Wetlands can be both a blessing and a curse. They are beneficial sources of safe water and nutrition and places from which humans derive their livelihoods. At the same time, wetlands are known to be sources of disease-causing microorganisms and invertebrates that can threaten human health. Safe water, sanitation and personal hygiene (WASH) are crucial preconditions for the prevention of disease transmission. And of special importance for people living in wetlands, depending on and being exposed to them. WASH should be prioritized especially in those wetlands that are subject to intensive use, that have a poor sanitation infrastructure, and which at the same time only provide limited water resources. However, despite this critical importance, WASH in wetlands is not well characterized in literature. This study therefore aimed at providing insights into the water, sanitation and hygiene conditions and behavioural determinants of households in wetlands by presenting the case of a rural wetland in East Africa. The mixed method approach included a broad set of empirical data collected during a household survey (n = 400), an observational WASH assessment (n =397) and in-depth interviews (n = 20) conducted from January to March 2015 in Ewaso Narok Swamp in Kenya. Different user groups of the wetland were targeted. The study in Ewaso Narok Swamp showed that wetland users' water supply and storage, sanitation and personal hygiene conditions were inadequate for large parts of the community and significantly differed between groups. Whereas the WASH conditions of people working in the service sector were rather positive, for pastoralists, they were correspondingly negative. The WASH behaviour was also perceived to be inadequate influenced by a variety of determining factors. The observational index as applied in this study indicated to be a valuable, rapid and efficient tool for assessing domestic WASH and for detecting differences between different groups in wetlands. Combined with the quantitative and qualitative data, the approach served as a very helpful model to develop a multi-layered understanding of WASH conditions and related behaviour. The people in the researched wetland use by far less improved water sources and sanitation facilities than the nationwide average for rural populations. Since Ewaso Narok Swamp serves as a model case for the domestic WASH conditions in a rural wetland in semiarid East Africa, this fact make the study relevant not only at a national, but also at an international level. The results underline the previously formulated need of an integrative approach that first and foremost complements wetland management by public health interventions. In order to improve WASH conditions and to change behaviour in the long term, interventions should include the provision of clean water and sanitation infrastructure, as well as widespread health education. The approach proved to be useful for wetland environments and will be integrated into the development of a health impact assessment tool for wetlands. Moreover, it can be adopted in other contexts. (C) 2016 Elsevier GmbH. All rights reserved.
