A systematic review of water, sanitation and hygiene among Roma communities in Europe: Situation analysis, cultural context, and obstacles to improvement

Women's political participation and disease prevention: Evidence from access to water and sanitation services

Unsafe water and sanitation remain notable conduits in spreading pathogens and have enormous health implications. It is argued that women are disproportionately affected by the consequences thereof. It is also believed that women who hold political positions tend to prioritize bills and issues that impact the accessibility of public goods and resources. Considering this, we examine the effect of women's political participation, measured as the proportion of seats held by women in national parliaments, on access to water and sanitation services using a panel of 47 Sub-Saharan African countries from 2000 to 2022. The analyses revealed that women's political participation is generally positively associated with access to water and sanitation services. Furthermore, women's political participation has a significantly positive effect on rural and urban populations' access to sanitation services. The impact for the rural population was however found to outweigh that of the urban population. We further show that women's political participation has a U-shaped relationship with access to water and sanitation services, where at higher levels of participation, these resources increase. These results are robust across different econometric techniques. The findings underscore the importance of women's political participation in access to water and, sanitation, and disease prevention.

Water pollution and sanitation in Indonesia: a review on water quality, health and environmental impacts, management, and future challenges

As an archipelagic tropical developing country, Indonesia is characterized by vast expanses of rural and isolated areas. This review aims to discuss water pollution and sanitation's existing condition, health, and environmental impacts, alongside its management and challenges in Indonesia. The systematic review approach was utilized to ensure transparency and replicability, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Many water sources in Indonesia are contaminated by various pollutants such as heavy metals, microplastics, pesticides, and endocrine-disrupting chemicals (EDCs). Moreover, the existing water and wastewater treatment plants cannot completely remove pollutants, including bacteria that cause waterborne diseases. The lack of proper sanitation facilities, including toilets and latrines, is not only reported in rural areas but also in peri-urban regions of Indonesia. This situation forces many to rely on unimproved water sources, such as river water, for their daily use and engage in open defecation, which may increase the risk of direct exposure to waterborne contaminants. Insufficient sanitation has been linked to significant public health issues in Indonesia, including maternal health complications, childhood stunting, and an increased incidence of waterborne diseases such as diarrhea. Based on the findings of this review, Indonesia still needs to improve its sanitation and water treatment facilities, as well as reduce pollution of the aquatic environment. This condition not only illustrates the condition of water and sanitation in Indonesia but can also be used as an illustration of how developing countries face various pollution and sanitation problems during the massive development and industry.

Social mechanisms behind the poor health of marginalized Roma: Novel insights and implications from four ethnographic studies in Slovakia

Roma represent one of the largest ethnic groups facing marginalization worldwide. However, significant knowledge gaps persist regarding: A) the social mechanisms supporting health-endangering practices among Roma; B) the social mechanisms adversely affecting their use of health services; and C) the social determinants underlying both above pathways. To fill these gaps, we conducted a series of four explorative ethnographic studies spanning over ten years. Beginning in 2004, the series involved 260 participants, including segregated Roma and health services staff in Slovakia. Of the four studies, two addressed gap A, two addressed gap B, and all addressed gap C. Regarding pathway A, we found that Roma in segregated Roma enclaves can be socialized into ethnically framed racialized ideologies that oppose the cultural standards of local non-Roma life, including certain healthy practices. This adherence to counter-cultural ideals of Roma identity increases specific health and care challenges. Regarding pathway B, we discovered that health service frontliners frequently lack any organizational support to better understand and accommodate the current living conditions and practices of segregated Roma, as well as their own and others' racism and professional expectations regarding equity. This lack of support leads many frontliners to become cynical about segregated Roma over their careers, resulting in health services being less effective and exacerbating health problems for both Roma and the frontliners themselves. Concerning pathway C, we found that the societal omnipresence of antigypsyism - racist and racialized anti-Roma ideas and sentiments - serves as a prominent driver of both the above pathways. We conclude that much of the unfavorable health status of Roma can be understood via a systems perspective that embraces structural racism.

Ethnicity and access to water, sanitation, and hygiene in Bangladesh: a study using MICS data and policy reviews

INTRODUCTION

Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. Reducing inequalities and ensuring universal access to WASH are essential to achieving the agenda of sustainable development. We aimed to measure access to WASH among ethnic minority populations in Bangladesh and understand the situation and factors affecting WASH practices among them. Additionally, we reviewed policy related to WASH to highlight the inequality faced by ethnic minority populations.

METHODOLOGY

We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multilevel mixed-effect logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling selected covariates. Furthermore, we systematically reviewed Bangladesh's WASH-related policies and programs.

FINDINGS

While 98.5% of Bengalis had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 87%, 45%, 31%, and 45% less access to water (aOR = 0.13, p ≤ 0.001), sanitation (aOR = 0.55, p ≤ 0.001), and handwashing (aOR = 0.69, p ≤ 0.05), and WASH facilities aOR = 0.55, p ≤ 0.001), respectively. Among the policies of Bangladesh, only one identified action for WASH rights of ethnic minorities.

CONCLUSION

The government should identify the issues of WASH among ethnic minorities and represent them adequately in policies to achieve the aim of 'leaving none behind' of sustainable development goals.

Assessing disparities in health and living conditions: a comparative study of Hungarian-speaking Roma and non-Roma women across Hungary, Romania, and Slovakia

Background

The Roma minority, Europe's largest ethnic minority, experiences significant disparities in living conditions and health outcomes compared to the non-Roma populations across the continent. Despite extensive documentation of the socio-economic challenges faced by the Roma, there is a notable lack of comparative research.

Methods

This study aims to fill this gap by examining the differences in socio-economic characteristics, living conditions, and self-reported health status between Roma (R) and non-Roma (nR) women in in Hungary (HU), Romania (RO), and Slovakia (SK), providing a cross-country comparative analysis. Utilizing simple and multiple binary logistic models, our research analysed data collected from September 2020 to March 2022, involving 322 Roma and 294 non-Roma women in Hungary, 258 Roma and 183 non-Roma women in Romania, and 146 Roma and 163 non-Roma women in Slovakia.

Results

Findings indicate significant associations between increased age (R:OR = 1.04[1.02,1.06], p < 0.001), (nR:OR = 1.04[1.02,1.05], p < 0.001) lower financial situation (R:OR = 2.05[1.01,4.18], p = 0.048) (nR:OR = 1.67[1.01,2.77], p = 0.047), and basic education level (R:OR = 3.60[1.29,10.08], p = 0.015) (nR:OR = 3.64[1.77,7.51], p < 0.001) with the likelihood of poor health status across both groups in Hungary. In Romania, increased age (OR = 1.04[1.02,1.06], p < 0.001) and basic education level (OR = 5.24[2.29,11.99], p < 0.001) were particularly predictive of poor health among non-Roma, while in Slovakia, age (OR = 1.05[1.02,1.07], p < 0.001) was a significant factor for Roma, and intermediate education level (OR = 2.68[1.16,6.20], p = 0.021) was for non-Roma. The study also found that a higher number of children (HU:OR = 1.35[1.12,1.63], p = 0.002), (RO:OR = 1.57[1.25,1.96], p < 0.001) and problems with housing comfort (RO:OR = 4.83[2.19,10.62], p = 0.015) and wall conditions (RO:OR = 2.81[1.22,6.46], p < 0.001) significantly impacted the health status of non-Roma women in Hungary and Romania. Conversely, an increase in household size was associated with a better health status among Roma women in Hungary (OR = 0.88[0.79,0.99]) and Slovakia (OR = 0.78[0.61,0.99]).

Conclusion

By offering a novel comparative analysis, this study highlights the critical need for focused attention on the health disparities faced by Roma women, particularly those in a multiply disadvantaged situation due to their ethnic and socio-economic status.

Shared sanitation in informal settlements: A systematic review and meta-analysis of prevalence, preferences, and quality

Shared sanitation facilities are not considered a type of basic sanitation by the WHO/UNICEF Joint Monitoring Programme (JMP), though they may be the only alternative to open defecation in urban informal settlements. Additionally, JMP indicators for sanitation do not cover aspects related to the quality of shared sanitation, such as those outlined in the Human Right to Water and Sanitation (HRTWS) framework. Data on the prevalence of shared sanitation within informal settlement areas is limited, and there is a need to understand user preferences, experiences, and barriers to the use of shared sanitation to inform effective policy and practice. This systematic review aims to summarize the prevalence and number of households sharing sanitation in informal settlements globally, as well as user experiences and barriers to successful implementation of shared sanitation. We included studies available in English and published after January 1, 2000. We retrieved 4741 articles from seven databases and included a total of 167 relevant publications. Among included studies, 54 reported the prevalence of shared sanitation in informal settlements, and 138 studies reported on user perceptions and experiences related to shared sanitation quality. A meta-analysis of studies reporting the prevalence of shared sanitation in informal settlements globally revealed an estimated overall prevalence of 67% [95% CI: 61%-73%]. Commonly reported user preferences included cleanliness to promote continued use of shared facilities, privacy with a lockable door, facilities for menstrual hygiene management, safety and protection against violence, 24/7 access, proper lighting, and shared responsibility for facility management - which align with the HRTWS framework and represent barriers to shared sanitation use. Based on the findings of this review, we recommend including the number of households or people sharing a sanitation facility in monitoring of shared sanitation quality, locating sanitation facilities within compounds, where applicable, and promoting safety, dignity, and privacy of all users in the development of shared sanitation quality indicators.

Poor housing quality and the health of newborns and young children

This study uses linked administrative data on live births, hospital stays, and census records for children born in Hungary between 2006 and 2011 to examine the relationship between poor housing quality and the health of newborns and children aged 1-2 years. We show that poor housing quality, defined as lack of access to basic sanitation and exposure to polluting heating, is not a negligible problem even in a high-income EU country like Hungary. This is particularly the case for disadvantaged children, 20-25% of whom live in extremely poor-quality homes. Next, we provide evidence that poor housing quality is strongly associated with lower health at birth and a higher number of days spent in inpatient care at the age of 1-2 years. These results indicate that lack of access to basic sanitation, hygiene, and non-polluting heating and their health impacts cannot be considered as the exclusive problem for low- and middle-income countries. In high-income countries, there is also a need for public policy programs that identify those affected by poor housing quality and offer them potential solutions to reduce the adverse effects on their health.

Isothermal and Kinetics Modeling Approach for the Bioremediation of Potentially Toxic Trace Metal Ions Using a Novel Biosorbent Acalypha wilkesiana (Copperleaf) Leaves

The presence of trace metals in wastewater brings serious environmental pollution that threatens human health as well as the ecosystem throughout the world due to their non-biodegradability nature. The present study focuses on the bioremediation of toxic trace metals, namely arsenic (As), cadmium (Cd), and chromium (Cr), using Acalypha wilkesiana leaf raw biomass. The optimization of various process variables was done to determine the removal percentage of trace metal using Acalypha wilkesiana leaf raw biomass, and the optimum conditions were an adsorbent dose of 0.5 g, contact time 10 h, 8 h, and 10 h, process temperature 30 °C, initial concentration of trace metal as 30 µg/L, 30 mg//L, and 40 mg/L, and pH of 7.5, 7 and 7.5 for As5+, and Cd2+ and Cr6+, respectively. Acalypha wilkesiana leaf raw biomass is characterized using a scanning electron microscope (SEM), energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and Fourier transformation infrared spectroscopy (FTIR), zeta potential before and after adsorption of the trace metal ions. The study was well fitted for the equilibrium data for Langmuir isotherm for As5+, Cd2+, and Cr6+, Freundlich for As5+, Dubinin-Radushkevinch (D-R) for Cr6+, and Temkin for As5+ and Cr6+. The adsorption of all three trace metals was confirmed by the kinetics and thermodynamic studies to be following pseudo-second-order kinetics with endothermic as well as spontaneous processes, respectively. Thus, the present study indicates Acalypha wilkesiana leaf raw biomass as an effective and efficient novel biosorbent to remediate different trace metals from aqueous systems with its possible application in existing and novel methods for wastewater management.

Greenhouse gas emissions from on-site sanitation systems: A systematic review and meta-analysis of emission rates, formation pathways and influencing factors

Onsite sanitation systems (OSS) are significant sources of greenhouse gases (GHG) including carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O). While a handful of studies have been conducted on GHG emissions from OSS, systematic evaluation of literature on this subject is limited. Our systematic review and meta-analysis provides state-of-the- art information on GHG emissions from OSS and identifies novel areas for investigation. The paper analyzes GHG emission rates from different OSS, the influence of various design, operational, and environmental factors on emission rates and proffers mitigation measures. Following the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines, we identified 16 articles which quantified GHG emissions from OSS. Septic tanks emit substantial amounts of CO2 and CH4 ranging from 1.74 to 398.30 g CO2/cap/day and 0.06-110.13 g CH4/cap/day, respectively, but have low N2O emissions (0.01-0.06 g N₂O/cap/day). CH4 emissions from pit latrines range from 0.77 to 20.30 g CH4/cap/day N2O emissions range from 0.76 to 1.20 gN2O/cap/day. We observed statistically significant correlations (p < 0.05) between temperature, biochemical oxygen demand, chemical oxygen demand, dissolved oxygen, storage period, and GHG emissions from OSS. However, no significant correlation (p > 0.05) was observed between soil volumetric water content and CO2 emissions. CH4 emissions (expressed as CO2 equivalents) from OSS estimated following Intergovernmental Panel for Climate Change (IPCC) guidelines were found to be seven times lower (90.99 g CO2e/cap/day) than in-situ field emission measurements (704.7 g CO2e/cap/day), implying that relying solely on IPCC guidelines may lead to underestimation of GHG emission from OSS. Our findings underscore the importance of considering local contexts and environmental factors when estimating GHG emissions from OSS. Plausible mitigation measures for GHG emissions from OSS include converting waste to biogas in anaerobic systems (e.g. biogas), applying biochar, and implementing mitigation policies that equally address inequalities in sanitation service access. Future research on GHG from OSS should focus on in-situ measurements of GHGs from pit latrines and other common OSS in developing countries, understanding the fate and transport of dissolved organics like CH4 in OSS effluents and impacts of microbial communities in OSS on GHG emissions. Addressing these gaps will enable more holistic and effective management of GHG emissions from OSS.

Assessment of water, sanitation, and hygiene among women living in precarious households in a Turkish urban area

BACKGROUND

This study aimed to identify the determinants of water, sanitation, and hygiene (WASH) behaviors and conditions among women in poor neighborhoods in Izmir, Turkey, and to develop a scale for assessing WASH behaviors and conditions that is specifically designed for use in precarious urban areas.

METHODS

The study used a cross-sectional design, as well as a methodological feature for developing the scale. The sample size was calculated as 243 households out of 2667 households in the Basmane neighborhood, with a 95% confidence interval and a 6% margin of error, and a woman who was responsible for cleaning was invited to participate from each household. The scales for WASH behaviors and conditions, which served as dependent variables, were developed in a four-stage process, yielding two distinct scales. The WASH-Behaviors Scale had 14 items about hand, body, and home hygiene, whereas the WASH-Conditions in Households Scale included 16 items about variables like area per capita, physical structure, and cleaning tool availability. Age, ethnicity, number of children, education, work status, and income were among the independent variables. Data was collected through household visits. The scales' validity was evaluated using exploratory factor analysis. Linear logistic regression analysis was employed to assess the determinants of WASH behaviors.

RESULTS

The women, with an average age of 40.65 ± 14.35 years, faced economic challenges, as a substantial portion earned an income below the minimum wage. More than half of them were uninsured, and 72.6% were identified as migrants or refugees. Factor analysis confirmed the compatibility of both scales (KMO = 0.78-0.80, p < 0.05), elucidating 52-54% of the total variance. Factors such as ethnicity, number of children, husband's education level, income perception, and WASH conditions explained 48% of WASH behaviors.

CONCLUSIONS

WASH-Behaviors and WASH-Conditions in Households scales met the validity criterion, and their scores were related to basic sociodemographic and economic characteristics like education, income, household size, and ethnicity. The scale development process emphasized the importance of considering both behaviors and household conditions, albeit using different techniques. The findings indicated that WASH conditions are more problematic than behaviors, and that behavioral interventions will not work unless the conditions are corrected.

[Energy poverty and self-rated health among Roma population and general population in Spain]

OBJECTIVE

To quantify energy poverty in Roma population and in general population in Spain, in 2016, as well as to observe the association of this phenomenon with self-rated health, adjusted according to the main socio-economic determinants.

METHOD

Energy poverty has been defined as the financial inability to keep a home warm, the presence of dampness in the dwelling and falling into arrears in utility bills, using data from two European surveys from Spain in 2016: the Survey on Income and Living Conditions (EU-SILC) and the Second Survey on Minorities and Discrimination (EU-MIDIS II). Hierarchical logistic regression models were estimated with self-rated health as the outcome variable, progressively adjusted according to demographic (gender and age), environmental (household temperature, humidity and arrears in utility bills) and socio-economic (level of education, marital status and employment status) variables.

RESULTS

Our results show that 45% of the Roma population had moderate or high levels of energy poverty. The odds ratio (OR) of poor self-rated health was higher in the Roma population (OR: 3.11; 95% confidence interval [95% CI]: 2.59-3.74). The inability to maintain an adequate indoor temperature significantly increased the risk of poor health (OR: 2.10; 95% CI: 1.90-2.32). After adjusting according to demographic, environmental and socio-economic variables, no association was observed between the population of ascription and self-rated health.

CONCLUSIONS

Taking into account the main social determinants, including energy poverty indicators, being Roma is not associated with reporting poor health. This result points to the importance of tackling socio-economic factors, including energy poverty, to reduce health inequalities.

Emotional relevance and prejudice: testing the differentiated effect of incidental disgust on prejudice towards ethnic minorities

Negative emotions such as disgust or anger influence the evaluation of minorities and amplify prejudice, stereotypes, and discrimination behaviors towards them. However, new discoveries suggest that these spillover effects might be more specific in the sense that the bias might occur only if the emotions are specific to the affect that is generally evoked by that particular minority, i.e. anger increases prejudice towards anger-relevant groups, and disgust towards disgust-relevant groups. Our study aimed to examine, the specificity of the spillover effects, namely the importance of emotion's relevance to the prejudice towards out-groups. To test this hypothesis, we investigated the influence of incidental disgust on the evaluation of two minorities, one that is usually associated with disgust (the Roma minority) and one usually associated with anger (the Hungarian minority). We used a 2 × 2 between-subjects experimental design where we manipulated the emotion experienced by the participants (disgust versus neutral) and the target they evaluated (Romani or Hungarian minority). We tested the effects of these manipulations on three aspects of prejudice toward the target group: cognitive, affective, and behavioral. The results support the specificity of the spillover effect, by showing that incidental disgust increased prejudice only towards the disgust-relevant target, namely the Roma minority, and that the intensity of this emotion experienced by the participants mediates this effect. Moreover, incidental disgust increased not only the negative emotions associated with the Romani (i.e., the affective component) but also the negative cognitions associated with them and the desire to maintain an increased social distance (i.e., behavioral prejudice). These findings highlight the importance of emotions' relevance in bias toward minorities and provide a starting point for future anti-discrimination interventions.

The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries

Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.

A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women

Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.

Genetic Determinants of Leisure-Time Physical Activity in the Hungarian General and Roma Populations

Leisure-time physical activity (LTPA) is one of the modifiable lifestyle factors that play an important role in the prevention of non-communicable (especially cardiovascular) diseases. Certain genetic factors predisposing to LTPA have been previously described, but their effects and applicability on different ethnicities are unknown. Our present study aims to investigate the genetic background of LTPA using seven single nucleotide polymorphisms (SNPs) in a sample of 330 individuals from the Hungarian general (HG) and 314 from the Roma population. The LTPA in general and three intensity categories of it (vigorous, moderate, and walking) were examined as binary outcome variables. Allele frequencies were determined, individual correlations of SNPs to LTPA, in general, were determined, and an optimized polygenetic score (oPGS) was created. Our results showed that the allele frequencies of four SNPs differed significantly between the two study groups. The C allele of rs10887741 showed a significant positive correlation with LTPA in general (OR = 1.48, 95% CI: 1.12-1.97; p = 0.006). Three SNPs (rs10887741, rs6022999, and rs7023003) were identified by the process of PGS optimization, whose cumulative effect shows a strong significant positive association with LTPA in general (OR = 1.40, 95% CI: 1.16-1.70; p < 0.001). The oPGS showed a significantly lower value in the Roma population compared with the HG population (oPGS_Roma: 2.19 ± SD: 0.99 vs. oPGS_HG: 2.70 ± SD: 1.06; p < 0.001). In conclusion, the coexistence of genetic factors that encourage leisure-time physical activity shows a more unfavorable picture among Roma, which may indirectly contribute to their poor health status.

Patterns of Socioeconomic Inequities in SDGs Relating to Children's Well-Being in Thailand and Policy Implications

Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children's wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women's health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people.

Roma Religion: 1775 and 2018 Compared over Time

The objective of the present study was to compare the religiosity of the Roma in the 18th century with the present. In 1775 and 1776, Samuel Augustini ab Hortis detailed the way of life of the Roma community in the Austro-Hungarian monarchy in his work "Von dem Heutigen Zustände, Sonderbaren Sitten und Lebensart, Wie Auch von Denen Übrigen Eigenschaften und Umständen der Zigeuner in Ungarn" (On the Contemporary Situation, Distinctive Manners and Way of Life, as Well as the Other Characteristics and Circumstances of Gypsies in Greater Hungary). A detailed content analysis of the part of his work dealing with religion was performed. Subsequently, in 2018, field research was conducted in the environment in which Samuel Augustini lived and worked. It involved six key informants, each representing a different municipality. Data collection was carried out over two periods: in the summer months of 2012-2013 and the winter period of 2018-2019. After the interviews with the key informants, more than 70 participants were included in semi-structured interviews through snowball sampling, and another 40 participants were included in two focus groups. The data was evaluated and content analysis was used to process the data. The findings confirm that both in the past and the present, the Roma community adopted the dominant religion of the host country. In the studied environments, the activities of the majority, present then and now in the Catholic Church, failed, and various other missionary movements, such as the Maranatha Mission, came to the fore. Membership in new religious movements resulted in social changes in marginalized Roma communities. However, they may not have only had positive effects. Various effects of their activities may be studied in the future.

Estimating global water, sanitation, and hygiene levels and related risks on human health, using global indicators data from 1990 to 2020

Water quality improvement, sanitation, and hygiene have been demonstrated to have positive impacts on health, social, and economic development. However, global understanding of water quality, sanitation, and hygiene is limited. The study extracted data from the Joint Monitoring Programme (WHO/UNICEF) and the Demographic and Health Surveys (DHS) to estimate global water, sanitation, and hygiene (WASH) levels. Statistical tools of univariate and multivariate analyses were used to process global access to WASH. Results show that men (53%) had access to safe water compared to women. Women (67%), on the other hand, demonstrated better hygiene practices than men (33%). In addition, adults had access to safe water compared to children, the elderly, and strangers. Globally, there is low water quality in landlock developing countries compared to small island developing states. The categorisation of countries into economic states of low, upper-middle, and high-income countries directly affects water quality, sanitation, and hygiene. Continentally, Africa recorded the least water quality, sanitation, and hygiene levels. Thus, African countries must learn from the best practice in governmental policies and management systems from other continents regarding water improvement, sanitation, and hygiene.

CVD Risk Factors in the Ukrainian Roma and Meta-Analysis of Their Prevalence in Roma Populations Worldwide

The Roma population suffers from severe poverty, social exclusion, and some of the worst health conditions in the industrialized world. Herein, we report on cardiovascular disease (CVD) risk factors in the Ukrainian Roma and present a meta-analysis of the prevalence of CVD risk factors in 16 Roma populations worldwide. The meta-analyses of CVD risk factors in Roma (n = 16,552) vs. non-Roma majority population of the same country (n = 127,874) included publicly available data. Ukrainian field survey included 339 adults of both sexes and outcomes of interest were hypertension, body mass index (BMI), smoking, education, and employment status. Furthermore, 35.7% of the Ukrainian Roma were hypertensive, 69.3% unemployed, and 48.4% never went to school. Ukrainian Roma women were more likely to be underweight and more prone to be hypertensive, with odds of hypertension increasing with age, BMI, and positive smoking status. Meta-analyses showed that, in comparison with non-Roma worldwide, the Roma bear significantly higher risk factor loads related to smoking (OR = 2.850), diabetes (OR = 1.433), abdominal obesity (OR = 1.276), and metabolic syndrome (OR = 1.975), with lower loads for hypertension (OR = 0.607) and BMI ≥ 25 kg/m² (OR = 0.872). To conclude, the CVD risk factors which are more common in Roma than in the majority population may reflect their poor health-related behaviors and inadequate access to health education.

Preprocessing alternatives for compositional data related to water, sanitation and hygiene

The Sustainable Development Goals (SDGs) 6.1 and 6.2 measure the progress of urban and rural populations in their access to different levels of water, sanitation and hygiene (WASH) services, based on multiple sources of information. Service levels add up to 100%; therefore, they are compositional data (CoDa). Despite evidence of zero value, missing data and outliers in the sources of information, the treatment of these irregularities with different statistical techniques has not yet been analyzed for CoDa in the WASH sector. Thus, the results may present biased estimates, and the decisions based on these results will not necessarily be appropriate. In this article, we therefore: i) evaluate methodological imputation alternatives that address the problem of having either zero values or missing values, or both simultaneously; and ii) propose the need to complement the point-to-point identification of the WHO/UNICEF Joint Monitoring Program (JMP) with other robust alternatives, to deal with outliers depending on the number of data points. These suggestions have been considered here using statistics for CoDa with isometric log-ratio (ilr) transformation. A selection of illustrative cases is presented to compare performance of different alternatives.

Hygienic Risk Exposures Across Ethnic Groups in Rural Areas of Guangxi, China: Prevalence, Associated Factors, and Perceptions of Policy

BACKGROUND

Controlling hygienic risk exposures (HREs) is important for reducing acute respiratory infection or parasitic infection; however, studies across vulnerable ethnicities are limited. This study aimed to identify the prevalence and associated factors of HREs and perception on HRE policies among ethnic groups in Guangxi, China.

METHODS

A community-based cross-sectional study was conducted in rural areas of Guangxi, China, among Han majority and Zhuang, Yao, Miao, Dong, Mulao, and Maonan minorities. The prevalence of HREs and perceptions concerning the HRE policies were presented using descriptive statistics. Associated factors were analyzed using a logistic regression model, and adjusted prevalence ratios and 95% confidence interval were calculated.

RESULTS

High prevalence of HREs on hand and soil hygiene were found in all ethnicities. Miao minority had the highest prevalence of HREs, particularly in poor hand washing (74.1%), infrequent nail clipping (90.4%), and outdoor soil contact (92.7%), compared with the others. Prevalence of HREs in some ethnic minority groups were significantly different from those in Han majority after adjusted with other significant factors. Village leaders were more aware of existing national and community regulations related to HREs than household heads. Village leaders and household heads of almost all ethnic groups perceived high policy's compliance in their village or household on avoiding fertilizing with farmyard manure.

CONCLUSIONS

HREs were prevalent in all ethnic groups, especially in Miao minority. Ethnicity, one of social determinants, was significantly associated with HREs. Raising awareness at both the village and household levels on HREs is needed for all ethnic groups.