Exploring geographic distributions of high-risk water, sanitation, and hygiene practices and their association with child diarrhea in Uganda
Open accessAbstract
BackgroundHigh-risk water, sanitation, and hygiene (WASH) practices are still prevalent in most low-income countries. Because of limited access to WASH, children may be put at an increased risk of diarrheal diseases.ObjectivesThis study aims to 1) develop a new measure of WASH-induced burden, the WASH Resource Index (WRI), and estimate its correlation with child diarrhea and an additive index of high-risk WASH practices; 2) explore the geographic distribution of high-risk WASH practices, child diarrhea, and summary indices at the cluster level; and 3) examine the association between the WRI and child diarrhea at the individual level.DesignA sample of 7,019 children from the Uganda Demographic and Health Survey 2011 were included in this study. Principal component analysis was used to develop a WRI, and households were classified as WASH poorest, poorer, middle, richer, and richest. A hot spot analysis was conducted to assess whether and how high-risk WASH practices and child diarrhea were geographically clustered. A potential association between the WRI and child diarrhea was examined through a nested regression analysis.ResultsHigh-risk WASH practices were clustered at geographically distant regions from Kampala. The 2-week prevalence of child diarrhea, however, was concentrated in Eastern and East Central regions where high-risk WASH practices were not prevalent. At the individual level, none of the high-risk WASH practices were significantly associated with child diarrhea. Being in the highest WASH quintile was, however, significantly associated with 24.9% lower prevalence of child diarrhea compared to being in the lowest quintile (p<0.05).ConclusionsOnly a weak association was found between the WRI and child diarrhea in this study. Future research should explore the potential utility of the WRI to examine WASH-induced burden.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In Ghana, availability and access to safe drinking water and proper sanitation depend on several factors, including geographical location.
“in Ghana, availability and access to safe drinking water and proper sanitation depend on several factors, including geographical location.”
From Demographic disparities in unimproved drinking water and sanitation in Ghana: a nationally representative cross-sectional study (2022) · cites this paper as [15]
The Results (Spatial analysis) and Conclusion report geographic differences in drinking-water and sanitation practices within Uganda. They support the geographic-disparity point, but do not establish it for Ghana or identify the several factors on which access there depends. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Kotloff, K. L., Nataro, J. P., Blackwelder, W. C., Nasrin, D., Farag, T. H., Panchalingam, S., Wu, Y., Sow, S. O., Sur, D., Breiman, R. F., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60844-2 · Cited by 3,560 · see citing works
Local Spatial Autocorrelation Statistics: Distributional Issues and an Application
Ord, J., & Getis, A. (2010) · Geographical Analysis · doi:10.1111/j.1538-4632.1995.tb00912.x · Cited by 3,365 · see citing works
Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., Cousens, S., Mathers, C., & Black, R. E. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61698-6 · Cited by 3,167 · see citing works
Global burden of childhood pneumonia and diarrhoea
Walker, C. L. F., Rudan, I., Liu, L., Nair, H., Theodoratou, E., Bhutta, Z. A., O'Brien, K. L., Campbell, H., & Black, R. E. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60222-6 · Cited by 2,356 · see citing works
Fewtrell, L., Kaufmann, R. B., Kay, D., Enanoria, W. T. A., Haller, L., & Colford, J. M. (2004) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(04)01253-8 · Cited by 1,688 · see citing works
Prüss‐Ustün, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., Bonjour, S., Dangour, A. D., De France, J., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12329 · Cited by 1,198 · see citing works
Demographic and health surveys: a profile
Corsi, D. J., Neuman, M., Finlay, J. E., & Subramanian, S. (2012) · International Journal of Epidemiology · doi:10.1093/ije/dys184 · Cited by 1,178 · see citing works
Microbial contamination of drinking water and disease outcomes in developing regions
Ashbolt, N. J. (2004) · Toxicology · doi:10.1016/j.tox.2004.01.030 · Cited by 1,107 · see citing works
Domestic water quantity, service level and health
Howard, G., Bartram, J., Williams, A. R., Overbo, A., Fuente, D. E., & Geere, J. A. (2020) · White Rose Research Online (University of Leeds, The University of Sheffield, University of York) · Cited by 931 · see citing works
Water, sanitation and hygiene for the prevention of diarrhoea
Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W.-P. (2010) · International Journal of Epidemiology · doi:10.1093/ije/dyq035 · Cited by 667 · see citing works
Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P. T., Wolf, J., Prüss‐Ustün, A., Bonjour, S., Hunter, P. R., Fewtrell, L., et al. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12339 · Cited by 524 · see citing works
Ngure, F. M., Reid, B. M., Humphrey, J. H., Mbuya, M. N. N., Pelto, G. H., & Stoltzfus, R. J. (2014) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.12330 · Cited by 502 · see citing works
Planned, motivated and habitual hygiene behaviour: an eleven country review
Curtis, V. A., Danquah, L. O., & Aunger, R. V. (2009) · Health Education Research · doi:10.1093/her/cyp002 · Cited by 482 · see citing works
Dreibelbis, R., WINCH, P. J., Leontsini, E., Hulland, K. R. S., Ram, P. K., UNICOMB, L. E., & Luby, S. P. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-1015 · Cited by 419 · see citing works
Freshwater availability and water fetching distance affect child health in sub-Saharan Africa
Pickering, A. J., & Davis, J. (2012) · Environmental Science & Technology · doi:10.1021/es203177v · Cited by 264 · see citing works
Excreta disposal for rural areas and small communities
(1959) · Medical Journal of Australia · doi:10.5694/j.1326-5377.1959.tb88741.x · Cited by 245 · see citing works
Hygiene: new hopes, new horizons
Curtis, V., Schmidt, W., Luby, S., Florez, R., Touré, O., & Biran, A. (2011) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(10)70224-3 · Cited by 228 · cited 2× · see citing works
“An in-depth discussion on the behavioral determinants of handwashing with soap is beyond the scope of this paper, but the importance of access to infrastructure or technology to elicit handwashing behaviors has been wellrecognized in literature (28, 29).”
BackgroundPullan, R. L., Freeman, M. C., Gething, P. W., & BROOKER, S. J. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001626 · Cited by 225 · see citing works
Richard, S. A., Black, R. E., Gilman, R. H., Guerrant, R. L., Kang, G., Lanata, C. F., Mølbak, K., Rasmussen, Z., Sack, R. B., Valentiner‐Branth, P., et al. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kwt094 · Cited by 163 · see citing works
Arnold, B. F., Galiani, S., Ram, P. K., Hubbard, A., Briceño, B., Gertler, P., & Colford, J. M. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kws281 · Cited by 126 · see citing works
Garriga, R. G., & Foguet, A. P. (2013) · Water Resources Management · doi:10.1007/s11269-012-0251-6 · Cited by 75 · see citing works
Accuracy of child morbidity data in demographic and health surveys
Manesh, A. O., Sheldon, T., Pickett, K. E., & Carr‐Hill, R. (2007) · International Journal of Epidemiology · doi:10.1093/ije/dym202 · Cited by 74 · see citing works
A simple index to measure hygiene behaviours
Webb, A. L., Stein, A. D., Ramakrishnan, U., Hertzberg, V. S., Urizar, M., & Martorell, R. (2006) · International Journal of Epidemiology · doi:10.1093/ije/dyl165 · Cited by 56 · see citing works
Almedom, A. M., Blumenthal, U. J., & Manderson, L. H. (1997) · Cited by 54 · see citing works
Measuring disparities in sanitation access: does the measure matter?
Rheingans, R., Anderson, J. D., Luyendijk, R., & Cumming, O. (2013) · Tropical Medicine & International Health · doi:10.1111/tmi.12220 · Cited by 36 · see citing works
Coombes, Y., & Devine, J. (2010) · World Bank, Washington, DC eBooks · doi:10.1596/27924 · Cited by 34 · see citing works
Water, sanitation and hygiene in wetlands. A case study from the Ewaso Narok Swamp, Kenya
Anthonj, C., Rechenburg, A., & Kistemann, T. (2016) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2016.06.006 · Cited by 27 · see citing works
Determinants of acute diarrhoea in children aged 0 – 5 years in Uganda
Ssenyonga, R., Muwonge, R., Twebaze, F., & Mutyabule, R. (2010) · East African Medical Journal · doi:10.4314/eamj.v86i11.55829 · Cited by 9 · see citing works
Flagged first, then by citations
1 of the 29 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [25]Mitchell A The ESRI guide to GIS analysis, volume 2: spatial measurements and statistics 2005 Redlands, CA ESRI Press
Cited by
Sorted by citations
He, Z., Bishwajit, G., Zou, D., Yaya, S., Cheng, Z., & Zhou, Y. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15061241 · Cited by 72 · see citing works
Kwesiga, B., Pande, G., Ario, A. R., Tumwesigye, N. M., Matovu, J. K. B., & Zhu, B. (2017) · BMC Public Health · doi:10.1186/s12889-017-4589-9 · Cited by 53 · see citing works
Getahun, W., & Adane, M. (2021) · BMC Pediatrics · doi:10.1186/s12887-021-02668-2 · Cited by 43 · see citing works
Onohuean, H., Agwu, E., & Nwodo, U. U. (2022) · Environmental Health Insights · doi:10.1177/11786302221099406 · Cited by 38 · see citing works
A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa
Manda, S., Haushona, N., & Bergquist, R. N. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17093070 · Cited by 36 · see citing works
Kalule, J. B., Smith, A. M., Vulindhlu, M., Tau, N. P., Nicol, M. P., Keddy, K. H., & Robberts, F. J. L. (2019) · BMC Microbiology · doi:10.1186/s12866-019-1620-6 · Cited by 35 · see citing works
Atnafu, A., Sisay, M. M., Demissie, G. D., & Tessema, Z. T. (2020) · Tropical Medicine and Health · doi:10.1186/s41182-020-00252-5 · Cited by 34 · see citing works
Oppong, F. B., Boateng, D., Senkyire, E. K., & Logo, D. D. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060595 · Cited by 21 · see citing works
Bidkhori, M., Yousefi, M., Rohani, H., Ebrahimi, H., & Mohammadi, A. A. (2018) · Human and Ecological Risk Assessment An International Journal · doi:10.1080/10807039.2018.1462089 · Cited by 12 · see citing works
Alemayehu, M. A., Agimas, M. C., Shewaye, D. A., Derseh, N. M., & Aragaw, F. M. (2023) · Frontiers in Water · doi:10.3389/frwa.2023.1166733 · Cited by 9 · see citing works
Terfa, Z., Ahmed, S., Khan, J. A. M., & Niessen, L. W. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116684 · Cited by 8 · see citing works
Grau-Pujol, B., Cano, J., Martí-Soler, H., Casellas, A., Giorgi, E., Nhacolo, A., Saúte, F., Garriga, R. G., Quintó, L., Sacoor, C. N., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13373-9 · Cited by 7 · see citing works
Akpabio, E. M., & Rowan, J. S. (2021) · Water International · doi:10.1080/02508060.2020.1867454 · Cited by 7 · see citing works
Prevalence of Intestinal Helminth Coinfection in Drug-Resistant Tuberculosis in Uganda
Baluku, J. B., Nakazibwe, B., Wasswa, A., Naloka, J., Ntambi, S., Waisswa, D., Okwir, M., Nabwana, M., Bongomin, F., Katuramu, R., et al. (2022) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofac541 · Cited by 5 · see citing works
Nakibuule, B., Semakula, H. M., Nseka, D., Wasswa, H., Aboda, C., Nampereza, P., Namakula, L. N., & Ndejjo, R. (2026) · Scientific Reports · doi:10.1038/s41598-026-37203-9 · Cited by 4 · see citing works
Fielmua, N., Mengba, J. D., & Kosoe, E. A. (2023) · Cogent Public Health · doi:10.1080/27707571.2023.2212852 · Cited by 3 · see citing works
fl, F. D., Iknane, A. A., Diawara, F., Coulibaly, D., Koite, N., Diarra, S., & Simaga, T. (2018) · Mali Santé Publique · doi:10.53318/msp.v8i01.1465 · Cited by 3 · see citing works
Shaaban, F. L., Kabatereine, N. B., & Chami, G. F. (2022) · BMC Infectious Diseases · doi:10.1186/s12879-022-07468-2 · Cited by 4 · see citing works
Neglected Water, Sanitation and Hygiene Aspects in Preventing Childhood Stunting
Dwipayanti, N. M. U., & Purnama, S. G. (2022) · Public Health and Preventive Medicine Archive · doi:10.53638/phpma.2022.v10.i2.p01 · Cited by 2 · see citing works
A spatial shared component random intercept model for assessing risk of diarrhea among men and women
KISMIANTINI, K., & Jaya, I. G. N. M. (2020) · Journal of Physics Conference Series · doi:10.1088/1742-6596/1581/1/012018 · Cited by 1 · see citing works
Muchangi, J. M., Muhula, S. O., Kuijpers, M., Jerop, M., Wanjiku, J., Nankanja, M., Arulraj, J., Ojakaa, D. I., Munai, D., & Mukasa, C. H. (2024) · Research Square · doi:10.21203/rs.3.rs-3785116/v1 · Cited by 1 · see citing works
Is Gender Based Violence Related to Sanitation? A Case Study of Patongo Town Council, Uganda
Roba, S. D. (2022) · Journal of Gender Related Studies · doi:10.47941/jgrs.1139
Shaaban, F. L., Kabatereine, N. B., & Chami, G. F. (2022) · Figshare · doi:10.6084/m9.figshare.19808951
Grau-Pujol, B., Cano, J., Marti-Soler, H., Casellas, A., Giorgi, E., Nhacolo, A., Saúte, F., Giné, R., Quintó, L., Sacoor, C. N., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19778169
Grau-Pujol, B., Cano, J., Marti-Soler, H., Casellas, A., Giorgi, E., Nhacolo, A., Saúte, F., Giné, R., Quintó, L., Sacoor, C. N., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19778166
Grau-Pujol, B., Cano, J., Marti-Soler, H., Casellas, A., Giorgi, E., Nhacolo, A., Saúte, F., Giné, R., Quintó, L., Sacoor, C. N., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19778163
Grau-Pujol, B., Cano, J., Marti-Soler, H., Casellas, A., Giorgi, E., Nhacolo, A., Saúte, F., Giné, R., Quintó, L., Sacoor, C. N., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19778172
Wembolua, B., James, B. B., Christine, K. B., Georgette, N. N. B., Vainqueur, M. L., & Corneille, K. M. (2025) · Pan-African Journal of Health and Environmental Science · doi:10.56893/ajhes2025v04i02.10
Olet, S. C., Katusiime, C., Kalyegira, S., Bamuloze, D., Ongom, S., Namatovu, A., Abuwo, C., Muluga, W. U., Ssebandeke, I., Nangira, P., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-10657375/v1
- Authors
- Hirai, M., Roess, A., Huang, C., & Graham, J.
- Affiliations
- George Washington University (US)
- Corresponding author
- Hirai, Mitsuaki
- Venue
- Global Health Action
- Publisher
- Informa UK Limited
- Published
- 2016-10-26
- Volume
- 9
- Issue
- 1
- Pages
- 32833-32833
- ISSN
- 1654-9716 (ISSN-L)
- 1654-9880
- PMC
- PMC5084380
- OpenAlex
- W2544367345
- Cited by
- 29
- References
- 29
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 13 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Global Health Action (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- childhood diarrhea, geographic clustering, household wealth, Uganda, hot spot analysis, principal component analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
