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The report said facilities in sub-Saharan Africa were lagging, with only 37 percent having handwashing facilities with soap and water at toilets. Half of the world’s healthcare facilities lack basic hygiene services, putting nearly four billion people at greater risk of infection, the United Nations said Tuesday.

These facilities do not have water and soap or alcohol-based hand rub where patients receive care, and in their toilets, according to the World Health Organization (WHO) and the UNICEF children’s agency.