Water, Sanitation and Hygiene Determinants of Diarrheal Disease in Urban Slum Settings: A CrossSectional Analysis of 250 Households in West Point, Liberia
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Background: Diarrhoeal infections remain a serious public health problem in West Africa's urban slums, where Water, Sanitation, and Hygiene (WASH) practices play an important role in disease transmission. This study investigates the sociodemographic factors that determine WASH practices and their impact on diarrhoeal disease in West Point, Liberia's largest slum neighbourhood. Methods: A community-based cross-sectional study was conducted in West Point, Montserrado County, Liberia, between December 2024 and January 2025. Using systematic random selection, 250 households were selected from five geographic zones. WASH practices, socio-demographic variables, and the frequency of diarrhoeal disease were collected using standardised questionnaires based on WHO/UNICEF JMP standards. Statistical analysis included descriptive statistics, chisquare tests, odds ratio calculations, and multivariate logistic regression. Results: According to the survey, 27.2% of households had diarrhoea in the last three months, much higher than the national average of 22%. Households with no formal education had a 2.84-fold increased incidence of diarrhoea (AOR = 2.84). Access to improved water was 52.0%, sanitation was 25.6%, and hygiene was 11.2%, with just 1.6% of families having access to all three components. There were significant regional inequalities, with the South Zone and Coastal Zone having the highest diarrhoea rates. Inadequate formal education, low water availability, and open defecation behaviours all significantly predicted diarrhoea, according to a logistic regression analysis. Conclusions: West Point's WASH practices are poor and are significantly associated with diarrhoea. Insufficient combined WASH access and high loads in certain areas underscore the need for tailored interventions. The findings suggest comprehensive strategies that prioritise improvements in water quality, sanitation infrastructure, and hygiene education, particularly in highburden areas and among people with low educational backgrounds.
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