Progress toward achieving Sustainable Development Goal 6, clean water and sanitation for all, is behind schedule and faces substantial financial challenges. Rigorous water, sanitation, and hygiene (WASH) interventions have underperformed, casting doubt on their efficacy and potentially undermining confidence in WASH funding and investments. But these interventions have leaned on a narrow set of WASH indicators—linear growth and diarrhea—that reflect a 20th‐century prioritization of microbiological water quality as the most important measurement of WASH intervention success. Even when water is microbiologically safe, hundreds of millions of people face harassment, assault, injury, poisoning, anxiety, exhaustion, depression, social exclusion, discrimination, subjugation, hunger, debt, or work, school, or family care absenteeism when retrieving or consuming household water. Measures of WASH intervention success should incorporate these impacts to reinforce the WASH value proposition. We present a way forward for implementing a monitoring and evaluation paradigm shift that can help achieve transformative WASH.This article is categorized under: Engineering Water > Water, Health, and Sanitation Human Water > Value of Water Human Water > Methods

Introduction: Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women’s experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya. Methods and materials: We analyzed data from a cross-sectional study with 307 women aged 18–49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women’s experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities. Results: The average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (β = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (β = -5.030, p = 0.006) and third trimester (β = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (β = -8.962, p = 0.016). Women who were interviewed by phone (β = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person. Conclusions: Factors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.

Packaged water, particularly bagged sachet water, has become an important drinking water source in West Africa as local governments struggle to provide safe drinking water supplies. In Ghana, sachet water has become an important primary water source in urban centers, and a growing literature has explored various dimensions of this industry, including product quality. There is very little data on sachet water quality outside of large urban centers, where smaller markets often mean less producer competition and less government regulation. This study analyzes the microbiological quality of sachet water alongside samples of other common water sources at point-of-collection (POC) and point-of-use (POU) in 42 rural, peri-urban, and small-town Ghanaian communities using the IDEXX Colilert^® 18 (Westbrook, ME). Levels of coliform bacteria and Escherichia coli detected in sachet water samples were statistically and significantly lower than levels detected in all other water sources at POU, including public taps and standpipes, and statistically similar or significantly lower at POC. In diverse waterscapes where households regularly patch together their water supply from different sources, sachet water appears to be an evolving alternative for safe drinking water despite many caveats, including higher unit costs and limited opportunities to recycle the plastic packaging.

Existing research has suggested children of caregivers with histories of exposure to trauma are at heightened risk for victimization, but few studies have explored potential mechanisms that explain this intergenerational transmission of risk. With data from peri-urban households in Lima, Peru (N= 402), this study analyzes parenting behaviors in the relation between caregivers’ trauma history and child victimization for children aged 4–17. Results indicated caregivers’ trauma history and negative parenting behaviors related to child victimization, and negative parenting behaviors mediated this relation. Positive parenting behaviors did not have significant direct effects and were not mediators of risk transmission. Parenting behaviors did not moderate the relation between caregiver and child victimization, suggesting parenting behaviors may not buffer or exacerbate intergenerational transmission. Post-hoc analyses revealed family type (e.g., single, cohabitating/married) exerted significant direct and moderating effects on child risk, interacting with positive parenting. Families with married/cohabitating caregivers reported overall lower levels of child victimization; however, the relation between positive parenting and victimization was slightly stronger for children in single-parent families. Results highlight potential pathways of the intergenerational cycle of victimization and suggest high-risk families in Peru may benefit from parenting supports, especially pertaining to remediation of negative parenting behaviors.

Motivation: Improved seed adoption can increase yield, enhance food security, improve livelihoods, and reduce poverty. Although many governments in the global South use seed subsidies to achieve these outcomes, the success and efficiency of input subsidies is subject to debate.Most smallholders in Nepal lack information and finance to access improved technologies, including improved seeds. To address this, Nepal's universal seed subsidy programme (SSP) began in 2012. SSP offers participants up to 50% off the price of rice seed from improved varieties.Purpose: We evaluate the impact of SSP on farmer participants five years after its inception. Until now, the programme had not been evaluated.Approach and Methods: We compare rice‐growing households receiving subsidized seeds (treatment group) with those that do not (control group). We match the two groups using propensity scoring. We compare rice yield per hectare for the two groups, looking at aggregate and heterogeneous treatment effects. Primary data come from a 2019 survey of 157 treated and 173 control farm households in the Terai lowlands.Findings: We find no evidence of SSP impact on rice yield in the aggregate. One potential explanation is that the programme tended to promote seed of a long‐standing open‐pollinated variety (OPV), rather than newer, higher‐yielding OPVs and hybrids. Examination of heterogenous impacts, however, shows higher yields among treated households who were either on low incomes or remote from agro‐dealers and agricultural extension offices.Policy implications: Given the lack of impact on yields of SSP, sustaining the programme in the same form is neither advisable nor justified. We suggest targeting households on low incomes and in remote areas; subsidizing only the more recent high‐yielding varieties; and considering cost‐effective approaches to administer the programme, such as seed vouchers. To improve last‐mile seed delivery, SSP needs to engage more with private seed providers and be more transparent in its operations. Results from this study may have broader implications for other long‐standing agricultural subsidies in Nepal and other developing countries with universal subsidy programmes.