Water, Sanitation and Health in Rural Areas: Issues and Challenges in Koussam (West Cameroon)

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It thus contributes to respecting human dignity and improving citizens' livelihoods. In Cameroon, particularly in the locality of Koussam, access to water is still an ongoing challenge for a considerable proportion of the population. With this mindset, the present study was carried out to examine the modes of drinking water supply and sanitation to visualize the health risks to which the citizens of Koussam are exposed. To achieve this, the methodology consisted essentially of documentary research, backed up by field investigations involving social surveys of about 196 household heads. The results revealed that water supply to households strongly depends on the climatic season. During the dry season, the population predominantly obtains water from streams (38%) and boreholes (29%). Whereas during the rainy season, they rely more on rainwater (36%) and streams (27%). The surveys also revealed that the main people in charge of supplying water to the households are the children (57,14%) and women (32.54%). Therefore, to constantly have water, almost all households (80.95%) mainly store (77,55%) their water in aluminum pots for one to over three days, without prior treatment (80,95%) before drinking. The surveys indicated that sanitation is autonomous. The disposal of liquid and solid household waste primarily occurs in open spaces, in the green space, or in fields. Excreta, on the other hand, is mainly disposed of in precarious overflow latrines. All these results enable understanding that these under-mentioned set of socio-environmental factors above, contribute to the development of health risks such as malaria (46%), typhoid (38%), and dermatosis (8%), which are the most common pathologies mentioned by the household heads. These latter conditions are largely responsible for the hospitalization or death rates among children under the age of 6 in Koussam. It is therefore imperative for governments to invest better in the water and sanitation sector in order to reduce the risks posed to human health. Water supply Sanitation Waterborne diseases Household practices Health risks Autonomous sanitation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. INTRODUCTION Access to drinking water and sanitation are prerequisites for health, growth and human development. Thus, promoting access to improved water sources and sanitation facilities is both a public health and human rights program [ 1 ]. However, lack of access to safe drinking water and adequate sanitation remains one of the most alarming public health problems of the 21st century, despite some progress in recent decades[ 1 ], [ 2 ]. In line with this, it is worth noting that almost a billion people in the world do not have access to potable water and over 2 billion live without adequate sanitation [ 2 ]. Yet, the right to drinking water and sanitation is a human right explicitly recognized by the United Nations Assembly in 2010. For this reason, several international meetings have been organized on the issue of access to drinking water and sanitation [ 3 ]. Moreover, providing drinking water and basic sanitation is one of the key strategic areas identified for poverty alleviation in Africa following the African Union’s Agenda 63. However, the delay in its implementation in Africa is the root of the main public health problems [ 3 ], [ 4 ]. For this reason, providing potable water and improved sanitation services constitutes a major challenge African countries face nowadays [ 5 ]. Cameroon, a country rich in biodiversity also has significant water resources. Despite these abundant resources and the efforts made by the public authorities and non-governmental organizations, access to drinking water and sanitation remains insufficient. The disparities regarding drinking water and sanitation access are particularly visible in rural and urban areas [ 6 ]. By way of illustration, around 71% of households in urban and peri-urban areas have access to drinking water, with more than 8 out of 10 households having access. In contrast, the situation is more deplorable in rural areas, where less than half of households have access to drinking water [ 6 ], [ 7 ]. Regarding sanitation, the situation is worrisome for both the urban and rural areas, given that accessibility to improved sanitation facilities is declining [ 7 ]. For example, the access rate recorded is 58% in urban areas, meanwhile it is 29% in rural areas [ 6 ]. This lack of water and sanitation services is the main cause of death among children under 5, the elderly, and the pregnant women [ 8 ], [ 9 ]. As a result, the most affected populations are mostly those living in rural areas or informal settlements. This corroborates the findings of Drissa Traoré in the Balouzon neighborhood of Daloa, who points out, that “the insufficiency of public infrastructures mostly hits the less privileged part of the population” [ 10 ]. The locality of Koussam, like other rural areas in Cameroon, faces persistent challenges regarding access to potable water and sanitation. These challenges are closely linked to structural and environmental factors such as the distance to water sources, the geographic dispersion of households, inadequate or deficient infrastructure, hygiene practices, limited financial resources, and the impacts of climate change. These factors exacerbate the prevalence of waterborne diseases and conditions associated with insufficient hygiene. The situation in Koussam significantly illustrates these issues, where the lack of reliable and adequate access to potable water and appropriate sanitation systems exposes the population to major health risks, thereby compromising their health and quality life. The main objective of this study is to examine the drinking water supply and sanitation systems to which the populations of Koussam are exposed. It aligns with the Sustainable Development Goals (SDG) number 6, targets 1 and 2which would desire drinking water and sanitation services to be made available to all by 2030 and not only the Njimom community. But this will also contribute to the development of national water and sanitation policies and the allocation of financial resources to decentralized authorities to identify the specific community needs and implement actions adapted to their context. Alongside the enrichment of the database regarding the precarious conditions of rural populations in parts of Africa related to access to essential services, as well as testing theoretical models on the determinants of health, hygiene behaviors and the impact of water and sanitation in specific contexts. 2. MATERIAL AND METHOD 2.1. Presentation of Study site Koussam is located between latitudes 5°49'42.98"et 5°47'09.09" North and longitudes 10°55'39.84" et 10°54’40.08". It is located in the West Cameroon region, Noun division, and is one of the twelve villages in the Njimom sub-division (Fig. 1 ). To the North, it is located around 17 km from downtown Njimom [ 11 ], on the Foumban - Magba national road, and to the south around 22 km from the secondary road to downtown Foumban. It comprises several neighborhoods (Njikouot, jitoupouem, quoubatou, etc.) and is bordered to the north by Mfolap, to the south by Njichom, to the east by Njiketnkié (Foumban) and the west by Njimom. Koussam lies in the transition zone between the great forest of the south and the savannah of northern Cameroon, dominated by a transitional Sudano-Guinean shrub savannah or peri-forest savannah partially modified by human occupation [ 12 ]. In some places, the natural vegetation has been replaced by man-made formations (mango, oil palm, coffee, cocoa, etc.) and food crops (maize, beans, peanuts, tomatoes, vegetables). The climate is of the tropical western mountain type, with two unevenly distributed alternating seasons: a short dry season from November to February and a long rainy season from March to October. Its relief is characterized by hills at altitudes of between 1,100 and 1,400 m, with a dense hydrographic network drained by several rivers that join the Mbam in the Sanaga basin [ 11 ], [ 12 ]. 2.2. Socio-environmental data collection To effectively execute this study, descriptive and analytical field surveys [ 13 ] were carried out among households in the Koussam locality. These essentially involved gathering information on the socio-economic level and conditions of access to basic services such as water, health and sanitation. To achieve this, a combination of quantitative and qualitative approaches was adopted using a number of certain tools [ 13 ]. The sample size or number of households to be surveyed was determined using a statistical formula [ 14 ] and reported [ 15 ], [ 16 ]. Equation 1 : N = Z 2 *p (1- p) / d 2 N: The sample size or number of households to be surveyed; Z: The value corresponding to a confidence level given by the centered reduced law, with a confidence level of 95%, (1.96); p: The proportion of responses from respondents (50%); d: The expected margin of error, (7%). 2.2.1. Quantitative approach A closed-ended questionnaire (in the form of multiple-choice questions and/or yes/no answers) was sent to 196 households. These were randomly selected with a spatial distribution in order to collect objective data, representative of all households in Koussam [ 13 ]. The door-to-door solicitation was carried out in 2023, skipping every 5 houses during the dry season (March) and the rainy season (August) which are the main seasons in this area. In addition, a series of individual interviews was carried out with heads of households of both sexes (men and women), lasting an average of 10 to 30 min, depending on the availability of the interviewer [ 13 ]. The various questions administered to households were formulated around four main themes: water management practices, prevalence of water waterborne and hygiene -related diseases; socio-economic factors; sanitation practices, and sanitary infrastructure. 2.2.2. Qualitative approach The method used in qualitative surveys was direct observation. This involved visual perception, enabling the capture of behaviors and facts as they occurred, without a witness’ testimonial [ 13 ], [ 17 ]. Direct observations enabled the identification of the latrine types, the location of wastewater and household refuse disposal, the collection and storage utensils used, and the domestic approach to water treatment. Also, photographs were taken to illustrate certain existing facts. 2.3. Epidemiological data collection Epidemiological data mainly comprised information on water and sanitation-related diseases. These were mainly statistical data from the last five years from the consultation and hospitalization registers collected in October 2023 from the Koussam Medical Center. It also included data from interviews conducted during the quantitative survey. 2.4. Data analysis Data from direct household interviews and observations, as well as from documentary research at the Koussam Medical Center, were manually analyzed, entered and processed using conventional statistical analysis methods and Microsoft Office Excel 2019 software. 3. RESULTS AND DISCUSSION 3.1. Socio-economic level of the population The socio-economic aspect is an important factor in water supply and sanitation. According to our surveys, 70% of the population does not receive formal education. This is a handicap for their well-being, considering that education is a determining factor in the quality of health outcomes in sub-Saharan African communities [ 18 ]. The primary and secondary levels, with 18% and 9% representation respectively (Fig. 2 a), are insufficient to assimilate the notion of hygiene, especially in terms of acquiring knowledge to understand the mechanisms of transmission of water-borne diseases [ 18 ]. Generally speaking, the low level of education of residents in the Koussam area has an impact on their understanding of water and sanitation issues, and especially on their contribution to promoting good hygiene practices within their community. It is also important to point out that “education protects against disease by influencing life systems and decision-making skills in the face of certain problems” [ 8 ], [ 9 ]. Since educated people are generally more aware of the conditions that guarantee their well-being, they may have easier access to resources that can create healthy conditions around them [ 18 ], [ 19 ]. In this locality, the informal sector (agriculture, livestock farming, masonry) accounts for over 80% of the inhabitants’ occupation, to the detriment of the formal sector (doctor, nurse, teacher, etc.), which accounts for less than 20% (Fig. 2 b). This could hinder access to an improved source of drinking water and an appropriate sanitary infrastructure, given that economic resources, financial cost and the activities carried out by inhabitants are determinants of household choice in terms of access to drinking water and adequate sanitation [ 20 ], [ 21 ]. Furthermore, the World Bank considers that the cost of drinking water should not exceed 5% of household income in developing countries [ 22 ]. Wealth has a positive influence on access to improved water and sanitation facilities, thus reducing water, hygiene, and sanitation-related diseases [ 18 ], [ 19 ], [ 20 ]. 3.2. Water source and Seasonality Access to water in quantity and quality, which is a fundamental right for every individual, must be sufficient and constant for personal and domestic use [ 23 ], [ 24 ]. In the absence of a public water distribution network, the inhabitants of Koussam resort directly to alternative water supplies, depending on the climatic season (Fig. 3 ). These include groundwater (boreholes, wells, and springs), watercourses (rivers and streams) and rainwater. This result is very different from the work presented by other authors, who have found that households obtain their water from boreholes, wells, springs and the public water distribution network [ 5 ], [ 20 ], [ 21 ], [ 25 ]. This difference may be since their studies were carried out in urban or peri-urban areas. During the dry season, streams (38%) and boreholes (29%) are the most used. During the rainy season, rainwater (36%) and streams (27%) are used. The survey and observation show that the primary source of water for domestic use in Koussam is streams, followed by boreholes, rainwater, springs, rivers and finally wells. The predominance of streams can be explained not only by their greater number but above all by the fact that they are better distributed spatially than the others, making them easier to access. The use of boreholes, on the other hand, stems from the fact that some people believe that the potability of water is summed up by its clarity [ 26 ], [ 27 ], despite its limited number and inaccessibility due to the distance separating them from homes. Rainwater, on the other hand, is available only during the wet season and requires no physical effort to obtain. The low use of wells, on the other hand, is because the locality has only one well, which is not only located more than 700 m from homes but also requires too much physical effort and time, as a rope and a 5l bucket are used to collect water. Overall, this study shows that only 38.9% of households obtain their water from more reliable sources (boreholes, wells and springs), while more than half (61.1%) obtain their water from less reliable sources (rainwater, rivers and streams). These results concur with the findings of similar studies [ 28 ] and are consistent with the statistical data from the joint report of the world health organization and the united nations children’s fund [ 7 ], which states that today, almost half the world's population without access to improved water sources lives in Sub-Saharan Africa. 3.3. Collection method How water is collected tells something about “who draws water” and “what is used to draw water”. More than two-thirds of the African population must leave their homes to fetch water for various domestic uses [ 3 ], [ 29 ]. According to the World Health Organization [ 8 ], [ 30 ], when the time taken to collect water exceeds thirty minutes, water collection is considered a chore [ 19 ]. Generally, the time spent collecting water has an impact on the quantity of water used daily [ 8 ], [ 19 ], [ 23 ]. In Koussam, children (57.14%) are more likely to ensure household water supplies. However, 10.32% of men are recorded when water supply requires transportation on wheels (Fig. 4 b and 4 d). Whereas the 32.54% of women recorded were as a result of customs in Africa referring women to household chores whatever their age group (Fig. 4 b). Furthermore, data from surveys reveal that more than half of households in charge of water supply are children, the majority of whom (60%) are in the 5 to 10 age range (Fig. 4 c). Moreover, collecting water is a domestic activity that requires time, physical strength and, above all, hygiene [ 28 ], [ 29 ], [ 30 ]. Yet it is difficult for children to scrupulously observe hygiene rules. Whether a child or a woman collects water is influenced by the socio-economic and demographic characteristics of the household [ 18 ], [ 28 ]. Moreover, in this locality, water is known to be only clean when it's clear [20] and so an educated person will know better how to preserve water quality right at the collection stage. For children, “going to fetch water” is an opportunity to play, and these games often have an impact on the water collected. Very few children are likely to adopt behaviors that positively influence their family's health [2 6 ], [31] 47.89% of households use plastic cans with a capacity between 5 and 20 liters, 26.58% collect water in plastic buckets with a volume of between 10 and 20 liters, and 19.47% in basins. While 3.42% and 2.63% of households respectively collect in drums and other available utensils (Fig. 4 a). However, direct observations reveal that some households do not cover the container and use dirty utensils, which could deteriorate the quality of the water during collection or transport, likely to be a source of water-borne diseases (Fig. 4 d). Plastic drums are the most popular, due to their availability. In fact, they are made from recycled cooking oil drums, which after use become water collection utensils. They are practical and easy to transport by any means (on foot or on wheels). 3.4. Water storage in homes Field survey data revealed a tiny proportion (10.32%) of Koussam's population consume their water on the same day, to the detriment of almost all (89.68%) who store it (Fig. 5 b). This high proportion indicates that storing water at home is a common practice in Koussam and is increasingly used by people living in rural areas [ 10 ], [ 30 ]. However, it can be an important factor in the preservation or degradation of water quality [ 32 ], [ 33 ]. Among those who store water at home (Fig. 5 c), almost a quarter do so for two days, while others store for one (6.35%), three (38.89%) or above three days (19.84%). This situation can be explained by the volume of the container used, the size of the household and the distance between the home and the source of supply [ 10 ], [ 30 ]. However, those who keep their water for one and two days do not have alterations of quality. After three days, more than 80% of the water samples analyzed were of poor quality [ 32 ], [ 33 ], and thus riskier. Households with running water at home do not store their drinking water for long periods and are therefore less exposed to health risks than others [ 5 ], [ 33 ]. As a result, the number of sick increases with the number of days of storage [ 30 ]. Furthermore, aluminum pans, drums, buckets, canisters and basins are the utensils used by households to store water in their homes. These results are in line with those of similar studies [ 5 ], [ 10 ], [ 21 ], [ 27 ]. Almost all households (77.55%) use the aluminum pot as their main water storage container at home, instead of the others (barrel, basin, bucket, and can). This situation can be explained by the preference given to wide – opening containers for drinking water due to their ease of cleaning and protection against contamination. Thus, the aluminum pans, which has a wide opening and is easy to maintain, represents a common choice. In addition, some households use utensils that are not covered or not completely covered, and that are located high up, i.e. more than 1 metre from the ground (Fig. 5 f), and therefore would seldom be contaminated (introduction of dirty cups or hands and soiled objects) by children under 6 years of age, which could jeopardize the health of the household. Furthermore, the majority (80.1%) of the population do not treat their water before consumption. However, of the 19.9% who do treat their water at home, 12% use filtration as their main method of treatment (Fig. 5 d and 5 e), which correlates with that of other authors [ 23 ], [ 25 ], [ 34 ] of the same scope. 3.5. Solid and liquid waste management Interviews and direct observations revealed that in Koussam, not only is there a total absence of collective sewage systems, but also of public toilets and garbage bins. As a result, waste disposal is the responsibility of the household. 3.5.1. Characterization of sanitation infrastructures in Koussam In the Koussam locality, several sanitary structures are used in households to dispose of human feces. These include disposal in nature (bush, riverbanks, etc.) and latrines, whether in concessions or not (full-bottom latrine, sub-modern latrine, manual flush latrine or septic tank). This disposal type is typical of developing countries, especially low-income rural areas [ 35 ], [ 36 ] Simple latrine This is a simple hole dug in the ground with a diameter varying from 1 to 1.5 meters and a depth varying from 2 to 5 meters [ 17 ]. The top is covered with pieces of wood with a hole (circular space varying from 10 to 12 cm) for defecation (Fig. 6 a). This structure may or may not have a superstructure made of mudbrick, sheet metal or foil, without doors or roofs to ensure the user's privacy and protection [ 35 ], [ 37 ]. Although this sanitary infrastructure is widespread due to its low construction cost, it has major drawbacks. It lacks privacy and its use is limited to the rainy season. They are difficult to empty mechanically, as they contain only feces and certain solid objects, making them difficult to pump out [ 17 ], [ 36 ]. Sub-modern latrine These are pits whose end is paved with solid building materials (concrete) and pierced by a defecation hole [ 17 ]. This structure contains a superstructure consisting of a wall made of mud bricks, or plastered or un-plastered breezeblocks, a roof and a door made of wood, sheet metal or loincloth (Fig. 6 b). This type of latrine ensures the user's privacy and protection and can be used by the household for showering [ 16 ], [ 27 ]. This type of latrine generally collects excreta and shower water. It has almost the same drawbacks as traditional latrines Modern or septic tank latrine These are latrines with a watertight chamber made of concrete, fiberglass, PVC or plastic for the storage and treatment of black water and household wastewater [ 17 ], [ 36 ]. These are latrines that require manual or mechanical flushing (Fig. 6 c). Although it requires a fair amount of water and regular emptying, it eliminates almost all odors and provides the best user comfort compared with other types of latrine, although its construction cost is relatively higher [ 17 ], [ 36 ]. Field survey data reveal that around 92% of the population of Koussam relieves themselves in traditional latrines (Fig. 6 d), made up of simple latrines (72.45%) and sub-modern latrines (19.39%), while the remaining 8% relieve themselves either in nature (2.55%), in modern latrines (4.08%) and/or in other sanitary infrastructures (1.53%). This situation can be explained by the living conditions of the local population, as septic tank latrines are found in high-status homes and traditional latrines in medium- and low-status homes. Generally, the traditional latrine is the main method of feces disposal in Koussam. This result is similar to those obtained by other researchers in peri-urban areas [18], [ 3 2], [ 3 7]. However, latrines are abandoned once full followed by the construction of a new one. This is because they cannot be emptied due to the total absence of emptying trucks in the district. This contributes to soil pollution and contamination of aquifers. 3.5.2. Sewage and household waste disposal Table 1 Household waste disposal sites Disposal sites Household waste water Average Kitchen Laundry Tableware Shower Yard 2,38% 28,57% 3,17% 0,00% 8,53% Open space behind home/ green space 9,52% 0,79% 29,37% 75,40% 28,77% Septic tank laterine 3,97% 1,59% 1,59% 15,87% 5,75% Farms 84,13% 2,38% 65,87% 0,00% 38,10% Water courses 0,00% 66,67% 0,00% 8,73% 18,85% Total 100% 100% 100% 100% 100% Wastewater disposal methods in households in the Koussam locality are strongly influenced by, or largely dependent on, the typology of wastewater produced in the household (Table 1 ). Nevertheless, the predominance of the use of the open space behind the house as the main place of wastewater discharge from showers can be explained, on the one hand, by the presence of an internal shower in each household which empty themselves behind houses. Secondly, traditional latrines are used exclusively for defecation. It is also worth noting that rivers are used extensively for the disposal of wastewater from washing, due to the absence of running water in homes and the distance separating water points from households. Furthermore, fieldwork revealed that wastewater produced during dishwashing and cooking in almost all households is discharged into fields, which are considered by local people to be the main dumping ground. This is because the physical composition of this wastewater requires filtration before it is discharged elsewhere. Overall, we can see that in the Koussam locality, most residents use unoccupied space (open space behind the house and fields) to dispose of domestic wastewater. This result is very different from those obtained by other authors, who have reported that households evacuate dirty water in the gutter and the yard [ 4 ], [ 5 ], [ 18 ], [ 27 ], [ 37 ]. This difference is obvious because in urban and peri-urban areas, where their studies were carried out, sanitation is collective, whereas in rural areas it is individual. Moreover, household waste management is haphazard and depends on the personal initiative or mentality of the people in each household. These management methods are due to the absence of waste collectors such as refuse bins, a lack of awareness and perhaps the illiteracy of the population. This can be seen by the absence of a sanitation service in the commune of Njimom. 3.6. Sanitary Risks Poorly maintained surroundings or environments in the vicinity of water points can constitute or encourage microbial sources [ 29 ], [ 37 ]. Socio-economic vulnerability, precarious water supply and solid and liquid waste disposal are factors that explain the health situation in Koussam. Epidemiological data show that over the last five years, several cases of malaria, typhoid fever, diarrhea, cholera and many others have been recorded. However, the mortality rate due to lack of access to drinking water and deficiencies in the sanitation system is estimated at 45.2 deaths per 100,000 inhabitants [ 38 ]. Figure 7 shows that the majority of the population is affected by malaria and typhoid fever. An average of 786 people suffering from malaria and 660 were affected by typhoid fever out of the 1,722 consultation cases, corresponding respectively to 46% and 38% of the hospitalization rate (Fig. 8 a). These results are similar to those reported by other authors of similar scope [ 4 ], [ 21 ], and the data collected over a five-year period allow us to affirm that the health risk in Koussam is permanent. Furthermore, a survey of household heads reveals that out of the 196 households surveyed, nearly all households in Koussam reported cases of waterborne diseases, regardless of their water supply source, during the months preceding the survey period. It revealed that the water source which is most likely to cause waterborne diseases is the river, while water from boreholes causes fewer cases (Fig. 8 c). The most commonly reported waterborne diseases are typhoid fever and dermatitis, with children under six years of age being the most vulnerable group. However, more illnesses are recorded from surface water sources due to their questionable quality, as these sources are highly exposed to contamination and therefore more vulnerable to pollution. In contrast, deep groundwater sources are generally of good quality [ 4 ], [ 17 ], [ 20 ]. Figure 8 b shows a positive linear relationship between the duration of water stored at home and the number of disease cases. Thus, the duration increase is directly proportional to the prevalence of diseases. According to the regression line equation, for each additional day of storage, the number of disease cases increases by an average of 25.5. In contrast, the number of cases decreases by 17.5 without storage. The coefficient of determination value is close to 1 (0.965), indicating a very strong relationship between the two variables, with a 95% confidence interval. 4. CONCLUSION One of the objectives of sustainable development is meeting drinking water and sanitation needs of all social strata. Within this context, this study therefore aimed to study the methods of supplying drinking water and sanitation in order to visualize the health risks to which the populations of Koussam are exposed. Faced with the difficulties of accessing running tap water in homes due to the absence of the public network in charge of distributing drinking water, the populations of the locality of Koussam use six (06) sources of drinking water supply depending on the climatic season. During the dry season, streams are dominant with a strong spatial distribution, leading the majority of the population to use them to the detriment of other sources of supply. On the other hand, in the wet season, rainwater is more in demand than other sources of water supply (stream, spring, river, boreholes and well) due to the ease of access and collection. However, from this study we can deduce that these waters are generally collected in plastic containers by children and consumed mostly untreated. In addition, due to certain factors (distance, size of the household, etc.), they are mostly kept in aluminum pots for two days or more in homes. It is also noteworthy that the open-ended latrines which constitute the main mode of evacuation of excreta are a major source of water contamination by infiltration. Similarly, other sources of water contamination have been highlighted throughout this work, namely: the disposal of domestic wastewater which is mostly discharged into green spaces or farms. Similarly, the uncontrolled dumping of household waste, which largely depends on personal initiative or the mentality of the people making up each household is also a source of water contamination. Therefore, it is clear from the above-mentioned elements that the socio-environmental factors of Koussam expose the population to various waterborne diseases, of which malaria and typhoid fever are the most widespread. Unfortunately, the most vulnerable group is that of children under 6 years old. It is therefore essential for public authorities to strengthen their investments in the water and sanitation sector to sustainably reduce the health risks to which rural populations, such as those in Koussam, are exposed. Although community initiatives, such as the construction of artisanal hydraulic works (boreholes and hand-dug wells) by local residents, supported by donations from non-governmental organization (NGO), foundations, and associations, have been undertaken to address existing deficiencies, these actions remain limited and cannot, on their own, provide lasting solutions to the scale of the challenges. A structural response, supported by appropriate public policies, local partnerships, and technically viable solutions, is necessary to ensure equitable, safe, and sustainable access to drinking water and sanitation. Declarations Author Contribution Abdou Nasser Njoya Mfokou, Amidou Moundi contributed to the study conception and design. Material preparation and datacollection were performed by Abdou Nasser Njoya Mfokou and Ateh Suh Nkwekeu Ndiforngu. All authors contributed to the analysis, interpretation, and processing of the data. The first draft of the manuscript was written by Abdou Nasser Njoya Mfokou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding Statement This research was entirely funded by the authors own funds. References UNICEF et OMS, « Drinking Water, Sanitation and Hygiene in Schools: Global Baseline Report 2018 », Organisation Mondiale de la Santé (OMS) et Fond des Natons Unies pour l’Enfance, Genève, Rapport d’évaluation premier, 2018. Consulté le: 24 avril 2025. [En ligne]. 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Nya, « Accès à l’eau potable et à l’assainissement dans le département du NDE (Region de l’Ouest -Cameroun) », Thèse de Doctorat, PhD, Département de Géographie, Université de Yaoundé I, Yaoundé, 2020. [En ligne]. Disponible sur: https://theses.hal.science/tel-02937356 P. Agbadi, E. Darkwah, et P. L. Kenney, « A Multilevel Analysis of Regressors of Access to Improved Drinking Water and Sanitation Facilities in Ghana », J. Environ. Public Health , vol. 2019, n o 1, p. 3983869, 2019, doi: 10.1155/2019/3983869. A. R. Dhungana et B. Baral, « Factors Affecting Willingness to Pay for Improved Water Supply System in Rural Tanahu, Nepal », Janapriya J. Interdiscip. Stud. , vol. 5, p. 1‑13, juill. 2017, doi: 10.3126/jjis.v5i0.17836. C. V. Santsa Nguefack, R. Ndjouenkeu, et M. B. N. Ngassoum, « Qualité de l’eau de la localité de Dschang et impact sur la santé des consommateurs », Afr. Sci. , vol. 14, n o 3, p. 96‑107, 2018. C. Moussa, A.-A. D. Florence, et T. 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Kamgang Kabeyene Beyala, L. Sigha Nkamdjou, G. Ekodeck, et A. Tita Margaret, « Water supply, sanitation and health risks in Douala, Cameroon », Afr. J. Environ. Sci. Technol. , vol. 2, n o 12, p. 422‑429, 2008. E. A. Adams, G. O. Boateng, et J. A. Amoyaw, « Socioeconomic and Demographic Predictors of Potable Water and Sanitation Access in Ghana », Soc. Indic. Res. , vol. 126, n o 2, p. 673‑687, mars 2016, doi: 10.1007/s11205-015-0912-y. R. Bain, R. Cronk, J. Wright, H. Yang, T. Slaymaker, et J. Bartram, « Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis », PLOS Med. , vol. 11, n o 5, p. e1001644, mai 2014, doi: 10.1371/journal.pmed.1001644. I. Sy et al. , « Eau potable, assainissement et risque de maladies diarrhéiques dans la Communauté Urbaine de Nouakchott, Mauritanie », Santé Publique , vol. 29, n o 5, p. 741‑750, déc. 2017, doi: 10.3917/spub.175.0741. A. J. Pickering et J. Davis, « Freshwater availability and water fetching distance affect child health in sub-Saharan Africa », Environ. Sci. Technol. , vol. 46, n o 4, p. 2391‑2397, févr. 2012, doi: 10.1021/es203177v. C. Moussa, C. Mamoutou, et D. Soumaïla, « Analyse du mode d’accès, de conservation de l’eau et risques de maladies hydriques dans un quartier populaire : Cas de Kennedy Clouetcha dans la commune d’Abobo (Côte d’Ivoire) », Rev. Can. Géographie Trop. , vol. 8, n o 1, p. 63‑69, 2021. A. A. Patunru, « Access to safe drinking water and sanitation in Indonesia », Études Polit. Sur Asie Pac. , vol. 2, n o 2, p. 234‑244, mai 2015, doi: 10.1002/app5.81. E. Ngnikam, B. Mougoue, et F. Tietche, « Eau, Assainissement et impact sur la santé: étude de cas d’un écosystème urbain à Yaoundé », Actes JSIRAUF , 2007. Leseau, « maîtrise de l’assainissement dans un écosystème urbain à Yaoundé au Cameroun et impact sur la santé des enfants âgés de moins de 5 ans », Laboratoire Environnement et Science de l’Eau (ENSP), Yaoundé, final de recherche Projet, 2005. J. Wethé, M. Radoux, et E. Tanawa, « Assainissement des eaux usées et risques socio – sanitaires et environnementaux en zones d’habitat planifié de Yaoundé (Cameroun) », VertigO - Rev. Électronique En Sci. Environ. , vol. 4, n o 1, Art. n o 4‑1, mai 2003, doi: 10.4000/vertigo.4741. W. Awoke et S. Muche, « A cross sectional study: latrine coverage and associated factors among rural communities in the District of Bahir Dar Zuria, Ethiopia », BMC Public Health , vol. 13, n o 1, p. 99, févr. 2013, doi: 10.1186/1471-2458-13-99. G. H. Mpakam et al. , « L’accès à l’eau potable et à l’assainissement dans les villes des pays en développement : cas de Basoussam (Cameroun) », Rev. Électronique En Sci. Environ. , vol. 7, n o 2, Art. n o 7‑2, sept. 2006. OMS, « Prévenir les maladies par des environnements salubres : vers une évaluation de la charge des maladies environnementales », Organisation mondiale de la Santé (OMS), Genève, rapport technique 9241593822, 2006. [En ligne]. Disponible sur: (https://www.who.int/publications/i/item/9241593822) OMS, « Stratégie pour la gestion sans risque de l’eau de boisson destinée à la consommation humaine: rapport du Secrétariat. », Organisation mondiale de la Santé (OMS), Genève, rapport technique 6, 2010. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6739220","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463278259,"identity":"e855c4d2-01a6-45a0-8d3a-795b5c53e516","order_by":0,"name":"Abdou Nasser Njoya Mfokou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDAC5gPMYAqIGR8ACR4+glrYEuBamA1AWtiI1QJmSoBJQjp025gPG3xsu8POL5H8rPJrjp0MGwPzw0c38GgxO8aWnDiz7Rmz5Iw0s9uy25KBDmMzNs7Bp+V+j/Fh3rbDzAY3EsxuS25jBmrhYZPGq+UYD0xL+rdiyW31xGlJhmjJMWP8uO0wMVrYkg1nnDvMLNnzpliacdtxHjZmQn45xnxY4kPZ4WR+9vSNH39uq7bnZ29++BifFhhIZhBIYGDmATGZCamFAjsG/gMMjD+IVD0KRsEoGAUjCwAA7ApEFzV5PFsAAAAASUVORK5CYII=","orcid":"","institution":"National Institute of Cartography","correspondingAuthor":true,"prefix":"","firstName":"Abdou","middleName":"Nasser Njoya","lastName":"Mfokou","suffix":""},{"id":463278260,"identity":"558c9782-0163-4523-8896-475ee1c1a6f6","order_by":1,"name":"Amidou Moundi","email":"","orcid":"","institution":"University of Yaoundé I","correspondingAuthor":false,"prefix":"","firstName":"Amidou","middleName":"","lastName":"Moundi","suffix":""},{"id":463278261,"identity":"39a1668f-d7d7-4832-85bd-d26953046a91","order_by":2,"name":"Ateh Suh Nkwekeu Ndiforngu","email":"","orcid":"","institution":"University of Padova","correspondingAuthor":false,"prefix":"","firstName":"Ateh","middleName":"Suh Nkwekeu","lastName":"Ndiforngu","suffix":""},{"id":463278262,"identity":"cf9e5353-0a2d-4090-a248-4cd147ddc1a8","order_by":3,"name":"Larissa Damaris Azengo Kenfack","email":"","orcid":"","institution":"Laboratoire LeauClean","correspondingAuthor":false,"prefix":"","firstName":"Larissa","middleName":"Damaris Azengo","lastName":"Kenfack","suffix":""},{"id":463278263,"identity":"6972aaac-f973-4ed7-ab8b-ee4c1244178c","order_by":4,"name":"Carole Joelle Beyala","email":"","orcid":"","institution":"National Institute of Cartography","correspondingAuthor":false,"prefix":"","firstName":"Carole","middleName":"Joelle","lastName":"Beyala","suffix":""},{"id":463278264,"identity":"af50236a-3e4a-4de7-a350-9a560a4a7498","order_by":5,"name":"Tidane Stella Donfack Nkemzem","email":"","orcid":"","institution":"National Institute of Cartography","correspondingAuthor":false,"prefix":"","firstName":"Tidane","middleName":"Stella Donfack","lastName":"Nkemzem","suffix":""},{"id":463278265,"identity":"8700ad95-6f5d-4425-a4c8-c7fc8f200f0d","order_by":6,"name":"Yaya Alim Ahmadou Yerima","email":"","orcid":"","institution":"Agricultural Research Institute for Development","correspondingAuthor":false,"prefix":"","firstName":"Yaya","middleName":"Alim Ahmadou","lastName":"Yerima","suffix":""},{"id":463278266,"identity":"429493d7-b015-4de6-a627-3d784df1cecc","order_by":7,"name":"Gouban Hamadjida","email":"","orcid":"","institution":"National Institute of Cartography","correspondingAuthor":false,"prefix":"","firstName":"Gouban","middleName":"","lastName":"Hamadjida","suffix":""}],"badges":[],"createdAt":"2025-05-24 13:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6739220/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6739220/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83758349,"identity":"3ec303a2-9b80-4559-ac1b-7219e0f33c13","added_by":"auto","created_at":"2025-06-02 08:46:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":775918,"visible":true,"origin":"","legend":"\u003cp\u003eLocation map of the study site. A) West region in Cameroon; B) Njimom sub-division in the West region; C) Koussam in Njimom sub-division ; D) overview of the study site.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/c38235c8185def8313c71633.png"},{"id":83758346,"identity":"4bde99d9-e156-48db-a5ce-cafd2b9cf35b","added_by":"auto","created_at":"2025-06-02 08:46:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":130790,"visible":true,"origin":"","legend":"\u003cp\u003eSocio-economic characteristics of households. a) Level of education b) Main occupation of household heads\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/d6f2e85171992b2d4047ceb7.png"},{"id":83759196,"identity":"1bf44928-a7c5-4482-8d74-88efffa7b51b","added_by":"auto","created_at":"2025-06-02 09:02:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":175925,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of drinking water supply. a) Dry season; b) Rainy season; c) General distribution of water source quality.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/f08e76a3382c87c31ecabd1e.png"},{"id":83759197,"identity":"50c051bb-bc70-41b5-9600-e124d3771477","added_by":"auto","created_at":"2025-06-02 09:02:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1726160,"visible":true,"origin":"","legend":"\u003cp\u003eWater collection from source to household by residents. a) Collection utensil; b) breakdown by gender and age ; c)Age pyramid of persons in charge of water supply; d) Illustration of water collection method.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/e79dd03675d96314d81da899.png"},{"id":83759778,"identity":"389bb73c-e97b-41e7-9de9-d9d352796ad6","added_by":"auto","created_at":"2025-06-02 09:10:05","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1211874,"visible":true,"origin":"","legend":"\u003cp\u003eWater storage at home. a) Distribution of water storage utensils at home; b) Practice of water storage at home; c) Duration of water storage; d) Practice of water treatment at home; e) Treatment method; f) Illustration of water storage method.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/ca0727a4bb789d7c5af4ff8b.png"},{"id":83758353,"identity":"fa935dcc-f305-4978-ae53-cb251dd43b71","added_by":"auto","created_at":"2025-06-02 08:46:05","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":2765079,"visible":true,"origin":"","legend":"\u003cp\u003eMethod of feces disposal. a) Simple latrine. b) Under-improved latrine. c) Improved latrine. d) Usage proportion of households.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/069997a4b6207867ba2b8a3f.png"},{"id":83758356,"identity":"95321b7a-22f2-411a-90b6-98fd37d8b981","added_by":"auto","created_at":"2025-06-02 08:46:05","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1765557,"visible":true,"origin":"","legend":"\u003cp\u003eWastewater discharge paths a) streams; b) Open spaces behind house\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/0e2ef05f63cb2392900d29cd.png"},{"id":83758357,"identity":"2242fd02-6425-437f-be68-141a2439c312","added_by":"auto","created_at":"2025-06-02 08:46:05","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":260607,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of diseases in the locality of Koussam. a) Most frequent pathologies from 2019 – 2023. b) Relationship between storage time and the health of local residents. c) Diseases reported by heads of households based on supply source\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/c774d9a45c49997def985588.png"},{"id":84319117,"identity":"a8b9da31-03b4-4299-99af-6a35ed944f76","added_by":"auto","created_at":"2025-06-10 13:54:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":14527267,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6739220/v1/a7603928-c401-44d9-84f7-e0c83702c5e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eWater, Sanitation and Health in Rural Areas: Issues and Challenges in Koussam (West Cameroon)\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eAccess to drinking water and sanitation are prerequisites for health, growth and human development. Thus, promoting access to improved water sources and sanitation facilities is both a public health and human rights program [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, lack of access to safe drinking water and adequate sanitation remains one of the most alarming public health problems of the 21st century, despite some progress in recent decades[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In line with this, it is worth noting that almost a billion people in the world do not have access to potable water and over 2\u0026nbsp;billion live without adequate sanitation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Yet, the right to drinking water and sanitation is a human right explicitly recognized by the United Nations Assembly in 2010. For this reason, several international meetings have been organized on the issue of access to drinking water and sanitation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, providing drinking water and basic sanitation is one of the key strategic areas identified for poverty alleviation in Africa following the African Union\u0026rsquo;s Agenda 63. However, the delay in its implementation in Africa is the root of the main public health problems [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For this reason, providing potable water and improved sanitation services constitutes a major challenge African countries face nowadays [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Cameroon, a country rich in biodiversity also has significant water resources. Despite these abundant resources and the efforts made by the public authorities and non-governmental organizations, access to drinking water and sanitation remains insufficient. The disparities regarding drinking water and sanitation access are particularly visible in rural and urban areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. By way of illustration, around 71% of households in urban and peri-urban areas have access to drinking water, with more than 8 out of 10 households having access. In contrast, the situation is more deplorable in rural areas, where less than half of households have access to drinking water [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Regarding sanitation, the situation is worrisome for both the urban and rural areas, given that accessibility to improved sanitation facilities is declining [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For example, the access rate recorded is 58% in urban areas, meanwhile it is 29% in rural areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This lack of water and sanitation services is the main cause of death among children under 5, the elderly, and the pregnant women [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a result, the most affected populations are mostly those living in rural areas or informal settlements. This corroborates the findings of Drissa Traor\u0026eacute; in the Balouzon neighborhood of Daloa, who points out, that \u0026ldquo;the insufficiency of public infrastructures mostly hits the less privileged part of the population\u0026rdquo; [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The locality of Koussam, like other rural areas in Cameroon, faces persistent challenges regarding access to potable water and sanitation. These challenges are closely linked to structural and environmental factors such as the distance to water sources, the geographic dispersion of households, inadequate or deficient infrastructure, hygiene practices, limited financial resources, and the impacts of climate change. These factors exacerbate the prevalence of waterborne diseases and conditions associated with insufficient hygiene. The situation in Koussam significantly illustrates these issues, where the lack of reliable and adequate access to potable water and appropriate sanitation systems exposes the population to major health risks, thereby compromising their health and quality life. The main objective of this study is to examine the drinking water supply and sanitation systems to which the populations of Koussam are exposed. It aligns with the Sustainable Development Goals (SDG) number 6, targets 1 and 2which would desire drinking water and sanitation services to be made available to all by 2030 and not only the Njimom community. But this will also contribute to the development of national water and sanitation policies and the allocation of financial resources to decentralized authorities to identify the specific community needs and implement actions adapted to their context. Alongside the enrichment of the database regarding the precarious conditions of rural populations in parts of Africa related to access to essential services, as well as testing theoretical models on the determinants of health, hygiene behaviors and the impact of water and sanitation in specific contexts.\u003c/p\u003e"},{"header":"2. MATERIAL AND METHOD","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Presentation of Study site\u003c/h2\u003e \u003cp\u003eKoussam is located between latitudes 5\u0026deg;49'42.98\"et 5\u0026deg;47'09.09\" North and longitudes 10\u0026deg;55'39.84\" et 10\u0026deg;54\u0026rsquo;40.08\". It is located in the West Cameroon region, Noun division, and is one of the twelve villages in the Njimom sub-division (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To the North, it is located around 17 km from downtown Njimom [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], on the Foumban - Magba national road, and to the south around 22 km from the secondary road to downtown Foumban. It comprises several neighborhoods (Njikouot, jitoupouem, quoubatou, etc.) and is bordered to the north by Mfolap, to the south by Njichom, to the east by Njiketnki\u0026eacute; (Foumban) and the west by Njimom. Koussam lies in the transition zone between the great forest of the south and the savannah of northern Cameroon, dominated by a transitional Sudano-Guinean shrub savannah or peri-forest savannah partially modified by human occupation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In some places, the natural vegetation has been replaced by man-made formations (mango, oil palm, coffee, cocoa, etc.) and food crops (maize, beans, peanuts, tomatoes, vegetables). The climate is of the tropical western mountain type, with two unevenly distributed alternating seasons: a short dry season from November to February and a long rainy season from March to October. Its relief is characterized by hills at altitudes of between 1,100 and 1,400 m, with a dense hydrographic network drained by several rivers that join the Mbam in the Sanaga basin [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Socio-environmental data collection\u003c/h2\u003e \u003cp\u003eTo effectively execute this study, descriptive and analytical field surveys [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] were carried out among households in the Koussam locality. These essentially involved gathering information on the socio-economic level and conditions of access to basic services such as water, health and sanitation. To achieve this, a combination of quantitative and qualitative approaches was adopted using a number of certain tools [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The sample size or number of households to be surveyed was determined using a statistical formula [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and reported [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eEquation 1 : N\u0026thinsp;=\u0026thinsp;Z\u003c/b\u003e \u003csup\u003e \u003cb\u003e2\u003c/b\u003e \u003c/sup\u003e \u003cb\u003e*p (1- p) / d\u003c/b\u003e \u003csup\u003e \u003cb\u003e2\u003c/b\u003e \u003c/sup\u003e \u003c/p\u003e \u003cp\u003eN: The sample size or number of households to be surveyed;\u003c/p\u003e \u003cp\u003eZ: The value corresponding to a confidence level given by the centered reduced law, with a confidence level of 95%, (1.96);\u003c/p\u003e \u003cp\u003ep: The proportion of responses from respondents (50%);\u003c/p\u003e \u003cp\u003ed: The expected margin of error, (7%).\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1. Quantitative approach\u003c/h2\u003e \u003cp\u003eA closed-ended questionnaire (in the form of multiple-choice questions and/or yes/no answers) was sent to 196 households. These were randomly selected with a spatial distribution in order to collect objective data, representative of all households in Koussam [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The door-to-door solicitation was carried out in 2023, skipping every 5 houses during the dry season (March) and the rainy season (August) which are the main seasons in this area. In addition, a series of individual interviews was carried out with heads of households of both sexes (men and women), lasting an average of 10 to 30 min, depending on the availability of the interviewer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The various questions administered to households were formulated around four main themes: water management practices, prevalence of water waterborne and hygiene -related diseases; socio-economic factors; sanitation practices, and sanitary infrastructure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Qualitative approach\u003c/h2\u003e \u003cp\u003eThe method used in qualitative surveys was direct observation. This involved visual perception, enabling the capture of behaviors and facts as they occurred, without a witness\u0026rsquo; testimonial [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Direct observations enabled the identification of the latrine types, the location of wastewater and household refuse disposal, the collection and storage utensils used, and the domestic approach to water treatment. Also, photographs were taken to illustrate certain existing facts.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Epidemiological data collection\u003c/h2\u003e \u003cp\u003eEpidemiological data mainly comprised information on water and sanitation-related diseases. These were mainly statistical data from the last five years from the consultation and hospitalization registers collected in October 2023 from the Koussam Medical Center. It also included data from interviews conducted during the quantitative survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data analysis\u003c/h2\u003e \u003cp\u003eData from direct household interviews and observations, as well as from documentary research at the Koussam Medical Center, were manually analyzed, entered and processed using conventional statistical analysis methods and Microsoft Office Excel 2019 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS AND DISCUSSION","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Socio-economic level of the population\u003c/h2\u003e \u003cp\u003eThe socio-economic aspect is an important factor in water supply and sanitation. According to our surveys, 70% of the population does not receive formal education. This is a handicap for their well-being, considering that education is a determining factor in the quality of health outcomes in sub-Saharan African communities [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The primary and secondary levels, with 18% and 9% representation respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea), are insufficient to assimilate the notion of hygiene, especially in terms of acquiring knowledge to understand the mechanisms of transmission of water-borne diseases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Generally speaking, the low level of education of residents in the Koussam area has an impact on their understanding of water and sanitation issues, and especially on their contribution to promoting good hygiene practices within their community. It is also important to point out that \u0026ldquo;education protects against disease by influencing life systems and decision-making skills in the face of certain problems\u0026rdquo; [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Since educated people are generally more aware of the conditions that guarantee their well-being, they may have easier access to resources that can create healthy conditions around them [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this locality, the informal sector (agriculture, livestock farming, masonry) accounts for over 80% of the inhabitants\u0026rsquo; occupation, to the detriment of the formal sector (doctor, nurse, teacher, etc.), which accounts for less than 20% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). This could hinder access to an improved source of drinking water and an appropriate sanitary infrastructure, given that economic resources, financial cost and the activities carried out by inhabitants are determinants of household choice in terms of access to drinking water and adequate sanitation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, the World Bank considers that the cost of drinking water should not exceed 5% of household income in developing countries [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Wealth has a positive influence on access to improved water and sanitation facilities, thus reducing water, hygiene, and sanitation-related diseases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Water source and Seasonality\u003c/h2\u003e \u003cp\u003eAccess to water in quantity and quality, which is a fundamental right for every individual, must be sufficient and constant for personal and domestic use [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the absence of a public water distribution network, the inhabitants of Koussam resort directly to alternative water supplies, depending on the climatic season (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These include groundwater (boreholes, wells, and springs), watercourses (rivers and streams) and rainwater. This result is very different from the work presented by other authors, who have found that households obtain their water from boreholes, wells, springs and the public water distribution network [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This difference may be since their studies were carried out in urban or peri-urban areas. During the dry season, streams (38%) and boreholes (29%) are the most used. During the rainy season, rainwater (36%) and streams (27%) are used.\u003c/p\u003e \u003cp\u003eThe survey and observation show that the primary source of water for domestic use in Koussam is streams, followed by boreholes, rainwater, springs, rivers and finally wells. The predominance of streams can be explained not only by their greater number but above all by the fact that they are better distributed spatially than the others, making them easier to access. The use of boreholes, on the other hand, stems from the fact that some people believe that the potability of water is summed up by its clarity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], despite its limited number and inaccessibility due to the distance separating them from homes. Rainwater, on the other hand, is available only during the wet season and requires no physical effort to obtain. The low use of wells, on the other hand, is because the locality has only one well, which is not only located more than 700 m from homes but also requires too much physical effort and time, as a rope and a 5l bucket are used to collect water. Overall, this study shows that only 38.9% of households obtain their water from more reliable sources (boreholes, wells and springs), while more than half (61.1%) obtain their water from less reliable sources (rainwater, rivers and streams). These results concur with the findings of similar studies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and are consistent with the statistical data from the joint report of the world health organization and the united nations children\u0026rsquo;s fund [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which states that today, almost half the world's population without access to improved water sources lives in Sub-Saharan Africa.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Collection method\u003c/h2\u003e \u003cp\u003eHow water is collected tells something about \u0026ldquo;who draws water\u0026rdquo; and \u0026ldquo;what is used to draw water\u0026rdquo;. More than two-thirds of the African population must leave their homes to fetch water for various domestic uses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. According to the World Health Organization [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], when the time taken to collect water exceeds thirty minutes, water collection is considered a chore [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Generally, the time spent collecting water has an impact on the quantity of water used daily [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In Koussam, children (57.14%) are more likely to ensure household water supplies. However, 10.32% of men are recorded when water supply requires transportation on wheels (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ed). Whereas the 32.54% of women recorded were as a result of customs in Africa referring women to household chores whatever their age group (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb). Furthermore, data from surveys reveal that more than half of households in charge of water supply are children, the majority of whom (60%) are in the 5 to 10 age range (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ec).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMoreover, collecting water is a domestic activity that requires time, physical strength and, above all, hygiene [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Yet it is difficult for children to scrupulously observe hygiene rules. Whether a child or a woman collects water is influenced by the socio-economic and demographic characteristics of the household [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e Moreover, in this locality, water is known to be only clean when it's clear [20] and so an educated person will know better how to preserve water quality right at the collection stage. For children, \u0026ldquo;going to fetch water\u0026rdquo; is an opportunity to play, and these games often have an impact on the water collected. Very few children are likely to adopt behaviors that positively influence their family's health [2\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], [31] 47.89% of households use plastic cans with a capacity between 5 and 20 liters, 26.58% collect water in plastic buckets with a volume of between 10 and 20 liters, and 19.47% in basins. While 3.42% and 2.63% of households respectively collect in drums and other available utensils (Fig. \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ea). However, direct observations reveal that some households do not cover the container and use dirty utensils, which could deteriorate the quality of the water during collection or transport, likely to be a source of water-borne diseases (Fig.\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ed). Plastic drums are the most popular, due to their availability. In fact, they are made from recycled cooking oil drums, which after use become water collection utensils. They are practical and easy to transport by any means (on foot or on wheels).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Water storage in homes\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eField survey data revealed a tiny proportion (10.32%) of Koussam's population consume their water on the same day, to the detriment of almost all (89.68%) who store it (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb). This high proportion indicates that storing water at home is a common practice in Koussam and is increasingly used by people living in rural areas [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, it can be an important factor in the preservation or degradation of water quality [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Among those who store water at home (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ec), almost a quarter do so for two days, while others store for one (6.35%), three (38.89%) or above three days (19.84%). This situation can be explained by the volume of the container used, the size of the household and the distance between the home and the source of supply [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, those who keep their water for one and two days do not have alterations of quality. After three days, more than 80% of the water samples analyzed were of poor quality [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and thus riskier.\u003c/p\u003e \u003cp\u003eHouseholds with running water at home do not store their drinking water for long periods and are therefore less exposed to health risks than others [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. As a result, the number of sick increases with the number of days of storage [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, aluminum pans, drums, buckets, canisters and basins are the utensils used by households to store water in their homes. These results are in line with those of similar studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Almost all households (77.55%) use the aluminum pot as their main water storage container at home, instead of the others (barrel, basin, bucket, and can). This situation can be explained by the preference given to wide \u0026ndash; opening containers for drinking water due to their ease of cleaning and protection against contamination. Thus, the aluminum pans, which has a wide opening and is easy to maintain, represents a common choice.\u003c/p\u003e \u003cp\u003eIn addition, some households use utensils that are not covered or not completely covered, and that are located high up, i.e. more than 1 metre from the ground (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ef), and therefore would seldom be contaminated (introduction of dirty cups or hands and soiled objects) by children under 6 years of age, which could jeopardize the health of the household. Furthermore, the majority (80.1%) of the population do not treat their water before consumption. However, of the 19.9% who do treat their water at home, 12% use filtration as their main method of treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ed and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ee), which correlates with that of other authors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] of the same scope.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Solid and liquid waste management\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eInterviews and direct observations revealed that in Koussam, not only is there a total absence of collective sewage systems, but also of public toilets and garbage bins. As a result, waste disposal is the responsibility of the household.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.5.1. Characterization of sanitation infrastructures in Koussam\u003c/h2\u003e \u003cp\u003eIn the Koussam locality, several sanitary structures are used in households to dispose of human feces. These include disposal in nature (bush, riverbanks, etc.) and latrines, whether in concessions or not (full-bottom latrine, sub-modern latrine, manual flush latrine or septic tank). This disposal type is typical of developing countries, especially low-income rural areas [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSimple latrine\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThis is a simple hole dug in the ground with a diameter varying from 1 to 1.5 meters and a depth varying from 2 to 5 meters [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The top is covered with pieces of wood with a hole (circular space varying from 10 to 12 cm) for defecation (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003ea). This structure may or may not have a superstructure made of mudbrick, sheet metal or foil, without doors or roofs to ensure the user's privacy and protection [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Although this sanitary infrastructure is widespread due to its low construction cost, it has major drawbacks. It lacks privacy and its use is limited to the rainy season. They are difficult to empty mechanically, as they contain only feces and certain solid objects, making them difficult to pump out [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSub-modern latrine\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese are pits whose end is paved with solid building materials (concrete) and pierced by a defecation hole [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This structure contains a superstructure consisting of a wall made of mud bricks, or plastered or un-plastered breezeblocks, a roof and a door made of wood, sheet metal or loincloth (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eb). This type of latrine ensures the user's privacy and protection and can be used by the household for showering [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This type of latrine generally collects excreta and shower water. It has almost the same drawbacks as traditional latrines\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eModern or septic tank latrine\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese are latrines with a watertight chamber made of concrete, fiberglass, PVC or plastic for the storage and treatment of black water and household wastewater [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. These are latrines that require manual or mechanical flushing (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003ec). Although it requires a fair amount of water and regular emptying, it eliminates almost all odors and provides the best user comfort compared with other types of latrine, although its construction cost is relatively higher [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Field survey data reveal that around 92% of the population of Koussam relieves themselves in traditional latrines (Fig. \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003ed), made up of simple latrines (72.45%) and sub-modern latrines (19.39%), while the remaining 8% relieve themselves either in nature (2.55%), in modern latrines (4.08%) and/or in other sanitary infrastructures (1.53%). This situation can be explained by the living conditions of the local population, as septic tank latrines are found in high-status homes and traditional latrines in medium- and low-status homes. Generally, the traditional latrine is the main method of feces disposal in Koussam. This result is similar to those obtained by other researchers in peri-urban areas [18], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e2], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e7]. However, latrines are abandoned once full followed by the construction of a new one. This is because they cannot be emptied due to the total absence of emptying trucks in the district. This contributes to soil pollution and contamination of aquifers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.5.2. Sewage and household waste disposal\u003c/h2\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\u003eHousehold waste disposal sites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDisposal sites\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eHousehold waste water\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKitchen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaundry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTableware\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShower\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYard\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28,57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e8,53%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOpen space behind home/ green space\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29,37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75,40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e28,77%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeptic tank laterine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e5,75%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFarms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84,13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65,87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e38,10%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWater courses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66,67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e18,85%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWastewater disposal methods in households in the Koussam locality are strongly influenced by, or largely dependent on, the typology of wastewater produced in the household (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Nevertheless, the predominance of the use of the open space behind the house as the main place of wastewater discharge from showers can be explained, on the one hand, by the presence of an internal shower in each household which empty themselves behind houses. Secondly, traditional latrines are used exclusively for defecation. It is also worth noting that rivers are used extensively for the disposal of wastewater from washing, due to the absence of running water in homes and the distance separating water points from households. Furthermore, fieldwork revealed that wastewater produced during dishwashing and cooking in almost all households is discharged into fields, which are considered by local people to be the main dumping ground. This is because the physical composition of this wastewater requires filtration before it is discharged elsewhere. Overall, we can see that in the Koussam locality, most residents use unoccupied space (open space behind the house and fields) to dispose of domestic wastewater. This result is very different from those obtained by other authors, who have reported that households evacuate dirty water in the gutter and the yard [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This difference is obvious because in urban and peri-urban areas, where their studies were carried out, sanitation is collective, whereas in rural areas it is individual. Moreover, household waste management is haphazard and depends on the personal initiative or mentality of the people in each household. These management methods are due to the absence of waste collectors such as refuse bins, a lack of awareness and perhaps the illiteracy of the population. This can be seen by the absence of a sanitation service in the commune of Njimom.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.6. Sanitary Risks\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ePoorly maintained surroundings or environments in the vicinity of water points can constitute or encourage microbial sources [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Socio-economic vulnerability, precarious water supply and solid and liquid waste disposal are factors that explain the health situation in Koussam. Epidemiological data show that over the last five years, several cases of malaria, typhoid fever, diarrhea, cholera and many others have been recorded. However, the mortality rate due to lack of access to drinking water and deficiencies in the sanitation system is estimated at 45.2 deaths per 100,000 inhabitants [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Figure\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows that the majority of the population is affected by malaria and typhoid fever. An average of 786 people suffering from malaria and 660 were affected by typhoid fever out of the 1,722 consultation cases, corresponding respectively to 46% and 38% of the hospitalization rate (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003ea).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese results are similar to those reported by other authors of similar scope [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and the data collected over a five-year period allow us to affirm that the health risk in Koussam is permanent. Furthermore, a survey of household heads reveals that out of the 196 households surveyed, nearly all households in Koussam reported cases of waterborne diseases, regardless of their water supply source, during the months preceding the survey period. It revealed that the water source which is most likely to cause waterborne diseases is the river, while water from boreholes causes fewer cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003ec). The most commonly reported waterborne diseases are typhoid fever and dermatitis, with children under six years of age being the most vulnerable group.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHowever, more illnesses are recorded from surface water sources due to their questionable quality, as these sources are highly exposed to contamination and therefore more vulnerable to pollution. In contrast, deep groundwater sources are generally of good quality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Figure\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003eb shows a positive linear relationship between the duration of water stored at home and the number of disease cases. Thus, the duration increase is directly proportional to the prevalence of diseases. According to the regression line equation, for each additional day of storage, the number of disease cases increases by an average of 25.5. In contrast, the number of cases decreases by 17.5 without storage. The coefficient of determination value is close to 1 (0.965), indicating a very strong relationship between the two variables, with a 95% confidence interval.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. CONCLUSION","content":"\u003cp\u003eOne of the objectives of sustainable development is meeting drinking water and sanitation needs of all social strata. Within this context, this study therefore aimed to study the methods of supplying drinking water and sanitation in order to visualize the health risks to which the populations of Koussam are exposed. Faced with the difficulties of accessing running tap water in homes due to the absence of the public network in charge of distributing drinking water, the populations of the locality of Koussam use six (06) sources of drinking water supply depending on the climatic season.\u003c/p\u003e \u003cp\u003eDuring the dry season, streams are dominant with a strong spatial distribution, leading the majority of the population to use them to the detriment of other sources of supply. On the other hand, in the wet season, rainwater is more in demand than other sources of water supply (stream, spring, river, boreholes and well) due to the ease of access and collection. However, from this study we can deduce that these waters are generally collected in plastic containers by children and consumed mostly untreated. In addition, due to certain factors (distance, size of the household, etc.), they are mostly kept in aluminum pots for two days or more in homes.\u003c/p\u003e \u003cp\u003eIt is also noteworthy that the open-ended latrines which constitute the main mode of evacuation of excreta are a major source of water contamination by infiltration. Similarly, other sources of water contamination have been highlighted throughout this work, namely: the disposal of domestic wastewater which is mostly discharged into green spaces or farms. Similarly, the uncontrolled dumping of household waste, which largely depends on personal initiative or the mentality of the people making up each household is also a source of water contamination. Therefore, it is clear from the above-mentioned elements that the socio-environmental factors of Koussam expose the population to various waterborne diseases, of which malaria and typhoid fever are the most widespread. Unfortunately, the most vulnerable group is that of children under 6 years old. It is therefore essential for public authorities to strengthen their investments in the water and sanitation sector to sustainably reduce the health risks to which rural populations, such as those in Koussam, are exposed. Although community initiatives, such as the construction of artisanal hydraulic works (boreholes and hand-dug wells) by local residents, supported by donations from non-governmental organization (NGO), foundations, and associations, have been undertaken to address existing deficiencies, these actions remain limited and cannot, on their own, provide lasting solutions to the scale of the challenges. A structural response, supported by appropriate public policies, local partnerships, and technically viable solutions, is necessary to ensure equitable, safe, and sustainable access to drinking water and sanitation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAbdou Nasser Njoya Mfokou, Amidou Moundi contributed to the study conception and design. Material preparation and datacollection were performed by Abdou Nasser Njoya Mfokou and Ateh Suh Nkwekeu Ndiforngu. All authors contributed to the analysis, interpretation, and processing of the data. The first draft of the manuscript was written by Abdou Nasser Njoya Mfokou and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was entirely funded by the authors own funds.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNICEF et OMS, \u0026laquo; Drinking Water, Sanitation and Hygiene in Schools: Global Baseline Report 2018 \u0026raquo;, Organisation Mondiale de la Sant\u0026eacute; (OMS) et Fond des Natons Unies pour l\u0026rsquo;Enfance, Gen\u0026egrave;ve, Rapport d\u0026rsquo;\u0026eacute;valuation premier, 2018. Consult\u0026eacute; le: 24 avril 2025. [En ligne]. 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Disponible sur: (https://www.who.int/publications/i/item/9241593822)\u003c/li\u003e\n\u003cli\u003eOMS, \u0026laquo; Strat\u0026eacute;gie pour la gestion sans risque de l\u0026rsquo;eau de boisson destin\u0026eacute;e \u0026agrave; la consommation humaine: rapport du Secr\u0026eacute;tariat. \u0026raquo;, Organisation mondiale de la Sant\u0026eacute; (OMS), Gen\u0026egrave;ve, rapport technique 6, 2010.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","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":"Water supply, Sanitation, Waterborne diseases, Household practices, Health risks, Autonomous sanitation","lastPublishedDoi":"10.21203/rs.3.rs-6739220/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6739220/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAccess to water and sanitation services is essential for citizens' health and well-being. It thus contributes to respecting human dignity and improving citizens' livelihoods. In Cameroon, particularly in the locality of Koussam, access to water is still an ongoing challenge for a considerable proportion of the population. With this mindset, the present study was carried out to examine the modes of drinking water supply and sanitation to visualize the health risks to which the citizens of Koussam are exposed. To achieve this, the methodology consisted essentially of documentary research, backed up by field investigations involving social surveys of about 196 household heads. The results revealed that water supply to households strongly depends on the climatic season. During the dry season, the population predominantly obtains water from streams (38%) and boreholes (29%). Whereas during the rainy season, they rely more on rainwater (36%) and streams (27%). The surveys also revealed that the main people in charge of supplying water to the households are the children (57,14%) and women (32.54%). Therefore, to constantly have water, almost all households (80.95%) mainly store (77,55%) their water in aluminum pots for one to over three days, without prior treatment (80,95%) before drinking. The surveys indicated that sanitation is autonomous. The disposal of liquid and solid household waste primarily occurs in open spaces, in the green space, or in fields. Excreta, on the other hand, is mainly disposed of in precarious overflow latrines. All these results enable understanding that these under-mentioned set of socio-environmental factors above, contribute to the development of health risks such as malaria (46%), typhoid (38%), and dermatosis (8%), which are the most common pathologies mentioned by the household heads. These latter conditions are largely responsible for the hospitalization or death rates among children under the age of 6 in Koussam. It is therefore imperative for governments to invest better in the water and sanitation sector in order to reduce the risks posed to human health.\u003c/p\u003e","manuscriptTitle":"Water, Sanitation and Health in Rural Areas: Issues and Challenges in Koussam (West Cameroon)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 08:46:00","doi":"10.21203/rs.3.rs-6739220/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":"e07669bd-3924-4f7b-bc2c-2393b24d9ba7","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-10T13:53:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-02 08:46:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6739220","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6739220","identity":"rs-6739220","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}