1
|
Calderón-Villarreal A, Avelar Portillo LJ, Abramovitz D, Goldenberg S, Flanigan S, Quintana PJE, Harvey-Vera A, Vera CF, Rangel G, Strathdee SA, Kayser GL. Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study. Int J Equity Health 2024; 23:79. [PMID: 38644494 PMCID: PMC11034064 DOI: 10.1186/s12939-024-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/27/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
Collapse
Affiliation(s)
- Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California San Diego (UCSD), San Diego, California, USA.
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA.
| | - Lourdes Johanna Avelar Portillo
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, California, USA
- Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, USA
| | - Daniela Abramovitz
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Shira Goldenberg
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA
| | - Shawn Flanigan
- School of Public Affairs, SDSU, San Diego, California, USA
| | - Penelope J E Quintana
- School of Public Health, San Diego State University (SDSU), San Diego, California, USA
| | - Alicia Harvey-Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
- Universidad de Xochicalco, Tijuana, Baja California, Mexico
| | - Carlos F Vera
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Gudelia Rangel
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
- Border Health Commission, Tijuana, Baja California, Mexico
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, USA
| | - Georgia L Kayser
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
2
|
Bellandi D. Global Health Care Facilities Lack Basic Hygiene Services. JAMA 2022; 328:1490-1491. [PMID: 36255419 DOI: 10.1001/jama.2022.18765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
3
|
Immurana M, Kisseih KG, Yusif HM, Yakubu ZM. The effect of financial inclusion on open defecation and sharing of toilet facilities among households in Ghana. PLoS One 2022; 17:e0264187. [PMID: 35245300 PMCID: PMC8896660 DOI: 10.1371/journal.pone.0264187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Globally, and in Ghana, a lot of people do practice open defecation as well as share toilet facilities with other households. Meanwhile, open defecation in particular, is associated with numerous negative health and economic effects. To this end, a number of empirical studies have been conducted on the determinants of access to sanitation facilities among households in Ghana. Nonetheless, while financial inclusion (sustainable ways of ensuring easier accessibility to cheap and useful financial products and services among individuals/firms) can enhance the ability of households or individuals to afford toilet facilities, hence, could help in curbing open defecation and sharing of toilet facilities among households, the previous studies on Ghana did not pay attention to it. This study therefore uses data from the 7th round of the Ghana Living Standards Survey (GLSS7) to examine the association of financial inclusion with open defecation and sharing of toilet facilities among households in Ghana. The binary logit regression is used as the empirical estimation technique. The results show that, financial inclusion in general is associated with lesser likelihood of open defecation and sharing of toilet facilities among households in Ghana after controlling for welfare quintile, urban or rural residence and other covariates. Moreover, while informal financial inclusion is statistically insignificant, formal financial inclusion is found to be associated with reduced open defecation and sharing of toilet facilities among households. Thus, in the attempt to eliminate open defecation as well as reduce the sharing of toilet facilities among households in Ghana, conscious efforts should be devoted towards enhancing formal financial inclusion.
Collapse
Affiliation(s)
- Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- * E-mail: ,
| | | | - Hadrat Mohammed Yusif
- Department of Economics, Kwame Nkrumah University of Science and Technology, PMB, Kumasi, Ghana
| | | |
Collapse
|
4
|
Jorga SD, Lulu Dessie Y, Reshad Kedir M, Donacho DO. Prevalence of Tungiasis and its risk factors of among children of Mettu woreda, southwest Ethiopia, 2020. PLoS One 2022; 17:e0262168. [PMID: 34986188 PMCID: PMC8730454 DOI: 10.1371/journal.pone.0262168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
Tungiasis is caused by the flea tunga penetrans and results in painful skin lesions, skin infections, and permanent disability. However, limited information is available that shows the magnitude of the problem and its risk factors that help for intervention in Ethiopia. The goal of this study was to determine the prevalence and risk factors of tungiasis in children aged 5 to 14 in Mettu woreda in 2020. A community based cross sectional study was conducted among randomly selected kebeles of Mettu woreda, in Southwest Ethiopia. To select study participants, multistage sampling was used. The data were collected through physical examination of the children, interview of parents/guardians of the children, and observation of the home environment using checklists and questionnaires. The descriptive analysis was done for socio-demographic characteristics, prevalence of tungiasis, and housing conditions. A logistic regression analysis was performed, and variables in multivariable regression reported odds ratios and their 95% confidence intervals once the variables were identified using a p-value of 0.05 as a risk factor of statistical significance. The prevalence of tungiasis among children 5–14 years of age in Mettu rural woreda was 52 percent (n = 821). As a risk factor, large family size (AOR: 2.9, 95% CI: 2.13, 4.40); school attendance (AOR: 1.5, 95% CI: 1.02, 2.18), floor inside the house (AOR: 3.8, 95% CI: 1.76, 8.43); having sleeping bed (AOR: 0.16, 95% CI: 0.03, 0.82); access to protected water sources (AOR: 0.24, 95% CI: 0.15, 0.39); access to improved toilet facilities(AOR: 0.63: 95% CI: 0.44, 0.89); access to electric services (AOR: 0.30, 95% CI: 0.15, 0.62); and lack of own farmland (AOR: 0.36, 95% CI: 0.26, 0.50) were found. Therefore, planning and implementation of interventions focus on those risk factors that are particularly important. Water, sanitation and hygiene interventions, and livelihood improvement interventions are required to solve the problem in the setting.
Collapse
Affiliation(s)
- Sime Daba Jorga
- Department of Public Health, College of Health Science, Mettu University, Metu, Ethiopia
| | - Yohannes Lulu Dessie
- Department of Nursing, College of Health Science, Mettu University, Metu, Ethiopia
| | - Mohammed Reshad Kedir
- Department of Public Health, College of Health Science, Mettu University, Metu, Ethiopia
| | - Dereje Oljira Donacho
- Department of Health Informatics, College of Health Science, Mettu University or Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia
- * E-mail:
| |
Collapse
|
5
|
Commissioners of the Lancet Commission on Water, Sanitation and Hygiene, and Health. The Lancet Commission on water, sanitation and hygiene, and health. Lancet 2021; 398:1469-70. [PMID: 34487681 DOI: 10.1016/S0140-6736(21)02005-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
|
6
|
Musoke D, Namata C, Lubega GB, Niyongabo F, Gonza J, Chidziwisano K, Nalinya S, Nuwematsiko R, Morse T. The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries. Environ Health Prev Med 2021; 26:100. [PMID: 34610785 PMCID: PMC8493696 DOI: 10.1186/s12199-021-01023-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.
Collapse
Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Carol Namata
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Filimin Niyongabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joviah Gonza
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kondwani Chidziwisano
- Department of Environmental Health, University of Malawi, Polytechnic, Blantyre, Malawi
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Nuwematsiko
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tracy Morse
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
| |
Collapse
|
7
|
Tamene A. What it takes to save lives: An assessment of water, sanitation, and hygiene facilities in temporary COVID-19 isolation and treatment centers of Southern Ethiopia: A mixed-methods evaluation. PLoS One 2021; 16:e0256086. [PMID: 34388184 PMCID: PMC8362949 DOI: 10.1371/journal.pone.0256086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/31/2021] [Indexed: 12/13/2022] Open
Abstract
Background Quality water, sanitation, and hygiene facilities act as barricades to the transmission of COVID-19 in health care facilities. These facilities ought to also be available, accessible, and functional in temporary treatment centers. Despite numerous studies on health care facilities, however, there is limited information on the status of WASH facilities in such centers. Methods The assessment of health care facilities for the COVID-19 response checklist and key informant interviews, were used for data collection. 35 treatment centers in Southern Ethiopia were surveyed. Eightkey informants were interviewed to gain an understanding of the WASH conditions in the treatment centers. The Quantitative data was entered using EPI-INFO 7 and exported to SPSS 20 for analysis. Results are presented using descriptive statistics. Open Code 4.02 was used for the thematic analysis of the qualitative data. Results Daily water supply interruptions occurred at 27 (77.1%) of the surveyed sites. Only 30 (85.72%) had bathrooms that were segregated for personnel and patients, and only 3 (3.57%) had toilets that were handicapped accessible. 20(57.2%) of the treatment centers did not have a hand hygiene protocol that satisfied WHO guidelines. In terms of infection prevention and control, 16 (45.71%) of the facilities lacked adequate personal protective equipment stocks. Between urban and rural areas, there was also a significant difference in latrine maintenance, hand hygiene protocol design and implementation, and incineration capacity. Conclusion The results reveal crucial deficiencies in the provision of WASH in the temporary COVID-19 treatment centers. Efforts to improve WASH should offer priority to hygiene service interventions to minimize the risk of healthcare-acquired infections. The sustainable provision of hygiene services, such as hand washing soap, should also be given priority.
Collapse
Affiliation(s)
- Aiggan Tamene
- Environmental Health Unit, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossaena, Ethiopia
- * E-mail:
| |
Collapse
|
8
|
Vong P, Banchonhattakit P, Sim S, Pall C, Dewey RS. Unhygienic stool-disposal practices among mothers of children under five in Cambodia: Evidence from a demographic and health survey. PLoS One 2021; 16:e0249006. [PMID: 34197455 PMCID: PMC8248716 DOI: 10.1371/journal.pone.0249006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Unhygienic disposal of children’s stools affects children’s health in terms of their susceptibility to many diseases. However, there are no existing studies into the impact of unhygienic stool disposal in Cambodia. Therefore, this study aimed to identify factors associated with the unhygienic disposal of children’s stools among children under the age of five in Cambodia. Methods An analytical cross-sectional study was conducted using data from the Cambodia Demographic and Health Survey (CDHS) 2014. A multivariable binary logistic regression was conducted using Stata to analyze factors associated with the unhygienic disposal of children’s stools. Results Overall, the prevalence of practicing unhygienic disposal of children’s stools was 29.27% (95%CI: 27.51%- 31.09%). Factors statistically associated with this practice were: living in the Central Plain, Plateau and Mountains, Coastal and Sea regions (AOR = 1.65; 95% CI: 1.33–2.04), (AOR = 2.53; 95% CI: 1.98–3.24) and (AOR = 4.16; 95% CI: 3.15–5.48) respectively, poor household wealth (AOR = 1.58; 95% CI: 1.31–1.91), the mother having no education (AOR = 1.45; 95% CI: 1.14–1.85), a high number of children aged under five (AOR = 1.11; 95% CI: 1.03–1.20), being in the “other” religious category (AOR = 1.77; 95% CI: 1.25–2.51), living in a household with unimproved toilet facilities (AOR = 1.22; 95% CI: 1.11–1.34), living in a household with inadequate hygiene (AOR = 1.33; 95% CI: 1.12–1.59), and the household not being visited by a family planning worker in the last year (AOR = 1.45; 95% CI: 1.19–1.77). However, an increase in the child’s age by even a month had significant negative associations with unhygienic practice (AOR = 0.65; 95% CI: 0.60–0.70), even when controlling for other covariates. Conclusion Almost one third of the mothers do not practice hygienic disposal of children’s stools in Cambodia. Unhygienic practices were more prevalent in certain regions, and were also associated with low wealth, lack of education, an increase in the number of children under five in the household, religion, lack of sanitation and access to healthcare professionals. Conversely, the child’s age was found to be positively associated with the hygienic disposal of children’s stools.
Collapse
Affiliation(s)
- Pisey Vong
- Office of Rural Health Care, Provincial Department of Rural Development, Pursat, Cambodia
- * E-mail:
| | | | - Samphors Sim
- Chea Sim University of Kamchaymear, Prey Veng, Cambodia
| | - Chamroen Pall
- Ministry of Education, Youth and Sport, Phnom Penh, Cambodia
| | | |
Collapse
|
9
|
Maroko AR, Hopper K, Gruer C, Jaffe M, Zhen E, Sommer M. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLoS One 2021; 16:e0252946. [PMID: 34161351 PMCID: PMC8221515 DOI: 10.1371/journal.pone.0252946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.
Collapse
Affiliation(s)
- Andrew R. Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Maayan Jaffe
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Erica Zhen
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| |
Collapse
|
10
|
Cheng AS, Kang YQ, Lim TSH, Ragen ES. Minimizing risk of infection when using developmental and psychological assessment tools: Looking beyond COVID-19. Nurse Pract 2021; 46:12-16. [PMID: 34004635 DOI: 10.1097/01.npr.0000751816.41679.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Anthonj C, Githinji S, Höser C, Stein A, Blanford J, Grossi V. Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities? Int J Hyg Environ Health 2021; 235:113756. [PMID: 34004452 DOI: 10.1016/j.ijheh.2021.113756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils' absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. METHODS We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. RESULTS The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. CONCLUSIONS The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools.
Collapse
Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands; Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | | | - Christoph Höser
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| | - Alfred Stein
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Justine Blanford
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Valentina Grossi
- Institute for Hygiene and Public Health, Medical Faculty, University of Bonn, GeoHealth Centre, Bonn, Germany.
| |
Collapse
|
12
|
Beyene SA, Weldegerima L, Tela FG, Seid O, Brown AT, Bezabih AM. Barriers to utilize nutrition interventions among lactating women in rural communities of Tigray, northern Ethiopia: An exploratory study. PLoS One 2021; 16:e0250696. [PMID: 33930036 PMCID: PMC8087028 DOI: 10.1371/journal.pone.0250696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background While lactation is a physiological process requiring high energy demand to fulfill the nutrient requirements of the mother and the breastfeeding child, many factors affecting maternal nutrient intake can lead to nutritional deficits. Previous studies in Ethiopia have reported the prevalence of maternal and child undernutrition and related complications. However, qualitative studies exploring potential barriers to utilizing available nutrition interventions are limited. This study, therefore, sought to qualitatively explore barriers hindering the uptake of nutrition services among lactating mothers from rural communities in Tigray, northern Ethiopia. Methods We conducted 6 in-depth interviews, 70 key informant interviews, and 13 focus group discussions among purposively selected community groups, experts, and lactating mothers between November- 2017 and January- 2018. Audio records of all interviews and focus group discussions were transcribed verbatim (word-to-word) and translated into English. Then, translated data were analyzed thematically using qualitative data analysis software Atlas ti-version 7.4. Results The participants in this study perceived that lactating mothers in their study area are not properly utilizing available and recommended nutrition interventions, and as a result, their nutrient intake was reported as inadequate. Participants identified inadequate accessibility and availability of foods, feeding practices, cultural and religious influences, focus on agricultural production and productivity, barriers related to health services and poor access to water, sanitation and hygiene as major barriers hindering the uptake of nutrition interventions by lactating women in Tigray, northern Ethiopia. Conclusion The uptake of nutrition intervention services was low among lactating mothers and was hindered by multiple socio-cultural and health service related factors requiring problem-specific interventions at community, health facility, and administrative levels to improve the nutritional status of lactating mothers in the study area.
Collapse
Affiliation(s)
- Selemawit Asfaw Beyene
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
- * E-mail:
| | - Lemlem Weldegerima
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Freweini Gebrearegay Tela
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Omer Seid
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir dar University, Bahir Dar, Ethiopia
| | | | - Afework Mulugeta Bezabih
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| |
Collapse
|
13
|
Sahiledengle B, Teferu Z, Tekalegn Y, Awoke T, Zenbaba D, Bekele K, Tesemma A, Seyoum F, Woldeyohannes D. Geographical variation and factors associated with unsafe child stool disposal in Ethiopia: A spatial and multilevel analysis. PLoS One 2021; 16:e0250814. [PMID: 33914836 PMCID: PMC8084221 DOI: 10.1371/journal.pone.0250814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Unsafe disposal of children’s stool makes children susceptible to fecal-oral diseases and children remain vulnerable till the stools of all children are disposed of safely. There is a paucity of data on spatial distribution and factors associated with unsafe child stool disposal in Ethiopia. Previous estimates, however, do not include information regarding individual and community-level factors associated with unsafe child stool disposal. Hence, the current study aimed (i) to explore the spatial distribution and (ii) to identify factors associated with unsafe child stool disposal in Ethiopia. Methods A secondary data analysis was conducted using the recent 2016 Ethiopian demographic and health survey data. A total of 4145 children aged 0–23 months with their mother were included in this analysis. The Getis-Ord spatial statistical tool was used to identify high and low hotspots areas of unsafe child stool disposal. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant spatial clusters. A multilevel multivariable logistic regression model was fitted to identify factors associated with unsafe child stool disposal. Results Unsafe child stool disposal was spatially clustered in Ethiopia (Moran’s Index = 0.211, p-value< 0.0001), and significant spatial SaTScan clusters of areas with a high rate of unsafe child stool disposal were detected. The most likely primary SaTScan cluster was detected in Tigray, Amhara, Afar (north), and Benishangul-Gumuz (north) regions (LLR: 41.62, p<0.0001). Unsafe child stool disposal is more prevalent among households that had unimproved toilet facility (AOR = 1.54, 95%CI: 1.17–2.02) and those with high community poorer level (AOR: 1.74, 95%CI: 1.23–2.46). Higher prevalence of unsafe child stool disposal was also found in households with poor wealth quintiles. Children belong to agrarian regions (AOR: 0.62, 95%CI 0.42–0.91), children 6–11 months of age (AOR: 0.65, 95%CI: 0.52–0.83), 12–17 months of age (AOR: 0.68, 95%CI: 0.54–0.86), and 18–23 months of age (AOR: 0.58, 95%CI: 0.45–0.75) had lower odds of unsafe child stool disposal. Conclusions Unsafe child stool disposal was spatially clustered. Higher odds of unsafe child stool disposal were found in households with high community poverty level, poor, unimproved toilet facility, and with the youngest children. Hence, the health authorities could tailor effective child stool management programs to mitigate the inequalities identified in this study. It is also better to consider child stool management intervention in existing sanitation activities considering the identified factors.
Collapse
Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
- * E-mail:
| | - Zinash Teferu
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Abdi Tesemma
- Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikadu Seyoum
- Department of Pediatrics, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | | |
Collapse
|
14
|
Bwire G, Orach CG, Aceng FL, Arianitwe SE, Matseketse D, Tumusherure E, Makumbi I, Muruta A, Merrill RD, Debes A, Ali M, Sack DA. Refugee Settlements and Cholera Risks in Uganda, 2016-2019. Am J Trop Med Hyg 2021; 104:1225-1231. [PMID: 33556038 PMCID: PMC8045616 DOI: 10.4269/ajtmh.20-0741] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/28/2020] [Indexed: 11/07/2022] Open
Abstract
During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016-2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case-control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.
Collapse
Affiliation(s)
- Godfrey Bwire
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | - Freda Loy Aceng
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | | | | | - Edson Tumusherure
- Department of Health, Isingiro District Local Government, Isingiro, Uganda
| | - Issa Makumbi
- Emergency Operational Centre, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala Uganda
| | - Rebecca D. Merrill
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
15
|
Budge S, Parker A, Hutchings P, Garbutt C, Rosenbaum J, Tulu T, Woldemedhin F, Jemal M, Engineer B, Williams L. Multi-Sectoral Participatory Design of a BabyWASH Playspace for Rural Ethiopian Households. Am J Trop Med Hyg 2021; 104:884-897. [PMID: 33534743 PMCID: PMC7941829 DOI: 10.4269/ajtmh.20-0945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
Growing evidence suggests current water, sanitation, and hygiene interventions do not improve domestic hygiene sufficiently to improve infant health, nor consider the age-specific behaviors which increase infection risk. A household playspace (HPS) is described as one critical intervention to reduce direct fecal-oral transmission within formative growth periods. This article details both the design and development (materials and methods), and testing (results) of a HPS for rural Ethiopian households. Design and testing followed a multi-sectoral, multistep participatory process. This included a focus group discussion (FGD), two user-centered and participatory design workshops in the United Kingdom and Ethiopia, discussions with local manufacturers, and a Trials by Improved Practices (TIPs) leading to a final prototype design. Testing included the FGD and TIPs study and a subsequent randomized controlled feasibility trial in Ethiopian households. This multi-sectoral, multistage development process demonstrated a HPS is an acceptable and feasible intervention in these low-income, rural subsistence Ethiopian households. A HPS may help reduce fecal-oral transmission and infection-particularly in settings where free-range domestic livestock present an increased risk. With the need to better tailor interventions to improve infant health, this article also provides a framework for future groups developing similar material inputs and highlights the value of participatory design in this field.
Collapse
Affiliation(s)
- Sophie Budge
- Cranfield Water Science Institute, Cranfield University, Cranfield, United Kingdom
| | - Alison Parker
- Cranfield Water Science Institute, Cranfield University, Cranfield, United Kingdom
| | - Paul Hutchings
- Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Julia Rosenbaum
- FHI360/United States Agency for International Development WASHPaLS Project, Washington, District of Columbia
| | | | | | | | | | - Leon Williams
- Centre for Competitive Creative Design, Cranfield University, Cranfield, United Kingdom
| |
Collapse
|
16
|
Islam M, Benjamin-Chung J, Sultana S, Unicomb L, Alam M, Rahman M, Ercumen A, Luby SP. Effectiveness of Mass Media Campaigns to Improve Handwashing-Related Behavior, Knowledge, and Practices in Rural Bangladesh. Am J Trop Med Hyg 2021; 104:1546-1553. [PMID: 33534770 PMCID: PMC8045613 DOI: 10.4269/ajtmh.20-1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and handwashing interventions that use intensive interpersonal communication improve targeted behaviors, but are expensive at scale. Mass media is an alternative that could reach more people at lower cost but has rarely been rigorously evaluated. We assessed the effectiveness of a mass media campaign in improving handwashing knowledge and practices in rural Bangladesh. We conducted a cross-sectional assessment before the campaign among 8,947 households and again after 4 months of the campaign among 8,400 different households in the same areas. Trained enumerators conducted spot checks of water, sanitation, and hygiene facilities, and recorded reported knowledge and practices. We compared these outcomes after versus before the campaign using generalized linear models with robust standard errors. After the media campaign, caregivers were more likely to recall ≥ 3 messages regarding handwashing (prevalence ratio [PR] = 1.44, 1.34-1.55), sanitation (PR = 1.45, 1.35-1.55), and safe water (PR = 1.17, 1.08-1.26). After the campaign, the prevalence of using soap and water during handwashing demonstrations was higher among caregivers (PR = 1.15, 1.12-1.19) and children (PR = 1.31, 1.22-1.41). Hands were more commonly observed to be visibly clean among caregivers (PR = 1.14, 1.07-1.20) and children (PR = 1.13, 1.05-1.21). Soap and water was more commonly observed in handwashing stations near latrines (PR = 1.12, 1.06-1.19) and in cooking/eating places (PR = 1.09, 1.01-1.18). Our findings indicate improved handwashing knowledge and behaviors following a mass media campaign. This promising approach can be deployed to improve water, sanitation, and hygiene practices at scale and should be evaluated in other contexts.
Collapse
Affiliation(s)
- Mahfuza Islam
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California
| | - Sonia Sultana
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Monirul Alam
- WASH Specialist, Water, Sanitation and Hygiene (WASH) Section, UNICEF, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, California
| |
Collapse
|
17
|
Simelane MS. A multilevel analysis of the determinants of handwashing behavior among households in Eswatini: a secondary analysis of the 2014 multiple indicator cluster survey. Afr Health Sci 2020; 20:1996-2006. [PMID: 34394266 PMCID: PMC8351842 DOI: 10.4314/ahs.v20i4.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Handwashing with soap has received considerable attention due to its importance in the prevention and interruption of the transmission of diseases. Regardless of the positive effects of handwashing with soap, developing countries still have a low rate of handwashing. Objective The study aimed to determine the individual, household and community-level factors associated with handwashing behavior among households in Eswatini Methods Using the Eswatini Multiple Indicator Cluster Survey conducted in 2014, a secondary analysis was done of the households surveyed. A total of 1,520 households nested in communities with complete data on handwashing practices were included in the analysis. Univariate, bivariate analysis and multivariate multilevel logistic regression were used to establish the factors that were associated with handwashing behavior. Results The prevalence of handwashing among households was 56% in 2014. Households whose heads were aged 35–54 and 55 years and older were more likely to practice handwashing (AOR=1.88, 95% CI:1.39, 2.54); and (AOR=1.77, 95% CI: 1.205, 2.62) compared to those aged 15–34 years. Households with a pit latrine or no toilet facility at all, were less likely to practice handwashing (AOR=0.24, 95% CI: 0.17, 0.35); (AOR=0.28, 95% CI: 0.11, 0.71) respectively compared to those with a flush toilet. Region of residence was a community-level variable associated with lower odds of handwashing, with those from the Hhohho (AOR=0.22, 95% CI: 0.14, 0.35) and Manzini region (AOR=0.42, 95% CI: 0.27, 0.67) compared to Lubombo region. Households from communities where access to mass media was high were more likely to practice handwashing (AOR =1.47, 95% CI: 1.05, 2.03) compared to those from communities where access to mass media was low Conclusion Households headed by young adults, with pit latrine or no toilet facility at all and lived in the Hhohho and Manzini regions and with low access to mass media, should be targeted for interventions aimed at improving handwashing practices.
Collapse
Affiliation(s)
- Maswati S Simelane
- Department of Statistics and Demography. Faculty of Social Sciences. The University of Eswatini
| |
Collapse
|
18
|
Seidu AA, Agbaglo E, Ahinkorah BO, Dadzie LK, Bukari I, Ameyaw EK, Yaya S. Individual and contextual factors associated with disposal of children's stools in Papua New Guinea: evidence from the 2016-2018 demographic and health survey. BMC Public Health 2020; 20:1762. [PMID: 33228606 PMCID: PMC7686747 DOI: 10.1186/s12889-020-09852-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Proper sanitation has been one of the topmost priorities on the global public health agenda. In the past few decades, sanitation programs targeting households have often paid little attention to the disposal of children's stools. We assessed the individual and contextual factors associated with disposal of children's faeces in Papua New Guinea. METHODS The data used for this study forms part of the 2016-2018 Papua New Guinea Demographic and Health Survey (PDHS). For this study, we focused on women with children less than five years (n = 2095). Both descriptive and inferential analyses were carried out. Descriptive statistics were used to summarize the data, using frequency counts and percentages. The inferential analysis used multilevel logistic regression models to investigate the individual and contextual factors associated with disposal of children's stools. These models were presented as adjusted odds ratio (AORs), together with their corresponding 95% confidence intervals. Statistical significance was set at p < 0.05. RESULTS More than half (56%) of the women had disposed of their children's stools unsafely. With the individual level factors, the results showed that women with children < 12 months [AOR =1.71; CI = 1.28-2.29] and women aged 20-24 [AOR =2.58; CI = 1.24-5.37], 35-39 [AOR =2.34; CI = 1.09-5.04], and 40 years and above [AOR =2.51; CI = 1.09-5.79] were more likely to practice unsafe disposal of children's stool. The odds of unsafe disposal of faeces was also higher among women who visited the health facility for child diarrhea [AOR =1.69; CI = 1.25-2.28]. With the contextual factors, the odds of unsafe disposal of children's stool was higher among women who lived in the Southern region [AOR =4.82; CI = 2.08-11.18], those who lived in male-headed households [AOR =1.79; CI = 1.19-2.70], and those who had unimproved toilet facilities [AOR =1.96; CI = 1.39-2.76]. On the contrary, women with unimproved source of drinking water were less likely to dispose of their children's stool unsafely [AOR =0.54; CI = 0.35-0.83]. CONCLUSION Both individual and contextual factors predict unsafe disposal of children's faeces in Papua New Guinea. It is recommended that sanitation programs should focus on behavioral change and not only on the extension of water and improved toilet facilities. Such programs should also focus on both individual and contextual factors of women.
Collapse
Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Tidwell JB, Chipungu J, Ross I, Antwi-Agyei P, Alam MU, Tumwebaze IK, Norman G, Cumming O, Simiyu S. Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings. Am J Trop Med Hyg 2020; 104:429-432. [PMID: 33241782 PMCID: PMC7866357 DOI: 10.4269/ajtmh.20-0985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 01/05/2023] Open
Abstract
Shared sanitation is not currently accepted within the international normative definitions of "basic" or "safely managed" sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring.
Collapse
Affiliation(s)
- James B. Tidwell
- World Vision Inc., Washington, District of Columbia
- Harvard Kennedy School of Government, Cambridge, Massachusetts
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ian Ross
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Prince Antwi-Agyei
- NHance Development Partners Ltd, Kumasi, Ghana
- University of Energy and Natural Resources, Sunyani, Ghana
| | - Mahbub-Ul Alam
- International Centre for Diarrhoeal Disease Research in Bangladesh, Dhaka, Bangladesh
| | | | - Guy Norman
- Urban Research, Guildford, United Kingdom
| | - Oliver Cumming
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
20
|
Affiliation(s)
- Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA, USA.
| |
Collapse
|
21
|
Bekele T, Rahman B, Rawstorne P. The effect of access to water, sanitation and handwashing facilities on child growth indicators: Evidence from the Ethiopia Demographic and Health Survey 2016. PLoS One 2020; 15:e0239313. [PMID: 32960921 PMCID: PMC7508389 DOI: 10.1371/journal.pone.0239313] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 09/04/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Poor access to water, sanitation, and handwashing (WASH) facilities frequently contribute to child growth failure. The role of access to WASH facilities on child growth outcomes in Ethiopia is largely unknown. The aim of this study was to determine individual and combined effects of access to WASH facilities on child growth outcomes. METHODS Data for this analysis was sourced from the recent Ethiopia Demographic and Health Survey (EDHS) 2016. A multivariable logistic regression model was applied to identify the separate and combined association of access to WASH facilities with child growth outcomes. Odds ratio (OR) and 95% confidence interval (CI) were estimated. Statistical significance was declared at p < 0.05. RESULTS Included in the analyses were data for children 0-59 months of age, which amounted to valid data for 9588 children with a height-for-age z-score (HAZ), 9752 children with a weight-for-age z-score (WAZ) and 9607 children with a weight-for-height z-score (WHZ). Children with access to improved combined sanitation with handwashing facilities had 29% lower odds of linear growth failure (stunting) (adjusted odds ratio (AOR) = 0.71; 95% CI: 0.51-0.99) compared with those with unimproved. Children with access to combined improved WASH facilities were 33% less likely to have linear growth failure (AOR = 0.67; 95% CI: 0.45-0.98). Access to improved handwashing alone reduced the odds of being underweight by 17% (AOR = 0.83; 95% CI: 0.71-0.98) compared with unimproved. Improved water and sanitation separately as well as combined WASH were not associated with decreased odds of underweight and wasting. CONCLUSIONS Combined access to improved water, sanitation and handwashing was associated with reduced child linear growth failure. Further research with robust methods is needed to examine whether combined WASH practices have synergistic effect on child growth outcomes.
Collapse
Affiliation(s)
- Tolesa Bekele
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Oromia, Ethiopia
- * E-mail:
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Patrick Rawstorne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
22
|
Kuang J, Thulin E, Ashraf S, Shpenev A, Das U, Delea MG, McNally P, Bicchieri C. Bias in the perceived prevalence of open defecation: Evidence from Bihar, India. PLoS One 2020; 15:e0238627. [PMID: 32915831 PMCID: PMC7485860 DOI: 10.1371/journal.pone.0238627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022] Open
Abstract
People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people’s perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.
Collapse
Affiliation(s)
- Jinyi Kuang
- Center for Social Norms and Behavior Dynamics, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail: (JK); (CB)
| | - Erik Thulin
- Center for Behavior & the Environment, Rare, Arlington, VA, United States of America
| | - Sania Ashraf
- Center for Social Norms and Behavior Dynamics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Alex Shpenev
- Center for Social Norms and Behavior Dynamics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Upasak Das
- Global Development Institute, University of Manchester, Manchester, United Kingdom
| | - Maryann G. Delea
- Gangarosa Department of Environmental Health & Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Peter McNally
- Center for Social Norms and Behavior Dynamics, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Cristina Bicchieri
- Center for Social Norms and Behavior Dynamics, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail: (JK); (CB)
| |
Collapse
|
23
|
Maillard JY, Bloomfield SF, Courvalin P, Essack SY, Gandra S, Gerba CP, Rubino JR, Scott EA. Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A position paper. Am J Infect Control 2020; 48:1090-1099. [PMID: 32311380 PMCID: PMC7165117 DOI: 10.1016/j.ajic.2020.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of health care facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in health care settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies, and health care professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.
Collapse
Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; International Scientific Forum on Home Hygiene, Somerset, UK.
| | | | | | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles P Gerba
- Departments of Soil, Water and Environmental Science and Environmental Health, University of Arizona, Tucson, AZ, USA
| | - Joseph R Rubino
- Research & Development, Home Hygiene, Lysol/Harpic, Reckitt Benckiser LLC., One Philips Parkway, Montvale, NJ, USA
| | - Elizabeth A Scott
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, MA, USA
| |
Collapse
|
24
|
Rakotomanana H, Komakech JJ, Walters CN, Stoecker BJ. The WHO and UNICEF Joint Monitoring Programme (JMP) Indicators for Water Supply, Sanitation and Hygiene and Their Association with Linear Growth in Children 6 to 23 Months in East Africa. Int J Environ Res Public Health 2020; 17:ijerph17176262. [PMID: 32872130 PMCID: PMC7503684 DOI: 10.3390/ijerph17176262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022]
Abstract
The slow decrease in child stunting rates in East Africa warrants further research to identify the influence of contributing factors such as water, sanitation, and hygiene (WASH). This study investigated the association between child length and WASH conditions using the recently revised WHO and UNICEF (United Nations Children’s Fund) Joint Monitoring Programme (JMP) indicators. Data from households with infants and young children aged 6–23 months from the Demographic and Health Surveys in Burundi, Ethiopia, Kenya, Malawi, Rwanda, Tanzania, Uganda, and Zambia were used. Associations for each country between WASH conditions and length-for-age z-scores (LAZ) were analyzed using linear regression. Stunting rates were high (>20%) reaching 45% in Burundi. At the time of the most recent Demographic and Health Survey (DHS), more than half of the households in most countries did not have basic or safely managed WASH indicators. Models predicted significantly higher LAZ for children living in households with safely managed drinking water compared to those living in households drinking from surface water in Kenya (β = 0.13, p < 0.01) and Tanzania (β = 0.08, p < 0.05) after adjustment with child, maternal, and household covariates. Children living in households with improved sanitation facilities not shared with other households were also taller than children living in households practicing open defecation in Ethiopia (β = 0.07, p < 0.01) and Tanzania (β = 0.08, p < 0.01) in the adjusted models. All countries need improved WASH conditions to reduce pathogen and helminth contamination. Targeting adherence to the highest JMP indicators would support efforts to reduce child stunting in East Africa.
Collapse
|
25
|
Muckey M, Huss AR, Yoder A, Jones C. Research Note: Evaluating the roles of surface sanitation and feed sequencing on mitigating Salmonella Enteritidis contamination on animal food manufacturing equipment. Poult Sci 2020; 99:3841-3845. [PMID: 32731970 PMCID: PMC7597915 DOI: 10.1016/j.psj.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to evaluate the efficacy of flushing surfaces with untreated feed vs. the use of 2 different dry chemical sanitizers on residual surface and feed Salmonella Enteritidis contamination. First, a Salmonella-negative batch of poultry feed was mixed in 9 laboratory-scale paddle mixers. A feed sample was collected, and targeted locations on surfaces within the mixer were swabbed to confirm Salmonella-negative. Next, a Salmonella-positive batch of poultry feed was mixed, sampled, and mixer surfaces swabbed. Mean Salmonella Enteritidis contamination across all 9 mixers were 3.63 cfu/g for sampled feed and 1.27 cfu/cm2 for surface contamination. Next, the mixers manufactured one of the following treatments (3 mixers/treatment): 1) none (control); 2) a commercially available essential oil blend; or 3) rice hulls treated with a 10% concentration of a propriety blend of medium-chain fatty acids (MCFA). After each treatment, each mixer manufactured another 2 batches of Salmonella-free feed (sequence 1 and sequence 2). Feed samples were collected, and surfaces were swabbed between each batch of feed. Manufacturing sequence (P < 0.0001) but not treatment (P > 0.05) impacted feed or surface contamination of Salmonella Enteritidis. There was Salmonella-positive residue in the batch of feed manufactured immediately after the positive control batch. However, no Salmonella residue was detected in batches of feed treated with either the commercial essential oil blend or MCFA. Low levels of Salmonella residue were observed from either feed (0.7 cfu/g for commercial essential oil blend) or surfaces (0.1 cfu/cm2 for MCFA) manufactured in sequence 1, but no residue was observed in sequence 2. These data suggest that sequencing of feed during manufacturing reduces Salmonella-positive contamination within animal food and on manufacturing surfaces, particularly after the second batch or with the use of chemical treatments.
Collapse
Affiliation(s)
- Mary Muckey
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, USA
| | - Anne R Huss
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, USA
| | - Ashton Yoder
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, USA
| | - Cassandra Jones
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, USA.
| |
Collapse
|
26
|
Abstract
BACKGROUND Management of children's stools is an important aspect of achieving open defecation free communities and reduction of diarrhea. However, information regarding individual- and community- level factors associated with safe child stool disposal in Malawi is limited. The current study aimed to assess the prevalence of safe child stool disposal and the associated individual- and community- level factors in Malawi. METHODS The cross-sectional study used data from the 2015-16 Malawi Demographic Health Survey in which 6326 children aged under 2 years, nested within 850 communities, were analyzed. Individual- and community- level factors were tested for association with safe child stool disposal practice using multilevel logistic regression models. RESULTS Results revealed that 85.6% of the women reported to have safely disposed of their children's stools. Women from households with improved sanitation had 36.0% greater odds of safely disposing of their children's stools compared with those from households with unimproved sanitation [(adjusted odds ratio (aOR): 1.36; 95% confidence interval (CI): 1.12-1.65). Further, women from communities with a middle (aOR: 1.62; 95% CI: 1.18-2.21) and high (aOR: 1.45; 95% CI: 1.14-1.84) percentage of educated women were more likely to have their children's stools safely disposed of than those from communities with a low percentage of educated women. Children's age, media exposure, and region were significantly associated with safe stool disposal. CONCLUSION Both Individual- and community-level factors were revealed to be important factors for child stool disposal. Public health strategies designed to promote sanitation/safe child stools disposal need to conduct thorough community assessments to identify community-specific needs/barriers. Additionally, public health practitioners should take into consideration the geographical and wealth inequalities when designing programs aimed to improve safe child stood disposal.
Collapse
Affiliation(s)
- Owen Nkoka
- Institute for Health Research and Communication (IHRC), P. O Box 1958, Lilongwe, Malawi.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, 110, Taiwan.
| |
Collapse
|
27
|
Fuente D, Allaire M, Jeuland M, Whittington D. Forecasts of mortality and economic losses from poor water and sanitation in sub-Saharan Africa. PLoS One 2020; 15:e0227611. [PMID: 32196493 PMCID: PMC7083270 DOI: 10.1371/journal.pone.0227611] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/22/2019] [Indexed: 11/18/2022] Open
Abstract
This paper presents country-level estimates of water, sanitation and hygiene (WASH)-related mortality and the economic losses associated with poor access to water and sanitation infrastructure in sub-Saharan Africa (SSA) from 1990 to 2050. We examine the extent to which the changes that accompany economic growth will “solve” water and sanitation problems in SSA and, if so, how long it will take. Our simulations suggest that WASH-related mortality will continue to differ markedly across countries in sub-Saharan Africa. In many countries, expected economic growth alone will not be sufficient to eliminate WASH-related mortality or eliminate the economic losses associated with poor access to water and sanitation infrastructure by 2050. In other countries, WASH-related mortality will sharply decline, although the economic losses associated with the time spent collecting water are forecast to persist. Overall, our findings suggest that in a subset of countries in sub-Saharan Africa (e.g., Angola, Niger, Sierra Leone, Chad and several others), WASH-related investments will remain a priority for decades and require a long-term, sustained effort from both the international community and national governments.
Collapse
Affiliation(s)
- David Fuente
- School of Earth, Ocean & Environment, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Maura Allaire
- Department of Urban Planning & Public Policy, University of California, Irvine, California, United States of America
| | - Marc Jeuland
- Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Dale Whittington
- Departments of Environmental Sciences & Engineering and City & Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Global Development Institute, University of Manchester, Manchester, England, United Kingdom
| |
Collapse
|
28
|
Quaranta G, Bruno S, Turnaturi C, Bresa B, Mandolini A, Boldrin A, Berloco F, Cambieri A, Laurenti P. [The assessment of the sanitation of surfaces and instruments in the context of hospital refection]. Ig Sanita Pubbl 2020; 76:119-129. [PMID: 32877396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Authors present the results of an experience carried out in a University General Hospital, for the assessment of the sanitation of surfaces and instruments in the context of hospital refection. A specific procedure has been quarterly implemented in order to verify the correct execution of the sanitization procedures. In the time-period September 2016 - March 2020 Petri dishes and tampons were used in order to determine the following microbiological parameters and indicators: total bacterial load at 30 degrees C, Coliforms, Listeria monocytogenes, Salmonella spp, Staphylococcus aureus, Escherichia coli and mycetic load. Only 7 out of 82 sanitized surfaces (8.5% of the total) were found to be not complying, only for total bacterial load at 30 degrees C, mycetic load and Coliforms. The systematic application of this procedure and the results of the survey conducted, comforting as a whole, confirm the attention reserved to the hygienic level of surfaces, tools, equipment and utensils, in the context of the centralized catering service of the hospital, in which the Health Department, sharing with the UOC Hospital Hygiene the specific hygienic procedure, has always been at the forefront of the proposal of interventions, considering the increased susceptibility and vulnerability of the hospitalized patients.
Collapse
Affiliation(s)
| | - Stefania Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Cinzia Turnaturi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Benedetto Bresa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | | | | | - Filippo Berloco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Andrea Cambieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | | |
Collapse
|
29
|
Troeger CE, Khalil IA, Blacker BF, Biehl MH, Albertson SB, Zimsen SRM, Rao PC, Abate D, Ahmadi A, Ahmed MLCB, Akal CG, Alahdab F, Alam N, Alene KA, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Anber NH, Anjomshoa M, Antonio CAT, Arabloo J, Aremu O, Atalay HT, Atique S, Avokpaho EFGA, Awad S, Awasthi A, Badawi A, Balakrishnan K, Banoub JAM, Barac A, Bassat Q, Bedi N, Bennett DA, Bhattacharyya K, Bhutta ZA, Bijani A, Car J, Carvalho F, Castañeda-Orjuela CA, Christopher DJ, Dandona L, Dandona R, Daryani A, Demeke FM, Deshpande A, Djalalinia S, Dubey M, Dubljanin E, Duken EE, El Sayed Zaki M, Endries AY, Fernandes E, Fischer F, Fullman N, Gardner WM, Geta B, Ghadiri K, Gorini G, Goulart AC, Guo Y, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Hassen HY, Hoang CL, Hostiuc M, Hussain Z, Irvani SSN, James SL, Jha RP, Jonas JB, Karch A, Kasaeian A, Kassa TD, Kassebaum NJ, Kefale AT, Khader YS, Khan EA, Khan MN, Khang YH, Khoja AT, Kimokoti RW, Kisa A, Kisa S, Kissoon N, Kochhar S, Kosen S, Koyanagi A, Kuate Defo B, Kumar GA, Lal DK, Leshargie CT, Li S, Lodha R, Macarayan ERK, Majdan M, Mamun AA, Manguerra H, Melese A, Memish ZA, Mengistu DT, Meretoja TJ, Mestrovic T, Miazgowski B, Mirrakhimov EM, Moazen B, Mohammad KA, Mohammed S, Monasta L, Moore CE, Mosser JF, Mousavi SM, Murthy S, Mustafa G, Nazari J, Nguyen CT, Nguyen LH, Nisar MI, Nixon MR, Ogbo FA, Okoro A, Olagunju AT, Olagunju TO, P A M, Pakhale S, Postma MJ, Qorbani M, Quansah R, Rafiei A, Rahim F, Rahimi-Movaghar V, Rai RK, Rezai MS, Rezapour A, Rios-Blancas MJ, Ronfani L, Rosettie K, Rothenbacher D, Safari S, Saleem Z, Sambala EZ, Samy AM, Santric Milicevic MM, Sartorius B, Sawhney M, Seyedmousavi S, Shaikh MA, Sheikh A, Shigematsu M, Smith DL, Soriano JB, Sreeramareddy CT, Stanaway JD, Sufiyan MB, Teklu TGE, Temsah MH, Tessema B, Tran BX, Tran KB, Ullah I, Updike RL, Vasankari TJ, Veisani Y, Wada FW, Waheed Y, Weaver M, Wiens KE, Wiysonge CS, Yimer EM, Yonemoto N, Zaidi Z, Zar HJ, Zarghi A, Lim SS, Vos T, Mokdad AH, Murray CJL, Kyu HH, Hay SI, Reiner RC. Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017. Lancet Infect Dis 2020; 20:37-59. [PMID: 31678029 PMCID: PMC7340495 DOI: 10.1016/s1473-3099(19)30401-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/13/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. METHODS This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. FINDINGS Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1-87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1-74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2-15·5), childhood wasting (9·9% decrease, 9·6-10·2), and low use of oral rehydration solution (6·9% decrease, 4·8-8·4). INTERPRETATION Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
30
|
Maina M, Tosas-Auguet O, McKnight J, Zosi M, Kimemia G, Mwaniki P, Hayter A, Montgomery M, Schultsz C, English M. Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST. PLoS One 2019; 14:e0226548. [PMID: 31841540 PMCID: PMC6913973 DOI: 10.1371/journal.pone.0226548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations' Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system. METHODS We adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability. RESULTS We present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals' overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees. CONCLUSION We propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.
Collapse
Affiliation(s)
- Michuki Maina
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Olga Tosas-Auguet
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mathias Zosi
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Kimemia
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul Mwaniki
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Arabella Hayter
- Water Sanitation and Hygiene Department, World Health Organization, Geneva, Switzerland
| | - Margaret Montgomery
- Water Sanitation and Hygiene Department, World Health Organization, Geneva, Switzerland
| | - Constance Schultsz
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Mike English
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
31
|
Mbuthia OW. Diarrheal correlates associated with enteric bacterial infections among children below five years in Murang'a County, Kenya. Pan Afr Med J 2019; 34:170. [PMID: 32153710 PMCID: PMC7046099 DOI: 10.11604/pamj.2019.34.170.17403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/20/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The burden of childhood diarrheal disease has resulted in massive mortality and morbidity globally. Children below 5 years in sub-Saharan Africa are most implicated by diarrheal illnesses resulting in numerous medical consultations, admissions, and deaths despite the disease being easy to prevent and control. The study aimed to determine the correlates of enteric bacterial infection causing diarrhea. METHODS During the months of April-October 2017, 163 children below five years presenting with diarrhea were randomly selected in Murang'a and Muriranja's hospitals. Bacterial agents were identified and correlates of diarrhea determined. The study used a hospital-based cross-sectional study design. A standardized questionnaire was used to collect information from the guardian. Statistical analyses were performed using STATA v. 13. RESULTS Forty-nine children were infected with enteric pathogenic bacteria (Enterotoxigenic Escherichia coli, Enteropathogenic Escherichia coli, Enteroaggregative Escherichia coli, Salmonella, Shigella, and Vibrio species). Factors associated with infection by these bacteria among the 49 children were evaluated. Children between 0-12 months (OR 0.3, 95% CI 0.1-0.8), those fed exclusively on breast milk (OR 0.3, 95% CI 0.09-0.9) and children weighing 1-5 kilograms (OR 0.2, 95% CI 0.04-0.9) were less likely to be infected with these enteric pathogenic bacteria. Female participants (OR 1.8, 95% CI 1.1-3.4) were nearly twice likely to be infected with enteric pathogenic bacteria. Children who presented with watery stool (OR 0.4, 95% CI 0.2-0.9) or mucoid stool (OR 0.3, 95% CI 0.2-0.7) remained associated with enteric pathogenic bacterial infection but less likely to be infected compared to those who presented with watery-blood stained stools. Piped water (OR 0.01, 95% CI 0.01-0.4) was less associated with enteric bacterial infection than water stored in jerry-cans while storing water without a lid (OR 1.9, 95% CI 1.1-3.7) was more likely to lead to bacterial infection. Hand washing after toilet use (OR 1.6, 95% CI 1.1-2.7) was associated with enteric bacterial infection compared to hand washing before meal preparation. CONCLUSION Sanitation, hygiene, nutritional and clinical factors were associated with enteric bacterial infections causing diarrhea among children below five years in the study area. Childhood diarrhea in Murang'a County is a major public health problem.
Collapse
Affiliation(s)
- Oliver Waithaka Mbuthia
- Department of Medical Laboratory Science, School of Medicine, Kenyatta University, Nairobi, Kenya
| |
Collapse
|
32
|
Tumwebaze IK, Rose JB, Hofstra N, Verbyla ME, Musaazi I, Okaali DA, Kaggwa RC, Nansubuga I, Murphy HM. Translating pathogen knowledge to practice for sanitation decision-making. J Water Health 2019; 17:896-909. [PMID: 31850897 DOI: 10.2166/wh.2019.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sanitation planners make complex decisions in the delivery of sanitation services to achieve health outcomes. We present findings from a stakeholder engagement workshop held in Kampala, Uganda, to educate, interact with, and solicit feedback from participants on how the relevant scientific literature on pathogens can be made more accessible to practitioners to support decision-making. We targeted Water, Sanitation and Hygiene (WASH) practitioners involved in different levels of service delivery. Practitioners revealed that different sanitation planning tools are used to inform decision-making; however, most of these tools are not user-friendly or adapted to meet their needs. Most stakeholders (68%) expressed familiarity with pathogens, yet less than half (46%) understood that fecal coliforms were bacteria and used as indicators for fecal pollution. A number of stakeholders were unaware that fecal indicator bacteria do not behave and persist the same as helminths, protozoa, or viruses, making fecal indicator bacteria inadequate for assessing pathogen reductions for all pathogen groups. This suggests a need for awareness and capacity development around pathogens found in excreta. The findings underscore the importance to engage stakeholders in the development of support tools for sanitation planning and highlighted broader opportunities to bridge science with practice in the WASH sector.
Collapse
Affiliation(s)
- Innocent K Tumwebaze
- Water, Health and Applied Microbiology Lab (WHAM Lab), Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA E-mail:
| | - Joan B Rose
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA
| | - Nynke Hofstra
- Water Systems and Global Change Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Matthew E Verbyla
- Department of Civil, Construction and Environmental Engineering, San Diego State University, San Diego, CA, USA
| | - Isaac Musaazi
- Department of Civil, Construction and Environmental Engineering, San Diego State University, San Diego, CA, USA
| | - Daniel A Okaali
- Water Systems and Global Change Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Rose C Kaggwa
- National Water and Sewerage Corporation, Kampala, Uganda
| | | | - Heather M Murphy
- Water, Health and Applied Microbiology Lab (WHAM Lab), Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA E-mail:
| |
Collapse
|
33
|
Abstract
While typhoid fever remains an important cause of illness in many low- and middle-income countries, important insights can be learned by exploring the historical experience with typhoid fever in industrialized countries. We used archival research to examine British and American attempts to control typhoid via sanitary interventions from the 1840s to 1940s. First, we assess how varying perceptions of typhoid and conflicts of interest led to a nonlinear evolution of control attempts in Oxford, United Kingdom. Our qualitative analysis shows how professional rivalries and tensions between Oxford's university and citizens ("gown and town"), as well as competing theories of typhoid proliferation stalled sanitary reform until the provision of cheap external credit created cross-party alliances at the municipal level. Second, we use historical mortality data to evaluate and quantify the impact of individual sanitary measures on typhoid transmission in major US cities. Together a historiographic and epidemiological study of past interventions provides insights for the planning of future sanitary programs.
Collapse
Affiliation(s)
| | - Maile T Phillips
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Claas Kirchhelle
- Wellcome Unit for the History of Medicine/Oxford Martin School, University of Oxford, United Kingdom
| |
Collapse
|
34
|
Gelli A, Headey D, Becquey E, Ganaba R, Huybregts L, Pedehombga A, Santacroce M, Verhoef H. Poultry husbandry, water, sanitation, and hygiene practices, and child anthropometry in rural Burkina Faso. Matern Child Nutr 2019; 15:e12818. [PMID: 30912287 PMCID: PMC6850613 DOI: 10.1111/mcn.12818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Poultry production in low income countries provides households with nutrient-rich meat and egg products, as well as cash income. However, traditional production systems present potential health and nutrition risks because poultry scavenging around household compounds may increase children's exposure to livestock-related pathogens. Data from a cross-sectional survey were analysed to examine associations between poultry, water, sanitation, and hygiene practices, and anthropometric indicators in children (6-59 months; n = 3,230) in Burkina Faso. Multilevel regression was used to account for the hierarchical nature of the data. The prevalence of stunting and wasting in children 6-24 months was 19% and 17%, respectively, compared with a prevalence of 26% and 6%, respectively, in children 25-60 months. Over 90% of households owned poultry, and chicken faeces were visible in 70% of compounds. Caregivers reported that 3% of children consumed eggs during a 24-hr recall. The presence of poultry faeces was associated with poultry flock size, poultry-husbandry and household hygiene practices. Having an improved water source and a child visibly clean was associated with higher height-for-age z scores (HAZ). The presence of chicken faeces was associated with lower weight-for-height z scores, and no associations were found with HAZ. Low levels of poultry flock size and poultry consumption in Burkina Faso suggest there is scope to expand production and improve diets in children, including increasing chicken and egg consumption. However, to minimize potential child health risks associated with expanding informal poultry production, research is required to understand the mechanisms through which cohabitation with poultry adversely affects child health and design interventions to minimize these risks.
Collapse
Affiliation(s)
- Aulo Gelli
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Derek Headey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Elodie Becquey
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | | | - Lieven Huybregts
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | | | - Marco Santacroce
- International Food Policy Research Institute (IFPRI)WashingtonDistrict of Columbia
| | - Hans Verhoef
- London School of Hygiene & Tropical Medicine (LSHTM)LondonUK
- MRC Unit The Gambia at LSHTMBanjulGambia
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
- Cell Biology and Immunology GroupWageningen UniversityWageningenThe Netherlands
| |
Collapse
|
35
|
Torondel B, Balls E, Chisenga CC, Kumwenda S, Okello E, Simiyu S, Morse T, Smith K, Mumma J, Banzi J, Harvey E, Chidziwisano K, Chipungu J, Grosskurth H, Beda A, Kapiga S, EstevesMills J, Cumming O, Cairncross S, Chilengi R. Experiences of capacity strengthening in sanitation and hygiene research in Africa and Asia: the SHARE Research Consortium. Health Res Policy Syst 2019; 17:77. [PMID: 31382967 PMCID: PMC6683551 DOI: 10.1186/s12961-019-0478-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Programme consortium is a programme funded by the United Kingdom Department for International Development (DFID) that aims to contribute to achieving universal access to effective, sustainable, and equitable sanitation and hygiene worldwide. The capacity development component is an important pillar for this programme and different strategies were designed and implemented during the various phases of SHARE. This paper describes and reflects on the capacity-building strategies of this large multi-country research consortium, identifying lessons learnt and proposing recommendations for future global health research programmes. In the first phase, the strategy focused on increasing the capacity of individuals and institutions from low- and middle-income countries in conducting their own research. SHARE supported six PhD students and 25 MSc students, and organised a wide range of training events for different stakeholders. SHARE peer-reviewed all proposals that researchers submitted through several rounds of funding and offered external peer-review for all the reports produced under the partner's research platforms. In the second phase, the aim was to support capacity development of a smaller number of African research institutions to move towards their independent sustainability, with a stronger focus on early and mid-career scientists within these institutions. In each institution, a Research Fellow was supported and a specific capacity development plan was jointly developed.Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans. The key lessons learnt were that research capacity-building programmes need to be driven by local initiatives tailored with support from partners. We recommend that future programmes seeking to strengthen research capacity should consider targeted strategies for individuals at early, middle and later career stages and should be sensitive to other institutional operations to support both the research and management capacities.
Collapse
Affiliation(s)
- Belen Torondel
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | - Emily Balls
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | | | - Save Kumwenda
- 0000 0001 2113 2211grid.10595.38Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi – The Polytechnic, Blantyre, Malawi
| | | | - Sheillah Simiyu
- grid.448911.1Great Lakes University of Kisumu, Kisumu, Kenya
| | - Tracy Morse
- 0000 0001 2113 2211grid.10595.38Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi – The Polytechnic, Blantyre, Malawi
| | - Kyla Smith
- WaterAid, London, United Kingdom
- WaterAid Tanzania, Dar es Salaam, Tanzania
| | - Jane Mumma
- grid.448911.1Great Lakes University of Kisumu, Kisumu, Kenya
| | - Joseph Banzi
- WaterAid, London, United Kingdom
- WaterAid Tanzania, Dar es Salaam, Tanzania
| | - Erik Harvey
- WaterAid, London, United Kingdom
- WaterAid Tanzania, Dar es Salaam, Tanzania
| | - Kondwani Chidziwisano
- 0000 0001 2113 2211grid.10595.38Centre for Water, Sanitation, Hygiene and Appropriate Technology Development, University of Malawi – The Polytechnic, Blantyre, Malawi
| | - Jenala Chipungu
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Amani Beda
- grid.452630.6Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Saidi Kapiga
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
- grid.452630.6Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | - Joanna EstevesMills
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | - Oliver Cumming
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | - Sandy Cairncross
- 0000 0004 0425 469Xgrid.8991.9Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| |
Collapse
|
36
|
MacRae ER, Clasen T, Dasmohapatra M, Caruso BA. 'It's like a burden on the head': Redefining adequate menstrual hygiene management throughout women's varied life stages in Odisha, India. PLoS One 2019; 14:e0220114. [PMID: 31369595 PMCID: PMC6675075 DOI: 10.1371/journal.pone.0220114] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/21/2019] [Indexed: 11/29/2022] Open
Abstract
There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.
Collapse
Affiliation(s)
- Elizabeth R. MacRae
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bethany A. Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| |
Collapse
|
37
|
Mackinnon E, Ayah R, Taylor R, Owor M, Ssempebwa J, Olago LD, Kubalako R, Dia AT, Gaye C, C Campos L, Fottrell E. 21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition. Int J Environ Health Res 2019; 29:457-478. [PMID: 30545246 DOI: 10.1080/09603123.2018.1550193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Abstract
Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue - 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization.
Collapse
Affiliation(s)
- Eve Mackinnon
- a Civil, Environmental and Geomatic Engineering , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Richard Ayah
- b Faculty of Science Engineering and Health , Daystar University Nairobi , Nairobi , Kenya
| | - Richard Taylor
- c Department of Geography , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Michael Owor
- d Department of Geology and Petroleum Studies , Makerere University , Kampala , Uganda
| | - John Ssempebwa
- e College of Agricultural and Environmental Sciences , Makerere University , Kampala , Uganda
| | - L Daniel Olago
- b Faculty of Science Engineering and Health , Daystar University Nairobi , Nairobi , Kenya
| | - Robinah Kubalako
- e College of Agricultural and Environmental Sciences , Makerere University , Kampala , Uganda
| | - Anta Tal Dia
- f Department of Geology, FST , Universite Cheikh Anta Diop , Dakar , Senegal
| | - Cheikh Gaye
- f Department of Geology, FST , Universite Cheikh Anta Diop , Dakar , Senegal
| | - Luiza C Campos
- a Civil, Environmental and Geomatic Engineering , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Edward Fottrell
- g University College, London Institute of Global Health , London , United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
38
|
Dockx K, Van Remoortel H, De Buck E, Schelstraete C, Vanderheyden A, Lievens T, Kinyagu JT, Mamuya S, Vandekerckhove P. Effect of Contextualized Versus Non-Contextualized Interventions for Improving Hand Washing, Sanitation, and Health in Rural Tanzania: Study Design of a Cluster Randomized Controlled Trial. Int J Environ Res Public Health 2019; 16:ijerph16142529. [PMID: 31311186 PMCID: PMC6678137 DOI: 10.3390/ijerph16142529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
Nearly 90% of diarrhea-related mortalities are the result of unsafe drinking water, poor sanitation, and insufficient hygiene. Although “Water, Sanitation, and Hygiene” (WASH) interventions may significantly reduce the risk of diarrheal disease, it is currently unclear which interventions are the most effective. In this study, we aim to determine the importance of contextualizing a WASH intervention to the local context and the needs for increasing impact (Clinicaltrials.gov NCT03709368). A total of 1500 households in rural Tanzania will participate in this cluster randomized controlled trial. Households will be randomized into one of three cohorts: (1) a control group receiving a basic intervention and 1 placebo household visit, (2) an intervention group receiving a basic intervention + 9 additional household visits which are contextualized to the setting using the RANAS approach, and (3) an intervention group receiving a basic intervention + 9 additional household visits, which are not contextualized, i.e., a general intervention. Assessments will take place at a baseline, 1 and 2 years after the start of the intervention, and 1 year after the completion of the intervention. Measurements involve questionnaires and spot checks. The primary outcome is hand-washing behavior, secondary objectives include, the impact on latrine use, health, WASH infrastructure, quality of life, and cost-effectiveness.
Collapse
Affiliation(s)
- Kim Dockx
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium.
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
| | | | | | | | | | - Simon Mamuya
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Philippe Vandekerckhove
- Belgian Red Cross, Mechelen 2800, Belgium
- Faculty of Medicine, Department of Public Health and Primary Care, KU Leuven, Leuven 3000, Belgium
| |
Collapse
|
39
|
Mardu F, Berhe B, Tesfay K, Negash H. Assessment of sanitary condition of services as implication for intestinal parasitic infections among prison inmates: institutional based cross-sectional study in eastern Tigrai zonal prison, northern Ethiopia, 2018. BMC Res Notes 2019; 12:393. [PMID: 31300055 PMCID: PMC6624882 DOI: 10.1186/s13104-019-4449-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/05/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study aimed to assess the sanitary condition of services and its implication for intestinal parasitic infections among prison inmates in eastern Tigrai, northern Ethiopia. RESULTS We have assessed the availability and sanitary condition of services at Adigrat prison. Frequent water cuts and unavailability of soap in the prison have challenged prisoners and food handlers to maintain their hygiene. The living rooms were overcrowded and poorly ventilated besides to unsatisfactory kitchen rooms. The prevalence of intestinal parasites among the participants was 40% (108/270). The dominant parasite was Entamoeba histolytica/dispar (60, 22.2%) followed by Giardia lamblia, 39 (14.4%). The mixed infections of Entamoeba histolytica/dispar and Giardia lamblia were detected among 17 (6.3%) of the participants. In multivariate analysis, participants who were feeding in groups were more likely to harbor intestinal parasites than those who were feeding alone (AOR: 2.1; CI 1.05-4.3). Intestinal parasites are significant health problems to the prisoners of Adigrat prison with poor sanitation of services. Therefore, provision of necessary facilities such as hand washing basins, soaps, disinfectants, disinfestations, and food utensils could significantly reduce the burden of intestinal parasites in the prison.
Collapse
Affiliation(s)
- Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| |
Collapse
|
40
|
Ravindra K, Mor S, Pinnaka VL. Water uses, treatment, and sanitation practices in rural areas of Chandigarh and its relation with waterborne diseases. Environ Sci Pollut Res Int 2019; 26:19512-19522. [PMID: 31077047 DOI: 10.1007/s11356-019-04964-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
Availability of clean water and adequate sanitation facilities are the principal measures for limiting various waterborne diseases. These basic amenities are critical for health and sustainable socio-economic development. This study attempted to assess the status of water and sanitation facilities and practices of the people living in rural areas of Chandigarh including awareness about the waterborne diseases. The community-based cross-sectional study design was adopted having 300 households across 12 villages of city Chandigarh. A standardized interview schedule was used to collect information related to water uses, storage, water treatment options, water conservation practices, personal hygiene, knowledge about waterborne diseases, and government schemes. The interview schedule was administered with the head of the family as a study approach during the door-to-door survey. Households in rural Chandigarh have municipal water supply for drinking as well as other domestic purposes. The mean per capita water usage was 67 ± 13.4 l. Most (68.6%) of the study participants reported that they do not treat water before drinking and store it in plastic bottles or bucket (58%). The survey shows that 97% of the household had functional toilets in their premises, remaining reported lack of finances, and space for construction as major barriers. Regarding personal hygiene, 83% of respondents wash hands with soap and rest used only water or ash. Observations made under the study highlighted the need to create awareness regarding the role of water and sanitation practices on health including knowledge about various government schemes to improve water quality, sanitation, and hygiene practices for better health.
Collapse
Affiliation(s)
- Khaiwal Ravindra
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, India
| | - Venkatamaha Lakshmi Pinnaka
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| |
Collapse
|
41
|
Burki T. Millions of health-care facilities lack WASH services. Lancet Infect Dis 2019; 19:583. [PMID: 31122778 DOI: 10.1016/s1473-3099(19)30224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
42
|
Vaz Nery S, Pickering AJ, Abate E, Asmare A, Barrett L, Benjamin-Chung J, Bundy DAP, Clasen T, Clements ACA, Colford JM, Ercumen A, Crowley S, Cumming O, Freeman MC, Haque R, Mengistu B, Oswald WE, Pullan RL, Oliveira RG, Einterz Owen K, Walson JL, Youya A, Brooker SJ. The role of water, sanitation and hygiene interventions in reducing soil-transmitted helminths: interpreting the evidence and identifying next steps. Parasit Vectors 2019; 12:273. [PMID: 31138266 PMCID: PMC6540378 DOI: 10.1186/s13071-019-3532-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
The transmission soil transmitted helminths (STH) occurs via ingestion of or contact with infective stages present in soil contaminated with human faeces. It follows therefore that efforts to reduce faecal contamination of the environment should help to reduce risk of parasite exposure and improvements in water, sanitation and hygiene (WASH) are seen as essential for the long-term, sustainable control of STH. However, the link between WASH and STH is not always supported by the available evidence from randomised controlled trials, which report mixed effects of WASH intervention on infection risk. This review critically summarises the available trial evidence and offers an interpretation of the observed heterogeneity in findings. The review also discusses the implications of findings for control programmes and highlights three main issues which merit further consideration: intervention design, exposure assessment, and intervention fidelity assessment.
Collapse
Affiliation(s)
- Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, USA
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
| | - Donald A. P. Bundy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Clasen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | | | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
| | - Ayse Ercumen
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA USA
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC USA
| | | | - Oliver Cumming
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Rashidul Haque
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Birhan Mengistu
- Neglected Tropical Diseases, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - William E. Oswald
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, USA
| | - Ashrafedin Youya
- Environmental Health, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Simon J. Brooker
- Global Health, Bill & Melinda Gates Foundation, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| |
Collapse
|
43
|
Tidwell JB, Chipungu J, Chilengi R, Curtis V, Aunger R. Using a theory-driven creative process to design a peri-urban on-site sanitation quality improvement intervention. BMC Public Health 2019; 19:565. [PMID: 31088432 PMCID: PMC6518808 DOI: 10.1186/s12889-019-6898-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Behavior change interventions have been developed by drawing from many different theories using design processes of varying specificity. We describe the development of a behavior change intervention to improve on-site peri-urban sanitation quality in Lusaka, Zambia using the Behavior Centered Design (BCD) framework to explain the results of the process applied to improving the quality of shared peri-urban sanitation and compare them to similar interventions. METHODS We used the BCD behavioral determinants model to synthesize the data from our literature review and formative research. Then, we partnered with creative professionals using a design process to develop a theory-driven on-site peri-urban sanitation intervention. Particular attention was paid to the implications of using BCD for intervention development on improving its effectiveness, increasing the contributions to knowledge for other behaviors and settings, and advancing the discipline of applied behavioral science. RESULTS Based on findings from a literature review and formative research, we designed an intervention to encourage landlords to improve their toilets by making them more accessible, desirable, hygienic, and sustainable. The intervention involved landlords meeting in facilitated groups every 2 weeks with individual follow-up after each meeting. The meetings presented surprising "hidden camera"-style videos to reveal tenants' perspectives, used participatory activities to help landlords reevaluate the benefits they would derive from improving sanitation on their plots, and provided practical guidance and mechanisms to facilitate the performance of construction and cleaning behaviors. CONCLUSIONS Using the BCD framework provided an easy-to-follow intervention design process. The resulting intervention is highly creative and multi-faceted, with each element having a theoretical role in an explicit theory of change. The development of this theory-driven intervention advances applied behavioral science by facilitating evaluation of each of the behavior change techniques and the overall delivery mechanism hypothesized to change the target behaviors. This informs the adaptation of these findings to improving on-site sanitation in other settings and the iterative development of the BCD model, which can be used to more effectively change other behaviors.
Collapse
Affiliation(s)
- James B. Tidwell
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Jenala Chipungu
- Center for Infectious Disease Research in Zambia, Plot 34620, Alick Nkhata Road, Lusaka, Zambia
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Plot 34620, Alick Nkhata Road, Lusaka, Zambia
| | - Val Curtis
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Robert Aunger
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| |
Collapse
|
44
|
Tidwell JB, Terris-Prestholt F, Quaife M, Aunger R. Understanding demand for higher quality sanitation in peri-urban Lusaka, Zambia through stated and revealed preference analysis. Soc Sci Med 2019; 232:139-147. [PMID: 31085398 DOI: 10.1016/j.socscimed.2019.04.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022]
Abstract
Poor peri-urban sanitation is a significant public health problem, likely to become more important as the world rapidly urbanizes. However, little is known about the role of consumer demand in increasing peri-urban sanitation quality, especially for tenants using shared sanitation as only their rental choices can be observed in the market. We analyzed data on existing housing markets collected between 9 Jun and 6 Jul 2017 using the Hedonic Pricing Method (HPM) to capture the percentage of rent attributable to sanitation quality (n = 933). We also conducted discrete choice experiments (DCEs) to obtain willingness to pay (WTP) estimates for specific sanitation components (n = 1087), and explored the implications by estimating the proportion of plots for which improved sanitation quality would generate a higher return on investment for landlords than building a place for an additional tenant to live. The HPM attributed 18% of rental prices to sanitation (∼US$8.10 per month), but parameters for several components were poorly specified due to collinearity and low overall prevalence of some products. DCEs revealed that tenants were willing to pay $2.20 more rent per month for flushing toilets on plots with running water and $3.39 more per month for solid toilet doors, though they were willing to pay little for simple hole covers and had negative WTP for adding locks to doors (-$1.04). Solid doors and flushing toilets had higher rent increase to cost ratios than other ways landlords commonly invested in their plots, especially as the number of tenant households on a plot increased. DCEs yielded estimates generally consistent with and better specified than HPM and may be useful to estimate demand in other settings. Interventions leveraging landlords' profit motives could lead to significant improvements in peri-urban sanitation quality, reduced diarrheal disease transmission, and increased well-being without subsidies or infrastructure investments by government or NGOs.
Collapse
Affiliation(s)
- James B Tidwell
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom.
| | - Fern Terris-Prestholt
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Matthew Quaife
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| | - Robert Aunger
- London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom
| |
Collapse
|
45
|
Mallory A, Crapper M, Holm RH. Agent-Based Modelling for Simulation-Based Design of Sustainable Faecal Sludge Management Systems. Int J Environ Res Public Health 2019; 16:ijerph16071125. [PMID: 30925829 PMCID: PMC6479626 DOI: 10.3390/ijerph16071125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022]
Abstract
Re-using faecal sludge (FS) to generate value has the potential to contribute towards solving the issue of long term sanitation solutions in growing urban areas across sub-Saharan Africa; however, hitherto, no design tools have been available that are capable of simulating a system involving economic factors, complex social issues and environmental circumstances. We hypothesized that Agent-Based Modelling (ABM), when deployed with appropriate rigour, can provide such a tool. Extensive field work was carried out in a Malawian city, investigating the adoption of Skyloo above-ground composting toilets by households, and the operation of the municipal FS site. 65 semi-structured interviews and 148 household interviews, together with observations, were carried out to characterize these processes, with the data acquired being used to construct two separate ABMs. The Skyloo ABM was run for various scenarios of start-up capital for business and payback of loans against the toilet cost to households. The municipal FS Site ABM was run for different patterns of dumping fee and enforcement structure. The field work demonstrated that there is potential for further expansion of FS reuse, with a market for agricultural application. The Skyloo ABM identified the significance of start-up capital for a business installing the toilet technology; the municipal FS Site ABM showed that existing fees, fines and regulatory structure were insufficient to reduce illegal dumping of FS to any useful degree, but that a monthly permit system would provide enhanced revenue to the city council compared with per-visit charging of disposal companies at the municipal FS site. Whilst each ABM ideally requires some additional data before full application, we have, for the first time, shown that ABM provides a basis for the simulation-based design of FS management systems, including complex social, economic and environmental factors.
Collapse
Affiliation(s)
- Adrian Mallory
- School of Water, Environment and Engineering, Cranfield University, Cranfield, MK43 0AL, UK.
| | - Martin Crapper
- Department of Mechanical and Construction Engineering, Northumbria University, Ellison Place, Newcastle Upon Tyne, NE1 8ST, UK.
| | - Rochelle H Holm
- Centre of Excellence in Water and Sanitation, Mzuzu University, P/Bag 201 Mzuzu 2, Malawi.
| |
Collapse
|
46
|
Magalhães Filho FJC, de Queiroz AAFSL, Machado BS, Paulo PL. Sustainable Sanitation Management Tool for Decision Making in Isolated Areas in Brazil. Int J Environ Res Public Health 2019; 16:ijerph16071118. [PMID: 30925776 PMCID: PMC6479376 DOI: 10.3390/ijerph16071118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
There is a worldwide range of technical sanitation guidelines focusing on small or traditional and isolated communities for ecological alternatives at the household level. However, a computational tool (software) that has a database and connects these guidelines in a single reference for resource-oriented sanitation concept decision making is still lacking. In this regard, an easy-to-use tool was developed using a participatory approach for the decision-making process from a choice of technical solutions to a type of system management. The results obtained from a pilot study indicate that the proposed tool in this paper will help with the decision-making process to aid in not only choosing sustainable sanitation solutions, but also sustainable operation and maintenance options for the systems. When presenting and discussing the tool with research groups and technicians, the potential for participatory application was noticed. The proposed tool can be used in the elaboration of municipal sanitation plans, assisting local technicians and environmental licensing agencies, designers and engineering students, among others. The software can be applied with other management tools, such as 5W2H and Canvas business model.
Collapse
Affiliation(s)
- Fernando J C Magalhães Filho
- Department of Sanitary and Environmental Engineering., Dom Bosco Catholic University, Mato Grosso do Sul, Campo Grande 79117-900, Brazil.
- Faculty of Engineering, Architecture, Urbanism and Geography, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul 79070-900, Brazil.
| | - Adriane A F S L de Queiroz
- Faculty of Engineering, Architecture, Urbanism and Geography, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul 79070-900, Brazil.
| | - Beatriz S Machado
- Department of Sanitary and Environmental Engineering., Dom Bosco Catholic University, Mato Grosso do Sul, Campo Grande 79117-900, Brazil.
| | - Paula L Paulo
- Faculty of Engineering, Architecture, Urbanism and Geography, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul 79070-900, Brazil.
| |
Collapse
|
47
|
Affiliation(s)
- V R Raman
- WaterAid India, New Delhi, 110029, India.
| | | |
Collapse
|
48
|
Persaud N, Steiner L, Woods H, Aratangy T, Wanigaratne S, Polsky J, Hwang S, Chahal G, Pinto A. Health outcomes related to the provision of free, tangible goods: A systematic review. PLoS One 2019; 14:e0213845. [PMID: 30893372 PMCID: PMC6426236 DOI: 10.1371/journal.pone.0213845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Free provision of tangible goods that may improve health is one approach to addressing discrepancies in health outcomes related to income, yet it is unclear whether providing goods for free improves health. We systematically reviewed the literature that reported the association between the free provision of tangible goods and health outcomes. METHODS A search was performed for relevant literature in all languages from 1995-May 2017. Eligible studies were observational and experimental which had at least one tangible item provided for free and had at least one quantitative measure of health. Studies were excluded if the intervention was primarily a service and the free good was relatively unimportant; if the good was a medication; or if the data in a study was duplicated in another study. Covidence screening software was used to manage articles for two levels of screening. Data was extracted using an adaption of the Cochrane data collection template. Health outcomes, those that affect the quality or duration of life, are the outcomes of interest. The study was registered with PROSPERO (CRD42017069463). FINDINGS The initial search identified 3370 articles and 59 were included in the final set with a range of 20 to 252 246 participants. The risk of bias assessment revealed that overall, the studies were of medium to high quality. Among the studies included in this review, 80 health outcomes were statistically significant favouring the intervention, 19 health outcomes were statistically significant favouring the control, 141 health outcomes were not significant and significance was unknown for 28 health outcomes. INTERPRETATION The results of this systematic review provide evidence that free goods can improve health outcomes in certain circumstances, although there were important gaps and limitations in the existing literature.
Collapse
Affiliation(s)
- Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Liane Steiner
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Tatiana Aratangy
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | | | - Jane Polsky
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Stephen Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Canada
| | - Gurleen Chahal
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Andrew Pinto
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
49
|
Gladstone MJ, Chandna J, Kandawasvika G, Ntozini R, Majo FD, Tavengwa NV, Mbuya MNN, Mangwadu GT, Chigumira A, Chasokela CM, Moulton LH, Stoltzfus RJ, Humphrey JH, Prendergast AJ. Independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved complementary feeding on early neurodevelopment among children born to HIV-negative mothers in rural Zimbabwe: Substudy of a cluster-randomized trial. PLoS Med 2019; 16:e1002766. [PMID: 30897095 PMCID: PMC6428259 DOI: 10.1371/journal.pmed.1002766] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Globally, nearly 250 million children (43% of all children under 5 years of age) are at risk of compromised neurodevelopment due to poverty, stunting, and lack of stimulation. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH) and improved infant and young child feeding (IYCF) on early child development (ECD) among children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. METHODS AND FINDINGS SHINE was a cluster-randomized community-based 2×2 factorial trial. A total of 5,280 pregnant women were enrolled from 211 clusters (defined as the catchment area of 1-4 village health workers [VHWs] employed by the Zimbabwean Ministry of Health and Child Care). Clusters were randomly allocated to standard of care, IYCF (20 g of small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counseling), WASH (ventilated improved pit latrine, handwashing stations, chlorine, liquid soap, and play yard), and WASH + IYCF. Primary outcomes were child length-for-age Z-score and hemoglobin concentration at 18 months of age. Children who completed the 18-month visit and turned 2 years (102-112 weeks) between March 1, 2016, and April 30, 2017, were eligible for the ECD substudy. We prespecified that primary inferences would be drawn from findings of children born to HIV-negative mothers; these results are presented in this paper. A total of 1,655 HIV-unexposed children (64% of those eligible) were recruited into the ECD substudy from 206 clusters and evaluated for ECD at 2 years of age using the Malawi Developmental Assessment Tool (MDAT) to assess gross motor, fine motor, language, and social skills; the MacArthur-Bates Communicative Development Inventories (CDI) to assess vocabulary and grammar; the A-not-B test to assess object permanence; and a self-control task. Outcomes were analyzed in the intention-to-treat population. For all ECD outcomes, there was not a statistical interaction between the IYCF and WASH interventions, so we estimated the effects of the interventions by comparing the 2 IYCF groups with the 2 non-IYCF groups and the 2 WASH groups with the 2 non-WASH groups. The mean (95% CI) total MDAT score was modestly higher in the IYCF groups compared to the non-IYCF groups in unadjusted analysis: 1.35 (0.24, 2.46; p = 0.017); this difference did not persist in adjusted analysis: 0.79 (-0.22, 1.68; p = 0.057). There was no evidence of impact of the IYCF intervention on the CDI, A-not-B, or self-control tests. Among children in the WASH groups compared to those in the non-WASH groups, mean scores were not different for the MDAT, A-not-B, or self-control tests; mean CDI score was not different in unadjusted analysis (0.99 [95% CI -1.18, 3.17]) but was higher in children in the WASH groups in adjusted analysis (1.81 [0.01, 3.61]). The main limitation of the study was the specific time window for substudy recruitment, meaning not all children from the main trial were enrolled. CONCLUSIONS We found little evidence that the IYCF and WASH interventions implemented in SHINE caused clinically important improvements in child development at 2 years of age. Interventions that directly target neurodevelopment (e.g., early stimulation) or that more comprehensively address the multifactorial nature of neurodevelopment may be required to support healthy development of vulnerable children. TRIAL REGISTRATION ClinicalTrials.gov NCT01824940.
Collapse
Affiliation(s)
- Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Jaya Chandna
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi N. N. Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Global Alliance for Improved Nutrition, Washington, District of Columbia, United States of America
| | | | | | | | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebecca J. Stoltzfus
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew J. Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | | |
Collapse
|
50
|
Humphrey JH, Mbuya MNN, Ntozini R, Moulton LH, Stoltzfus RJ, Tavengwa NV, Mutasa K, Majo F, Mutasa B, Mangwadu G, Chasokela CM, Chigumira A, Chasekwa B, Smith LE, Tielsch JM, Jones AD, Manges AR, Maluccio JA, Prendergast AJ. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health 2019; 7:e132-e147. [PMID: 30554749 PMCID: PMC6293965 DOI: 10.1016/s2214-109x(18)30374-7] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.
Collapse
Affiliation(s)
- Jean H Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
| | - Mduduzi N N Mbuya
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA; Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | | | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amee R Manges
- University of British Columbia, Vancouver, BC, Canada
| | | | - Andrew J Prendergast
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|