ArticleBMJ global health2018
What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 7 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- A systematic review of water, sanitation, and hygiene practices in developing countries: exploring the effects on public health.BMC public health · 2026Pooled it
- Does WASH FIT Improve Water, Sanitation, and Hygiene and Related Health Impacts in Healthcare Facilities? A Systematic Review.International journal of environmental research and public health · 2025Pooled it
- Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis.Scientific reports · 2024Pooled it
- Acceptability measures of water, sanitation and hygiene interventions in low- and middle-income countries, a systematic review.PLoS neglected tropical diseases · 2022Pooled it
- Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review.BMC health services research · 2021Pooled it
- Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries.International journal of environmental research and public health · 2021Pooled it
- Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing.International journal of environmental research and public health · 2020Pooled it
- Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program.International journal of environmental research and public health · 2024Trial
- Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya.Tropical medicine & international health : TM & IH · 2023Trial
- Article
- Global capacity for implementing the eight practical steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: A qualitative study using implementation science.SSM - health systems · 2026Article
- Implementation and adaptation of WASH FIT in healthcare facilities: A systematic scoping review.World development sustainability · 2026Article
- Incidence of nosocomial infection in the intensive care unit of Ghazi Al-Hariri teaching hospital.Wiener klinische Wochenschrift · 2026Article
- The perceived impacts of United States foreign development assistance reductions on health system building blocks at healthcare facilities in Zambia: A mixed-methods study.PLOS global public health · 2026Article
- Qualitative assessment of the water and sanitation for health facility improvement tool (WASH FIT) implementation in Zimbabwe.Discover public health · 2026Article
- Towards dignified healthcare: Patients' understanding and experiences of respectful and disrespectful care in healthcare facilities in Ghana.PLOS global public health · 2026Article
- Prevalence and factors associated with poor hand hygiene practices among adult carers of children under five in Mbale district Uganda.Scientific reports · 2025Article
- Mapping the evidence on environmental health services in healthcare facilities in low- and middle-income countries: A systematic literature inventory of over 4,000 studies.medRxiv : the preprint server for health sciences · 2025Article
- Water (In)Accessibility, Healthcare Delivery, and Patients' Health Outcomes in Ghana: Perspectives from the Yendi Hospital.Nursing reports (Pavia, Italy) · 2025Article
- Global capacity for implementing the Eight Practical Steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: a qualitative study.medRxiv : the preprint server for health sciences · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Patient satisfaction with healthcare has clear implications on service use and health outcomes. Barriers to care seeking are complex and multiple and delays in seeking care are associated with significant morbidity and mortality. We sought to assess the relationship between water, sanitation and hygiene (WASH) provision in healthcare facilities (HCF) and patient satisfaction/care seeking behaviour in low-income and middle-income countries. Pubmed and Medline Ovid were searched using a combination of search terms. 984 papers were retrieved and only 21 had a WASH component warranting inclusion. WASH was not identified as a driver of patient satisfaction but poor WASH provision was associated with significant patient dissatisfaction with infrastructure and quality of care. However, this dissatisfaction was not sufficient to stop patients from seeking care in these poorly served facilities. With specific regard to maternal health services, poor WASH provision was the reason for women choosing home delivery, although providers' attitudes and interpersonal behaviours were the main drivers of patient dissatisfaction with maternal health services. Patient satisfaction was mainly assessed via questionnaires and studies reported a high risk of courtesy bias, potentially leading to an overestimation of patient satisfaction. Patient satisfaction was also found to be significantly affected by expectation, which was strongly influenced by patients' socioeconomic status and education. This systematic review also highlighted a paucity of research to describe and evaluate interventions to improve WASH conditions in HCF in low-income setting with a high burden of healthcare-associated infections. Our review suggests that improving WASH conditions will decrease patience dissatisfaction, which may increase care seeking behaviour and improve health outcomes but that more rigorous research is needed.
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