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Finell E, Pyysiäinen J, Walden A. Frames of agency in a school with poor indoor-air quality: A longitudinal composite narrative study. Health Place 2024; 88:103256. [PMID: 38739984 DOI: 10.1016/j.healthplace.2024.103256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
Problems with schools' indoor-air quality are common, and they can cause health problems to adolescents. However, no previous research has examined how adolescents make sense of such contaminated socio-material environments or what kinds of agency those environments afford. Taking an ecological psychology perspective informed by frame analysis, we analysed longitudinal focus group interviews with adolescents in a Finnish school with longstanding indoor-air problems. We constructed three composite first-person narratives that reflected different experiential frames, with corresponding forms and changes of agency. We found that our adolescents made sense of the same socio-material environment and its affordances in very different ways, and this process afforded them to develop many kinds of agency that changed over time.
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Affiliation(s)
- Eerika Finell
- Faculty of Social Sciences and Business Studies, Kuopio Campus, University of Eastern Finland, PO Box 1627, 70211, Finland.
| | - Jarkko Pyysiäinen
- Department of Economics and Management, University of Helsinki, Latokartanonkaari 5, 00790, Helsinki, Finland.
| | - Aino Walden
- Faculty of Social Sciences and Business Studies, Kuopio Campus, University of Eastern Finland, PO Box 1627, 70211, Finland.
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Manisha M, Verma K, Ramesh N, Anirudha TP, Santrupt RM, Rao L. Water, sanitation, and hygiene implications of large-scale recycling of treated municipal wastewater in semi-arid regions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166631. [PMID: 37659564 DOI: 10.1016/j.scitotenv.2023.166631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
Access to water, sanitation, and hygiene (WaSH) is crucial for national development, as it improves human health and fulfills a fundamental need. This study examines the impact of a large-scale groundwater (GW) recharge scheme using secondary treated wastewater (STW) on WaSH characteristics and identifies the major determinants of improved WaSH charecteristics in drought-hit regions of Kolar district, southern India. The study quantifies improved WaSH practices by comparing WaSH characteristics between impacted areas (influenced by STW) and non-impacted areas (not influenced by STW) of Kolar, using household survey data. Pearson's chi-square and student's t-test are used to verify differences between WaSH characteristics. Furthermore, a composite WaSH score is formulated, and a hierarchical stepwise multiple linear regression model is constructed to identify major determinants of improved WaSH scores. The results show that impacted areas have better WaSH characteristics, including daily water supply by gram panchayat, enhanced toilet uses among all family members, bathing patterns, cloth washing practices, toilet cleaning patterns, and water consumption per capita per day. The maximum and minimum WaSH scores of impacted areas were 17.50 and 6.50, respectively, while those of non-impacted areas were 14 and 4.5. This study finds that improved water availability, quality, and security due to daily water supply at the household level are the major determinants of improved WaSH practices. These results can inform policymakers in designing sanitation and hygiene improvement policies that integrate water recycling projects in drought-hit areas.
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Affiliation(s)
- Manjari Manisha
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India.
| | - Kavita Verma
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - N Ramesh
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - T P Anirudha
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - R M Santrupt
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - Lakshminarayana Rao
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
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Gu Y, Zhou W, Zheng T, Huang F. Health effects and externalities of the popularization of sanitary toilets: evidence from Rural China. BMC Public Health 2023; 23:2225. [PMID: 37951864 PMCID: PMC10640730 DOI: 10.1186/s12889-023-17192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND This study aimed to assess the impact of the increased prevalence of sanitary toilets in rural areas on the health of rural residents, and whether the popularity thereof has a positive externality. This study investigates whether the broader use of sanitary toilets has had a positive effect on the health of people who do not have access to them. METHODS Data from the China Family Panel Studies from 2012 to 2014 and a two-way fixed effect model were used to investigate the relationship between the prevalence of village sanitary toilets and the health of rural residents of all ages. RESULTS The results showed that: (1) the increase in the prevalence of sanitary toilets in villages is conducive to improving the health level of rural residents; (2) the widespread adoption of sanitary toilets in rural areas has improved the health of not only residents with access to these toilets but also residents without access; (3) the health of children is more sensitive to improvements in sanitary conditions of toilets; and (4) there are significant regional differences in the impact of the popularity of sanitary toilets on the health of rural residents. CONCLUSIONS This study found that the popularity of sanitary toilets has externalities, improving not only the health of residents who use them but also the health of other residents. This study enriches the literature in the field of health effects of sanitation improvement, while providing a reference for developing countries to further enhance the living environment in rural areas. In the future, the popularization of sanitary toilets should be vigorously promoted to reduce the incidence of diseases.
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Affiliation(s)
- Yingwen Gu
- College of Humanities, Hubei University of Chinese Medicine, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
| | - Wanli Zhou
- School of Finance and Public Administration, Hubei University of Economics, Wuhan, China.
- Collaborative Innovation Center for Medical Insurance Reform, Hubei University of Economics, Wuhan, China.
| | - Tan Zheng
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
| | - Fang Huang
- Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China.
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de Oliveira VC, Pena ÉD, de Andrade GN, Felisbino-Mendes MS. Menstrual hygiene access and practices in Latin America: scoping review. Rev Lat Am Enfermagem 2023; 31:e4028. [PMID: 37878965 PMCID: PMC10594935 DOI: 10.1590/1518-8345.6736.4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/27/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE to synthesize available evidence related to menstrual hygiene access and practices in Latin America and the Caribbean. METHOD literature scoping review with research protocol registered in the Open Science Framework, carried out in the bibliographic databases: PubMed, Scopus, Web of Science and Portal Regional da Biblioteca Virtual em Saúde. Data were analyzed using simple descriptive statistics and thematic analysis. RESULTS 15 publications were included, the majority of which addressed adolescents in Brazil: 12 articles, two technical reports and a course conclusion monograph. As recurring themes in the publications, the following stand out: Access to dignified conditions for managing menstrual hygiene; Need for access to information on menstrual hygiene management; and Practices for managing menstrual hygiene. CONCLUSION adolescents report difficulties in accessing toilets, water and absorbent materials, and lack of information about menstrual health, including in schools, leading to school absenteeism. Thus, gaps in the Latin American scientific literature reveal inequalities and diversity in menstrual experiences intersected by categories such as gender, social class and ethnicity. HIGHLIGHTS (1) Lack of access to hygiene products, toilets and water for personal hygiene. (2) Invisibility of the problem of period poverty in Latin America. (3) Lack of physical structure in schools aggravates and leads to school absenteeism. (4) Menstrual health literacy was insufficient for the demands of adolescents. (5) Primary studies on menstrual hygiene in Latin America are scarce.
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Affiliation(s)
| | - Érica Dumont Pena
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brasil
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Jiang Y, Yang F. Effect of household toilet accessibility on physical health of ethnic minority adolescents: a longitudinal study from the China Education Panel Survey 2013 and 2014. BMC Public Health 2023; 23:685. [PMID: 37046235 PMCID: PMC10091831 DOI: 10.1186/s12889-023-15547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Accessing household toilets is vital for adolescent health during crucial stages of growth and development; however, some ethnic minority families in China lack toilets. The relationship between household toilet accessibility and the physical health of adolescents in China's ethnic minority areas has been underexamined. METHODS Using two waves of data from the China Education Panel Survey (2013 and 2014), this study explored the effect of household toilet accessibility on Chinese ethnic minority adolescents' physical health. The sample consisted of 576 ethnic minority adolescents with an average age of approximately 13 years. To test the health effect of household toilet accessibility on ethnic minority adolescents, a fixed effects ordinary least squares model and difference-in-differences combined with propensity score matching method were used. RESULTS The results of the fixed effects model and difference-in-differences combined with propensity score matching showed a significant and positive effect of household toilet accessibility on adolescents' physical health. The heterogeneity analysis indicated that among the toilet types of soil cesspits, cement cesspits, squat toilets, and flush toilets, the flush toilets were proven to be the most efficient in improving adolescents' physical health. Moreover, the family living arrangement was proven to play a moderating role in the effect of household toilet accessibility on the physical health of ethnic minority adolescents. The average marginal effects of household toilet accessibility on the physical health of ethnic minority adolescents who lived without parents were more evident and significant than those who lived with their parents. CONCLUSION Promoting household toilet accessibility in China's ethnic minority areas is essential for improving adolescents' health. Moreover, having a household toilet is not sufficient, the quality and dignity of household toilets are also important.
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Affiliation(s)
- Yao Jiang
- Department of Demography, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Fan Yang
- Department of Labor and Social Security, School of Public Administration, Sichuan University, Chengdu, China.
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Poague KI, Blanford JI, Martínez JA, Anthonj C. Water, sanitation and hygiene (WASH) in schools in Brazil pre-and peri-COVID-19 pandemic: Are schools making any progress? Int J Hyg Environ Health 2023; 247:114069. [PMID: 36423433 PMCID: PMC9637527 DOI: 10.1016/j.ijheh.2022.114069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/23/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
The previous paucity of data and research on water, sanitation and hygiene (WASH) in schools in Brazil have been preventing an assessment of how safe and healthy schools are to reopen during the COVID-19 pandemic. This study aimed first to assess the current situation of WASH in schools in Brazil and, second, to evaluate to what extent Brazilian schools have been making any progress in providing WASH since the beginning of the COVID-19 pandemic. Data on WASH conditions in schools in Brazil was retrieved from the 2020 and 2021 Brazilian National School Census (BNSC). For the first objective, frequencies of 31 variables were calculated for the whole country and regions, considering all 173,700 schools from BNSC of 2021. Five main variables were considered as indicators of adequate WASH infrastructure in schools. T-test and ANOVA were used to assess differences in these five variables according to the locality, management model and regions. For the second objective only schools presented in both datasets (n = 170,422) were considered to compare WASH in schools pre- and peri-COVID-19 pandemic. Frequencies of 31 variables were calculated for the whole country and regions before and during the pandemic. Paired t-tests were conducted when differences in variables across the years were observed. At the present moment, the majority of schools in Brazil have bathrooms (97%), drinking water with quality suitable for human consumption (95%), improved sanitation facilities (78%) and solid waste collection (70%). Between 2020 and 2021, there was a mix of improvements and deterioration in the school's WASH infrastructure in all regions of the country. Overall, solely considering the WASH infrastructure, schools in the South and Southeast regions of the country are better prepared for the safe reopening. Nevertheless, public schools, schools located in rural areas and the North and Northeast regions of the country, are more in need of WASH interventions. Results indicate that little progress was achieved, and schools in Brazil are still in need of improvements.
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Affiliation(s)
- Kasandra I.H.M. Poague
- Corresponding author. Faculty of Geo-Information Science and Earth Observation–ITC, University of Twente, Hengelosestraat 99, P.O. Box 217, 7500, AE, Enschede, the Netherlands
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Muhati-Nyakundi LI. Teachers' perceptions of children's access to toilets in urban ECDE institutions, and the psychosocial consequences. Glob Public Health 2022; 17:3785-3801. [PMID: 35388740 DOI: 10.1080/17441692.2022.2059693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACTAccess to clean and functional toilet is quintessential in meeting children's physiological and psychosocial needs in a learning environment. However, little is known on experiences of children's access to quality toilets while in preschool institutions within urban settings of sub-Saharan Africa countries. This paper draws from a study that explored experiences of vulnerable children in early childhood development education (ECDE) institutions in underserved and informal urban settings of Kenya and South Africa. 11 urban ECDE centres were purposively selected and 17 teachers were recruited as key informants. Data was collected using an adapted infrastructural checklist, observation and conversational interviews. Findings indicated that a majority of toilets in ECDE centres were inadequate, inappropriate, poorly maintained, or had structural weaknesses which affected children's experiences of access and use of the facilities. Scheduled toilet visits as a control measure and toilet avoidance potentially exposed them to psychosocial and health risks. Insights into children's toilet facilities, managing their access in institutions located within informal and low resourced areas, and investment policies that target preschool children' sanitary facilities are given. Suggestions are made for interventions for children's positive toilet experiences in poor urban areas.
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Affiliation(s)
- Linet Imbosa Muhati-Nyakundi
- Department of Educational Studies, Faculty of Education - Siyabuswa Campus, University of Mpumalanga, Mpumalanga, South Africa
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Buitrago-García T, Sawadogo NH, Souares A, Koulidiati JL, Sié A, Bärnighausen T, Langlotz S, McMahon SA. Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation. J Glob Health 2022; 12:04057. [PMID: 36073661 PMCID: PMC9454237 DOI: 10.7189/jogh.12.04057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty. Methods This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities. Results No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials. Conclusions WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.
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Affiliation(s)
- Teresa Buitrago-García
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.,La Paz University Hospital, Madrid, Spain
| | | | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.,Nouna Health Research Centre, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.,Africa Health Research Institute, Nelson R. Mandela Medical School, Umbilo, Durban, South Africa.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah Langlotz
- Chair of Development Economics (Prof. Fuchs), Georg-August-Universität Göttingen, Göttingen, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Alam MU, Sultana F, Hunter EC, Winch PJ, Unicomb L, Sarker S, Mahfuz MT, Al-Masud A, Rahman M, Luby SP. Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study. BMC Public Health 2022; 22:1100. [PMID: 35655267 PMCID: PMC9161596 DOI: 10.1186/s12889-022-13478-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Girls’ menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance. We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs– reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers’ training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression. The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: − 12%; 95% CI: − 22, − 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: − 8%; 95% CI: − 14, − 2). Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.
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Poague KIHM, Blanford JI, Anthonj C. Water, Sanitation and Hygiene in Schools in Low- and Middle-Income Countries: A Systematic Review and Implications for the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3124. [PMID: 35270814 PMCID: PMC8910349 DOI: 10.3390/ijerph19053124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
The global COVID-19 pandemic has revealed the extent to which schools are struggling with the provision of safe drinking water, sanitation and hygiene (WASH). To describe the WASH conditions in schools and discuss the implications for the safe reopening of schools during the ongoing COVID-19 pandemic, a systematic review of peer-reviewed literature on WASH in schools in low- and middle-income countries was performed. In April 2021, five databases, including MEDLINE (via PubMed), Web of Science, Scopus, AJOL, and LILACS, were used to identify studies. Sixty-five papers met the inclusion criteria. We extracted and analyzed data considering the Joint Monitoring Programme (JMP) definitions and the normative contents of Human Rights to safe drinking water and sanitation. Publications included in this systematic review considered 18,465 schools, across 30 different countries. Results indicate a lack of adequate WASH conditions and menstrual hygiene management requirements in all countries. The largely insufficient and inadequate school infrastructure hampers students to practice healthy hygiene habits and handwashing in particular. In the context of the COVID-19 pandemic, being hindered to implement such a key strategy to contain the spread of SARS-CoV-2 in the school environment is of major concern.
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Affiliation(s)
- Kasandra I. H. M. Poague
- Faculty of Geo-Information Science and Earth Observation–ITC, University of Twente, Hengelosestraat 99, P.O. Box 217, 7500 AE Enschede, The Netherlands; (J.I.B.); (C.A.)
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Robinson HJ, Barrington DJ. Drivers of menstrual material disposal and washing practices: A systematic review. PLoS One 2021; 16:e0260472. [PMID: 34860828 PMCID: PMC8641861 DOI: 10.1371/journal.pone.0260472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Disposal and washing facilities and services for menstrual materials are often designed based upon technical specifications rather than an in-depth understanding of what drives peoples’ choices of practices. Objectives and data sources This systematic review identified and summarised the main behavioural drivers pertaining to the choice of disposal and washing practices of menstrual materials through the thematic content analysis and study appraisal of 82 publications (80 studies) on menstrual health and hygiene published since 1999, reporting the outcomes of primary research across 26 countries. Results Disposal and washing behaviours are primarily driven by the physical state of sanitation facilities; however, this is intrinsically linked to taboos surrounding and knowledge of menstruation. Implications Using reasons given for disposal and washing practices by menstruators or those who know them well, or inferred by authors of the reviewed studies, we identify the key considerations needed to design facilities and services which best suit the desired behaviours of both planners and those who menstruate. Inclusivity The term menstruators is used throughout to encompass all those mentioned in the studies reviewed (girls and women); although no studies explicitly stated including non-binary or transgender participants, this review uses inclusive language that represents the spectrum of genders that may experience menstruation. Registration The review protocol is registered on PROSPERO: 42019140029.
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Affiliation(s)
| | - Dani Jennifer Barrington
- University of Leeds, Leeds, West Yorkshire, United Kingdom
- The University of Western Australia, Crawley, Western Australia, Australia
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Shoham DA, Wang Z, Lindberg S, Chu H, Brubaker L, Brady SS, Coyne-Beasley T, Fitzgerald CM, Gahagan S, Harlow BL, Joinson C, Low LK, Markland AD, Newman DK, Smith AL, Stapleton A, Sutcliffe S, Berry A. School Toileting Environment, Bullying, and Lower Urinary Tract Symptoms in a Population of Adolescent and Young Adult Girls: Preventing Lower Urinary Tract Symptoms Consortium Analysis of Avon Longitudinal Study of Parents and Children. Urology 2021; 151:86-93. [PMID: 32679271 PMCID: PMC8074340 DOI: 10.1016/j.urology.2020.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To examine whether the school toilet environment at age 13, including bullying at toilets, is associated with female lower urinary tract symptoms (LUTS) at ages 13 and 19, as little is known about the association among school toilet environment, voiding behaviors, and LUTS in adolescent girls. METHODS The sample comprised 3962 female participants from the Avon Longitudinal Study of Parents and Children. At age 13, participants reported on 7 school toilet environment characteristics and a range of LUTS items. At age 19, participants completed the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS All toilet environmental factors were associated with at least 1 LUTS outcome at age 13. Holding behavior was associated with all school toilet environmental factors, with odds ratios ranging from 1.36 (95% confidence interval [CI]: 1.05, 1.76) for dirty toilets to 2.38 (95% CI: 1.60, 3.52) for feeling bullied at toilets. Bullying was associated with all daytime LUTS symptoms and nocturia; odds ratios ranged from 1.60 (95% CI: 1.04, 2.07) for nocturia to 2.90 (95% CI: 1.77, 4.75) for urgency. Associations between age 13 school toilets and age 19 LUTS were in the same direction as age 13 LUTS. CONCLUSION This is the first examination of associations between school toilets and LUTS. Toileting environments were cross-sectionally associated with LUTS in adolescent girls. While further work is needed to determine whether these associations are causal, school toilet environments are modifiable and thus a promising target for LUTS prevention.
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Affiliation(s)
- David A Shoham
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.
| | - Zhenxun Wang
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Sarah Lindberg
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Haitao Chu
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham Medical School, Birmingham, AL
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Sheila Gahagan
- Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, CA
| | | | | | - Lisa Kane Low
- University of Michigan School of Nursing, Women's Studies, Dept. Obstetrics and Gynecology, Ann Arbor, MI
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Diane K Newman
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ariana L Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ann Stapleton
- Department of Medicine, University of Washington, Seattle, WA
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, University of Minnesota, Minneapolis, MN
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Assefa GM, Sherif S, Sluijs J, Kuijpers M, Chaka T, Solomon A, Hailu Y, Muluneh MD. Gender Equality and Social Inclusion in Relation to Water, Sanitation and Hygiene in the Oromia Region of Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084281. [PMID: 33920729 PMCID: PMC8073105 DOI: 10.3390/ijerph18084281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
The main purpose of the study was to deepen the understanding of gender and social inclusion in the context of water, sanitation, and hygiene (WASH) in the Oromia region of Ethiopia. An explorative qualitative study was conducted in three districts of the Oromia region using gender analysis frameworks. Twenty-one key informant interviews and nine focus group discussions were conducted. Findings showed 52% of households in the study area have basic service level water, 29% have basic service level sanitation, and 14% have basic service level hygiene. Women, girls, and people living with disability disproportionately experience poor access to quality WASH services. Women and girls participate in unequal domestic labor related to water management which often exposes them to discrimination and violence such as rape, abduction, and assault. Overall, women, girls, and other socially excluded groups are rarely consulted and engaged by local actors. This results in incongruent policy and political commitment which limits action at the grassroots level. Integrating gender equality and inclusion efforts into local governance agendas can help to increase access to and the quality of WASH services. These efforts must advocate for moving beyond gender parity to promote gender transformative approaches and inclusion to realize better WASH services for the communities they serve.
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Affiliation(s)
- Geteneh Moges Assefa
- Monitoring, Evaluation and Research Department, Amref Health Africa in Ethiopia, P.O. Box 20855, Addis Ababa 1000, Ethiopia;
- Correspondence: ; Tel.: +251-913141467
| | | | - Jose Sluijs
- Amref Flying Doctors, Leiden, Schuttersveld 9, 2316 XG Leiden, The Netherlands; (J.S.); (M.K.)
| | - Maarten Kuijpers
- Amref Flying Doctors, Leiden, Schuttersveld 9, 2316 XG Leiden, The Netherlands; (J.S.); (M.K.)
| | - Tamene Chaka
- Amref Health Africa in Ethiopia, P.O. Box 20855, Addis Ababa 1000, Ethiopia; (T.C.); (A.S.); (Y.H.)
| | - Arsema Solomon
- Amref Health Africa in Ethiopia, P.O. Box 20855, Addis Ababa 1000, Ethiopia; (T.C.); (A.S.); (Y.H.)
| | - Yeshitila Hailu
- Amref Health Africa in Ethiopia, P.O. Box 20855, Addis Ababa 1000, Ethiopia; (T.C.); (A.S.); (Y.H.)
| | - Muluken Dessalegn Muluneh
- Monitoring, Evaluation and Research Department, Amref Health Africa in Ethiopia, P.O. Box 20855, Addis Ababa 1000, Ethiopia;
- School of Nursing and Midwifery, Western Sydney University, Sydney 2751, Australia
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McMichael C, Vally H. Children's perspectives on water, sanitation and hygiene in schools: A case-study from the Philippines. Health Place 2020; 62:102290. [PMID: 32479367 DOI: 10.1016/j.healthplace.2020.102290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Celia McMichael
- School of Geography, Faculty of Science, The University of Melbourne, VIC, Australia.
| | - Hassan Vally
- School of Psychology & Public Health, La Trobe University, VIC, Australia.
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Camenga DR, Brady SS, Hardacker CT, Williams BR, Hebert-Beirne J, James AS, Burgio K, Nodora J, Wyman JF, Berry A, Low LK. U.S. Adolescent and Adult Women's Experiences Accessing and Using Toilets in Schools, Workplaces, and Public Spaces: A Multi-Site Focus Group Study to Inform Future Research in Bladder Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3338. [PMID: 31510038 PMCID: PMC6765808 DOI: 10.3390/ijerph16183338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023]
Abstract
The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women's lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 focus groups with female participants (n = 360; ages 11-93). Focus groups were stratified by age (11-14, 15-17, 18-25, 26-44, 45-64, 65+) and conducted across 7 geographically diverse U.S. sites from July 2017-April 2018. Using a transdisciplinary approach, we conducted conventional qualitative coding informed by our PLUS conceptual framework and used content analysis processes to identify salient themes. Across settings, toilet access was restricted by "gatekeepers" (i.e., individuals who control access to toilets). In contrast, self-restricting toilet use (deciding not to use the toilet despite biologic need to urinate) was based on internalized norms to prioritize school and job responsibilities over urination. In public spaces, self-restricting use was largely in response to lack of cleanliness. Across the life course, participants perceived gender disparities in the ability to easily access public toilets. Further research is needed to determine if and how these factors impact bladder health across the life course.
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Affiliation(s)
- Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA.
| | - Cecilia T Hardacker
- Department of Education, Center for Education, Research and Advocacy, Howard Brown Health, Chicago, IL 60613, USA.
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO 63110, USA.
| | - Kathryn Burgio
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs, Birmingham, AL 35233, USA.
| | - Jesse Nodora
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine & Moores Cancer Center, La Jolla, CA 92093, USA.
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Amanda Berry
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA.
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