (COD) concentrations (mg l(-1)) were found to be 316 ± 15 and 582 ± 28 compared with 50 and 100 maximum permissible environment discharge limits, respectively. Despite these deficits in WWTP performance, the wetland buffer effectively reduced pollutant loads for suspended solids (73%), organic matter (BOD5, 88% and COD, 75%), nutrients (total nitrogen, 74% and total phosphorus, 83%) and pathogens (faecal coliforms, 99%). These findings underpin the challenge of managing municipal wastewater using centralized mechanical WWTPs in the region. However, the wetland buffer system demonstrated a critical role these ecosystems play in abating both pulse and intermittent pollution loads from urban environments of sub-Saharan Africa whose sanitation systems are defective and inadequate. Therefore, it was concluded that integrating wetland ecosystems in urban planning as natural landscape features to enhance municipal wastewater management and pollution control is paramount.