The relationship between water, sanitation and hygiene (WASH) levels and infectious diseases, Khammouane province, Lao PDR

Collaboration

• Luxembourg Ministry of Foreign and European Affairs, Defence, Development Cooperation and Foreign Trade.
• Luxembourg Institute of Health.

Collaboration

The objective of the study is to investigate the current water, sanitation and hygiene (WASH) levels in rural Lao communities and their relationship to infectious diseases.

The specific objectives of this study are to evaluate the knowledge, attitude and practice of the general population towards WASH levels, to determine the relationship between WASH levels and parasite infestation and to define the relationship between WASH levels and WASH-related disease incidence.

Background

Adequate WASH levels are important for the health of individuals and communities. WASH levels are defined according to specific WHO criteria which include improved water sources, improved facilities and availability of handwashing facilities on premises with soap and water. In Laos, the percentage of the population using improved drinking water and sanitation sources has increased significantly over the past 30 years. However, in some areas such as rural Khammuane province, the prevalence of infections related to poor WASH levels remains high. Data on infectious diseases related to WASH are scarce in Laos and there are a limited number of studies addressing the relationship between WASH levels and infectious diseases. These data are, however, valuable for policymakers, highlighting the importance of WASH and supporting efforts to improve WASH standards in rural communities.

Methodology

The study was designed using a village-based crosssectional sampling approach. Three districts of Khammuane province were included: Mahaxay, Nakiay and Bualapha district. The villages and households were randomly selected using a cluster sampling approach. All household members over the age of 5 years in 81 villages were invited to participate, leading to 2300 participants from 888 households. From each study participant, questionnaire forms, venous blood and stool samples were collected. The standard enzyme-linked immunosorbent assay technique was used to assess the antibody levels against key infectious diseases (hepatitis A and E virus). Formalin-ether concentration technique was used to assess the current infection with helminths.

Results

Serum samples were collected from 2300 participants in three districts: Nakai (349; 15%), Mahaxay (1047; 46%), and Bualapha district (904; 39%) (Table 2). Nearly half of the participants were male (1033; 45%), with an average age of 32.0 years (±16.6), ranging from 5 to 87 years. The majority belonged to the Tai-Kadai/Lao-Loum ethnicity (1249; 54%). The education levels of adult participants (n=1683) varied: 561 (33%) stated that they had not received any education, approximately half completed primary school, and only 39 (2%) attained a university degree. The majority of adults were engaged in farming (1534; 91%). In all participants with available data (n=2263), the wealth index measurement was stratified into three categories: poor (754; 33%), moderate (753; 33%), and high (756; 33%) (Table 2).

Table 2. Socio-demographic characteristics of study participants.

Conclusion & perspectives

This study will provide a comprehensive assessment of WASH conditions and their association with infectious diseases in rural Lao communities. By evaluating the knowledge, attitudes, and practices related to WASH, we will gain insights into community behaviors that significantly influence health outcomes as a basis for designing future interventions.