1
|
Graham JP, Kaur M, Jeuland MA. Access to environmental health assets across wealth strata: Evidence from 41 low- and middle-income countries. PLoS One 2018; 13:e0207339. [PMID: 30444899 PMCID: PMC6239312 DOI: 10.1371/journal.pone.0207339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/30/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Low levels of household access to basic environmental health assets (EHAs)-including technologies such as clean cookstoves and bed nets or infrastructure such as piped water and electricity-in low- and middle-income countries (LMICs) are known to contribute significantly to the global burden of disease. This low access persists despite decades of promotion of many low-cost, life-saving technologies, and is particularly pronounced among poor households. This study aims to characterize variation in access to EHAs among LMIC households as a function of wealth, as defined by ownership of various assets. METHODS Demographic and Health Survey (DHS) data from 41 low- and middle-income countries were used to assess household-level access to the following EHAs: 1) improved water supply; 2) piped water supply; 3) improved sanitation; 4) modern cooking fuels; 5) electricity; and 6) bed nets. For comparison, we included access to mobile phones, which is considered a highly successful technology in terms of its penetration into poor households within LMICs. Ownership levels were compared across country-specific wealth quintiles constructed from household assets using bivariate analysis and multivariable linear regression models. RESULTS Access to EHAs was low among the households in the bottom three quintiles of wealth. Access to piped water, modern cooking fuels, electricity and improved sanitation, for example, were all below 50% for households in the bottom three wealth quintiles. Access to certain EHAs such as improved water supply and bed nets increased only slowly with concomitant increases in wealth, while gaps in access to other EHAs varied to a greater degree by wealth quintile. For example, disparities in access between the richest and poorest quintiles were greatest for electricity and improved sanitation. Rural households in all wealth quintiles had much lower levels of access to EHAs, except for bed nets, relative to urban households. CONCLUSIONS The findings of this study provide a basis for understanding how EHAs are distributed among poor households in LMICs, elucidate where inequalities in access are particularly pronounced, and point to a need for strategies that better reach the poor, if the global environmental burden of disease is to be reduced.
Collapse
Affiliation(s)
- Jay P. Graham
- Public Health Institute, Oakland, California, United States of America
| | - Maneet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Marc A. Jeuland
- Duke University, Durham, North Carolina, United States of America
- RWI-Leibniz Institute for Economic Research, Essen, Germany
- * E-mail:
| |
Collapse
|
2
|
Sabot K, Marchant T, Spicer N, Berhanu D, Gautham M, Umar N, Schellenberg J. Contextual factors in maternal and newborn health evaluation: a protocol applied in Nigeria, India and Ethiopia. Emerg Themes Epidemiol 2018; 15:2. [PMID: 29441117 PMCID: PMC5800046 DOI: 10.1186/s12982-018-0071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022] Open
Abstract
Background Understanding the context of a health programme is important in interpreting evaluation findings and in considering the external validity for other settings. Public health researchers can be imprecise and inconsistent in their usage of the word “context” and its application to their work. This paper presents an approach to defining context, to capturing relevant contextual information and to using such information to help interpret findings from the perspective of a research group evaluating the effect of diverse innovations on coverage of evidence-based, life-saving interventions for maternal and newborn health in Ethiopia, Nigeria, and India. Methods We define “context” as the background environment or setting of any program, and “contextual factors” as those elements of context that could affect implementation of a programme. Through a structured, consultative process, contextual factors were identified while trying to strike a balance between comprehensiveness and feasibility. Thematic areas included demographics and socio-economics, epidemiological profile, health systems and service uptake, infrastructure, education, environment, politics, policy and governance. We outline an approach for capturing and using contextual factors while maximizing use of existing data. Methods include desk reviews, secondary data extraction and key informant interviews. Outputs include databases of contextual factors and summaries of existing maternal and newborn health policies and their implementation. Use of contextual data will be qualitative in nature and may assist in interpreting findings in both quantitative and qualitative aspects of programme evaluation. Discussion Applying this approach was more resource intensive than expected, in part because routinely available information was not consistently available across settings and more primary data collection was required than anticipated. Data was used only minimally, partly due to a lack of evaluation results that needed further explanation, but also because contextual data was not available for the precise units of analysis or time periods of interest. We would advise others to consider integrating contextual factors within other data collection activities, and to conduct regular reviews of maternal and newborn health policies. This approach and the learnings from its application could help inform the development of guidelines for the collection and use of contextual factors in public health evaluation. Electronic supplementary material The online version of this article (10.1186/s12982-018-0071-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kate Sabot
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Tanya Marchant
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Neil Spicer
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,3Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Della Berhanu
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Meenakshi Gautham
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nasir Umar
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Joanna Schellenberg
- 1The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
3
|
Bensch G, Peters J. The intensive margin of technology adoption--Experimental evidence on improved cooking stoves in rural Senegal. JOURNAL OF HEALTH ECONOMICS 2015; 42:44-63. [PMID: 25841214 DOI: 10.1016/j.jhealeco.2015.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 05/22/2023]
Abstract
Today, almost 3 billion people in developing countries rely on biomass as primary cooking fuel, with profound negative implications for their well-being. Improved biomass cooking stoves are alleged to counteract these adverse effects. This paper evaluates take-up and impacts of low-cost improved stoves through a randomized controlled trial. The randomized stove is primarily designed to curb firewood consumption, but not smoke emissions. Nonetheless, we find considerable effects not only on firewood consumption, but also on smoke exposure and, consequently, smoke-related disease symptoms. The reduced smoke exposure results from behavioural changes in terms of increased outside cooking and a reduction in cooking time. We conclude that in order to assess the effectiveness of a technology-oriented intervention, it is critical to not only account for the incidence of technology adoption - the extensive margin - but also for the way the new technology is used - the intensive margin.
Collapse
Affiliation(s)
- Gunther Bensch
- Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI), Essen, Germany
| | - Jörg Peters
- Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI), Essen, Germany; AMERU, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|