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Authors: Joyce Aputere Ndago, Paul Adjorlolo, Martin Nyaaba Adokiya, Micheal Boah

Access to and use of improved water sources and sanitation facilities in Sub-Saharan Africa (SSA) remains a significant public health concern, with notable variations across countries. Achieving the Sustainable Development Goals related to water and sanitation require evidence on current levels of access and factors that shape them. This study examined household access to and use of improved water sources and sanitation facilities, as well as the determinants of their use in SSA. Demographic and Health Survey data from 465,208 households across 30 SSA countries conducted between 2014 and 2025 was used for this study. Descriptive analyses examined access levels. Multivariable Poisson regression with robust variance was used to identify the factors associated with reported use. Overall, 76.3% of households had access to and use of improved water sources, 56.7% had access to improved toilets, and 35.4% had access to basic sanitation facilities (unshared improved toilet facilities), with wide variations across countries. Significant factors associated with access and use of improved toilet and sanitation facilities included wealth and residence, while educational attainment was significantly associated with access to and use of improved water sources. The findings highlight that disparities in access to water and sanitation exist in the SSA region, with household wealth, place of residence, and education significantly associated with households’ access and use of improved water sources and sanitation facilities. Governments in SSA should prioritize improving access to water and sanitation, particularly in underserved areas. Additionally, targeted strategies are needed to address disparities driven by socioeconomic and demographic factors.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006195. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Mmeli Dube, Fiona Anciano, Alesia D. Ofori, Lindokuhle Mabaso, Dani J. Barrington

Container based sanitation (CBS) is marketed as an innovative ‘improved’ service with potential to provide ‘safely managed’ sanitation for people living in low resource settings. Yet little research has investigated this claim regarding the most marginalised individuals within these populations, many of whom experience myriad intersectional vulnerabilities. This paper examines and compares whether household CBS (in the form of portable flush toilets, PFTs) and shared sanitation users in a South African informal settlement are able to realise their Human Right to Sanitation (HRtS). Thirteen residents of BM Section, Cape Town, were purposively selected to understand how sanitation service types, age, gender, (dis)ability, income and personal shocks shape experiences. Data was collected using Photovoice and analysed using Winkler’s interpretation of the normative contents of the HRtS and Crenshaw’s theory of intersectionality. In this context, the adoption of household CBS and its ability to function as a private, dignified, safe (hygienic and physical) form of sanitation depends on users’ capacity to adapt it to overcome the technology’s limitations. Users with limited or no capacity to adapt their PFTs face limitations in accessing sanitation safely, privately and with dignity. This in turn, worsens disparities in sanitation outcomes among vulnerable PFT users, underscoring that technical provision alone is insufficient to realise the HRtS. Shared sanitation remains functionally limited or unsafe for many. When the HRtS and intersectionality are considered, household CBS may have the potential to be ‘safely managed’ in theory, but in reality, barely meets the needs of the most vulnerable users.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000524. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Nikita Surani, Nathalia Carolina Fernandes Fagundes, Harmanpreet Kaur, Rebecca Gokiert, Arnaldo Perez-Garcia, Maryam Amin

Children experience significant oral health problems, compromising learning and quality of life. Schools are effective in promoting children’s overall health, within which oral health can be integrated. This scoping review aimed to map integration of oral health within primary school health programs. The review was guided by Arksey and O’Malley’s framework and adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses extensions for Scoping Reviews (PRISMA-ScR). JBI Manual for Evidence Synthesis was referred to for data extraction. A systematic search was performed across six databases with no restrictions on dates and locations. The review included 31 articles published between 1981 and 2025. Over 70% studies were concentrated exclusively in high-income and upper-middle income regions. Quantitative methods were reported in twenty-one studies. All studies reported programs targeting children. Only 12 included parents or guardians, mostly as passive recipients. Most common intervention delivery agents were teachers, identified in 25 studies. Unhealthy diet and poor hygiene were frequently targeted common risk factors, identified in 18 and 11 studies respectively. Tobacco use, stress, and injury were largely overlooked. Twenty-seven studies reported activity-based learning to promote general health. Classroom education, followed by interest holder engagement and structured toothbrushing were used to promote oral health, focusing on student skill-building and empowerment, alongside teacher involvement. None of the studies applied integration-specific or implementation science frameworks or models. Twenty-six studies assessed child-level oral health outcomes. In contrast, only seven reported changes in knowledge, attitudes, and practices among educators and parents. Ten reported program-related outcomes. Structured programs engaging children, targeting risk factors related to hygiene and diet alongside interest holder engagement and curriculum integration hold promise. This review highlights the need for theoretically informed, comprehensive, policy-focused, multi-level, multi-risk factor approaches to support sustainable integration of oral health into school health programs.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007390. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: L. Marcela Montilla Rodríguez, Jorge Alejandro Obando Bastidas, Hugo Andrés Rodríguez Fajardo, Astrid Magaly Mora López, Shirley Viviana Tique Aragón, Dora Patricia Rozo Cruz, Edgar Calderón Vega, Norma Cristina Pavas Escobar, Laura Nathalia Obando Vargas, Jean Paul Farfán, Marina Sthella Gonzalez Robayo

Food safety is an important component of global public health, particularly in low- and middle-income countries (LMICs). This study aimed to identify factors associated with microbiological non-compliance in ready-to-eat (RTE) foods using seven years of official surveillance data from the Colombian Orinoquía region. RTE foods were defined as foods intended for immediate consumption without additional cooking or thermal processing. A retrospective analysis was conducted on 1,868 samples collected between 2017 and 2023, of which 1,846 were included in inferential analyses. Microbiological non-compliance, defined as failure to meet at least one regulatory microbiological criterion, was the primary outcome. Associations were assessed using multivariable logistic regression, complemented by descriptive and exploratory analyses, including heatmaps and principal component analysis. Microbiological non-compliance was identified in 39.5% of the evaluated samples. Hygiene indicators predominated, particularly total coliforms (29.0%), aerobic mesophilic bacteria (12.7%), and Escherichia coli (12.3%), whereas foodborne pathogens were infrequently detected. Raw or highly handled foods had higher odds of microbiological non-compliance than thermally processed foods (OR = 8.40; 95% CI: 6.59–10.72). Higher odds were also observed for samples from rural or dispersed municipalities (OR = 1.31; 95% CI: 1.01–1.70) and samples collected in 2020 (OR = 1.78; 95% CI: 1.16–2.74). Exploratory analyses revealed heterogeneous microbiological profiles across temporal, territorial, operational, and food-related dimensions, with a consistent predominance of hygiene indicators. Overall, microbiological non-compliance was mainly associated with food matrix type, territorial characteristics, and sampling year. The predominance of hygiene indicators supports incorporating hygienic quality and process control alongside pathogen detection into microbiological surveillance. These findings provide evidence to support risk-based food safety surveillance and targeted prioritization strategies in tropical low- and middle-income settings.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006492. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Lauren D’Mello-Guyett, Neelina Jaggarwal, Jane Wilbur, Belen Torondel, Meghna Ranganathan

Menstrual health and hygiene (MHH) encompasses access to menstrual materials; water, sanitation, and disposal facilities; privacy and safety; accurate information; supportive social environments; access to care for menstrual discomfort and disorders; enabling people to manage menstruation with dignity and choice. Climate change is disrupting these interlinked domains, disproportionately affecting women, girls, and people who menstruate. This review synthesises evidence on how climate change affects MHH across diverse climate hazard contexts. We conducted a global mixed-methods systematic review of studies published in English between 1947 and 2025, examining associations between climate-related hazards and MHH. We conducted searches in Medline, Scopus, Embase, and Web of Science. Quantitative, qualitative, and mixed-methods studies were eligible. Given the heterogeneity in exposures, outcomes, and designs, findings were synthesised narratively. From 3,890 records, 25 studies met inclusion criteria, covering floods (n = 7), air pollution (n = 6), cyclones (n = 3), droughts (n = 3), saltwater intrusion (n = 3), and multiple hazards (n = 4). Flood- and cyclone-related studies reported disrupted access to menstrual materials, damaged water and sanitation infrastructure, reduced privacy and safety, limited access to care for menstrual disorders, and unsupportive social environments characterised by stigma and restricted mobility. Drought and salinity intrusion constrained hygiene practices through reduced water availability and quality, affecting comfort, dignity, and infection risk. Across hazards, studies documented adverse physical outcomes, including dermatological irritation and reproductive or urinary tract infections, alongside psychosocial consequences such as shame, anxiety, and harassment. Air pollution studies linked exposures with earlier menarche and menstrual cycle irregularities. Evidence on extreme heat and several MHH domains, including access to information, was limited. Climate-related hazards undermine multiple, interconnected domains of MHH. The evidence base remains fragmented across hazards, geographies, methods, underscoring the need to integrate MHH into climate adaptation, disaster preparedness, and humanitarian response frameworks and to address critical research gaps related to extreme heat, slow-onset hazards, and equity.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001083. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Cameron Smith, Emily M. H. Woerner, Alan Leslie, Benjamin Beale, Kelly Nichols, Shannon Dill, Sarah Hirsh, Jeff Semler, Andrew Kness, Jack Keane, Marina Costa, Julie Yang, Raul Cruz-Cano, Andrew Lazur, Rachel Rosenberg Goldstein

Over 43 million individuals in the United States use private wells for drinking water, but these wells are not regulated by the Safe Drinking Water Act. Unmaintained private wells on farms could become contaminated from pathogens from various potential sources including on-farm animal waste. Microbial contaminants in private wells could increase infectious disease risks among well users, therefore it is important to conduct well water testing and keep a well maintained system. We distributed surveys and collected water samples from private wells that supply drinking water on farms from all seven regions of Maryland. Our objective was to evaluate the presence of total coliforms and E. coli in private wells and the impact of well, geographic, and precipitation factors on the bacterial contamination risk. Eighty-four water samples were collected from 79 private wells on farms across Maryland. Samples were analyzed for total coliforms and E. coli with U.S. EPA Method 1604. Data were analyzed using Fisher’s Exact test and logistic regression. Forty-three percent (34/79) of the sampled wells were positive for total coliforms and 10% (8/79) were positive for E. coli. Total coliform presence was significantly associated with county (p = 0.02), region (p < 0.01), and well condition description (p = 0.02). E. coli presence was significantly associated with region (p < 0.01), geological province type (p < 0.01), county (p = 0.04), and wellhead cover type (p = 0.03). Based on the multivariable logistic regression, wells that were described as being in okay or fair condition had significantly lower odds of total coliforms compared to wells described as being in good or excellent condition (p = 0.03), suggesting a lack of understanding about actual well conditions. There was a significant decrease in the odds of E. coli presence as precipitation levels 14 days prior to sampling increased (p = 0.02). These results emphasize the importance of private well water testing, particularly for farmers.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000636. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Fred Tusabe, Sarah Lebu, Musa Manga

Climate change is intensifying rainfall extremes and urban flooding, amplifying public health risks in settings with fragile sanitation and drainage systems. In dense urban informal settlements, floods can overwhelm onsite sanitation and fecal sludge management systems, causing pit inundation, latrine overflow or collapse, and contamination of household environments and water sources. These conditions increase fecal exposure and can amplify cholera risk, particularly where water supply is intermittent and households depend on unsafe sources. Using Lusaka, Zambia as an illustrative case, this essay illustrates flood-driven sanitation failure modes and the feedback loops that can sustain exposure and delay recovery. Lessons from prolonged cholera epidemics in fragile water and sanitation settings underscore that emergency response tools can suppress transmission, but long-term durability depends on sustained investment in safe water and sanitation services and reliable surveillance. Building on recent calls for climate-resilient sanitation, this essay frames sanitation functionality during floods as a core component of epidemic preparedness in LMIC cities, with priorities including flood-resilient containment and fecal sludge services, management of shared sanitation facilities (clear responsibility, cleaning and maintenance systems), routine maintenance and supply-chain reliability, community-engaged early warning and response, and monitoring systems that link service and environmental indicators to health outcomes.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001082. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Rebecca S. Kann, Sydney Hubbard, Jedidiah Snyder, Sandy McGunegill, Bacelar Muneme, João Luis Manuel, Lance A. Waller, Rassul Nalá, Karen Levy, Matthew C. Freeman, the PAASIM Study Authorship Consortium

Diarrhea remains a leading cause of morbidity and mortality for children under five, despite reductions in its global burden in recent decades. However, climate change, and its associated meteorological conditions - heavy rainfall, temperature, flooding - has the potential to impede or reverse progress, particularly in low-income, climate-vulnerable communities. Better characterization of the impact of weather and season on drinking water quality and child health will allow us to capture the anticipated health burden associated with climate change. We characterized the associations of weather and season on infant diarrhea and household stored water quality in Beira, Mozambique. We collected data from mother-child dyads in the third trimester of pregnancy and when the infant was 3-, 6-, 9-, and 12-months old. Using modified Poisson regression mixed effects models, we evaluated associations between weather (i.e., season, heavy rainfall events, ambient temperature, and flooding) and (1) household stored water quality and (2) infant diarrhea. Rainy season (aPR: 1.49; 95% CI: [1.34, 1.67]) was associated with a higher prevalence of stored water contamination, and higher temperatures were associated with a higher prevalence of stored water contamination during the dry season only (aPR: 1.14; 95% CI: [1.03, 1.27]). Source water contamination was associated with a higher prevalence of stored water contamination during both rainy (aPR: 1.32; 95% CI: [1.11, 1.56]) and dry seasons (aPR: 1.56; 95% CI: [1.22, 2.00]). Rainy season (aPR: 1.18; 95% CI: [1.01, 1.38]) was associated with a higher prevalence of infant diarrhea, as was higher temperatures, though only during the dry season (aPR: 1.19; 95% CI: [1.05, 1.35]). This study highlights the importance of addressing household water contamination for reducing the burden of diarrheal disease as well as the importance of understanding the seasonal and weather-dependent variation in both water contamination and infant diarrhea.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000599. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Maya Lubeck-Schricker, Valerie Bauza, Winnie Felix-Jean, Frederick G.B. Goddard, Miselie Fanor Pierre, Bridj Ozeris, Miles Schelling, Sasha Kramer

EkoLakay container-based sanitation (CBS) with weekly waste collection and treatment is one of the only household-level safely managed sanitation options in northern Haiti. Despite a low monthly fee of 350 HTG (less than 3 USD), some households still struggle to pay for the service, indicating that targeted subsidies could expand coverage to the poorest and most vulnerable households. To inform targeted subsidy design, we conducted surveys with 603 households in four neighborhoods of Cap Haitien to investigate willingness to pay (WTP) for EkoLakay CBS services and to determine the socio-economic, behavioral, and contextual factors associated with WTP. We used contingent valuation to measure stated WTP and multivariate regression to assess factors associated with WTP. We also conducted focus group discussions with household members and community leaders to further explore the findings. In the overall survey population, 60% reported a willingness to pay 350 HTG per month for EkoLakay service (the current fee), 77% were willing to pay 250 HTG, and 85% were willing to pay 150 HTG. Household wealth, sanitation privacy, and satisfaction with the current sanitation facility were associated with WTP in multivariate regression analysis. However, a household’s current ownership of a private toilet was not associated with WTP. Focus group participants identified several reasons why households that already owned private toilets may be willing to pay for the EkoLakay CBS service. These included pit emptying costs, smell, and pest concerns of pit latrines, the desire for multiple toilets within the home, and the benefits of CBS in flood-prone areas. Our results suggest that an additional subsidy that reduces the price to 150–200 HTG could achieve up to 80% CBS coverage in the study area. These results may inform other basic service providers and government partners to better understand willingness to pay for basic service provision in the region.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000618. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Abdullah Alhassan, Ziemah Boyeh, Abdul-Kadri Yahaya

In low-resource settings, drinking-water safety decisions are frequently shaped by subjective perceptions rather than objective contamination data, yet this correspondence is poorly characterized. This cross-sectional study (n = 425) in Nadowli-Kaleo District, Upper West Region, Ghana examined concordance between perceived drinking-water quality and field-observed sanitary contamination risk, together with socioeconomic determinants of risk appraisal calibration. Perceived quality was rated on a 1–5 Likert scale; field-observed sanitary contamination risk was aggregated into a 0–4 ordinal risk index from a structured observation checklist (a proxy for, not a direct microbiological measure of, water quality), reverse-scaled, with perceptions classified as calibrated when |gap| ≤ 0.5. Perceived quality was strongly and inversely associated with observed contamination risk (Spearman’s ρ = −0.780; p < 0.001), indicating that household perceptions tracked broad contamination-risk gradients well. However, agreement at the individual household level was weaker: only 49.4% of households met the calibration criterion (mean gap = −0.86) under our primary threshold, and this proportion was sensitive to the threshold chosen (ranging from 26.1% at ±0.3 to 63.1% at ±1.0). Educational attainment showed no reliable association with calibration accuracy (no formal education 55.5%; secondary 44.1%; postgraduate 12.5%, n = 8; Pearson χ²(4) = 7.24, p = 0.124), and a quadratic logistic model provided no evidence of a non-linear (inverted-U) relationship (quadratic OR = 0.94; p = 0.462); income and residence duration were likewise not significant predictors. These findings suggest that perception-based metrics alone may be insufficient for individual-level risk assessment, and that common socioeconomic proxies do not reliably identify well-calibrated households, calling for objective monitoring and tailored risk communication to advance SDG 6.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000590. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.