Influence of Seasonal Hazards on Water, Sanitation, and Hygiene–Related Behavior and Implications for Cholera Transmission in Bangladesh

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Most cholera outbreaks in Bangladesh are seasonal, peaking in the dry and post-monsoon periods. Therefore, we investigated whether changes in water, sanitation, and hygiene (WASH) behavior in three populations in Bangladesh during the year could help explain why these two periods are particular to cholera transmission. The study used a mixed-method design, including a repeated cross-sectional study, focus group discussions, and key informant interviews. Through a repeated cross-sectional study, WASH-related variables were assessed during the dry, monsoon, and control seasons in 600 households from coastal Satkhira, inland Sirajganj, and the Dhaka slums. Seasonal behavioral changes were observed in all study areas. Dhaka and Satkhira had an increased mean distance to water sources during the dry and monsoon seasons (Dhaka: control season, 12 m [95% CI, 11–13]; dry season, 36 m [95% CI, 18–55]; and monsoon season, 180 m [95% CI, 118–243]; Satkhira: control season, 334 m [95% CI, 258–411]; dry season, 669 m [95% CI, 515–822]; and monsoon season, 2,437 m [95% CI, 1,665–3,209]). The participants attributed this to pollution of the usual water source. Perceived water quantity was lowest during the dry season in Dhaka and Sirajganj, and during the monsoon season in Satkhira. Handwashing with soap declined in all areas during the dry and monsoon seasons. Open defecation was frequent among children younger than 5 years, increasing during seasonal climate hazards. Results show that WASH-related behavior changed seasonally, increasing the risk of cholera transmission through multiple hygiene-related transmission pathways. Future research would benefit by ensuring that the length of studies covers all seasons throughout the year and also by looking in more detail at people’s behavior and hygiene practices.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Tropical Medicine and Hygiene
Vol/bind108
Udgave nummer3
Sider (fra-til)518-523
Antal sider6
ISSN0002-9637
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Financial support: This work was funded by the University of Copenhagen Star program and DANIDA, the Danish foreign ministry (FFU grant no. 12-040KU).

Publisher Copyright:
Copyright © 2023 The American Society of Tropical Medicine and Hygiene.

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