WASH (Water, Sanitation, and Hygiene) Deficits and Infectious Disease Burden in Urban Slums: A Cross-sectional Survey of Households in Nigeria
Taiwo Bakare-Abidola *
Department of Environmental Science, Georgia Southern University, Statesboro, GA, USA.
Esan Oluwasegun Isaac
Department of Environmental Chemistry, Chemistry Department, Faculty of Science, University of Lagos, Lagos, Nigeria.
Uzoma Eucharia Ibeanu
Department of Process and Life Science Engineering, Lund University, Lund, Sweden.
Temitope Olufunmi Atoyebi
Department of Information Technology and Information Systems, Nile University of Nigeria, Abuja, Nigeria.
Kehinde Adebusola Lawal
Central Teaching and Research Laboratory, Bells University of Technology, Ota, Ogun State, Nigeria.
Elekwa Phillip
University of Illinois Springfield (UIS), Illinois, USA.
Darlington Chukwuma Ugwu
Local Manufacturing Division, Africa Centre for Disease Control and Prevention, Addis Ababa, Ethiopia.
Mame Diarra Bousso Diouf
Département de Génie Civil, École Supérieure d’Electricity, de Batiment et des Travaux Publiques (ESEBAT), Dakar, Senegal.
Chizaram Onyeaghala
Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Urban informal settlements frequently experience inadequate water, sanitation, and hygiene (WASH) services, increasing exposure to enteric and environmentally mediated infections. Multi-city primary data linking household WASH conditions with disease outcomes in Nigerian slum communities remain limited.
Objectives: To describe WASH access and water quality in selected slum communities in Lagos, Kano, and Port Harcourt; estimate household-reported 30-day occurrence of selected WASH-related illnesses; describe soil-transmitted helminth positivity among stool-tested participants; and examine associations between selected WASH exposures and disease outcomes.
Methods: A multi-site cross-sectional household survey was conducted from January to August 2024. A total of 1,157 households were enrolled through stratified cluster sampling. Drinking-water microbiology was assessed in 580 sampled households, and 648 consenting household members provided stool specimens for Kato-Katz examination. Multivariable logistic regression models adjusted for household income, caregiver education, household size, number of children younger than five years, and city of residence.
Results: Household WASH conditions were poor: 37.4% of households practised open defecation, 10.5% had a functioning handwashing station with soap and water, and 63.8% of point-of-use water samples exceeded the study microbiological threshold. Household-reported 30-day diarrhoeal episodes occurred in 35.3% of households, while the combined suspected/confirmed typhoid outcome occurred in 19.1%. Among the 648 stool-tested participants, 478 were Kato-Katz positive for at least one soil-transmitted helminth (73.8%). Unimproved water source was associated with diarrhoea (adjusted odds ratio [aOR] 5.10, 95% CI 3.90-6.70), open drainage within 50 m with suspected cholera (aOR 4.20, 95% CI 3.10-5.70), and absence of household sanitation with the combined typhoid outcome (aOR 3.80, 95% CI 2.60-5.40).
Conclusion: In the surveyed communities, multiple WASH deficits co-occurred with substantial burdens of household-reported enteric illness and microbiological contamination. The cross-sectional design supports association rather than causation, but the findings identify potentially actionable deficits in water quality, sanitation, hygiene, and household water handling.
Keywords: WASH, urban slums, diarrhoeal disease, cholera, typhoid fever, soil-transmitted helminths, Nigeria