It is increasingly clear that resolution of complex global health problems requires interdisciplinary, intersectoral expertise and cooperation from governmental, non-governmental and educational agencies. ‘One Health’ refers to the collaboration of multiple disciplines and sectors working locally, nationally and globally to attain optimal health for people, animals and the environment. One Health offers the opportunity to acknowledge shared interests, set common goals, and drive toward team work to benefit the overall health of a nation. As in most countries, the health of Rwanda's people and economy are highly dependent on the health of the environment. Recently, Rwanda has developed a One Health strategic plan to meet its human, animal and environmental health challenges. This approach drives innovations that are important to solve both acute and chronic health problems and offers synergy across systems, resulting in improved communication, evidence-based solutions, development of a new generation of systems-thinkers, improved surveillance, decreased lag time in response, and improved health and economic savings. Several factors have enabled the One Health movement in Rwanda including an elaborate network of community health workers, existing rapid response teams, international academic partnerships willing to look more broadly than at a single disease or population, and relative equity between female and male health professionals. Barriers to implementing this strategy include competition over budget, poor communication, and the need for improved technology. Given the interconnectedness of our global community, it may be time for countries and their neighbours to follow Rwanda's lead and consider incorporating One Health principles into their national strategic health plans.

Introduction: In Sierra Leone, diseases related to water, sanitation, and hygiene remain among the leading cause of morbidity and account for 20% of all death. This study assessed the water, sanitation, and hygiene services and practices at household level in Sierra Leone. Methods: A cluster survey was conducted among 1002 households in 4 districts of Sierra Leone. Data was collected on water, sanitation, and hygiene indicators, occurrence of diarrhoeal diseases at household level within 14-day prior to the survey. Chi-square test at 95% significant level was computed to compare the difference in accessing improved water sources, sanitation, and hygiene in urban and rural areas. Result: Of the 1002 households surveyed, 650 (65%) had access to improved drinking water sources. In the urban areas, 432 (88%) out of 486 households had improved drinking water source, which is higher as compared to rural areas. Only 218 (42%) out of 516 households had improved drinking water ( P < .001). Of the total households surveyed, 167 (17%) had improved sanitation with 45 (5%) having a handwashing facility. There were 173 households reporting diarrhoeal disease within 2 weeks prior to the survey, with prevalence of 17%. Conclusion: Majority of households in rural areas do not have access to improved water sources, sanitation, and handwashing facilities. This study found a high prevalence of diarrhoeal disease at the household level. It is recommended that The Ministry of Health and Sanitation work with relevant sectors to increase access to improved drinking water, sanitation, and handwashing facilities in rural areas.

Introduction: many studies have shown that unimproved water sources, inadequate sanitation facilities and poor hygiene are the main causes of diarrheal diseases, especially in developing countries. The aim of this study was to determine the prevalence and risk factors associated with diarrheal diseases in Sierra Leone. Methods: a cross-sectional study was conducted in March 2019. We used a questionnaire to collect data from study participants. Descriptive statistical analysis was followed to determine frequencies and percentages. Univariate analysis was used to find any association between dependent variable and independent variables. Independent variables that had an association in univariate were included in the multivariate model. Results: we surveyed 1,002 households (516 in rural and 486 in urban), and 2,311 respondents in four districts. The main source of income was farming 437 (43.6%). A total of 49 (54.2%) households earned below the national minimum wage per month. Females represented 61.9% of respondents. A total of 242 (32.2%) households had one to five household members and 229 (30.5%) households had more than ten members. Around 88.9% of households in urban, and 42.2% rural areas use improved water sources. The prevalence of diarrheal diseases was 12.3%. Multivariate analysis showed that using of unimproved water sources (aOR=1.9; 95% CI, 1.01 to 3.63, p=0.045), and large family size (aOR= 2.5; 95% CI, 1.18 to 5.35, p=0.017) were associated with diarrheal disease. Conclusion: we concluded that the risk factors associated with diarrheal diseases included unimproved water sources and large family size. More efforts required to improve water resources, adequate sanitation, and hygiene, particularly in rural areas.

INTRODUCTION There is limited information on the knowledge and prevention practices of diarrheal disease transmission among adults in Sierra Leone. We assessed the level of knowledge and practices of adults on diarrheal disease transmission and prevention in Sierra Leone. METHODOLOGY A community-based cross-sectional cluster survey was conducted in four districts of Sierra Leone. A pre-tested, structured questionnaire was used to collect demographic, knowledge and practices on water, sanitation and hygiene (WASH), diarrheal diseases transmission and prevention. On Knowledge questions, a score above 50% was categorized as adequate and below 50% was categorized as poor. We calculated frequencies, proportions and chi-square to compare knowledge and practice differences between urban and rural settings. RESULTS Of the total 926 study subjects, 676 (73%) were female, with a median age of 29 years (range:18 - 96 years). Almost, 75% (671/926) of study participants had adequate knowledge of the critical moments of hand washing, higher in urban (79%) compared to rural areas (66%), (p<0.001). Forty-one per cent (377/926) of the study participants had limited knowledge of diarrheal diseases transmission with 48% in urban and 33% in rural areas (p<0.001), 87% (801/926) had limited knowledge of the measures of diarrheal diseases prevention, higher in rural, 416 (92%) compared to urban, 385 (81%), (p<0.001). CONCLUSION Study participants had adequate knowledge on the importance of handwashing, and the critical times to wash hands. Study participants had limited knowledge about the transmission and prevention of diarrheal disease. The majority of the study subjects practice hand hygiene and safe water treatment method in urban as compared to rural settings. We recommend developing a WASH-related sensitization program to improve community awareness of diarrheal disease transmission and prevention.

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