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Grembi JA, Nguyen AT, Riviere M, Heitmann GB, Patil A, Athni TS, Djajadi S, Ercumen A, Lin A, Crider Y, Mertens A, Karim MA, Islam MO, Miah R, Famida SL, Hossen MS, Mutsuddi P, Ali S, Rahman MZ, Hussain Z, Shoab AK, Haque R, Rahman M, Unicomb L, Luby SP, Arnold BF, Bennett A, Benjamin-Chung J. Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh. PLoS Negl Trop Dis 2024; 18:e0012157. [PMID: 38739632 PMCID: PMC11115220 DOI: 10.1371/journal.pntd.0012157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/23/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. OBJECTIVES Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change. METHODS We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters. RESULTS Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null. DISCUSSION Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.
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Affiliation(s)
- Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Anna T. Nguyen
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Marie Riviere
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Gabriella Barratt Heitmann
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Arusha Patil
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Tejas S. Athni
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Stephanie Djajadi
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California, United States of America
| | - Yoshika Crider
- King Center on Global Development, Stanford University, Stanford, California, United States of America
| | - Andrew Mertens
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Md Abdul Karim
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Ohedul Islam
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rana Miah
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syeda L. Famida
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Saheen Hossen
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Palash Mutsuddi
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shahjahan Ali
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zahir Hussain
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abul K. Shoab
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, United States of America
- PATH, Seattle, Washington, United States of America
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
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Caputo A, Tomai M, Lai C, Desideri A, Pomoni E, Méndez HC, Castellanos BA, La Longa F, Crescimbene M, Langher V. The Perception of Water Contamination and Risky Consumption in El Salvador from a Community Clinical Psychology Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031109. [PMID: 35162132 PMCID: PMC8834013 DOI: 10.3390/ijerph19031109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/21/2022]
Abstract
This study was carried out as part of the international cooperation project “Agua Futura” for the improvement of water resource management and the promotion of water, sanitation, and hygiene (WASH) behaviors in rural communities of Central America. Given the relevant healthcare problem of water pollution, especially in El Salvador, the aim was to detect some key factors affecting the perception of water contamination and its risky consumption from a community clinical psychological perspective. Ninety rural inhabitants of El Salvador were administered a structured interview exploring their perceptions about water quality and the impact of water consumption on health. Data were analyzed through a computer-aided thematic analysis—complemented by a qualitative analysis—allowing the detection of sense-making processes based on lexical variability. Different themes were identified with regard to the perception of water quality (i.e., mistrust, danger, and safety) and the beliefs about the impact of water consumption on health (i.e., rationalization, denial, awareness, displacement, and isolation of affect). The results showed heterogeneous perspectives about water quality and sanitation. However, the perceived negative impact of water consumption on health was mostly denied or minimized through massive distortions. Overall, the study highlights the role of defensive patterns in facing issues of water contamination, which may prevent the community from adopting healthy behaviors and adequate water management behaviors.
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Affiliation(s)
- Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy; (M.T.); (C.L.); (A.D.); (V.L.)
- Correspondence:
| | - Manuela Tomai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy; (M.T.); (C.L.); (A.D.); (V.L.)
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy; (M.T.); (C.L.); (A.D.); (V.L.)
| | - Asia Desideri
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy; (M.T.); (C.L.); (A.D.); (V.L.)
| | - Elpiniki Pomoni
- Institute of Geosciences and Earth Resources, National Research Council, 56127 Pisa, Italy;
| | - Hilda Cecilia Méndez
- Faculty of Medicine, University of El Salvador (UES), San Salvador, El Salvador; (H.C.M.); (B.A.C.);
| | | | - Federica La Longa
- National Institute of Geophysics and Volcanology, 00143 Rome, Italy; (F.L.L.); (M.C.)
| | - Massimo Crescimbene
- National Institute of Geophysics and Volcanology, 00143 Rome, Italy; (F.L.L.); (M.C.)
| | | | - Viviana Langher
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy; (M.T.); (C.L.); (A.D.); (V.L.)
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Nelson S, Drabarek D, Jenkins A, Negin J, Abimbola S. How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review. BMJ Open 2021; 11:e053320. [PMID: 34857572 PMCID: PMC8640661 DOI: 10.1136/bmjopen-2021-053320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/14/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services. DESIGN Realist review. DATA SOURCES PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible). ANALYSIS Inductive and deductive coding was used to generate context-mechanism-outcome configurations. RESULTS 73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation. CONCLUSIONS The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.
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Affiliation(s)
- Sarah Nelson
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aaron Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone. BMC Public Health 2021; 21:1857. [PMID: 34649535 PMCID: PMC8515313 DOI: 10.1186/s12889-021-11923-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior. Methods This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data. Results The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions. Conclusion This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11923-1.
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Smeets HM, Keìta FS. Decreasing child death from diarrhoea requires more focus on poor hygiene. J Glob Health 2020; 10:020386. [PMID: 33214894 PMCID: PMC7648906 DOI: 10.7189/jogh.10.020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hugo M Smeets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Momberg DJ, Mahlangu P, Ngandu BC, May J, Norris SA, Said-Mohamed R. Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa. Health Policy Plan 2020; 35:829-841. [PMID: 32535623 DOI: 10.1093/heapol/czaa028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), contribute to poor child health, nutritional status and physical growth. The primary responsibility for the provision of water and sanitation, as a basic service and human right, lies with the State, as such, a number of stakeholders are involved. Despite relatively high levels of WASH infrastructure coverage in South Africa, enteric infections and stunting remain high for a middle-income country. The aim of this study is to elucidate the landscape of WASH in South Africa in relation to nutritional status of children under the age of 5 years in the South African, Gauteng and City of Johannesburg contexts. The authors detailed the national and provincial public sector departments and through purposive sampling proceeded to map the various departments and associated policies that are responsible for the provision of WASH facilities, as well the nutritional status of children. Of the six policies identified for review, three mentioned WASH, nutrition and children; however, none explicitly linked WASH to nutritional status in children. An in-depth review and analysis of these three crucial policy documents was conducted. Finally, a set of expert interviews were conducted and a consensus development conference convened, with experts at the intersection between WASH and nutritional status. The authors found that the public sector would benefit from better integration of the concept of WASH into their policy, planning and implementation frameworks. The WASH sector should emphasize the role in which WASH plans consider the impact of WASH on the nutritional status of children. The various public sector departments involved in WASH service provision, and other WASH stakeholders, including community-based organizations, non-governmental organizations and intergovernmental organizations, should be involved in the decision-making of the nutrition sector.
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Affiliation(s)
- D J Momberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,DSI-NRF Centre of Excellence in Food Security, University of the Western Cape, South Africa
| | - P Mahlangu
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - B C Ngandu
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - J May
- DSI-NRF Centre of Excellence in Food Security, University of the Western Cape, South Africa
| | - S A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
| | - R Said-Mohamed
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.,DSI-NRF Centre of Excellence in Food Security, University of the Western Cape, South Africa.,DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa
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McGuinness SL, O'Toole J, Barker SF, Forbes AB, Boving TB, Giriyan A, Patil K, D'Souza F, Vhaval R, Cheng AC, Leder K. Household Water Storage Management, Hygiene Practices, and Associated Drinking Water Quality in Rural India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:4963-4973. [PMID: 32167297 DOI: 10.1021/acs.est.9b04818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Household drinking water storage is commonly practiced in rural India. Fecal contamination may be introduced at the water source, during collection, storage, or access. Within a trial of a community-level water supply intervention, we conducted five quarterly household-level surveys to collect information about water, sanitation, and hygiene practices in rural India. In a random subsample of households, we tested stored drinking water samples for Escherichia coli, concurrently observing storage and access practices. We conducted 9961 surveys and collected 3296 stored water samples. Stored water samples were frequently contaminated with E. coli (69%), and E. coli levels were the highest during the wet season. Most households contributing two or more drinking water samples had detectable E. coli in some (47%) or all (44%) samples. Predictors of stored water contamination with E. coli included consumption of river water and open defecation; consumption of reverse osmosis-treated water and safe water access practices appeared to be protective. Until households can be reached with on-premises continuous safe water supplies, suboptimal household water storage practices are likely to continue. Improvements to source water quality alone are unlikely to prevent exposure to contaminated drinking water unless attention is also given to improving household water storage, access, and sanitation practices.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Thomas B Boving
- Department of Geosciences & Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island 02281, United States
| | - Asha Giriyan
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Kavita Patil
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Fraddry D'Souza
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Ramkrishna Vhaval
- The Energy and Resources Institute (TERI), Southern Regional Centre, Santa Cruz, Goa 403005, India
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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McGuinness SL, O'Toole J, Ayton D, Giriyan A, Gaonkar CA, Vhaval R, Cheng AC, Leder K. Barriers and Enablers to Intervention Uptake and Health Reporting in a Water Intervention Trial in Rural India: A Qualitative Explanatory Study. Am J Trop Med Hyg 2020; 102:507-517. [PMID: 31933461 DOI: 10.4269/ajtmh.19-0486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Consumption of unsafe drinking water contributes to the global disease burden, necessitating identification and implementation of effective, acceptable, and sustainable water interventions in resource-limited settings. In a quantitative stepped-wedge cluster randomized trial of a community-based water intervention in rural India, we identified low rates of intervention uptake and reported diarrhea. To better understand and explain these findings, we performed a qualitative study examining barriers and enablers to intervention uptake and health reporting using the COM-B model, where capabilities, opportunities, and motivators interact to generate behavior. We conducted 20 focus groups and one semi-structured interview with participants and four focus groups with data collectors. Multifactorial barriers to intervention uptake included distorted perceptions of water-related health effects, implementation issues that reduced treated water availability; convenience of, and preference for, alternative drinking water sources; delivery of water to plastic storage tanks (perceived as affecting water quality and taste); and resistance to change. Enablers included knowledge of water-related health risks, proximity to tanks, and social opportunity. Barriers to health reporting included variability in interpretation of illness, suspicion regarding the consequences of reporting disease, weariness with repeated questions, and perceived inaction on health data already provided; low survey implementation fidelity was also important. Enablers included surveyor initiatives to encourage reporting and a sense of social responsibility. This qualitative explanatory study allowed better understanding of our quantitative results. It also identified obstacles and facilitators to implementing and evaluating community water interventions, providing insight on how to achieve better intervention uptake and health reporting in future studies.
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Affiliation(s)
- Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Asha Giriyan
- The Energy and Resources Institute (TERI), Panaji, India
| | | | | | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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