Linkage between water, sanitation, hygiene, and child health in Bugesera District, Rwanda: a cross-sectional study

Rwanda met the Millennium Development Goal targets for access to drinking water and sanitation. However, the WASH practices of high-risk communities are undocumented. Lack of information may hide disparities that correlate with disease. The purpose of this study was to assess WASH and childhood diarrhoea in Bugesera District. A survey was administered to caregivers. Water and stool samples were collected to assess physical and biological characteristics. Focus groups provided information on community context. Analysis included descriptive statistics, Chi-square, logistic regression, and thematic analysis. Piped water and unimproved sanitation were used by 45.28 per cent and 88.38 per cent of respondents. Most respondents (51.47 per cent) travelled 30–60 minutes per trip for water and 70 per cent lacked access to hand-washing near the latrine. Diarrhoea was less prevalent in children who used a toilet facility (p = 0.009). Disposal of faeces anywhere other than the toilet increased the odds of having diarrhoea (OR = 3.1, 95 per cent CI = 1.2–8.2). Use of a narrow mouth container for storage was associated with decreased intestinal parasites (p = 0.011). The presence of a hand-washing station within 10 metres of the toilet was associated with lower odds of intestinal parasites (OR = 0.54, 95 per cent CI: 0.29–0.99). Water and sanitation access, water handling and storage, and unsanitary household environment underlie high diarrhoeal disease prevalence.