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Vicario EF, Annis J, Namakula P, Kasozi GK, Mihelcic JR. Do Sanitation Marketing Activities Increase Households' Likelihoods of Reaching Improved Sanitation or Involving Women in Decision Making? ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:16851-16861. [PMID: 37874361 DOI: 10.1021/acs.est.3c04125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Poor sanitation causes 30% of diarrheal deaths globally, and much of the world has struggled to finance top-down interventions. Sanitation marketing is a demand-led approach that uses a mixture of social and commercial marketing methods and direct sales to households. However, little is known about its impacts on household decision making. This mixed-methods study uses data from eight focus groups and 86,666 household surveys from participants in a five-year sanitation marketing program in Uganda. Logistic regression models identified 10 variables predicting attainment of improved (limited or basic) sanitation and four variables predicting female involvement in decision making. Triggering session attendance increased chances of reaching improved sanitation by 15-28%, depending on who attended, and by 19% if the household found the session motivational. Although women were engaged in decision-making conversations, they were not viewed as primary decision makers, even in female-headed households. Women were more likely to become involved in decision making if they had attended triggering sessions with men (+70%) or engaged with sales promoters alone (+74%) or with men (+78%). For both outcomes, joint activity engagement was more effective than male or female engagement alone. This work highlights two sanitation marketing activities as pathways to improving latrine coverage and women's decision-making agency.
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Affiliation(s)
- Elizabeth F Vicario
- Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., Tampa, Florida 33620, United States
| | - Jonathan Annis
- USAID Uganda Sanitation for Health Activity, Tetra Tech, Plot 12A, Farady Road, Bugolobi, Kampala, Uganda
| | - Patricia Namakula
- USAID Uganda Sanitation for Health Activity, Tetra Tech, Plot 12A, Farady Road, Bugolobi, Kampala, Uganda
| | - Gloria K Kasozi
- United States Agency for International Development, Uganda Mission, Kampala, Uganda
| | - James R Mihelcic
- Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., Tampa, Florida 33620, United States
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Hoang TKD, Binh QA, Bui XT, Le TH, Dang BT, Nguyen HH, Ngo TTM, Kohler P, Makohliso S, Maryna P, Raab M, Vanobberghen A, Hayter A, Schönenberger K. Assessment of water, sanitation, and hygiene services in district health care facilities in rural area of Mekong Delta, Vietnam. ENVIRONMENTAL MONITORING AND ASSESSMENT 2022; 194:775. [PMID: 36255561 DOI: 10.1007/s10661-022-10179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/12/2021] [Indexed: 06/16/2023]
Abstract
Access to sufficient water, sanitation, and hygiene (WASH) services is a crucial requirement for patients during therapy and general well-being in the hospital. However, in low- and middle-income countries, these services are often inadequate, resulting in increased morbidity and mortality of patients. This study aimed at assessing the current situation of WASH services in six District Health Care Facilities (DHCFs) in rural areas of the Mekong Delta provinces, Vietnam. The results showed that these services were available with inappropriate quality, which did not compromise the stakeholders' needs. The revealed WASH infrastructures have raised concerns about the prolonged hospital stays for patients and push nosocomial infections to a high level. The safety of the water supply was doubted as the high E. coli (> 60%) and total coliform incidence (86%) was observed with very low residual chlorine concentration (< 0.1 mg/L) in water quality assessment. Moreover, water supply contained a high concentration of iron (up to 15.55 mg/L) in groundwater in one DHCF. Technical assessment tool analysis proved that the improper management and lack of knowledge by human resources were the primary roots of the observed status WASH services. Improvement of the perceptions of WASH should be done for the hospital staff with collaboration and support from the government to prevent incidents in the future.
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Affiliation(s)
- Thi-Khanh-Dieu Hoang
- Key Laboratory of Advanced Waste Treatment Technology & Faculty of Environment and Natural Resources, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, district 10, Ho Chi Minh City, 700000, Vietnam
- Vietnam National University Ho Chi Minh (VNU-HCM), Linh Trung Ward, Ho Chi Minh City, 700000, Vietnam
| | - Quach-An Binh
- Dong Nai Technology University, Dong Nai, Bien Hoa City, Vietnam
| | - Xuan-Thanh Bui
- Key Laboratory of Advanced Waste Treatment Technology & Faculty of Environment and Natural Resources, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, district 10, Ho Chi Minh City, 700000, Vietnam.
- Vietnam National University Ho Chi Minh (VNU-HCM), Linh Trung Ward, Ho Chi Minh City, 700000, Vietnam.
| | - Thi-Hieu Le
- Key Laboratory of Advanced Waste Treatment Technology & Faculty of Environment and Natural Resources, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, district 10, Ho Chi Minh City, 700000, Vietnam
- Vietnam National University Ho Chi Minh (VNU-HCM), Linh Trung Ward, Ho Chi Minh City, 700000, Vietnam
| | - Bao-Trong Dang
- HUTECH University, 475A, Dien Bien Phu, Ward 25, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Hong-Hai Nguyen
- Institute of Environmental Sciences, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thi-Tra-My Ngo
- Key Laboratory of Advanced Waste Treatment Technology & Faculty of Environment and Natural Resources, Ho Chi Minh City University of Technology (HCMUT), 268 Ly Thuong Kiet street, district 10, Ho Chi Minh City, 700000, Vietnam
- Vietnam National University Ho Chi Minh (VNU-HCM), Linh Trung Ward, Ho Chi Minh City, 700000, Vietnam
| | - Petra Kohler
- EssentialTech Centre, Ecole Polytechnique Fédérale de Lausanne, Station 10, EPFL 1015, Lausanne, Switzerland
| | - Solomzi Makohliso
- EssentialTech Centre, Ecole Polytechnique Fédérale de Lausanne, Station 10, EPFL 1015, Lausanne, Switzerland
| | - Peter Maryna
- University of Applied Sciences & Arts, Northwestern Switzerland, Muttenz, Switzerland
| | - Martin Raab
- Swiss Tropical and Public Health, Allschwil, Switzerland
| | - Alexandre Vanobberghen
- Health Technology and Telemedicine Unit (HTTU) of the Swiss Centre for International Health (SCIH), Basel, Switzerland
| | | | - Klaus Schönenberger
- EssentialTech Centre, Ecole Polytechnique Fédérale de Lausanne, Station 10, EPFL 1015, Lausanne, Switzerland
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Peletz R, Delaire C, Kones J, MacLeod C, Samuel E, Easthope-Frazer A, Khush R. Will Households Invest in Safe Sanitation? Results from an Experimental Demand Trial in Nakuru, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094462. [PMID: 33922311 PMCID: PMC8122837 DOI: 10.3390/ijerph18094462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022]
Abstract
Unsafe sanitation is an increasing public health concern for rapidly expanding cities in low-income countries. Understanding household demand for improved sanitation infrastructure is critical for planning effective sanitation investments. In this study, we compared the stated and revealed willingness to pay (WTP) for high-quality, pour-flush latrines among households in low-income areas in the city of Nakuru, Kenya. We found that stated WTP for high-quality, pour-flush latrines was much lower than market prices: less than 5% of households were willing to pay the full costs, which we estimated between 87,100–82,900 Kenyan Shillings (KES), or 871–829 USD. In addition, we found large discrepancies between stated and revealed WTP. For example, 90% of households stated that they would be willing to pay a discounted amount of 10,000 KES (100 USD) for a high-quality, pour-flush latrine, but only 10% of households redeemed vouchers at this price point (paid via six installment payments). Households reported that financial constraints (i.e., lack of cash, other spending priorities) were the main barriers to voucher redemption, even at highly discounted prices. Our results emphasize the importance of financial interventions that address the sizable gaps between the costs of sanitation products and customer demand among low-income populations.
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Affiliation(s)
- Rachel Peletz
- The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA; (C.D.); (A.E.-F.); (R.K.)
- Correspondence:
| | - Caroline Delaire
- The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA; (C.D.); (A.E.-F.); (R.K.)
| | - Joan Kones
- The Aquaya Institute, P.O. Box 21862-00505, Nairobi 00100, Kenya; (J.K.); (C.M.); (E.S.)
| | - Clara MacLeod
- The Aquaya Institute, P.O. Box 21862-00505, Nairobi 00100, Kenya; (J.K.); (C.M.); (E.S.)
| | - Edinah Samuel
- The Aquaya Institute, P.O. Box 21862-00505, Nairobi 00100, Kenya; (J.K.); (C.M.); (E.S.)
| | - Alicea Easthope-Frazer
- The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA; (C.D.); (A.E.-F.); (R.K.)
| | - Ranjiv Khush
- The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA; (C.D.); (A.E.-F.); (R.K.)
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Parvez SM, Rahman MJ, Azad R, Rahman M, Unicomb L, Ashraf S, Mondol MH, Jahan F, Winch PJ, Luby SP. Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh. Int J Equity Health 2021; 20:16. [PMID: 33407549 PMCID: PMC7789645 DOI: 10.1186/s12939-020-01353-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels. Methods The current analysis selected 4 indicators from the WASH Benefits trial— presence of water and soap in household handwashing stations, observed mother’s hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline. Results For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (− 4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, − 25% (− 35, − 15) Q2: − 34% (− 44, − 23%)] than the wealthiest household [Q5 DID: − 1% (− 11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1–4 DID: 50–54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). Conclusion By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. Trial registration WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Date of registration: April 30, 2012 ‘Retrospectively registered’. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-020-01353-7.
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Affiliation(s)
- Sarker Masud Parvez
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Musarrat Jabeen Rahman
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashidul Azad
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sania Ashraf
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Farjana Jahan
- Environmental Intervention Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
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Trimmer JT, Miller DC, Byrne DM, Lohman HAC, Banadda N, Baylis K, Cook SM, Cusick RD, Jjuuko F, Margenot AJ, Zerai A, Guest JS. Re-Envisioning Sanitation As a Human-Derived Resource System. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:10446-10459. [PMID: 32867485 DOI: 10.1021/acs.est.0c03318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sanitation remains a global challenge, both in terms of access to toilet facilities and resource intensity (e.g., energy consumption) of waste treatment. Overcoming barriers to universal sanitation coverage and sustainable resource management requires approaches that manage bodily excreta within coupled human and natural systems. In recent years, numerous analytical methods have been developed to understand cross-disciplinary constraints, opportunities, and trade-offs around sanitation and resource recovery. However, without a shared language or conceptual framework, efforts from individual disciplines or geographic contexts may remain isolated, preventing the accumulation of generalized knowledge. Here, we develop a version of the social-ecological systems framework modified for the specific characteristics of bodily excreta. This framework offers a shared vision for sanitation as a human-derived resource system, where people are part of the resource cycle. Through sanitation technologies and management strategies, resources including water, organics, and nutrients accumulate, transform, and impact human experiences and natural environments. Within the framework, we establish a multitiered lexicon of variables, characterized by breadth and depth, to support harmonized understanding and development of models and analytical approaches. This framework's refinement and use will guide interdisciplinary study around sanitation to identify guiding principles for sanitation that advance sustainable development at the nature-society interface.
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Affiliation(s)
- John T Trimmer
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 N. Mathews Ave., Urbana, Illinois 61801, United States
| | - Daniel C Miller
- Department of Natural Resources and Environmental Sciences, University of Illinois at Urbana-Champaign, 1102 S. Goodwin Ave., Urbana, Illinois 61801, United States
| | - Diana M Byrne
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 N. Mathews Ave., Urbana, Illinois 61801, United States
| | - Hannah A C Lohman
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 N. Mathews Ave., Urbana, Illinois 61801, United States
| | - Noble Banadda
- Department of Agricultural & Biosystems Engineering, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Katherine Baylis
- Department of Agricultural & Consumer Economics, University of Illinois at Urbana-Champaign, 1301 W. Gregory Dr., Urbana, Illinois 61801, United States
| | - Sherri M Cook
- Department of Civil, Environmental and Architectural Engineering, University of Colorado Boulder, UCB 428, Boulder, Colorado 80309, United States
| | - Roland D Cusick
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 N. Mathews Ave., Urbana, Illinois 61801, United States
| | - Fulgensio Jjuuko
- Community Integrated Development Initiatives, P.O. Box 692, Kampala, Uganda
| | - Andrew J Margenot
- Department of Crop Sciences, University of Illinois at Urbana-Champaign, 1201 S. Dorner Dr., Urbana, Illinois 61801, United States
| | - Assata Zerai
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico 87131, United States
| | - Jeremy S Guest
- Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, 205 N. Mathews Ave., Urbana, Illinois 61801, United States
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Peletz R, Kisiangani J, Ronoh P, Cock-Esteb A, Chase C, Khush R, Luoto J. Assessing the Demand for Plastic Latrine Slabs in Rural Kenya. Am J Trop Med Hyg 2019; 101:555-565. [PMID: 31392946 PMCID: PMC6726948 DOI: 10.4269/ajtmh.18-0888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/09/2019] [Indexed: 12/19/2022] Open
Abstract
Improving access to safe and affordable sanitation facilities is a global health priority that is essential for meeting the United Nation's Sustainable Development Goals. To promote the use of improved sanitation in rural and low-income settings, plastic latrine slabs provide a simple option for upgrading traditional pit latrines. The International Finance Corporation/World Bank Selling Sanitation program estimated that plastic slabs would have a 34% annual growth, with a market size of US$2.53 million in Kenya by 2017. In this study, we examined the commercial viability of these plastic latrine slabs in rural Kenya by evaluating a financing and distribution model intervention, documenting household slab sales to date, and assessing consumer exposure and perceptions. We also determined household willingness to pay through a real-money auction with 322 households. We found that no households in our study area had purchased the plastic slabs. The primary barriers to slab sales were limited marketing activities and low demand compared with the sales price: households were willing to pay an average of US$5 compared with a market price of US$16. Therefore, current household demand for the plastic latrine slabs in rural Kenya is too low to support commercial distribution. Further efforts are required to align the price of plastic latrine slabs with consumer demand in this setting, such as additional demand creation, product financing, and public sector investment.
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Affiliation(s)
| | | | | | | | | | | | - Jill Luoto
- Rand Corporation, Santa Monica, California
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Lybbert TJ, Vosti SA, Adams KP, Guissou R. Household demand persistence for child micronutrient supplementation. JOURNAL OF HEALTH ECONOMICS 2018; 62:147-164. [PMID: 30368033 PMCID: PMC6277815 DOI: 10.1016/j.jhealeco.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
Addressing early-life micronutrient deficiencies can improve short- and long-term outcomes. In most contexts, private supply chains will be key to effective and efficient preventative supplementation. With established vendors, we conducted a 60-week market trial for a food-based micronutrient supplement in rural Burkina Faso with randomized price and non-price treatments. Repeat purchases - critical for effective supplementation - are extremely price sensitive. Loyalty cards boost demand more than price discounts, particularly in non-poor households where the father is the cardholder. A small minority of households achieved sufficient supplementation for their children through purely retail distribution, suggesting the need for more creative public-private delivery platforms informed by insights into household demand persistence and heterogeneity.
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