Assessment of the Water, Sanitation, and Hygiene(WASH) situation and identifying the implementation challenges of the water surveillance system in Dhulikhel Municipality

Assessment of the Water, Sanitation, and Hygiene(WASH) situation and identifying the implementation challenges of the water surveillance system in Dhulikhel Municipality | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of the Water, Sanitation, and Hygiene(WASH) situation and identifying the implementation challenges of the water surveillance system in Dhulikhel Municipality Safal Jung Thapa, Biraj Man Karmacharya, Bandana Paneru, Yunika Acharya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9073621/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Diarrheal diseases remain a significant public health concern, especially in U5 children, with inadequate Water, Sanitation, and Hygiene (WASH) practices contributing heavily to the disease burden. This study aimed to assess the household WASH situation with at least 1 U5 child in Dhulikhel Municipality and evaluate the barriers and facilitators of implementing a water surveillance system. Objectives included determining household U5 diarrhea prevalence, assessing caregiver WASH knowledge and practices, and identifying key barriers and facilitators for effective water surveillance. Methodology : A cross-sectional study was conducted among 250 households with 308 U5 children in the (3-8) ward of Dhulikhel Municipality. Data were collected using “Core questions on drinking water and sanitation for household surveys” developed by the WHO and UNICEF to assess the household prevalence of diarrhea cases among children. Statistical tools (STATA 18.5) assessed WASH Knowledge practices and their association with U5 diarrhea prevalence. Semi-structured interviews with 16 stakeholders and focus group discussions with water consumer groups explored potential barriers and facilitators of the water surveillance system. Data were analyzed using the CFIR framework to identify recurring themes. Findings : Diarrhea prevalence among U5 children was 14.8%, exceeding national averages. Despite high awareness of practices like handwashing (96.8%) and water treatment (80%), gaps in consistent application remained. Socio-demographic factors influenced WASH practices, but no significant association with diarrhea prevalence was observed. Barriers included low public awareness, cultural misconceptions, role ambiguity, authority unaccountability, perceived complexity, resource constraints, and political instability. Facilitators encompassed community training, technological innovations, effective leadership, partnership, and stakeholder collaboration. Advanced tools improved data accuracy, while partnerships with NGOs enhanced resource mobilization for an improved surveillance system. Conclusion : Increasing WASH outcomes and water surveillance in Dhulikhel requires addressing systemic barriers like resource constraints and awareness gaps. Leveraging technology, community ownership, strong governance, and stakeholder collaboration can ensure safer water access, better hygiene practices, and reduced U5 diarrheal disease prevalence. Epidemiology WASH (Water Sanitation and Hygiene) Diarrhea U5 Children Household U5 Caregiver Dhulikhel Municipality Public Health Water Safety Plan Water Surveillance Stakeholders Figures Figure 1 Background 1.1 Introduction Diarrheal disease continues to be a major source of morbidity and mortality among U5 children worldwide, accounting for nearly 0.5 million deaths and 1.7 billion cases each year 1 . Over 90% of deaths in LMICs among U5 children result from diarrhea, emphasizing urgent improvements in WASH access 2 . Water surveillance helps monitor drinking water quality and prevent health risks associated with contamination 3 . Enhancing WASH dramatically lowers the number of deaths caused by diarrhea and prevents neglected tropical diseases 4 . Adhering to WHO criteria, a risk-based approach to drinking water prioritizes surveillance parameters depending on the outputs of water safety plans, thereby improving public health safety 5 . The rights to clean water, sanitation, and hygiene are essential for human development and well-being. Their absence brings on diarrhea and impacts millions of children globally 6 , 7 . To achieve good health, gender equality, poverty reduction, and general socioeconomic advancement, the Sustainable Development Goals strongly emphasize the importance of water and sanitation 8 . Research in many areas emphasizes the significance of appropriate water sources, sanitation amenities, and hygiene protocols in averting illnesses and advancing communal well-being 9 . The world is facing challenges as a result of pollution-related water shortages 10 . Nearly two-thirds of the world population faces water challenges for at least one month every year 11 . Many nations' drinking water does not adhere to WHO guidelines which account for 80% waterborne disease 12 . 3.1% of deaths are attributable to dirty, low-quality drinking water 13 .2.4 billion people are deprived of safely managed drinking water supply 14 . Inadequate WASH facilities contribute to an increased burden of diseases, with 90% of diarrhea-related deaths globally attributed to inadequate access to water and poor sanitation practices 6 , 15 . Over 2 billion people worldwide lack access to basic sanitation facilities, which makes it easier for illnesses like diarrhea to spread 16 . The majority of the diseases that cause the burden of water, sanitation, and hygiene-related illnesses are preventable, accounting for 5.7% of all diseases and 4.0% of all deaths globally 17 .Nearly 110 million people in Southeast Asia are facing water challenges 18 . SEAR, including Bangladesh, India, and Sri Lanka, confronts poor WASH practices, contributing to public health concerns 19 . The prevalence of open defecation is still high in some places due to inadequate sanitation coverage 20 . Pollution and waterborne illnesses persist because of inadequate sanitation system design and upkeep, even in nations with improved sanitation coverage, such as Vietnam, Thailand, and Myanmar 21 . Water, sanitation, and hygiene (WASH) in Nepal face challenges despite being a water-abundant country 22 . WASH access inequalities across social, economic, and gender lines due to inadequate infrastructure, financial constraints, and policy issues, worsened by climate change risks, hinder reliable services 23 , 24 . Nepal struggles with providing basic water services to a significant population, with over 10 million lacking improved sanitation facilities 25 . Factors such as unhygienic drinking water storage systems and drainage issues have been linked with an increased risk of diarrhea in children in Nepal 26 . Bacterial coliform has been identified as a prime cause of acute diarrhea in U5 Children 27 . Addressing hygiene practices and sanitation conditions is vital in reducing the burden of infectious diseases within communities 28 . Proper water resource management is crucial to stopping waterborne illnesses, particularly infections that cause diarrhea among U5 children. 1.2 Statement of the Problems The prevalence of poor sanitation and lack of access to quality water has led to a high burden of infectious diseases 29 . Waterborne diseases result in 1.5 million deaths yearly, mainly affecting children in poor households 30 . Over 2 billion people lack access to basic sanitation services globally, which contributes to the spread of diarrhea 31 . Water-related illnesses continue to be a major cause of mortality, particularly for children under five who live in rural parts of poor countries 32 . Urbanization, poor technology, complex institutional frameworks, and the disregard for rural areas in developing nations are some of the reasons why challenges continue 33 . Waterborne illnesses like diarrhea have become more common in SEAR as a result of inadequate water sanitation and hygiene (WASH) standards, especially in nations like Nepal 34 , 35 . The presence of coliform bacteria in water sources indicates fecal contamination and poses a risk of diarrheal diseases 36 . Subnational disparities continue despite efforts to increase access to WASH services; obstacles include incompatibilities in policy, funding, and technological limitations 37 . The prevalence of diarrheal disease in U5 children has been reported to be around 20.8% in urban regions of Nepal 38 . Natural catastrophes like the earthquake in Nepal can worsen the situation by disrupting the clean water supply and causing inadequate sanitation, which increases the likelihood of epidemics 39 . Water sanitation and hygiene (WASH) initiatives in Dhulikhel have been crucial due to prevalent waterborne diseases like diarrhea 40 . DDWUC reports a huge gap in supply (2.2 million liters /day) and demand (3.7 million liters/day) of drinking water. 1.3 Rationale of the Study Preventing waterborne illnesses like diarrhea requires improving WASH 41 . The lack of access to sanitary facilities harms the environment and the lives of billions of people worldwide 42 . Ensuring human health in developing nations requires access to safe drinking water, proper sanitation, and good hygiene 43 . Achieving WASH targets is crucial because poor WASH contributes significantly to major health outcomes, including malnutrition and diarrhoea 44 . Improving access to sanitary facilities and clean water could prevent the average annual deaths of 297,000 U5 children 45 . Nepal faces WASH challenges due to infrastructure, funding, and policy issues, stressing the need for long-term strategies to enhance access and equity 46 . Enhancing sanitation and water quality is crucial because contamination can cause fatal illnesses 47 . Water surveillance protects public health by monitoring drinking water for safety and quality 48 Conducting WASH in Dhulikhel is crucial to tackling water contamination, guaranteeing fair access to WASH facilities for everyone, and advancing sustainable WASH practices in the area. 1.4 Objective of the Study To determine the household prevalence of diarrheal disease among U5 children in the Dhuilkhel municipality To assess the knowledge and practice regarding WASH among caregivers of U5 children in the Dhulikhel municipality To assess the association between diarrheal disease, knowledge and practice among caregivers of U5 children in the Dhulikhel municipality To explore barriers and facilitators of the water surveillance system in Dhulikhel municipality Research Methodology A multi-method study was conducted in Dhulikhel Municipality from March to mid-June 2024, employing a cross-sectional design at the household level in wards 3–8, which included households with at least one under-five (U5) child. The study aimed to measure diarrheal prevalence and assess the WASH situation at a specific point in time. Dhulikhel was selected due to the ongoing UMD project, the involvement of the Dhulikhel Drinking Water User Committee (DDWUC) in water governance for wards 3–8, and the municipality’s inadequate clean water and sanitation, highlighting the need for urgent research and intervention. Eligible households were within wards 3–8, with at least one U5 child and a consenting primary caregiver available for questionnaires, while households with language barriers, caregivers with severe medical or cognitive impairments, or U5 children residing less than two weeks were excluded. 2.1 Sample Size N = Total number of households with atleast 1 U5 child under our study p = Prevalence of household U5 children with diarrheal cases Where, p = 0. 1 49 and q = 1- 0.1 = 0.9 d= allowable error Where d = 4 % or 0.04 Z = 1.96 (At 95% Confidence interval) Sample size of U5 children under our study (n 1 ) =(Z^2*p*q)/d^2 Number of U5 children taken to assess the WASH situation in Dhulikhel Municipality (n 1 ) = 217 Non-response rate for households with atleast 1 U5 child = 15% of 217 = 32.6 ≈ 33 Therefore, total number of households with atleast 1 U5 child under our study (N) = 217+33 = 250 2.2 Sampling Techniques Households in wards 3–8 of Dhulikhel Municipality, where the DDWUC supplies drinking water, were purposively selected. Within these wards, households with at least one (U5) child were conveniently chosen to assess the WASH situation. A list of such households was provided by the the Municipality office, enabling assessment of both WASH conditions and U5 diarrheal prevalence. 2.3 Study Variable Dependent Variable Prevalence of U5 diarrheal disease = (Total U5 diarrheal disease at household level / Total U5 children household under study) * 100% Independent Variable 1. Socio-demographic and household characteristics Age (in years) Sex (Male/Female) Level of Education(Primary/Secondary/Tertiary/Vocational) Marital Status(Single/Married/Divorce/Widow/Seprate/other) Religion(Hindu/Christianity/Islam/Buddhist/other) Ethnicity (Brahmin or Chhetri/ Newar /Tamang /other) Status of Respondent (Father/Mother/Sibling/Blood relative) Occupation(farmer/trader/unemployed/retired/teacher/other) Income (daily/monthly/weekly/not regular/not earned) Monthly income in Rupees 2. Knowledge & Practice on WASH Water Sanitation Hygiene & practice Hand washing & latrine use WASH Knowledge 2.4 Sampling strategy : Household caregivers with at least 1 U5 child were selected through a purposive form of the water consumer group within the (3–8) ward households in Dhulikhel municipality . 2. 5 Data Collection Tools and Techniques: a. Quantitative Phase Technique: Face-to-face interview Tool: Pre-structured questionnaires. 2.6 Pre-testing the Data Collection Tools: The study was conducted among 10% of the total sample size in a non-study area. 2.7 Validity and Reliability of the Study Tools Validity Proper operationalization of the variables and explanation of the research title, objectives, and the tools used. Questionnaires were translated into both Nepali and English. The WASH questionnaire was adapted from “ Core questions on drinking-water and sanitation for household surveys ” developed by the WHO & UNICEF 50 . Sociodemographic questionnaires adopted from the NDHS report 2022. Reliability The questionnaire was checked, and modification of the tools was done as per the requirements after pretesting . 2.8 Potential Biases: Data collection timing, social desirability, and potential over- or underrepresentation may affect findings and limit their generalizability to Dhulikhel’s entire population. 2.9 Limitation: The study’s cross-sectional design limits causal inference, may be affected by recall bias, and only captures a specific time, missing seasonal variations. Multiple U5 children per household and a focus on selected wards may limit generalizability. 2.10 Supervision and Monitoring: The research team held regular reviews, conducted site visits, ensured data quality, analyzed findings, prepared reports, followed ethical protocols, and maintained transparency to achieve project goals effectively. 2.11 Data Management and Analysis: Quantitative Study Socio-demographic characteristics, knowledge, and practices in WASH were analyzed using structured questionnaires. Diarrhea prevalence and WASH practice frequency and percentage, The WASH Knowledge Score in our study was calculated based on caregivers' responses to structured questionnaire items assessing their knowledge of safe water storage, handwashing, sanitation behaviors, and contamination risks. Mean Knowledge Score = (∑Individual Scores/Total number of U5 Caregiver) Association between knowledge and practice with diarrhea was assessed using univariate and multivariate logistic regression (reporting unadjusted and adjusted odds ratios, 95% CI, and p-value < 0.05). Data were collected, cleaned regularly for consistency, stored separately to maintain confidentiality ensuring anonymity, and data were destroyed after study completion. 2.12 Expected Outcome of the Research: WASH assessment ensured the delivery of clean and safe water to communities, safeguarding public health, and reducing the risk of waterborne diseases. 2.13 Ethical Issues and Considerations: The study received ethical approval from Kathmandu University, and participants provided voluntary verbal informed consent; a copy of the consent form is included in the annex. Qualitative Study : We were conducting focus group discussions among homogeneous water consumer groups while in-depth interviews were done among key stakeholders. 2.14 Study Unit The qualitative study was among Key stakeholders at various levels Municipal and ward Representative/Policy level, Water testing lab and DDWUC/Organizational level, FCHV / intrapersonal level and Water consumer group/ interpersonal level a. Inclusion Criteria The study includes a water consumer group and key informants (KIs) inside Dhulikhel Municipality who were eligible participants willing to be involved in our research Age > 18 years b. Exclusion Criteria Reluctant to participate Medically unfit 2.15 Sample Size Calculation We had conducted 16 purposive in-depth interviews with data until saturation, when no new codes/themes emerged from further interviews among key stakeholders 51 3 focus group discussions (fgd) with (6-10) participants each 52 , among water consumer groups to gain insights into their perspectives on implementation challenges of the water surveillance system in Dhulikhel Municipality. 2.16 Tools and Techniques for the Qualitative Phase Technique: In-depth Interviews, Focus Group Discussions(FGD) Tools: Semi-structured interview guides, focus group discussion guides. 2.17 Data management We conducted a CFIR Framework analysis for the implementation challenges of the water surveillance system in the municipality. Themes were iteratively identified and refined, providing a robust understanding of factors influencing surveillance effectiveness. 2.18 Expected outcome Implementing a water surveillance system for evaluating the current state of water sources and distribution networks can have a transformative impact on the Dhulikhel Municipality. 2.19 Limitations of the Study The quality of qualitative data is highly dependent on the skills of interviewers. Participant Social desirability biases. Results 3.1 Descriptive Analysis 3.1.1 Socio-demographic characteristics of respondents The study surveyed 250 caregivers of under-five children in Dhulikhel Municipality, with an average age of 31 years, suggesting that most were young to middle-aged adults. The majority were female (78%), reflecting the traditional caregiving role of mothers, while 94.4% were married and 78.4% identified as Hindu. Ethnically, Brahmin/Chhetri (29.6%), Tamang (28.4%), and Newar (27.2%) made up the largest groups, with smaller proportions from Magar and other ethnicities. Education levels varied, with 12% having no formal education, 30.4% completing primary school, 44.4% reaching secondary education, and 13.2% holding a university degree. Most caregivers were mothers (68%), while 32% were fathers or other relatives. Occupations included housewives (28.4%), traders (22%), farmers (19.6%), teachers (13.2%), retired individuals (9.2%), and unemployed caregivers (7.6%). More than half (59.6%) had a source of income, with an average monthly household income of NPR 14,337 (median = NPR 10,000), highlighting substantial income disparity. 3.1.2 Water-related characteristics The study found that access to safe drinking water was limited, with 58.4% of households relying on non-piped water sources and only 41.6% having piped connections. Water availability for other uses was slightly better, with 51.6% using piped sources. Seasonal water scarcity was a major concern, as 73.6% of households reported shortages during the dry season, while 12% experienced shortages in the rainy season and 9.6% faced year-round inconsistency. Most households (72.8%) had water available inside their homes, but 20% spent more than 30 minutes fetching water, indicating accessibility challenges. Water storage practices varied, with households commonly using covered jars (44.4%), tanks (46.4%), and plastic bottles (47.2%). Although 93.6% reported clear water, 6.4% noticed discoloration, and a similar percentage reported unpleasant odors, suggesting possible contamination risks. Encouragingly, 80% of households treated their drinking water through boiling, filtration, or disinfection, while 20% did not use any treatment method. 3.1.3 Sanitation–related characteristics Proper sanitation is vital for preventing the spread of diarrheal diseases. The study found that 78.4% (196) of households disposed of waste by dumping it, while 21.6% (54) did not engage in waste dumping, possibly using alternative disposal methods. The proximity of dumping sites was also examined, with 39.6% (99) of households having dumping sites located more than 30 minutes away, while 38.8% (97) had sites within a 30-minute walk, and 21.6% (54) were unaware of the distance to their dumping site. Payment for household waste management varied, with 51.2% (122) paying monthly fees for waste collection, while 48.8% (128) did not pay, suggesting that waste management services were not utilized. 3.1.4 WASH Practice-related characteristics Handwashing was widely practiced among caregivers, particularly before eating (89.2%), after eating (81.6%), and after using the washroom (79.6%), with 96.8% using soap and water. However, many did not meet the recommended handwashing duration, as 50% washed for up to 1 minute and only 7.6% for 3 minutes or more. Regarding sanitation, 86% of households had sanitary latrines, with 81.6% located inside the house, but 37.6% shared toilets with other households. Half of the households relied on public toilets, and 49.6% reported no open defecation. While hygiene awareness and sanitation access were generally high, challenges remained in handwashing duration, shared or public toilet use, and waste management, indicating areas for targeted public health interventions. 3.1.5 WASH Knowledge-related characteristics Most caregivers had basic knowledge of safe drinking water practices, primarily filtration (75.6%) and boiling (66%), while awareness of chlorination (18.4%), sedimentation (10%), and alum use (2.8%) was limited, and 5.2% knew no method. Recognition of contamination indicators was moderate, with color change (59.2%), bad odor (50.8%), and poor taste (46.4%) identified, though 14.4% could not identify any. Open defecation (88.35%) and washing near water sources (72.29%) were widely recognized as contamination sources, while fewer acknowledged waste disposal, fertilizer use, or mining. Health risks, particularly diarrhea (96.8%), were well understood. Waste management practices included composting (90.4%), recycling (29.6%), biogas (10.4%), and landfilling (10.4%), though 8.4% lacked awareness. The main sources of WASH information were radio/TV (67.6%), health workers (52%), and information centers (49.6%). 3.2.1 Prevalence of U5 diarrhea at the household level The findings revealed that 37(14.8%) households with at least 1 U5 child had experienced diarrhea within the two weeks before the survey, a rate higher than the national average in Nepal. Table 1 Prevalence of household diarrhea cases among U5 children (N = 250) Variable Category Frequency % Household Diarrhea Prevalence Presence 37 14.8 Absence 213 85.2 3.3 Inferential Analysis 3.3.1 WASH Knowledge score among household U5 children's caregivers The Level of WASH Knowledge Score among Household U5 Children Caregivers (n = 250) was assessed based on a total possible knowledge score of 25 points. The mean knowledge score among caregivers was 11.6, with a standard deviation of 4.99. The minimum and maximum scores recorded were 4 and 25, respectively 3.3.2 Association between caregiver WASH Knowledge & U5 children diarrhea Prevalance at household level The association between Caregiver WASH Knowledge and U5 Children Diarrhea Prevalence at the Household Level was analyzed using both univariate and multivariate logistic regression models to assess the relationship between caregivers' knowledge and the likelihood of diarrhea occurrence among under-five (U5) children. The univariate analysis showed that the knowledge sum score had an odds ratio (OR) of 0.98 (95% CI: 0.91–1.05, p = 0.60), suggesting that an increase in WASH knowledge among caregivers had no statistically significant association with reduced diarrhea prevalence. The multivarient shows an adjusted OR 0.99(95% CI: 0.908–1.08, p = 0.64) These findings indicate that higher WASH knowledge alone does not significantly reduce diarrhea prevalence among U5 children. 3.3.3: Association between caregiver WASH Practice & U5 children diarrhea prevalence at household level The analysis of caregiver WASH practices and diarrhea prevalence among under-five children showed no statistically significant associations across all examined variables. Children in households with unsanitary latrines, toilets located outside the home, or shared toilets had slightly higher odds of diarrhea, but these associations were not significant even after adjusting for socioeconomic and demographic factors. Similarly, water treatment practices such as boiling and filtering were linked to lower odds of diarrhea, but the results were not statistically significant after adjustment. Waste management practices, including waste dumping, also showed no meaningful association with diarrhea prevalence. Handwashing with soap appeared to reduce diarrhea risk compared to using only water, but this too was not statistically significant in univariate or multivariate models. These findings suggest that while WASH practices are important, other environmental, socioeconomic, and behavioral determinants may play a greater role in influencing diarrhea incidence among children. Table 2 Socio-demographic characteristics of the qualitative study participants- Water Surveillance Variable Category Frequency % Age Mean/SD 44 9.13 Gender Female 22 61.11 Male 14 38.89 Residential Status Permanent 30 83.33 Temporary 6 16.67 Religion Hindu 32 88.89 Non-Hindu 4 11.11 Ethnicity Brahmin/Chhetri 23 63.8 Newar 13 36.2 Marital Status Married 36 100 Education Status Primary/Up to grade 8 14 38.8 Secondary/Grade (9–12) 11 30.6 University (Bachelor's/Master's degree) 11 30.6 Study Participant DDWUC Member 3 8.3 Municipality Representative 3 8.3 Ward member 4 11.11 [email protected] Water test lab member 3 8.3 FCHV 3 8.3 Water Consumer Group 20 55.55 3.4.2 Facilitator and barrier of the water surveillance system using the CFIR framework in Dhulikhel municipality The findings were categorized into key themes based on stakeholder perspectives and analyzed using the Consolidated Framework for Implementation Research (CFIR). 3.4.2.1. Barriers to Water Surveillance Implementation 4.4.2.1.1. Limited Awareness and Perceptions of Water Safety A significant barrier to effective water surveillance was low public awareness regarding water safety and contamination risks. Several participants, including municipality representatives, water test lab members, and ward members, indicated that community members often perceive water as safe based solely on its appearance (e.g., clear water) rather than scientific testing. One municipality representative stated: " Many community members assume that municipal distributed water is clean without understanding the need for additional purification methods like boiling or filtration and further testing to ensure water quality at the household level." 3.4.2.1.2. Financial Constraints and Resource Limitations The financial burden of establishing and maintaining a water surveillance system was frequently cited as a challenge. Municipality representatives emphasized that without long-term government funding, sustainability remains uncertain. A Dhulikhel Drinking Water User Committee (DDWUC) member mentioned: "Water testing systems are perceived as more expensive, complex and without sustained financial support, communities fear that these programs may collapse in near future" 3.4.2.1.3. Political and Institutional Challenges Frequent political transitions and lack of accountability among concerned authorities were also identified as key barriers to the success of the surveillance system. A municipality representative highlighted: "Frequent changes in local government and political system interrupt effective funding mechanism, program support delaying the rollout of planned water surveillance programs goal." 3.4.2.1.4. Limited Access to Advanced Testing Equipment The lack of modern laboratory facilities and reliable testing kits limits the accuracy and scope of water quality monitoring. A water testing laboratory member noted: "Without proper tools or water testing kits, we rely on outdated tools that are slow, unreliable, and less effective in detecting potential water contamination." 3.4.2.1.5. Environmental Challenges Natural disasters such as landslides, earthquakes, and seasonal floods pose a risk to water infrastructure, especially in slope regions, making consistent surveillance difficult and increasing potential water contamination risks. A ward member stated: "During monsoon, many water pipelines break down, leakage in slope area and there is no immediate action to repair them, leading to potential contamination cause several health risk." 3.4.2.1.6. Poor Inter-Agency Coordination Weak collaboration between municipal authorities, health agencies, and ward and local water consumer groups has led to fragmented efforts in water surveillance implementation. A ward member emphasized: "Different concern agencies work in isolation, poor communication which results in delayed response and uncoordinated actions at the time of epidemic" 3.4.2.1.7. Trust Issues Regarding the Surveillance System Inconsistent water testing results due to poor equipment maintenance have led to skepticism among community members in the system, which ultimately reduced trust among consumer groups from concern agencies (Water testing lab, DDWUC, Municipality). A water consumer stated: "We receive conflicting reports on water quality, leading different water quality result across different testing labs inside Dhulikhel, which makes it hard to trust the efficiency of water Surveillance system." 3.4.2.1.8. Cultural Misconceptions About Water Quality Traditional beliefs that untreated water is natural and safe for drinking purposes without contamination risk contribute to resistance against modern water testing and purification practices in the community. An FCHV noted: "People usually believe that boiling water changes its original taste and quality, leading them to consume untreated or untested water considering them safe from their health." 3.4.2.1.9. Delayed Implementation During Outbreaks Delays caused by complicated procedures and logistical challenges make it difficult to implement water safety measures quickly during disease outbreaks. A Municipal officer explained: "By the time we gather the necessary resources and take action during an outbreak, the harm has already occurred in the community in an unmanageable manner due to epidemic." 3.4.2.1.10. Lack of Community Engagement The limited involvement of local communities in decision-making processes has led to weak compliance with surveillance guidelines. A Ward member noted: "When community people are not included in planning and not well informed about the importance of the surveillance system, they do not feel responsible for water safety-related issues in the community." 3.4.2.1.11. Lack of Standardized Testing Protocols Inconsistent testing protocols across different monitoring agencies hinder the reliability of surveillance efforts. A municipal health officer stated: "Different agencies use varied testing tools and techniques, lacking uniformity leading to inconsistencies in water quality test reports across different water testing site." 4.4.2.1.12. Weak Law Enforcement on Water Quality Standards Despite proper regulations for the surveillance system, enforcement remains weak, resulting in continued contamination issues. A water test lab member emphasized: "Without strict enforcement, industries and households fail to comply with water safety guidelines, failing the surveillance system." 4.4.2.2. Facilitators for Effective Water Surveillance 4.4.2.2.1. Community Training and Awareness Programs Community-based training programs and awareness campaigns have played a crucial role in improving water surveillance. A Female Community Health Volunteer (FCHV) noted: "We conduct training programs in the community to teach safe water handling practices, the importance of water testing including boiling and proper filtration methods." 3.4.2.2.2. Technological Innovations in Water Testing The use of modern digital water quality monitoring tools has improved efficiency and data accuracy, enabling early detection and rapid response to contamination events. A water testing laboratory member stated: "Modern digital tools provide more reliable testing, helping us detect contamination early and take preventive measures quickly and more accurately." 3.4.2.2.3. Stakeholder Collaboration and Policy Initiatives Collaborations between municipal authorities, NGOs, and water user groups have strengthened implementation efforts, ensuring better resource allocation and surveillance sustainability. A DDWUC member emphasized: "Strong partnerships with concerned stakeholders and support have allowed us to secure more funding and technical support from concerned agencies." 3.4.2.2.4. Government Commitment and Financial Support Financial support from central and local governments has helped sustain water surveillance programs in the municipality. A municipal official stated: "Government funding ensures that necessary water testing resources are available at the local level and sustainable for a surveillance system.” 3.4.2.2.5. Leadership and Governance The involvement of ward representatives and local leaders has ensured regular monitoring, timely interventions, and improved accountability in water quality management. A ward leader mentioned: "Strong Political leadership drives effective water surveillance and ensures community participation, ownership, and support for water surveillance action." 3.4.2.2.6. Integration of Water Surveillance with Public Health Programs The integration of water surveillance with broader public health initiatives has enhanced disease prevention strategies and improved hygiene practices within communities. A Municipal officer stated: "Linking water surveillance with Public health programs from municipal level leadership has reduced the incidence of waterborne diseases in present days." 3.4.2.2.7. Capacity Building and Training for Health Workers Training programs for local authorities, health workers, and community members have strengthened technical competencies related to water surveillance. A water lab technician noted: "Continuous training and capacity building action helps ensure that concerned laboratory personnel and health workers are well-equipped to handle water quality monitoring effectively." 3.4.2.2.8. Increased Community Participation in Water Governance The active engagement of local communities in decision-making processes has fostered a sense of ownership, ensuring the long-term sustainability of water surveillance efforts. A water consumer stated: "When the community people are involved in the decision-making process, people take ownership and motivate themselves to keep water sources safe, ensuring the success of water surveillance system goal." 3.4.2.2.9. Use of Mobile and Digital Data Collection Systems The implementation of mobile-based water quality reporting tools and digital data collection systems has improved data accessibility and enhanced real-time monitoring capabilities. A DDWUC mentioned: "Mobile data collection systems or use of modern technology have made tracking water quality issues more efficient and transparent manner ensuring reliable and valid test result" 3.4.2.2.10. Infrastructure Improvements Upgrades in the water supply network and sanitation infrastructure have facilitated better monitoring and reduced contamination risks. A municipal engineer noted: "Municipal Investments in WASH-related infrastructure and supply networks have led to a more consistent and safer water supply system for Dhulikhel residents." 3.4.2.2.11. Standardization of Water Quality Testing The adoption of uniform testing protocols has improved the consistency and reliability of water quality data. A municipal officer noted: "Availability of the standardized water testing kits ensures that we have comparable data across different regions." 3.4.2.2.12. Strengthened Regulatory Frameworks Enhanced water safety policies, guidelines, and stricter enforcement mechanisms from municipalities have improved compliance with water quality standards. A municipal official noted: "With stricter regulations and penalties provision regarding water testing, and quality control we will see fewer violations of water safety guidelines." Discussion 4.1 Prevalence of U5 children's diarrhea at the household level In Nepal, the Prevalence of U5 diarrheal cases ranges from 10.2% to 13.6% 53 , which is quite lower than our finding of 14.8%. This is because our data were collected during rainy seasons, leading to more chance of water contamination, rather than in other seasons. Studies from Bangladesh and India report similar prevalence rates of 13.9% and 15.5%, respectively, indicating that U5 diarrheal disease remains a significant public health concern in the South Asia region 54 , 55 . Similar seasonal variations in diarrheal prevalence have been reported in other studies in South Asia, with an average seasonal diarrhea prevalence of 15.2% in Southeast Asia 56 , 57 . Research from Cambodia and Vietnam indicates seasonal peaks reaching 16.8% and 17.2%, respectively, further emphasizing the influence of environmental factors on diarrheal disease prevalance 58 , 59 . 4.2 WASH Knowledge & practice among U5 children caregiver The study highlights the critical deficiencies of WASH–related knowledge among caregivers, such as improper handwashing & unsafe water storage leading to diarrheal disease 60 – 62 . Studies in Ethiopia and Bangladesh have shown that knowledge gaps in water handling and sanitation practices significantly increase the risk of waterborne diseases 63 , 64 . Additionally, research in Kenya found that only 45% of caregivers demonstrated proper handwashing techniques, correlating with higher diarrheal prevalence among children 65 . A study conducted in India showed that inadequate knowledge regarding safe water storage and open defecation significantly contributed to the persistence of diarrheal diseases in rural areas 66 . Similarly, findings from Cambodia and Vietnam emphasize the role of educational interventions in improving sanitation behaviors and reducing diarrheal disease burden 67 , 68 . In our study, limited awareness about sanitary practices among caregivers leads to a higher prevalence of diarrheal cases in comparison to the national average 69 . The research emphasizes the need to address broader environmental factors that influence WASH Practice 23 , 24 . Limited resources, such as financial constraints for water purification methods or improper sanitation facilities, increased the risk of diarrheal disease 42 , 75 . 4.3 Association between U5 diarrhea cases with knowledge score & practice among caregiver Although WASH knowledge and practice are crucial components of effective interventions, their lack of significant association with diarrhea prevalence in this study underscores the need for a multifaceted approach. Studies in Ethiopia and India have similarly found that improved WASH knowledge alone does not always translate into lower disease prevalence, as environmental and infrastructural factors play a crucial role 70 , 71 . Other studies have also suggested that while individual behaviors play a role, broader environmental, socio-economic, and cultural factors exert a greater influence on WASH-related health outcomes 72 . A study in Bangladesh demonstrated that factors such as water source contamination and seasonal variations had a more significant impact on diarrheal prevalence than hygiene practices alone 73 . Similar research from Sub-Saharan Africa and South Asia has emphasized the importance of improving water infrastructure and sanitation facilities rather than relying solely on behavioral interventions 74 , 75 . Evidence from developing countries supports this view, showing that investments in clean water access and improved sanitation facilities significantly reduce diarrhea cases, independent of individual hygiene behaviors 76 , 77 . 4.4 Barrier and facilitator of water surveillance system in Dhulikhel Municipality 4.4.1 Barriers to the Water Surveillance System Key barriers include limited public awareness, where many individuals assume that clear water is safe for consumption without recognizing the potential for microbial contamination. This aligns with findings from Hunter et al. and Bartram & Cairncross, who emphasize that public misconceptions about water safety contribute to increased health risks 74 , 75 . Many regions lack access to modern testing equipment, resulting in delays in detecting and addressing waterborne contamination. Mara et al. highlight that outdated tools provide inaccurate results, reducing the efficiency of surveillance mechanisms 78 . Environmental challenges, such as seasonal fluctuations, natural disasters, and climate change, also contribute to inconsistent water quality. Levy et al. found that climate-related factors influence waterborne disease outbreaks, stressing the need for adaptive surveillance strategies 79 . These findings align with previous studies conducted in Nepal and other LMICs, where financial and technical constraints have hindered water quality monitoring efforts 78 , 79 . 4.4.2 Facilitator to the Water Surveillance System Conversely, leveraging technological advancements, innovative water testing methods, and stakeholder participation can significantly enhance surveillance effectiveness. Stakeholder collaboration, including partnerships between government agencies, non-governmental organizations (NGOs), and community water user groups, strengthens implementation efforts. Hunter et al. stress that multi-sector coordination improves resource allocation, ensuring a more systematic and sustainable approach to water quality monitoring 74 . The use of digital monitoring tools and automated water quality sensors allows for real-time detection of contaminants. Bartram & Cairncross highlight that technology-driven approaches enhance data accuracy and enable quicker response times to potential health threats 75 . Prendergast & Humphrey found that well-funded programs are more likely to implement long-term surveillance strategies that address both emerging and existing water quality concerns 77 . Strong leadership at the local level ensures regulatory compliance and effective enforcement of water safety measures. Mara et al. argue that proactive governance structures lead to better adherence to water quality standards, ultimately benefiting public health 78 .Educational initiatives help inform communities about safe water handling, contamination risks, and preventive measures. Velleman et al. emphasize that participatory approaches foster greater community ownership, encouraging individuals to take proactive steps in water safety 80 . Research from Bangladesh and India suggests that community engagement and decentralized water monitoring systems improve water quality outcomes and public health indicators 80 , 81 . A comprehensive approach incorporating elements like increased investment, advanced technology, stronger governance, and community ownership is crucial for ensuring sustainable improvements in water quality and public health outcomes in Dhulikhel Municipality. Conclusion & Recommendation WASH knowledge gaps and a 14.8% diarrhea prevalence among U5 children are driven by water scarcity, poor infrastructure, and limited resources. Community participation and technology can facilitate improvements, but barriers like low awareness and political constraints remain. Enhance WASH knowledge through workshops, promote handwashing, waste management, and household water treatment, and strengthen collaboration among authorities and communities. 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Quantitative study on Ward-wise distribution of households with at least 1 U5 Children caregiver (N=250) Dhulikhel ward number Frequency % 3 53 21.20 4 32 12.80 5 26 10.40 6 44 17.60 7 73 29.20 8 22 8.800 Table 1: Sociodemographic Information of household with U5 children caregiver (N=250) Variable Category Frequency % Age in years Mean/SD 31 8.35 Gender Male 55 22 Female 195 78 Education Level None/Uneducated 30 12 Primary(Upto 8) 76 30.4 Secondary(9-12) 111 44.4 University(Bachelor/Master) 33 13.2 Marital Status Single/Unmarried 14 5.6 Married 236 94.4 Religion Hinduism 196 78.4 Non hindu 54 21.6 Ethnicity Brahmin/Chhetri 74 29.6 Tamang 71 28.4 Newar 68 27.2 Magar 19 7.6 Other ( Dalit/Gurung/Rai/Limbu) 18 7.2 Household U5 Size One 194 77.6 Two 54 21.6 Three 2 0.80 Relation to U5 Children Mother 170 68 Other ( Father/Sibling/Blood Relative ) 80 32 Respondent Occupation Housewife 71 28.4 Trader 55 22 Farmer 49 19.6 Teacher 33 13.2 Retired 23 9.2 Unemployed 19 7.6 Earning Yes 149 59.6 No 101 40.4 Income in Rupees Mean (SD) 14337 31735 Median (IQR) 10000 20000 Table 2: Water-related characteristics of households with U5 children (N=250) Variable Category Frequency % Water Source for Drinking Purposes Non-Pipeline 146 58.6 Pipeline 104 41.6 Water Source Other than drinking purposes like Cooking, washing, etc Non-Pipeline 121 48.4 Pipeline 129 51.6 Water Scarcity Seasons Dry 184 73.6 Rainy 30 12 Inconsistency 24 9.6 Don’t Know 19 7.6 Water assessability Inside House 182 72.8 >30 min distance 50 20 <30 min distance 18 7.2 Water Storage Covered in Water Jar 110 44.4 Tank 116 46.4 Plastic Bottle 118 47.2 Water Apperance Clear 234 93.6 Colored 16 6.4 Water-Odor Don’t Smell 234 93.6 Smell 16 6.40 Water treatment in the household No 50 20 Yes 200 80 Table 3: Sanitation characteristics of households with U5 Children (N= 250) Variable Category Frequency % Household refuses disposal method Dumping site 196 78.4 Non-dumping site 54 21.6 Dumping site distance from house Not Known 54 21.6 >30 min Walk distance from house 99 39.6 <30 min Walk distance from house 97 38.8 Payment for household Waste management Don’t Pay 122 48.8 Pay Monthly 128 51.2 Table 4: WASH Practice characteristics of households with U5 Children (N= 250) Variable Category Frequency % Handwashing time by a household member (Multiple Responses) Before eating 223 89.2 After eating 204 81.6 After use of Washroom 199 79.6 Before cooking food 165 66 Arrival at the house from a new place 165 66 Hand washing use Soap and water 241 96.8 Water Only 8 3.2 Handwashing time Upto 1 min 125 50 Upto 2 min 106 42.4 Upto 3 min 19 7.6 Household latrine type Sanitary latrine 215 86 Open pit latrine 35 14 Toilet location Inside Compound 46 18.4 Inside House 204 81.6 Household toilet Condition Single 156 62.4 Shared 94 37.6 Defecate Outside Never 124 49.6 Use a Public toilet 126 50.4 Table 5: WASH Knowledge characteristics of household U5 children caregiver (N = 250) Variable Category Frequency % Way to make drinking water safe Filtration 189 75.6 Boiling 165 66 Chlorination 46 18.4 Sedimentation 25 10 Alum 7 2.8 Don’t Know 13 5.2 Water Contamination Identification Poor taste 116 46.4 Color Change 148 59.2 Bad odor 127 50.8 Don’t Know 36 14.4 Human activity causes water contamination Mining 34 13.65 Washing clothes/vehicles near water sources 180 72.29 Open defecation 220 88.35 Mixing Chemical fertilizer near water source 98 39.36 Industrial/Household waste 125 50 Water Contamination Health Effects Diarrhea 242 96.8 Stomach ache 194 77.6 Head ache 109 43.6 Vomiting 124 49.6 Cholera 131 52.4 Skin Rashes 70 28 Other(Typhoid/Hepatitis/Dysentry) 6 0.24 Household waste management Recycling 74 29.6 Biogas 26 10.4 Compost manure 226 90.4 Land filling 26 10.4 Not Known 21 8.4 Source of WASH-related health information Newspaper 45 18 Radio/Television 169 67.6 Information Center 124 49.6 Health worker 130 52 Acquaintance 73 29.2 Table 6: Level of WASH Knowledge Score among household U5 children caregiver (N=250) Variable Category WASH Knowledge Score Mean/SD 11.6 4.99 Max/Min 25 4 Total WASH Knowledge Score =25 Table 7: Association between caregiver WASH Knowledge & U5 children diarrhea Prevalance at household level (N=250) Univariate Multivariate Characteristics OR 95% CI P Value aOR 95% CI P Value Knowledge Sum Score 0.98 0.91-1.05 0.6 0.99 0.908-1.08 0.64 Adjusting for all sociodemographic variables ( Age , Gender , Education , Marital status , Religion , Ethnicity , Relationship status , Occupation , and Income ) Table 8: Association between caregiver WASH Practice & U5 children diarrhea Prevalance at household level (N=250) Characteristics Univariate Multivariate OR 95% CI P Value aOR 95% CI P Value Latrine type Sanitary/ref Unsanitary 1.22 0.67-0.47 0.67 1.22 0.44-3.38 0.95 Toilet location Outside home/ref Inside home 1.19 0.46-3.05 0.711 1.20 0.46-3.10 0.73 Toilet using household Single/ref Shared 1.15 0.4-9.68 0.64 1.13 0.55-2.34 0.80 Water treatment No treatment/ref Treatment 0.74 0.32-1.69 0.4 0.78 0.33-1.81 0.96 Household waste management No dumping/ref Dumping 1.25 0.45-3.45 0.64 1.27 0.43-3.70 0.26 Handwashing Soap &water/ref Water Only 1.97 0.417-0.38 0.44 2.07 0.39-11.03 0.87 In Multivariate Analysis # Latrine type has adjusted variables such as Income, Education, and Ethnicity ## Toilet location has adjusted variables such as Age, Gender, and Marital Status ### Toilet-using household adjusted for Income, education, and Water Source #### Water treatment has adjusted for variables such as Education, Income, and Religion ##### Household waste management has adjusted for variables such as Income, Education, and Marital Status ##### Handwashing has adjusted for variables such as Education, Age, and Income Additional Declarations The authors declare no competing interests. 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Thapa","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0008-9233-0993","institution":"Kathmandu University School of Medical Science","correspondingAuthor":true,"prefix":"","firstName":"Safal","middleName":"Jung","lastName":"Thapa","suffix":""},{"id":603169445,"identity":"fed8a1fe-7347-4ee6-ac47-0a026f4c87d5","order_by":1,"name":"Biraj Man Karmacharya","email":"","orcid":"","institution":"Kathmandu University School of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Biraj","middleName":"Man","lastName":"Karmacharya","suffix":""},{"id":603169446,"identity":"d5886175-b564-441b-a12e-e9e56cfdd4a9","order_by":2,"name":"Bandana Paneru","email":"","orcid":"","institution":"Kathmandu University School of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Bandana","middleName":"","lastName":"Paneru","suffix":""},{"id":603169447,"identity":"48625511-1ff6-40aa-9f46-fe072fce0381","order_by":3,"name":"Yunika Acharya","email":"","orcid":"","institution":"Kathmandu University School of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Yunika","middleName":"","lastName":"Acharya","suffix":""}],"badges":[],"createdAt":"2026-03-09 13:34:32","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9073621/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9073621/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104342192,"identity":"3a7923de-3b5c-43dc-9f13-9e3c0037af36","added_by":"auto","created_at":"2026-03-10 16:59:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59192,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConceptual framework showing household U5 Caregiver knowledge and practice, its association with U5 diarrhea Prevalance\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9073621/v1/41ceddea2b6932f644e3ca65.png"},{"id":104779796,"identity":"84c410fb-112b-4f33-ad89-c7cb5d53b90c","added_by":"auto","created_at":"2026-03-17 07:46:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3588008,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9073621/v1/4af4466b-c9c5-48a0-9931-26de5128ae3f.pdf"},{"id":104342193,"identity":"a1c69848-38a8-433f-b853-f5d8fb59eb6b","added_by":"auto","created_at":"2026-03-10 16:59:44","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1916328,"visible":true,"origin":"","legend":"","description":"","filename":"Question.docx","url":"https://assets-eu.researchsquare.com/files/rs-9073621/v1/fbfd6a32feddb0b6461fdb47.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssessment of the Water, Sanitation, and Hygiene(WASH) situation and identifying the implementation challenges of the water surveillance system in Dhulikhel Municipality\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Introduction\u003c/h2\u003e \u003cp\u003eDiarrheal disease continues to be a major source of morbidity and mortality among U5 children worldwide, accounting for nearly 0.5\u0026nbsp;million deaths and 1.7\u0026nbsp;billion cases each year\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Over 90% of deaths in LMICs among U5 children result from diarrhea, emphasizing urgent improvements in WASH access\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Water surveillance helps monitor drinking water quality and prevent health risks associated with contamination \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Enhancing WASH dramatically lowers the number of deaths caused by diarrhea and prevents neglected tropical diseases\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Adhering to WHO criteria, a risk-based approach to drinking water prioritizes surveillance parameters depending on the outputs of water safety plans, thereby improving public health safety\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The rights to clean water, sanitation, and hygiene are essential for human development and well-being. Their absence brings on diarrhea and impacts millions of children globally\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. To achieve good health, gender equality, poverty reduction, and general socioeconomic advancement, the Sustainable Development Goals strongly emphasize the importance of water and sanitation\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Research in many areas emphasizes the significance of appropriate water sources, sanitation amenities, and hygiene protocols in averting illnesses and advancing communal well-being\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe world is facing challenges as a result of pollution-related water shortages\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Nearly two-thirds of the world population faces water challenges for at least one month every year \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Many nations' drinking water does not adhere to WHO guidelines which account for 80% waterborne disease \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. 3.1% of deaths are attributable to dirty, low-quality drinking water\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.2.4\u0026nbsp;billion people are deprived of safely managed drinking water supply \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Inadequate WASH facilities contribute to an increased burden of diseases, with 90% of diarrhea-related deaths globally attributed to inadequate access to water and poor sanitation practices\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Over 2\u0026nbsp;billion people worldwide lack access to basic sanitation facilities, which makes it easier for illnesses like diarrhea to spread\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The majority of the diseases that cause the burden of water, sanitation, and hygiene-related illnesses are preventable, accounting for 5.7% of all diseases and 4.0% of all deaths globally \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.Nearly 110\u0026nbsp;million people in Southeast Asia are facing water challenges\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. SEAR, including Bangladesh, India, and Sri Lanka, confronts poor WASH practices, contributing to public health concerns\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The prevalence of open defecation is still high in some places due to inadequate sanitation coverage\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Pollution and waterborne illnesses persist because of inadequate sanitation system design and upkeep, even in nations with improved sanitation coverage, such as Vietnam, Thailand, and Myanmar\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Water, sanitation, and hygiene (WASH) in Nepal face challenges despite being a water-abundant country \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. WASH access inequalities across social, economic, and gender lines due to inadequate infrastructure, financial constraints, and policy issues, worsened by climate change risks, hinder reliable services \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNepal struggles with providing basic water services to a significant population, with over 10\u0026nbsp;million lacking improved sanitation facilities \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Factors such as unhygienic drinking water storage systems and drainage issues have been linked with an increased risk of diarrhea in children in Nepal\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Bacterial coliform has been identified as a prime cause of acute diarrhea in U5 Children\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAddressing hygiene practices and sanitation conditions is vital in reducing the burden of infectious diseases within communities\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Proper water resource management is crucial to stopping waterborne illnesses, particularly infections that cause diarrhea among U5 children.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Statement of the Problems\u003c/h2\u003e \u003cp\u003eThe prevalence of poor sanitation and lack of access to quality water has led to a high burden of infectious diseases\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Waterborne diseases result in 1.5\u0026nbsp;million deaths yearly, mainly affecting children in poor households\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Over 2\u0026nbsp;billion people lack access to basic sanitation services globally, which contributes to the spread of diarrhea \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Water-related illnesses continue to be a major cause of mortality, particularly for children under five who live in rural parts of poor countries\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Urbanization, poor technology, complex institutional frameworks, and the disregard for rural areas in developing nations are some of the reasons why challenges continue\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Waterborne illnesses like diarrhea have become more common in SEAR as a result of inadequate water sanitation and hygiene (WASH) standards, especially in nations like Nepal\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. The presence of coliform bacteria in water sources indicates fecal contamination and poses a risk of diarrheal diseases\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Subnational disparities continue despite efforts to increase access to WASH services; obstacles include incompatibilities in policy, funding, and technological limitations\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The prevalence of diarrheal disease in U5 children has been reported to be around 20.8% in urban regions of Nepal \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Natural catastrophes like the earthquake in Nepal can worsen the situation by disrupting the clean water supply and causing inadequate sanitation, which increases the likelihood of epidemics \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Water sanitation and hygiene (WASH) initiatives in Dhulikhel have been crucial due to prevalent waterborne diseases like diarrhea\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. DDWUC reports a huge gap in supply (2.2\u0026nbsp;million liters /day) and demand (3.7\u0026nbsp;million liters/day) of drinking water.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Rationale of the Study\u003c/h2\u003e \u003cp\u003ePreventing waterborne illnesses like diarrhea requires improving WASH\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. The lack of access to sanitary facilities harms the environment and the lives of billions of people worldwide\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Ensuring human health in developing nations requires access to safe drinking water, proper sanitation, and good hygiene\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Achieving WASH targets is crucial because poor WASH contributes significantly to major health outcomes, including malnutrition and diarrhoea\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Improving access to sanitary facilities and clean water could prevent the average annual deaths of 297,000 U5 children\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Nepal faces WASH challenges due to infrastructure, funding, and policy issues, stressing the need for long-term strategies to enhance access and equity\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Enhancing sanitation and water quality is crucial because contamination can cause fatal illnesses\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Water surveillance protects public health by monitoring drinking water for safety and quality\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e Conducting WASH in Dhulikhel is crucial to tackling water contamination, guaranteeing fair access to WASH facilities for everyone, and advancing sustainable WASH practices in the area.\u003c/p\u003e \u003cp\u003e \u003cb\u003e1.4 Objective of the Study\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTo determine the household prevalence of diarrheal disease among U5 children in the Dhuilkhel municipality\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the knowledge and practice regarding WASH among caregivers of U5 children in the Dhulikhel municipality\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the association between diarrheal disease, knowledge and practice among caregivers of U5 children in the Dhulikhel municipality\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo explore barriers and facilitators of the water surveillance system in Dhulikhel municipality\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Research Methodology","content":"\u003cp\u003eA multi-method study was conducted in Dhulikhel Municipality from March to mid-June 2024, employing a cross-sectional design at the household level in wards 3\u0026ndash;8, which included households with at least one under-five (U5) child. The study aimed to measure diarrheal prevalence and assess the WASH situation at a specific point in time. Dhulikhel was selected due to the ongoing UMD project, the involvement of the Dhulikhel Drinking Water User Committee (DDWUC) in water governance for wards 3\u0026ndash;8, and the municipality\u0026rsquo;s inadequate clean water and sanitation, highlighting the need for urgent research and intervention. Eligible households were within wards 3\u0026ndash;8, with at least one U5 child and a consenting primary caregiver available for questionnaires, while households with language barriers, caregivers with severe medical or cognitive impairments, or U5 children residing less than two weeks were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Sample Size\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN = Total number of households with atleast 1 U5 child under our study\u003c/p\u003e\n\u003cp\u003ep = Prevalence of household U5 children with diarrheal cases\u003c/p\u003e\n\u003cp\u003eWhere, p = 0. 1\u003csup\u003e49\u003c/sup\u003e\u0026nbsp; and q = 1- 0.1 = 0.9\u003c/p\u003e\n\u003cp\u003ed= allowable error Where d = 4 % or 0.04\u003c/p\u003e\n\u003cp\u003eZ = 1.96 (At 95% Confidence interval)\u003c/p\u003e\n\u003cp\u003eSample size of U5 children under our study (n\u003csup\u003e1\u003c/sup\u003e) =(Z^2*p*q)/d^2\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Number of U5 children taken to assess the WASH situation in Dhulikhel Municipality (n\u003csup\u003e1\u003c/sup\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;= 217\u003c/p\u003e\n\u003cp\u003eNon-response rate for households with atleast 1 U5 child\u003c/p\u003e\n\u003cp\u003e= 15% of 217\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e= 32.6 \u0026asymp; 33\u003c/p\u003e\n\u003cp\u003eTherefore, total number of households with atleast 1 U5 child under our study (N) = 217+33 = 250\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Sampling Techniques\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHouseholds in wards 3\u0026ndash;8 of Dhulikhel Municipality, where the DDWUC supplies drinking water, were purposively selected. Within these wards, households with at least one (U5) child were conveniently chosen to assess the WASH situation. A list of such households was provided by the the Municipality office, enabling assessment of both WASH conditions and U5 diarrheal prevalence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 \u0026nbsp;Study Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Dependent Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevalence of U5 diarrheal disease = (Total U5 diarrheal disease at household level / Total U5 children household under study) * 100%\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Independent Variable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eSocio-demographic and household characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAge (in years)\u003c/li\u003e\n \u003cli\u003eSex (Male/Female)\u003c/li\u003e\n \u003cli\u003eLevel of Education(Primary/Secondary/Tertiary/Vocational)\u003c/li\u003e\n \u003cli\u003eMarital Status(Single/Married/Divorce/Widow/Seprate/other)\u003c/li\u003e\n \u003cli\u003eReligion(Hindu/Christianity/Islam/Buddhist/other)\u003c/li\u003e\n \u003cli\u003eEthnicity (Brahmin or Chhetri/ Newar /Tamang /other)\u003c/li\u003e\n \u003cli\u003eStatus of Respondent (Father/Mother/Sibling/Blood relative)\u003c/li\u003e\n \u003cli\u003eOccupation(farmer/trader/unemployed/retired/teacher/other)\u003c/li\u003e\n \u003cli\u003eIncome (daily/monthly/weekly/not regular/not earned)\u003c/li\u003e\n \u003cli\u003eMonthly income in Rupees\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2. Knowledge \u0026amp; Practice on WASH\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWater\u003c/li\u003e\n \u003cli\u003eSanitation\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHygiene \u0026amp; practice\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eHand washing \u0026amp; latrine use\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWASH Knowledge\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Sampling strategy\u003c/strong\u003e: Household caregivers with at least 1 U5 child were selected through a purposive form of the water consumer group within the (3\u0026ndash;8) ward households in Dhulikhel municipality\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. 5 \u0026nbsp;Data Collection Tools and Techniques:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea. Quantitative Phase\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTechnique: Face-to-face interview\u003c/p\u003e\n\u003cp\u003eTool: Pre-structured questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Pre-testing the Data Collection Tools:\u0026nbsp;\u003c/strong\u003eThe study was conducted among 10% of the total sample size in a non-study area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.7 Validity and Reliability of the Study Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eProper operationalization of the variables and explanation of the research title, objectives, and the tools used.\u003c/li\u003e\n \u003cli\u003eQuestionnaires were translated into both Nepali and English.\u003c/li\u003e\n \u003cli\u003eThe WASH \u0026nbsp;questionnaire was adapted from \u003cem\u003e\u0026ldquo;\u003cstrong\u003eCore questions on drinking-water and sanitation for household surveys\u003c/strong\u003e\u003c/em\u003e\u0026rdquo; developed by the WHO \u0026amp; UNICEF\u003csup\u003e50\u003c/sup\u003e.\u003c/li\u003e\n \u003cli\u003eSociodemographic questionnaires adopted from the NDHS report 2022.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eReliability\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe questionnaire was checked, and modification of the tools was done as per the requirements after pretesting\u003cstrong\u003e.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.8 Potential Biases:\u0026nbsp;\u003c/strong\u003eData collection timing, social desirability, and potential over- or underrepresentation may affect findings and limit their generalizability to Dhulikhel\u0026rsquo;s entire population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.9 Limitation:\u0026nbsp;\u003c/strong\u003eThe study\u0026rsquo;s cross-sectional design limits causal inference, may be affected by recall bias, and only captures a specific time, missing seasonal variations. Multiple U5 children per household and a focus on selected wards may limit generalizability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.10 Supervision and Monitoring:\u0026nbsp;\u003c/strong\u003eThe research team held regular reviews, conducted site visits, ensured data quality, analyzed findings, prepared reports, followed ethical protocols, and maintained transparency to achieve project goals effectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.11 Data Management and Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative Study\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSocio-demographic characteristics, knowledge, and practices in WASH were analyzed using structured questionnaires.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDiarrhea prevalence and WASH practice frequency and percentage,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;The WASH Knowledge Score in our study was calculated based on caregivers\u0026apos; responses to structured questionnaire items assessing their knowledge of safe water storage, handwashing, sanitation behaviors, and contamination risks.\u003c/li\u003e\n \u003cli\u003eMean\u0026nbsp;Knowledge\u0026nbsp;Score = (\u0026sum;Individual\u0026nbsp;Scores/Total number of U5 Caregiver)\u003c/li\u003e\n \u003cli\u003eAssociation between knowledge and practice with diarrhea was assessed using univariate and multivariate logistic regression (reporting unadjusted and adjusted odds ratios, 95% CI, and p-value \u0026lt; 0.05).\u003c/li\u003e\n \u003cli\u003eData were collected, cleaned regularly for consistency, stored separately to maintain confidentiality ensuring anonymity, and data were destroyed after study completion.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e2.12\u003cstrong\u003e\u0026nbsp;Expected Outcome of the Research:\u0026nbsp;\u003c/strong\u003eWASH assessment ensured the delivery of clean and safe water to communities, safeguarding public health, and reducing the risk of waterborne diseases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.13 Ethical Issues and Considerations:\u0026nbsp;\u003c/strong\u003eThe study received ethical approval from Kathmandu University, and participants provided voluntary verbal informed consent; a copy of the consent form is included in the annex.\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eQualitative Study\u003c/strong\u003e: We were conducting focus group discussions among homogeneous water consumer groups while in-depth interviews were done among key stakeholders.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e2.14 Study Unit\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eThe qualitative study was among Key stakeholders at various levels \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMunicipal and ward Representative/Policy level,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWater testing lab and DDWUC/Organizational level,\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFCHV / intrapersonal level and\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWater consumer group/ interpersonal level\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ea. Inclusion Criteria\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe study includes a water consumer group and key informants (KIs) inside Dhulikhel Municipality who were eligible participants willing to be involved in our research\u003c/li\u003e\n \u003cli\u003eAge \u0026gt; 18 years\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;b. Exclusion Criteria\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eReluctant to participate\u003c/li\u003e\n \u003cli\u003eMedically unfit\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.15 Sample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWe had conducted 16 purposive in-depth interviews with data until saturation, when no new codes/themes emerged from further interviews among key stakeholders\u003csup\u003e51\u003c/sup\u003e\u003c/li\u003e\n \u003cli\u003e3 focus group discussions (fgd) with (6-10) participants each\u003csup\u003e52\u003c/sup\u003e, among water consumer groups to gain insights into their perspectives on implementation challenges of the water surveillance system in Dhulikhel Municipality.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.16 Tools and Techniques for the Qualitative Phase\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTechnique: In-depth Interviews, Focus Group Discussions(FGD)\u003c/li\u003e\n \u003cli\u003eTools: Semi-structured interview guides, focus group discussion guides.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.17 Data management\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWe conducted a CFIR Framework analysis for the implementation challenges of the water surveillance system in the municipality.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThemes were iteratively identified and refined, providing a robust understanding of factors influencing surveillance effectiveness.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.18 Expected outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eImplementing a water surveillance system for evaluating the current state of water sources and distribution networks can have a transformative impact on the Dhulikhel Municipality.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.19 Limitations of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe quality of qualitative data is highly dependent on the skills of interviewers.\u003c/li\u003e\n \u003cli\u003eParticipant Social desirability biases.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Descriptive Analysis\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 Socio-demographic characteristics of respondents\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe study surveyed 250 caregivers of under-five children in Dhulikhel Municipality, with an average age of 31 years, suggesting that most were young to middle-aged adults. The majority were female (78%), reflecting the traditional caregiving role of mothers, while 94.4% were married and 78.4% identified as Hindu. Ethnically, Brahmin/Chhetri (29.6%), Tamang (28.4%), and Newar (27.2%) made up the largest groups, with smaller proportions from Magar and other ethnicities. Education levels varied, with 12% having no formal education, 30.4% completing primary school, 44.4% reaching secondary education, and 13.2% holding a university degree. Most caregivers were mothers (68%), while 32% were fathers or other relatives. Occupations included housewives (28.4%), traders (22%), farmers (19.6%), teachers (13.2%), retired individuals (9.2%), and unemployed caregivers (7.6%). More than half (59.6%) had a source of income, with an average monthly household income of NPR 14,337 (median\u0026thinsp;=\u0026thinsp;NPR 10,000), highlighting substantial income disparity.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Water-related characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study found that access to safe drinking water was limited, with 58.4% of households relying on non-piped water sources and only 41.6% having piped connections. Water availability for other uses was slightly better, with 51.6% using piped sources. Seasonal water scarcity was a major concern, as 73.6% of households reported shortages during the dry season, while 12% experienced shortages in the rainy season and 9.6% faced year-round inconsistency. Most households (72.8%) had water available inside their homes, but 20% spent more than 30 minutes fetching water, indicating accessibility challenges. Water storage practices varied, with households commonly using covered jars (44.4%), tanks (46.4%), and plastic bottles (47.2%). Although 93.6% reported clear water, 6.4% noticed discoloration, and a similar percentage reported unpleasant odors, suggesting possible contamination risks. Encouragingly, 80% of households treated their drinking water through boiling, filtration, or disinfection, while 20% did not use any treatment method.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Sanitation\u0026ndash;related characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eProper sanitation is vital for preventing the spread of diarrheal diseases. The study found that 78.4% (196) of households disposed of waste by dumping it, while 21.6% (54) did not engage in waste dumping, possibly using alternative disposal methods. The proximity of dumping sites was also examined, with 39.6% (99) of households having dumping sites located more than 30 minutes away, while 38.8% (97) had sites within a 30-minute walk, and 21.6% (54) were unaware of the distance to their dumping site.\u003c/p\u003e \u003cp\u003ePayment for household waste management varied, with 51.2% (122) paying monthly fees for waste collection, while 48.8% (128) did not pay, suggesting that waste management services were not utilized.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.1.4 WASH Practice-related characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eHandwashing was widely practiced among caregivers, particularly before eating (89.2%), after eating (81.6%), and after using the washroom (79.6%), with 96.8% using soap and water. However, many did not meet the recommended handwashing duration, as 50% washed for up to 1 minute and only 7.6% for 3 minutes or more. Regarding sanitation, 86% of households had sanitary latrines, with 81.6% located inside the house, but 37.6% shared toilets with other households. Half of the households relied on public toilets, and 49.6% reported no open defecation. While hygiene awareness and sanitation access were generally high, challenges remained in handwashing duration, shared or public toilet use, and waste management, indicating areas for targeted public health interventions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.1.5 WASH Knowledge-related characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMost caregivers had basic knowledge of safe drinking water practices, primarily filtration (75.6%) and boiling (66%), while awareness of chlorination (18.4%), sedimentation (10%), and alum use (2.8%) was limited, and 5.2% knew no method. Recognition of contamination indicators was moderate, with color change (59.2%), bad odor (50.8%), and poor taste (46.4%) identified, though 14.4% could not identify any. Open defecation (88.35%) and washing near water sources (72.29%) were widely recognized as contamination sources, while fewer acknowledged waste disposal, fertilizer use, or mining. Health risks, particularly diarrhea (96.8%), were well understood. Waste management practices included composting (90.4%), recycling (29.6%), biogas (10.4%), and landfilling (10.4%), though 8.4% lacked awareness. The main sources of WASH information were radio/TV (67.6%), health workers (52%), and information centers (49.6%).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Prevalence of U5 diarrhea at the household level\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe findings revealed that 37(14.8%) households with at least 1 U5 child had experienced diarrhea within the two weeks before the survey, a rate higher than the national average in Nepal.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of household diarrhea cases among U5 children (N\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Diarrhea Prevalence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Inferential Analysis\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 WASH Knowledge score among household U5 children's caregivers\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe Level of WASH Knowledge Score among Household U5 Children Caregivers (n\u0026thinsp;=\u0026thinsp;250) was assessed based on a total possible knowledge score of 25 points. The mean knowledge score among caregivers was 11.6, with a standard deviation of 4.99. The minimum and maximum scores recorded were 4 and 25, respectively\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Association between caregiver WASH Knowledge \u0026amp; U5 children diarrhea Prevalance at household level\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe association between Caregiver WASH Knowledge and U5 Children Diarrhea Prevalence at the Household Level was analyzed using both univariate and multivariate logistic regression models to assess the relationship between caregivers' knowledge and the likelihood of diarrhea occurrence among under-five (U5) children.\u003c/p\u003e \u003cp\u003eThe univariate analysis showed that the knowledge sum score had an odds ratio (OR) of 0.98 (95% CI: 0.91\u0026ndash;1.05, p\u0026thinsp;=\u0026thinsp;0.60), suggesting that an increase in WASH knowledge among caregivers had no statistically significant association with reduced diarrhea prevalence. The multivarient shows an adjusted OR 0.99(95% CI: 0.908\u0026ndash;1.08, p\u0026thinsp;=\u0026thinsp;0.64) These findings indicate that higher WASH knowledge alone does not significantly reduce diarrhea prevalence among U5 children.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3: Association between caregiver WASH Practice \u0026amp; U5 children diarrhea prevalence at household level\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe analysis of caregiver WASH practices and diarrhea prevalence among under-five children showed no statistically significant associations across all examined variables. Children in households with unsanitary latrines, toilets located outside the home, or shared toilets had slightly higher odds of diarrhea, but these associations were not significant even after adjusting for socioeconomic and demographic factors. Similarly, water treatment practices such as boiling and filtering were linked to lower odds of diarrhea, but the results were not statistically significant after adjustment. Waste management practices, including waste dumping, also showed no meaningful association with diarrhea prevalence. Handwashing with soap appeared to reduce diarrhea risk compared to using only water, but this too was not statistically significant in univariate or multivariate models. These findings suggest that while WASH practices are important, other environmental, socioeconomic, and behavioral determinants may play a greater role in influencing diarrhea incidence among children.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the qualitative study participants- Water Surveillance\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean/SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidential Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemporary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrahmin/Chhetri\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNewar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary/Up to grade 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary/Grade (9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity (Bachelor's/Master's degree)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy Participant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDDWUC Member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMunicipality Representative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\[email protected]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater test lab member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFCHV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWater Consumer Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 Facilitator and barrier of the water surveillance system using the CFIR framework in Dhulikhel municipality\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe findings were categorized into key themes based on stakeholder perspectives and analyzed using the Consolidated Framework for Implementation Research (CFIR).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section4\"\u003e \u003ch2\u003e3.4.2.1. Barriers to Water Surveillance Implementation\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section5\"\u003e \u003ch2\u003e4.4.2.1.1. Limited Awareness and Perceptions of Water Safety\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA significant barrier to effective water surveillance was low public awareness regarding water safety and contamination risks. Several participants, including municipality representatives, water test lab members, and ward members, indicated that community members often perceive water as safe based solely on its appearance (e.g., clear water) rather than scientific testing. One municipality representative stated:\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eMany community members assume that municipal distributed water is clean without understanding the need for additional purification methods like boiling or filtration and further testing to ensure water quality at the household level.\"\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.2. Financial Constraints and Resource Limitations\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe financial burden of establishing and maintaining a water surveillance system was frequently cited as a challenge. Municipality representatives emphasized that without long-term government funding, sustainability remains uncertain. A Dhulikhel Drinking Water User Committee (DDWUC) member mentioned:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Water testing systems are perceived as more expensive, complex and without sustained financial support, communities fear that these programs may collapse in near future\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.3. Political and Institutional Challenges\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFrequent political transitions and lack of accountability among concerned authorities were also identified as key barriers to the success of the surveillance system. A municipality representative highlighted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Frequent changes in local government and political system interrupt effective funding mechanism, program support delaying the rollout of planned water surveillance programs goal.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.4. Limited Access to Advanced Testing Equipment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe lack of modern laboratory facilities and reliable testing kits limits the accuracy and scope of water quality monitoring. A water testing laboratory member noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Without proper tools or water testing kits, we rely on outdated tools that are slow, unreliable, and less effective in detecting potential water contamination.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.5. Environmental Challenges\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNatural disasters such as landslides, earthquakes, and seasonal floods pose a risk to water infrastructure, especially in slope regions, making consistent surveillance difficult and increasing potential water contamination risks. A ward member stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"During monsoon, many water pipelines break down, leakage in slope area and there is no immediate action to repair them, leading to potential contamination cause several health risk.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.6. Poor Inter-Agency Coordination\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWeak collaboration between municipal authorities, health agencies, and ward and local water consumer groups has led to fragmented efforts in water surveillance implementation. A ward member emphasized:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Different concern agencies work in isolation, poor communication which results in delayed response and uncoordinated actions at the time of epidemic\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.7. Trust Issues Regarding the Surveillance System\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eInconsistent water testing results due to poor equipment maintenance have led to skepticism among community members in the system, which ultimately reduced trust among consumer groups from concern agencies (Water testing lab, DDWUC, Municipality). A water consumer stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We receive conflicting reports on water quality, leading different water quality result across different testing labs inside Dhulikhel, which makes it hard to trust the efficiency of water Surveillance system.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.8. Cultural Misconceptions About Water Quality\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTraditional beliefs that untreated water is natural and safe for drinking purposes without contamination risk contribute to resistance against modern water testing and purification practices in the community. An FCHV noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"People usually believe that boiling water changes its original taste and quality, leading them to consume untreated or untested water considering them safe from their health.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.9. Delayed Implementation During Outbreaks\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDelays caused by complicated procedures and logistical challenges make it difficult to implement water safety measures quickly during disease outbreaks. A Municipal officer explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"By the time we gather the necessary resources and take action during an outbreak, the harm has already occurred in the community in an unmanageable manner due to epidemic.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec33\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.10. Lack of Community Engagement\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e The limited involvement of local communities in decision-making processes has led to weak compliance with surveillance guidelines. A Ward member noted:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"When community people are not included in planning and not well informed about the importance of the surveillance system, they do not feel responsible for water safety-related issues in the community.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.1.11. Lack of Standardized Testing Protocols\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eInconsistent testing protocols across different monitoring agencies hinder the reliability of surveillance efforts. A municipal health officer stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Different agencies use varied testing tools and techniques, lacking uniformity leading to inconsistencies in water quality test reports across different water testing site.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec35\" class=\"Section5\"\u003e \u003ch2\u003e4.4.2.1.12. Weak Law Enforcement on Water Quality Standards\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDespite proper regulations for the surveillance system, enforcement remains weak, resulting in continued contamination issues. A water test lab member emphasized:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"Without strict enforcement, industries and households fail to comply with water safety guidelines, failing the surveillance system.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec36\" class=\"Section4\"\u003e \u003ch2\u003e4.4.2.2. Facilitators for Effective Water Surveillance\u003c/h2\u003e \u003cdiv id=\"Sec37\" class=\"Section5\"\u003e \u003ch2\u003e4.4.2.2.1. Community Training and Awareness Programs\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCommunity-based training programs and awareness campaigns have played a crucial role in improving water surveillance. A Female Community Health Volunteer (FCHV) noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We conduct training programs in the community to teach safe water handling practices, the importance of water testing including boiling and proper filtration methods.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec38\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.2. Technological Innovations in Water Testing\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe use of modern digital water quality monitoring tools has improved efficiency and data accuracy, enabling early detection and rapid response to contamination events. A water testing laboratory member stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Modern digital tools provide more reliable testing, helping us detect contamination early and take preventive measures quickly and more accurately.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.3. Stakeholder Collaboration and Policy Initiatives\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCollaborations between municipal authorities, NGOs, and water user groups have strengthened implementation efforts, ensuring better resource allocation and surveillance sustainability. A DDWUC member emphasized:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Strong partnerships with concerned stakeholders and support have allowed us to secure more\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003efunding and technical support from concerned agencies.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec40\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.4. Government Commitment and Financial Support\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFinancial support from central and local governments has helped sustain water surveillance programs in the municipality. A municipal official stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Government funding ensures that necessary water testing resources are available at the local level and sustainable for a surveillance system.\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec41\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.5. Leadership and Governance\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe involvement of ward representatives and local leaders has ensured regular monitoring, timely interventions, and improved accountability in water quality management. A ward leader mentioned:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Strong Political leadership drives effective water surveillance and ensures community participation, ownership, and support for water surveillance action.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec42\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.6. Integration of Water Surveillance with Public Health Programs\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe integration of water surveillance with broader public health initiatives has enhanced disease prevention strategies and improved hygiene practices within communities. A Municipal officer stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Linking water surveillance with Public health programs from municipal level leadership has reduced the incidence of waterborne diseases in present days.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec43\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.7. Capacity Building and Training for Health Workers\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTraining programs for local authorities, health workers, and community members have strengthened technical competencies related to water surveillance. A water lab technician noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Continuous training and capacity building action helps ensure that concerned laboratory personnel and health workers are well-equipped to handle water quality monitoring effectively.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec44\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.8. Increased Community Participation in Water Governance\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe active engagement of local communities in decision-making processes has fostered a sense of ownership, ensuring the long-term sustainability of water surveillance efforts. A water consumer stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When the community people are involved in the decision-making process, people take ownership and motivate themselves to keep water sources safe, ensuring the success of water surveillance system goal.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec45\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.9. Use of Mobile and Digital Data Collection Systems\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe implementation of mobile-based water quality reporting tools and digital data collection systems has improved data accessibility and enhanced real-time monitoring capabilities. A DDWUC mentioned:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Mobile data collection systems or use of modern technology have made tracking water quality issues more efficient and transparent manner ensuring reliable and valid test result\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec46\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.10. Infrastructure Improvements\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eUpgrades in the water supply network and sanitation infrastructure have facilitated better monitoring and reduced contamination risks. A municipal engineer noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Municipal Investments in WASH-related infrastructure and supply networks have led to a more consistent and safer water supply system for Dhulikhel residents.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec47\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.11. Standardization of Water Quality Testing\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe adoption of uniform testing protocols has improved the consistency and reliability of water quality data. A municipal officer noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Availability of the standardized water testing kits ensures that we have comparable data across different regions.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec48\" class=\"Section5\"\u003e \u003ch2\u003e3.4.2.2.12. Strengthened Regulatory Frameworks\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e Enhanced water safety policies, guidelines, and stricter enforcement mechanisms from municipalities have improved compliance with water quality standards. A municipal official noted:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"With stricter regulations and penalties provision regarding water testing, and quality control we will see fewer violations of water safety guidelines.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec51\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Prevalence of U5 children's diarrhea at the household level\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn Nepal, the Prevalence of U5 diarrheal cases ranges from 10.2% to 13.6% \u003csup\u003e53\u003c/sup\u003e, which is quite lower than our finding of 14.8%. This is because our data were collected during rainy seasons, leading to more chance of water contamination, rather than in other seasons.\u003c/p\u003e \u003cp\u003eStudies from Bangladesh and India report similar prevalence rates of 13.9% and 15.5%, respectively, indicating that U5 diarrheal disease remains a significant public health concern in the South Asia region \u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. Similar seasonal variations in diarrheal prevalence have been reported in other studies in South Asia, with an average seasonal diarrhea prevalence of 15.2% in Southeast Asia \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. Research from Cambodia and Vietnam indicates seasonal peaks reaching 16.8% and 17.2%, respectively, further emphasizing the influence of environmental factors on diarrheal disease prevalance \u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec52\" class=\"Section2\"\u003e \u003ch2\u003e4.2 WASH Knowledge \u0026amp; practice among U5 children caregiver\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe study highlights the critical deficiencies of WASH\u0026ndash;related knowledge among caregivers, such as improper handwashing \u0026amp; unsafe water storage leading to diarrheal disease \u003csup\u003e\u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. Studies in Ethiopia and Bangladesh have shown that knowledge gaps in water handling and sanitation practices significantly increase the risk of waterborne diseases \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e,\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u003c/sup\u003e. Additionally, research in Kenya found that only 45% of caregivers demonstrated proper handwashing techniques, correlating with higher diarrheal prevalence among children \u003csup\u003e\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e. A study conducted in India showed that inadequate knowledge regarding safe water storage and open defecation significantly contributed to the persistence of diarrheal diseases in rural areas\u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. Similarly, findings from Cambodia and Vietnam emphasize the role of educational interventions in improving sanitation behaviors and reducing diarrheal disease burden\u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, limited awareness about sanitary practices among caregivers leads to a higher prevalence of diarrheal cases in comparison to the national average \u003csup\u003e\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. The research emphasizes the need to address broader environmental factors that influence WASH Practice \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Limited resources, such as financial constraints for water purification methods or improper sanitation facilities, increased the risk of diarrheal disease\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e .\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec53\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Association between U5 diarrhea cases with knowledge score \u0026amp; practice among caregiver\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAlthough WASH knowledge and practice are crucial components of effective interventions, their lack of significant association with diarrhea prevalence in this study underscores the need for a multifaceted approach. Studies in Ethiopia and India have similarly found that improved WASH knowledge alone does not always translate into lower disease prevalence, as environmental and infrastructural factors play a crucial role \u003csup\u003e\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e,\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e\u003c/sup\u003e. Other studies have also suggested that while individual behaviors play a role, broader environmental, socio-economic, and cultural factors exert a greater influence on WASH-related health outcomes \u003csup\u003e\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e\u003c/sup\u003e. A study in Bangladesh demonstrated that factors such as water source contamination and seasonal variations had a more significant impact on diarrheal prevalence than hygiene practices alone \u003csup\u003e\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e. Similar research from Sub-Saharan Africa and South Asia has emphasized the importance of improving water infrastructure and sanitation facilities rather than relying solely on behavioral interventions \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Evidence from developing countries supports this view, showing that investments in clean water access and improved sanitation facilities significantly reduce diarrhea cases, independent of individual hygiene behaviors\u003csup\u003e\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e,\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec54\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Barrier and facilitator of water surveillance system in Dhulikhel Municipality\u003c/h2\u003e \u003cdiv id=\"Sec55\" class=\"Section3\"\u003e \u003ch2\u003e4.4.1 Barriers to the Water Surveillance System\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eKey barriers include limited public awareness, where many individuals assume that clear water is safe for consumption without recognizing the potential for microbial contamination. This aligns with findings from Hunter et al. and Bartram \u0026amp; Cairncross, who emphasize that public misconceptions about water safety contribute to increased health risks \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e,\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Many regions lack access to modern testing equipment, resulting in delays in detecting and addressing waterborne contamination. Mara et al. highlight that outdated tools provide inaccurate results, reducing the efficiency of surveillance mechanisms\u003csup\u003e\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u003c/sup\u003e. Environmental challenges, such as seasonal fluctuations, natural disasters, and climate change, also contribute to inconsistent water quality. Levy et al. found that climate-related factors influence waterborne disease outbreaks, stressing the need for adaptive surveillance strategies\u003csup\u003e\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u003c/sup\u003e. These findings align with previous studies conducted in Nepal and other LMICs, where financial and technical constraints have hindered water quality monitoring efforts \u003csup\u003e\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e,\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec56\" class=\"Section3\"\u003e \u003ch2\u003e4.4.2 Facilitator to the Water Surveillance System\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eConversely, leveraging technological advancements, innovative water testing methods, and stakeholder participation can significantly enhance surveillance effectiveness. Stakeholder collaboration, including partnerships between government agencies, non-governmental organizations (NGOs), and community water user groups, strengthens implementation efforts. Hunter et al. stress that multi-sector coordination improves resource allocation, ensuring a more systematic and sustainable approach to water quality monitoring \u003csup\u003e\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e\u003c/sup\u003e. The use of digital monitoring tools and automated water quality sensors allows for real-time detection of contaminants. Bartram \u0026amp; Cairncross highlight that technology-driven approaches enhance data accuracy and enable quicker response times to potential health threats\u003csup\u003e\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e\u003c/sup\u003e. Prendergast \u0026amp; Humphrey found that well-funded programs are more likely to implement long-term surveillance strategies that address both emerging and existing water quality concerns\u003csup\u003e\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e\u003c/sup\u003e. Strong leadership at the local level ensures regulatory compliance and effective enforcement of water safety measures. Mara et al. argue that proactive governance structures lead to better adherence to water quality standards, ultimately benefiting public health\u003csup\u003e\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u003c/sup\u003e .Educational initiatives help inform communities about safe water handling, contamination risks, and preventive measures. Velleman et al. emphasize that participatory approaches foster greater community ownership, encouraging individuals to take proactive steps in water safety\u003csup\u003e\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e\u003c/sup\u003e. Research from Bangladesh and India suggests that community engagement and decentralized water monitoring systems improve water quality outcomes and public health indicators \u003csup\u003e\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e,\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eA comprehensive approach incorporating elements like increased investment, advanced technology, stronger governance, and community ownership is crucial for ensuring sustainable improvements in water quality and public health outcomes in Dhulikhel Municipality.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion \u0026 Recommendation","content":"\u003cp\u003eWASH knowledge gaps and a 14.8% diarrhea prevalence among U5 children are driven by water scarcity, poor infrastructure, and limited resources. Community participation and technology can facilitate improvements, but barriers like low awareness and political constraints remain.\u003c/p\u003e \u003cp\u003eEnhance WASH knowledge through workshops, promote handwashing, waste management, and household water treatment, and strengthen collaboration among authorities and communities. 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Environ Sci Technol 51(15):8725\u0026ndash;8734\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003ea. Quantitative study on Ward-wise distribution of households with at least 1 U5 Children caregiver (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDhulikhel ward number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.6186%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e21.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e12.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e10.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e17.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e29.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.9584%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6895%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4743%;\"\u003e\n \u003cp\u003e8.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Sociodemographic Information of household with U5 children caregiver (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMean/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNone/Uneducated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003ePrimary(Upto 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eSecondary(9-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eUniversity(Bachelor/Master)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eSingle/Unmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eHinduism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e78.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNon hindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eBrahmin/Chhetri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eTamang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNewar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e27.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMagar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003cp\u003e( Dalit/Gurung/Rai/Limbu)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold U5 Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eOne\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eTwo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelation to U5 Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eOther ( Father/Sibling/Blood Relative )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondent Occupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eTeacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e59.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome in Rupees\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e14337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e31735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e20000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e \u003cstrong\u003eWater-related characteristics of households with U5 children (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"637\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater Source for Drinking Purposes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-Pipeline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePipeline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWater Source Other than drinking purposes like Cooking, washing, etc\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-Pipeline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e48.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePipeline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e51.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater Scarcity Seasons\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e73.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eRainy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInconsistency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t Know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater assessability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInside House\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026gt;30 min distance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026lt;30 min distance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater Storage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCovered in Water Jar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePlastic Bottle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater Apperance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eClear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e93.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eColored\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater-Odor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t Smell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e93.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSmell\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater treatment in the household\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 211px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Sanitation characteristics of households with U5 Children (N= 250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold refuses disposal method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDumping site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e78.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNon-dumping site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDumping site distance from house\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNot Known\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026gt;30 min Walk distance from house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026lt;30 min Walk distance from house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePayment for household Waste management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t Pay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e48.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePay Monthly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: WASH Practice characteristics of households with U5 Children (N= 250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing time by a household member (Multiple Responses)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBefore eating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAfter eating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAfter use of Washroom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e79.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBefore cooking food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eArrival at the house from a new place\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHand washing use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSoap and water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWater Only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUpto 1 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUpto 2 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUpto 3 min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold latrine type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSanitary latrine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eOpen pit latrine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToilet location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInside Compound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInside House\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold toilet Condition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eShared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefecate Outside\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUse a Public toilet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: WASH Knowledge characteristics of household U5 children caregiver (N = 250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWay to make drinking water safe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFiltration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e75.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBoiling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eChlorination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSedimentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAlum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t Know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater Contamination Identification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePoor taste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eColor Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e59.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBad odor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t Know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman activity causes water contamination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e13.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWashing clothes/vehicles near water sources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e72.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eOpen defecation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e88.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMixing Chemical fertilizer near water source\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e39.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eIndustrial/Household waste\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWater Contamination Health Effects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eStomach ache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHead ache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCholera\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSkin Rashes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eOther(Typhoid/Hepatitis/Dysentry)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold waste management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eRecycling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBiogas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCompost manure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e90.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLand filling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNot Known\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of WASH-related health information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNewspaper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eRadio/Television\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInformation Center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHealth worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAcquaintance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Level of WASH Knowledge Score among household U5 children caregiver (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWASH Knowledge Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMean/SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMax/Min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal WASH Knowledge Score =25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Association between caregiver WASH Knowledge \u0026amp; U5 children diarrhea Prevalance at household level (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge Sum Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.91-1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.908-1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAdjusting for all sociodemographic variables ( Age , Gender , Education , Marital status , Religion , Ethnicity , Relationship status , Occupation , and Income )\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8: Association between caregiver WASH Practice \u0026amp; U5 children diarrhea Prevalance at household level (N=250)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLatrine type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSanitary/ref\u003c/p\u003e\n \u003cp\u003eUnsanitary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.67-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.44-3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToilet location\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eOutside home/ref\u003c/p\u003e\n \u003cp\u003eInside home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.46-3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.46-3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToilet using household\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle/ref\u003c/p\u003e\n \u003cp\u003eShared\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4-9.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.55-2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo treatment/ref\u003c/p\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.32-1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.33-1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold waste management\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo dumping/ref\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Dumping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.45-3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.43-3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandwashing\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSoap \u0026amp;water/ref\u003c/p\u003e\n \u003cp\u003eWater Only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.417-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.39-11.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eIn Multivariate Analysis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e# Latrine type has adjusted variables such as Income, Education, and Ethnicity\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e## Toilet location has adjusted variables such as Age, Gender, and Marital Status\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e### Toilet-using household adjusted for Income, education, and Water Source\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e#### Water treatment has adjusted for variables such as Education, Income, and Religion\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e##### Household waste management has adjusted for variables such as Income, Education, and Marital Status\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e##### Handwashing has adjusted for variables such as Education, Age, and Income\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kathmandu University School of Medical Science","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"WASH (Water, Sanitation, and Hygiene), Diarrhea, U5 Children, Household U5 Caregiver, Dhulikhel Municipality, Public Health, Water Safety Plan, Water Surveillance, Stakeholders","lastPublishedDoi":"10.21203/rs.3.rs-9073621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9073621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Diarrheal diseases remain a significant public health concern, especially in U5 children, with inadequate Water, Sanitation, and Hygiene (WASH) practices contributing heavily to the disease burden. This study aimed to assess the household \u0026nbsp;WASH situation with at least 1 U5 child in Dhulikhel Municipality and evaluate the barriers and facilitators of implementing a water surveillance system. Objectives included determining household U5 diarrhea prevalence, assessing caregiver WASH knowledge and practices, and identifying key barriers and facilitators for effective water surveillance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology : \u003c/strong\u003eA cross-sectional study was conducted among 250 households with 308 U5 children in the (3-8) ward of Dhulikhel Municipality. Data were collected using “Core questions on drinking water and sanitation for household surveys” developed by the WHO and UNICEF to assess the household prevalence of diarrhea cases among children. Statistical tools (STATA 18.5) assessed WASH Knowledge practices and their association with U5 diarrhea prevalence.\u003c/p\u003e\n\u003cp\u003eSemi-structured interviews with 16 stakeholders and focus group discussions with water consumer groups explored potential barriers and facilitators of the water surveillance system. Data were analyzed using the CFIR framework to identify recurring themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings : \u003c/strong\u003eDiarrhea prevalence among U5 children was 14.8%, exceeding national averages. Despite high awareness of practices like handwashing (96.8%) and water treatment (80%), gaps in consistent application remained. Socio-demographic factors influenced WASH practices, but no significant association with diarrhea prevalence was observed.\u003c/p\u003e\n\u003cp\u003eBarriers included low public awareness, cultural misconceptions, role ambiguity, authority unaccountability, perceived complexity, resource constraints, and political instability. Facilitators encompassed community training, technological innovations, effective leadership, partnership, and stakeholder collaboration. Advanced tools improved data accuracy, while partnerships with NGOs enhanced resource mobilization for an improved surveillance system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion : \u003c/strong\u003eIncreasing WASH outcomes and water surveillance in Dhulikhel requires addressing systemic barriers like resource constraints and awareness gaps. Leveraging technology, community ownership, strong governance, and stakeholder collaboration can ensure safer water access, better hygiene practices, and reduced U5 diarrheal disease prevalence.\u003c/p\u003e","manuscriptTitle":"Assessment of the Water, Sanitation, and Hygiene(WASH) situation and identifying the implementation challenges of the water surveillance system in Dhulikhel Municipality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 16:59:39","doi":"10.21203/rs.3.rs-9073621/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00989c1c-a365-40d3-aa8e-13360d301c52","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":64181147,"name":"Epidemiology"}],"tags":[],"updatedAt":"2026-03-10T16:59:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 16:59:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9073621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9073621","identity":"rs-9073621","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}