Clean-Living, Healthier Communities: Assessing Water, Sanitation, and Hygiene Practices in Peri-Urban Community of Peshawar

Abstract

Background: Safe water, sanitation, and hygiene (WASH) are essential determinants of public health. Despite substantial infrastructure gains, peri-urban regions in developing countries remain disproportionately burdened by waterborne diseases due to unreliable water supply, unsafe storage, and limited behavioral adherence. Pakistan’s peri-urban areas, particularly Peshawar, exhibit persistent fecal contamination risks and intermittent supply patterns, necessitating context-specific data to guide Sustainable Development Goal (SDG) 6 implementation. Objective: To assess household-level WASH practices and their association with diarrheal prevalence in a peri-urban community of Peshawar, Pakistan. Methods: A community-based cross-sectional survey was conducted among 421 systematically selected households in Palosi, Peshawar, using WHO/UNICEF Joint Monitoring Programme tools. Data on water sources, point-of-use (POU) treatment, storage, sanitation, and hygiene behaviors were collected through interviewer-administered questionnaires and direct observation. Associations between WASH variables and 14-day self-reported diarrhea were analyzed using design-adjusted Rao–Scott χ² tests. Results: Boreholes were the predominant water source (77.9%), yet only 14.5% practiced any POU treatment, primarily boiling (48.4%) or cloth straining (41.9%). Diarrhea prevalence was significantly higher among households with community water sources (31.1%), intermittent supply (42.9%), and open storage (37.0%) compared to those with on-premises, continuous supply and tank storage (p<0.001). Lack of handwashing facilities nearly doubled diarrhea odds (OR 1.9; 95% CI 1.0–3.6). Conclusion: Despite high sanitation and hygiene coverage, minimal household water treatment and unsafe storage sustain diarrheal risk in peri-urban Peshawar. Continuous supply, effective POU treatment, and secure storage must be prioritized alongside community-level behavior-change interventions to achieve equitable progress toward SDG 6.