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

Background : Diarrheal diseases remain a significant public health concern, especially in U5 children, with inadequate Water, Sanitation, and Hygiene (WASH) practices contributing heavily to the disease burden. This study aimed to assess the household WASH situation with at least 1 U5 child in Dhulikhel Municipality and evaluate the barriers and facilitators of implementing a water surveillance system. Objectives included determining household U5 diarrhea prevalence, assessing caregiver WASH knowledge and practices, and identifying key barriers and facilitators for effective water surveillance. Methodology : A cross-sectional study was conducted among 250 households with 308 U5 children in the (3-8) ward of Dhulikhel Municipality. Data were collected using “Core questions on drinking water and sanitation for household surveys” developed by the WHO and UNICEF to assess the household prevalence of diarrhea cases among children. Statistical tools (STATA 18.5) assessed WASH Knowledge practices and their association with U5 diarrhea prevalence. Semi-structured interviews with 16 stakeholders and focus group discussions with water consumer groups explored potential barriers and facilitators of the water surveillance system. Data were analyzed using the CFIR framework to identify recurring themes. Findings : Diarrhea prevalence among U5 children was 14.8%, exceeding national averages. Despite high awareness of practices like handwashing (96.8%) and water treatment (80%), gaps in consistent application remained. Socio-demographic factors influenced WASH practices, but no significant association with diarrhea prevalence was observed. Barriers included low public awareness, cultural misconceptions, role ambiguity, authority unaccountability, perceived complexity, resource constraints, and political instability. Facilitators encompassed community training, technological innovations, effective leadership, partnership, and stakeholder collaboration. Advanced tools improved data accuracy, while partnerships with NGOs enhanced resource mobilization for an improved surveillance system. Conclusion : Increasing WASH outcomes and water surveillance in Dhulikhel requires addressing systemic barriers like resource constraints and awareness gaps. Leveraging technology, community ownership, strong governance, and stakeholder collaboration can ensure safer water access, better hygiene practices, and reduced U5 diarrheal disease prevalence.