{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:02:04Z","timestamp":1789984924360,"version":"4.0.1"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Diarrhea and acute respiratory infections (ARI) remain leading causes of under\u2010five morbidity in low\u2010 and middle\u2010income countries. Although Ghana achieved improved drinking water and sanitation coverage, significant regional and socioeconomic inequities persist. This study examined the associations between household water, sanitation, and hygiene (WASH) practices and diarrhea, ARI, and their comorbidity among under\u2010five children in Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross\u2010sectional analysis of 6344 children aged 0\u201359 months from the 2022 Ghana Demographic and Health Survey was conducted. Survey\u2010weighted descriptive statistics and multilevel logistic regression were applied. Predictive performance was assessed using fivefold cluster\u2010preserving cross\u2010validation, Brier scores, calibration slopes, calibration plots, and cross\u2010validated area under the curve (AUC). Spatial patterns were described using choropleth maps, Global Moran's I, Getis\u2010Ord Gi*, and Local Moran's I (LISA). Counterfactual WASH reductions were estimated with bootstrap confidence intervals (200 replicates). A complementary random\u2010effects meta\u2010analysis quantified between\u2010region heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two\u2010week prevalence of diarrhea, ARI, and comorbidity was 14.4% (95% CI: 12.7%\u201316.3%), 5.6% (95% CI: 4.7%\u20136.6%), and 1.8% (95% CI: 1.3%\u20132.5%), respectively, with a pronounced north\u2013south gradient. No WASH variable reached significance in adjusted multilevel models. Diarrhea was associated with child age 6\u201335 months, maternal secondary and higher education, and household wealth. ARI was associated with co\u2010occurring diarrhea and stunting. Stunting was the sole significant predictor of comorbidity. Community\u2010level factors explained 21%\u201335% of variance. Cross\u2010validated AUC was 0.787 (diarrhea), 0.896 (ARI), and 0.577 (comorbidity); calibration slopes were 3.68\u201311.68 (all poor). Global Moran's I showed no significant spatial autocorrelation for all three outcomes. Improving cooking fuel universally was the only scenario associated with a statistically significant absolute reduction in diarrhea prevalence: 1.4% points (relative reduction 13.9%; 95% CI: 6.2%\u201321.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Household WASH infrastructure showed no significant adjusted association with childhood diarrhea, ARI, or comorbidity after controlling for socioeconomic and nutritional confounders. A pronounced north\u2013south disease gradient calls for geographically targeted, multisectoral interventions. Predictive models demonstrated adequate discrimination but poor calibration, limiting their use to population\u2010level risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72628","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:59:53Z","timestamp":1781071193000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Household Water and Sanitation Practices and Their Association With Diarrheal and Acute Respiratory Infections Among Children Under Five in Ghana: A Cross\u2010Sectional Predictive Model and Spatial Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-1765","authenticated-orcid":false,"given":"Yula","family":"Salifu","sequence":"first","affiliation":[{"name":"Department of Population, Family and Reproductive Health, School of Public Health University of Ghana Legon Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gyan","sequence":"additional","affiliation":[{"name":"Health Facilities Regulatory Agency Ashanti Region Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lasong","sequence":"additional","affiliation":[{"name":"Department of Population and Reproductive Health University for Development Studies Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2938-1332","authenticated-orcid":false,"given":"Williams","family":"Walana","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, School of Medicine University for Development Studies Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-24415-3"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-023-04033-x"},{"key":"e_1_2_18_4_1","volume-title":"Water, Sanitation and Hygiene (WASH)","author":"World Health Organization","year":"2025"},{"key":"e_1_2_18_5_1","unstructured":"Ghana Statistical Service Ghana Health Service ICF. Ghana Demographic and Health Survey 2022. Accra Ghana and Rockville Maryland USA: GSS GHS and ICF; 2024."},{"key":"e_1_2_18_6_1","volume-title":"WHO\/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) \u2013 Progress on Household Drinking Water, Sanitation and Hygiene 2000\u20132022: Special Focus on Gender","author":"UN Water","year":"2023"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihad046"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1518427"},{"key":"e_1_2_18_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-025-00705-9"},{"key":"e_1_2_18_10_1","doi-asserted-by":"publisher","DOI":"10.3961\/jpmph.24.246"},{"key":"e_1_2_18_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1748_22"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-10065-x"},{"key":"e_1_2_18_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21070823"},{"key":"e_1_2_18_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-025-01286-9"},{"key":"e_1_2_18_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-025-01866-3"},{"key":"e_1_2_18_16_1","volume-title":"2021 Population and Housing Census \u2013 Press Release on Provisional Results","author":"Ghana Statistical Service","year":"2021"},{"key":"e_1_2_18_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-15705-2"},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2119409120"},{"issue":"3","key":"e_1_2_18_19_1","first-page":"39","article-title":"Breastfeeding and Acute Respiratory Infection (ARI) in Infants: A Systematic Review in Nigeria","volume":"22","author":"George A.","year":"2024","journal-title":"Ann Ibadan Postgrad Med"},{"key":"e_1_2_18_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0215572"}],"container-title":["Health Science Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72628","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hsr2.72628","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hsr2.72628","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T09:15:32Z","timestamp":1789982132000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hsr2.72628"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":19,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/hsr2.72628"],"URL":"https:\/\/doi.org\/10.1002\/hsr2.72628","archive":["Portico"],"relation":{},"ISSN":["2398-8835","2398-8835"],"issn-type":[{"value":"2398-8835","type":"print"},{"value":"2398-8835","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-10-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72628"}}