Household water, sanitation and hygiene and their effects on child health in Nepal

Water, sanitation and hygiene (WASH) are public health concerns associated with communicable diseases. Despite some progress toward the increase of WASH over the past decade, the population of Nepal still has poor access to WASH facilities, and diarrhoea is ranked the second-highest disease-related cause of child mortality. This thesis identifies the availability of household-level WASH facilities and examines individual-,family/household-, and community-level factors associated with WASH assesses the effects of households’ WASH facilities on diarrhoea and malnutrition (stunting, wasting and underweight) among children under five years in Nepal. Firstly, a systematic review on maternal handwashing with soap was conducted. Next, Nepal Demographic and Health Survey 2016 data from 11,040 households were used to map current WASH facilities. To do this, bivariate and spatial analyses were conducted. Then, data from 5,038 mothers with children under five years were analysed to examine individual-, family/household-, and community-level factors associated with WASH and to assess the effects of WASH on diarrhea and malnutrition among children under five in Nepal. This thesis showed approximately 95% of households had access to improved water sources, 84% had access to sanitary toilets, 81% had access to fixed places for handwashing, and 47% had access to soap and water for handwashing. Education level, place of residence and Province were significantly associated with sanitary toilets and handwashing facilities. The household wealth index, ecology and distance to a water source were significantly associated with WASH facilities. Lack of combined WASH facilities was associated with a 50% higher chance of contracting diarrhoea among children under five years. Lack of sanitary toilets increased the likelihood of children suffering from stunting and underweight, while the absence of a fixed place for handwashing increased the risk of wasting. This is the first study of WASH in Nepal that has included a comprehensive measure of the combined WASH factors. This thesis highlights the need to create enabling environments for sustainable WASH facilities. The Government of Nepal should launch a comprehensive WASH package for all households. This is possible by mobilising teachers, traditional healers, priests, politicians, and other organisations and resources to meet this aim.