1 INTRODUCTION

Cleaning techniques and hygiene practices are critical for preventing and slowing the spread of infectious diseases. Not only underdeveloped countries, but also developed ones, have performed research on water, sanitation, and hygiene (WASH) to improve human life quality.¹ Due to increasing handwashing, the most significant increases in domestic water use are predicted in Africa (23.88%), Asia (15.05%), Latin America, and the Caribbean (7.18%).² Japanese views about personal cleanliness are substantially influenced by early schooling, cultural experiences with handwashing, and reciprocal tendencies in case of during and after emergency.³ Korean individuals with hypertension and diabetes were more likely than those without these conditions to have sadness, concern about contracting COVID-19 and suffering from it, and a lower inclination to practice good hand hygiene.⁴ Another study attempted to create a context-specific relationship from a regional viewpoint by outlining the sociodemographic and WASH factors in southern Punjab, Pakistan and explored that hand pumps and tank water were the main drinking water sources associated with stunting. Batool et al.⁵ In rural areas and small towns in South Africa inequitable access to WASH services is caused by high inequality, rising unemployment, and the Apartheid legacy of a segregated service delivery system.⁶ Due to the unwillingness of WASH practice a large amount of people specially the children suffer from many diseases such as diarrhoea in Southeast Nigeria.⁷ Stunting and anaemia among adolescents in India are significantly predicted by dietary variety and cleanliness practices.⁸ WASH behaviors are most effective in the early years when it comes to improving children's long-term health.⁹ In some rural residents of Ethiopia have limited access to basic water utilities. Moreover, there were few safe water storage practices in the area, and residential water treatment was not a routine habit.¹⁰

The developing countries suffer from WASH poverty for example in the central and eastern Indian states of West Bengal, Bihar, Odisha, Jharkhand, Chhattisgarh, Uttar Pradesh, and Madhya Pradesh, study found clusters of districts which were significantly affected by WASH poverty.¹¹ According to a study in Nepal, students from schools with improved WASH facilities had a favorable and statistically significant impact on their health.¹² In Myanmar a study discovered that consuming untreated water and developing diarrhea were significantly related and the proportion of people who used the anti-diarrhea measures was low.¹³

In Bangladesh, there has been conducted several studies regarding WASH practice specifically in the rural, urban and slum areas.^14-16 Not only the urban and rural areas but also the in St. Martin's Island, some WASH components, particularly the sanitation infrastructure and hygiene standards, did not meet standards.¹⁷ As a result, due to inadequate methods of water purification, irregular toilet usage, a lack of handwashing practices, and restricted access to sources of safe drinking water are all variables that contribute to the prevalence of diarrhea among children.¹⁸ In case of slum areas, nearly every slum in Bangladesh reported having a severe lack of drinking water during the survey. Moreover, when it comes to access to clean water, slum residents are faced with a terrible situation during Covid-19 pandemic.¹⁹ A research was conducted to see the changes of before and after to improve the intervention, the prevalence of childhood diarrhea remained equal in both groups.²⁰ In contrast, one of the studies revealed that culturally acceptable households who are engaged with WASH practice behavior have a lesser chance to be affected by diseases such as typhoid or any types of fever.²¹ People of rural areas have an unwillingness to do WASH practice and behavior. Most of the mothers of the rural areas have a good knowledge about WASH practice in Bangladesh, but only a third of them do not practice it and sociodemographic characteristics play a significant role in this case.^{22, 23}

The Bihari refugee camp in Bangladesh, hosting a marginalized and vulnerable population, faces significant challenges in ensuring adequate water, hygiene, and sanitation practices. Inadequate access to clean water and proper sanitation facilities can lead to a myriad of health issues, including waterborne diseases, which disproportionately affect already marginalized communities. Despite the importance of addressing this issue, there is a notable lack of comprehensive research on the current state of water, hygiene, and sanitation practices and the factors influencing them within the Bihari refugee camp in Bangladesh. While there have been studies on water, hygiene, and sanitation in refugee camps regionally and globally, the specific context of the Bihari refugee camp in Bangladesh has been relatively overlooked. In the realm of WASH research in Bangladesh, the focus has predominantly centered on slums, rural areas, and even on the Rohingya refugee population, leaving a conspicuous void in our understanding of the historically neglected and marginalized Bihari refugees in Bangladesh. The absence of research in this specific context underscores a critical gap in our collective knowledge. This study serves as a bold step towards rectifying this long-standing oversight by bringing to light the dire WASH challenges faced by the Bihari community. Moreover, it is a resounding call to action, illuminating the pressing need to address their unique circumstances, thereby amplifying the voices of an underserved population, and contributing to the broader discourse on humanitarian assistance and equitable resource allocation. The contribution of this study extends beyond its immediate context to have a significant impact on the fields of public health, humanitarian aid, and refugee assistance. By thoroughly assessing water, hygiene, and sanitation practices and their associated factors within the Bihari refugee camp in Bangladesh, this research provides a crucial foundation for addressing a pressing global challenge.

2 METHODS AND MATERIALS

3 RESULTS

4 DISCUSSION

The study revealed the practice level of WASH of Bihari Refugees and associated factors. Education (p ≤ 0.01) and occupation (p ≤ 0.05) are associated factors of water supply. Education (p ≤ 0.05) and occupation (0.004) are associated with satisfaction of drinking water. Education (p ≤ 0.05) and monthly income (p ≤ 0.01) are associated with hygiene practice. Educated respondents with high monthly income are not satisfied with hygiene practice. Occupation (p ≤ 0.01), monthly income (p ≤ 0.05) and number of rooms (p ≤ 0.01) are associated with sanitation practice.

The study has some limitations. The study is cross-sectional in design, which means that it only captures a snapshot of the situation at one point in time and cannot establish causality or determine changes in behavior over time and study only focuses on one refugee camp in Bangladesh and may not be representative of all refugee camps in the country or in other parts of the world. The study relies on self-reported data from the refugees, which may be subject to social desirability bias or recall bias.

The assessment of water, hygiene, and sanitation practice suggests that the surveyed population faces significant challenges related to WASH practices. There are many similar findings of various studies about challenges related to WASH practices. A study conducted in refugee camps in Bangladesh found that access to safe water, sanitation facilities, and hygiene promotion programs was inadequate, leading to a high prevalence of waterborne diseases and poor hygiene practices among the population.²⁴ Another study in a rural community in Nigeria reported that lack of access to clean water and sanitation facilities led to poor hygiene practices, contributing to the high prevalence of diarrheal diseases among children.²⁶

Inadequate practices in the domains of WASH can yield adverse consequences for both public health and the environment. Numerous regions across the globe suffer from inadequate access to a dependable and uncontaminated supply of potable water (Orimoloye et al., 2015). Consequently, individuals are compelled to rely on compromised water sources, thereby increasing the likelihood of contracting waterborne illnesses. Insufficient or absent sanitation facilities, encompassing poor toilet infrastructure, can result in the practice of open defecation, inappropriate waste disposal, and the pollution of water sources. Certain cultural habits and beliefs may impede the adoption of enhanced WASH practices.²⁷ For example, cultural norms and beliefs regarding sanitation or the utilization of certain water sources can discourage communities from embracing and implementing healthy practices. Lack of adequate understanding on the significance of appropriate hygiene and sanitation might lead to the adoption of substandard practices.²⁸ There exists a potential lack of awareness among individuals regarding the potential hazards linked to inadequate hygiene practices, or a potential lack of knowledge regarding the methods and practices necessary to uphold optimal hygiene standards. Low-income communities may encounter challenges in terms of financial accessibility and sustainability when it comes to procuring and upkeeping adequate WASH infrastructure. These circumstances may lead to the presence of below-standard facilities, limited availability of clean water, and poor provision of hygiene products.²⁹

A study in urban slums in India found that inadequate water supply and poor sanitation facilities were major contributors to poor health outcomes, with high rates of diarrhoea and other waterborne diseases.²⁷ In rural Cambodia a study was conducted which found that lack of access to safe water and sanitation facilities led to poor hygiene practices and contributed to high rates of waterborne diseases and other health problems.²⁹

These studies highlight the challenges faced by populations in different contexts related to WASH practices, and emphasize the need for effective interventions to improve access to clean water, sanitation facilities, and hygiene promotion programs. There is a need to improve access to safe and clean water, increase the availability of private toilet facilities, and address the challenges associated with multiple people using the same toilet. Improving hygiene practices and addressing the challenges associated with living in crowded conditions could also help improve the overall health and well-being of the population.

The Chi-square analysis of water, hygiene, and sanitation practice with demographic characteristics found that education and occupation are important factors that influence water practices, particularly regarding safe drinking water and comfort with the water supply. Respondents who were less educated or worked as homemakers were more likely to be unsatisfied with safe drinking water and less comfortable with the water supply. The analysis also found a statistically significant association between education, occupation, monthly income, and the number of rooms in the house with both hygiene and sanitation practices. Specifically, those who are illiterate or have only completed primary school, homemakers, those with lower monthly incomes, and those with fewer rooms in the house are less satisfied with both hygiene and sanitation practices compared to their counterparts. In Kenya, the sanitation coverage stood at 47.6%, with a majority of individuals use shared sanitary facilities.³⁰ Atuyambe et al., conducted a study in Eastern Uganda and reported that gender was significantly associated with WASH practice.³¹ Males did 1.583 times more good practice of WASH.³¹ In Mongolia, a study was conducted by Enkhbat et al., and reported that handwashing practice among pupils for both key occasions was found to be 50.1%. The results indicate a significant association between the female gender (AOR = 0.56, 95% CI = 0.45, 0.70), number of siblings (AOR = 0.72, 95% CI = 0.61, 0.80), and the presence of handwashing facilities at school (AOR = 1.15, 95% CI = 0.86, 1.42).³² According to the data, a mere 34% of students engage in the practice of handwashing with soap while at school. The primary factors contributing to the omission of handwashing include the unavailability of soap, accounting for 23.9% of cases, the absence of a sink facility, which constituted 14.5% of instances, and the substitution of hand sanitizer, which accounted for 19.7% of occurrences.³² In the Nigerian context, a significant majority of respondents, specifically 386 individuals (representing 96.5% of the sample), engage in the practice of handwashing mostly after consuming meals.³³ Additionally, a substantial proportion of participants, 318 individuals (equivalent to 79.5% of the sample), reported engaging in handwashing before eating. Furthermore, a considerable number of respondents, 284 individuals (representing 71.0% of the sample), indicated that they engage in handwashing after coming into contact with children's feces. Furthermore, the data revealed that a significant majority of houses, specifically 357 (89.2%), lacked a drainage system. Additionally, 313 (78.3%) of the houses were found to possess a waste storage facility, while 325 (81.3%) had access to a rubbish dumpsite. Notably, a substantial proportion of houses, 358 (89.5%), did not exhibit any stench of excreta in their vicinity (Inah et al., 33).

Water, hygiene, and sanitation practices are critical in refugee camps as they are key factors in maintaining the health and well-being of refugees. Access to clean and safe drinking water is essential to prevent the spread of waterborne diseases such as cholera, typhoid, and diarrhoea. Proper water management and sanitation systems help to prevent the spread of disease, improve overall health, and ensure adequate hydration. Hygiene practices, such as regular handwashing, are essential to prevent the spread of disease. In a crowded environment like a refugee camp, where disease can easily spread, it is important to promote and encourage good hygiene practices. Proper sanitation facilities, including toilets and waste disposal systems, are crucial in preventing the spread of disease. Inadequate sanitation facilities can lead to the contamination of water sources and the spread of diseases. Access to appropriate sanitation facilities can help to maintain the dignity and privacy of refugees. It can also reduce the risk of gender-based violence. Access to safe and adequate water, hygiene, and sanitation facilities can have a positive impact on the mental health of refugees. It can reduce stress and anxiety and promote a sense of well-being.^34-36

5 CONCLUSION AND POLICY IMPLICATIONS

In a world that often perceives WASH issues as predominantly affecting developing countries, this study serves as a poignant reminder that the challenges within this realm transcend geographical and socioeconomic boundaries. The evaluation of WASH practices among Bihari refugees in Bangladesh sheds light on a broader, universal concern—the fundamental human right to access clean water, proper sanitation, and hygienic conditions, which should be upheld regardless of one's refugee status or location. The findings reveal a stark reality: the vast majority of respondents express dissatisfaction with their WASH conditions, indicating an urgent need for intervention and improvement. These statistics not only reflect the immediate plight of the Bihari refugee community but also echo the struggles of numerous marginalized and displaced populations worldwide. Moreover, the study identifies specific socioeconomic factors influencing WASH satisfaction, emphasizing the complex interplay between individual circumstances and broader systemic issues. It underscores the importance of tailored and holistic approaches to address the multifaceted challenges faced by refugee communities, seeking to empower them to take control of their living conditions and futures.

The assessment of water, hygiene, and sanitation practices among Bihari refugees in Bangladesh provides broader policy recommendations and implications for refugee management and humanitarian efforts. Firstly, the study underscores the critical importance of addressing the basic needs of refugees, including access to clean water and proper sanitation facilities, as a fundamental right. It highlights the necessity for governments, humanitarian organizations, and international bodies to work collaboratively to ensure adequate infrastructure and resources are in place to meet these needs.

Additionally, the findings emphasize the significance of culturally sensitive educational programs and community engagement initiatives aimed at improving hygiene and sanitation practices within refugee camps. These programs can help empower refugees to take ownership of their living conditions and promote healthier behaviors. Moreover, the study underscores the need for long-term solutions, including potential resettlement or integration programs, to improve the overall well-being and prospects of the refugee population. Such initiatives can alleviate the strain on host countries and facilitate the self-reliance and self-sufficiency of refugees. Furthermore, this study's implications extend to a broader context of refugee management, emphasizing the critical importance of basic needs provision, education, and long-term solutions in ensuring the welfare and dignity of displaced populations.

AUTHOR CONTRIBUTIONS

Md. Khaled Sifullah: formal analysis; investigation; methodology; validation; visualization; writing—original draft. Md. Salman Sohel: data curation; formal analysis; investigation; methodology; resources; supervision; writing—original draft; writing—review & editing. Safayet Jamil: data curation; investigation; software; visualization; writing—original draft. Md. Mahdi Hasan: investigation; resources; validation; visualization; writing—original draft. Jeba Anika: data curation; investigation; software; validation; writing—original draft. Husain Rakib Swadhin: formal analysis; methodology; software; writing—original draft. Neeru Chaudhary: formal analysis; supervision; validation; visualization. Md. Naimur Rahman: conceptualization; formal analysis; methodology; project administration; supervision; writing—original draft; writing—review & editing. Mohima Shaiara: data curation; validation; visualization; writing—original draft. Md Tariqul Islam: data curation; formal analysis; investigation; resources; writing—original draft. Babor Ahmad: methodology; resources; validation; visualization; writing—original draft. Mishal Islam Shomapto: investigation; visualization; writing—original draft. Md Fouad Hossain Sarker: conceptualization; investigation; methodology; visualization; writing—original draft; writing—review & editing. S. M. Sohag: data curation; formal analysis; software; visualization; writing—original draft.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHIC STATEMENT

The study was approved by Institutional Ethical Review Board, Faculty of Humanities and Social Science, Daffodil International University, Dhaka 1212, Bangladesh, (Protocol No. Ethics/khaled2/2022). The respondent's identity was maintained anonymous. Before each interview, participants were asked for permission, and they had the option to withdraw at any moment.

TRANSPARENCY STATEMENT

The lead author Md. Naimur Rahman affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.