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Abdulhadi R, Bailey A, Van Noorloos F. Access inequalities to WASH and housing in slums in low- and middle-income countries (LMICs): A scoping review. Glob Public Health 2024; 19:2369099. [PMID: 38940272 DOI: 10.1080/17441692.2024.2369099] [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: 12/15/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Abstract
Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity amongst the slum population lead to differential experiences in Water, Sanitation, and Hygiene (WASH) and housing access. This scoping review provides evidence of the interconnection of WASH and housing and presents barriers to access and the consequences thereof for slum dwellers. It does so while considering the social stratification amongst urban slum dwellers and their lived experiences. A systematic search of journal articles was conducted in November 2022 in PubMed, Scopus, and Web of Science. A total of 33 papers were identified which were full text reviewed and data extracted. Infrastructure, social and cultural, socio-economic, governance and policy and environmental barriers emerged as general themes. Barriers to WASH and housing were more frequently described concerning women and girls due to gender norms within WASH and the home. Barriers to WASH lead to compromised health, socio-economic burdens, and adverse social impacts, thus causing residents of slums to navigate their WASH mobility spatially and over time. Insights from this review underscore the need for an intersectional approach to understanding access inequalities to WASH and housing.
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Affiliation(s)
- Ranna Abdulhadi
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
| | - Femke Van Noorloos
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, the Netherlands
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Sustainability in Peri-Urban Informal Settlements: A Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14137591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study of peri-urbanization attracted attention in the final quarter of the 20th century, due to the pace it acquired worldwide and the implication that urbanization and overall settlement patterns have on social sustainability and development. Theoretical and conceptual achievements are remarkable. Multi-country collaboration has produced a growing body of research on sustainability and peri-urban settlements. There is a lack, however, of a review of the practices of peri-urban informal settlements, the predominant mode of urban expansion, mainly in developing and rapidly urbanizing regions of the world. The purpose is, then, to systematize, from recent literature, the knowledge of the context, challenges, and practices, as well as their impacts and potential courses of action, to ensure sustainability in human–natural complex of the territory beyond urban cores, suburbs, or slums. A systematic review approach was adopted, for articles published in reputable journals, with support of previous reviews, books, and reports. A pragmatist combination of content analysis and critical review identified core topics and highlighted contrasting views. An analytical framework is proposed. Four categories—drivers, challenges and practices, impact, and future trends—are proposed as an adequate approach to systematizing the literature. The review finds that the practices focus on service and resource provision, on regulations to approximate informal to formal institutions, and on an economy founded on the resource base and service provision. This review provides insights on future trends and research topics.
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Nelson S, Drabarek D, Jenkins A, Negin J, Abimbola S. How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review. BMJ Open 2021; 11:e053320. [PMID: 34857572 PMCID: PMC8640661 DOI: 10.1136/bmjopen-2021-053320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/14/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services. DESIGN Realist review. DATA SOURCES PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible). ANALYSIS Inductive and deductive coding was used to generate context-mechanism-outcome configurations. RESULTS 73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation. CONCLUSIONS The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.
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Affiliation(s)
- Sarah Nelson
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aaron Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Legge H, Halliday KE, Kepha S, Mcharo C, Witek-McManus SS, El-Busaidy H, Muendo R, Safari T, Mwandawiro CS, Matendechero SH, Pullan RL, Oswald WE. Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:6052-6064. [PMID: 33826310 PMCID: PMC8154356 DOI: 10.1021/acs.est.0c05647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 05/08/2023]
Abstract
Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.
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Affiliation(s)
- Hugo Legge
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Katherine E. Halliday
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Stella Kepha
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Carlos Mcharo
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Stefan S. Witek-McManus
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Hajara El-Busaidy
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Redempta Muendo
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Th’uva Safari
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Charles S. Mwandawiro
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Sultani H. Matendechero
- Division
of Vector Borne and Neglected Tropical Diseases Unit, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya
| | - Rachel L. Pullan
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - William E. Oswald
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
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Patrick M, Tsige Y, Adow A, Abdirashid M, Yunis H, Githiri D, Hulland E, Murphy J, Akers P, Brown TW, Blanton C, Handzel T. Acceptability of urine diversion dry toilets in Dollo Ado refugee camp, Ethiopia. Int J Hyg Environ Health 2021; 234:113745. [PMID: 33799074 DOI: 10.1016/j.ijheh.2021.113745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Given the increasing frequency and duration of humanitarian emergencies worldwide, there is a need to identify a greater range of effective and contextually appropriate water, sanitation and hygiene (WASH) interventions. Typical sanitation systems may be poorly suited for some of the conditions in which humanitarian emergencies can occur, such as in drought-prone regions. Urine-diversion dry toilets (UDDTs) are one potential alternative sanitation option which can be used in these conditions. Between 2014 and 2016, the U.S. Centers for Disease Control and Prevention (CDC) partnered with local agencies to evaluate the acceptability of UDDTs in a refugee camp in Ethiopia. The overall goals were to provide evidence regarding the level of adoption and satisfaction with UDDTs in this emergency context and the factors associated with satisfaction. Two cross-sectional surveys were conducted 18-months apart, using a stratified design to sample UDDT and latrine users for comparison. The proportion who reported to use their UDDT consistently was 88.8% (95% CI 85.1-92.5) in the first survey and 93.4% (95% CI 90.6-96.2) in the second survey. Reported satisfaction levels were significantly higher among respondents in the second survey (p < 0.0001), where 97.0% (95% CI 95.1-98.9) of respondents stated either that they were mostly or very satisfied with their UDDT. There was no significant difference detected in satisfaction between UDDT and latrine users (p = 0.28). Using a multivariable logistic regression model, we identified several factors associated with a higher level of satisfaction with UDDTs. Those who had previously (before coming to the camp) used a pit latrine (AOR = 4.2; 95% CI 1.4-12.7) or had no sanitation system (AOR = 2.4; 95% CI 1.3-4.4) relative to a pour-flush toilet, had a clean UDDT (AOR = 2.8; 95% CI 1.7-4.6), had been in the camp for a longer time period (AOR = 2.3; 95% CI 1.7-3.0), did not share their UDDT (AOR = 1.8; 95% CI 1.0-3.0) and had used their UDDT for a longer time period (AOR = 1.7; 95% CI 1.2-2.4) had higher odds of satisfaction. The findings demonstrate that UDDTs have been effectively introduced and utilized in this context and this may have implications for other humanitarian settings where they can be similarly managed.
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Affiliation(s)
- Molly Patrick
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Yegerem Tsige
- United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211 Genève 2 Dépôt, Geneva, Switzerland
| | - Ahmed Adow
- Norwegian Refugee Council, Park Lane Tower (Near Edna Mall) 2nd Floor, Addis Ababa, Ethiopia
| | - Mohamed Abdirashid
- Norwegian Refugee Council, Park Lane Tower (Near Edna Mall) 2nd Floor, Addis Ababa, Ethiopia
| | - Hassan Yunis
- Norwegian Refugee Council, Park Lane Tower (Near Edna Mall) 2nd Floor, Addis Ababa, Ethiopia
| | - David Githiri
- United Nations High Commissioner for Refugees, Case Postale 2500, CH-1211 Genève 2 Dépôt, Geneva, Switzerland
| | - Erin Hulland
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Akers
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Travis W Brown
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051808. [PMID: 32164375 PMCID: PMC7084698 DOI: 10.3390/ijerph17051808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/02/2020] [Accepted: 03/07/2020] [Indexed: 01/03/2023]
Abstract
Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity—if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups—we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention.
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