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Cha S, Jung S, Abera T, Beyene ET, Schmidt WP, Ross I, Jin Y, Bizuneh DB. Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200541. [PMID: 38834532 PMCID: PMC11216697 DOI: 10.9745/ghsp-d-22-00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/30/2024] [Indexed: 06/06/2024]
Abstract
In sanitation policies, "improved sanitation" is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; P=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; P=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; P=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.
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Affiliation(s)
- Seungman Cha
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
| | - Sunghoon Jung
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Ermias Tadesse Beyene
- Department of Human Ecology and Technology, Graduate School of Advanced Convergence, Handong Global University, Pohang, South Korea
| | - Wolf-Peter Schmidt
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ian Ross
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, Korea
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Sahiledengle B, Agho K. Determinants of Childhood Diarrhea in Households with Improved Water, Sanitation, and Hygiene (WASH) in Ethiopia: Evidence from a Repeated Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211025180. [PMID: 34220201 PMCID: PMC8221697 DOI: 10.1177/11786302211025180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Determinants of childhood diarrhea in households with improved WASH (ie, households with improved drinking water sources, improved sanitation facilities, and those who practiced safe child stool disposal) are limited. This study aimed to identify the determinants of diarrhea among under-five children exclusively in households with improved Water, Sanitation, and Hygiene (WASH). METHODS A repeated cross-sectional study design was followed, and data from the Demographic and Health Survey (DHS) conducted between 2005 and 2016 in Ethiopia was used. A total of 1,975 child-mother pairs (257 children with diarrhea and 1718 children without diarrhea) in households with improved WASH were included in this study. Hierarchical conditional logistic regression models were used. Adjusted odds ratios (AOR) with corresponding 95% confidence intervals (CI) were estimated to determine the strength of association. RESULTS Children aged 13 to 24 months (Adjusted Odds Ratio [AOR] = 2.70, 95%CI: 1.69-4.32), children who did not receive the measles vaccine (AOR = 2.33, 95%CI: 1.60-3.39), and those residing in the agrarian region (AOR = 1.66, 95%CI: 1.10-2.49) were significantly more likely to develop diarrheal morbidity. The size of the child at birth was also found to be significantly associated with diarrheal morbidity. CONCLUSION In this study, child factors (age of the child, vaccinated for measles, and the size of a child at birth), and household-related factors (contextual region) had a significant effect on the risk of childhood diarrheal morbidity in households with improved WASH in Ethiopia.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Agho
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia
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Bharti R, Dhillon P, Narzary PK. A spatial analysis of childhood stunting and its contextual correlates in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2019.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Arbi Care application increases preschool children's hand-washing self-efficacy among preschool children. ENFERMERIA CLINICA 2019. [PMID: 29650200 DOI: 10.1016/s1130-8621(18)30031-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This research aimed to examine the effectiveness of an Android mobile game application called Arbi Care as a means to prevent diarrhea and build self-efficacy in hand washing among preschool children. METHOD This research used a pre- and post-test control group and time series design approach. Respondents were chosen randomly from a group of four to six years children. The intervention group (n = 60) received Arbi Care intervention for 25 minutes, twice a week, for five weeks while the control group (n = 60) received standard education. Self-efficacy was measured by using questionnaire and observation. Measurement was carried out three times in the sixth, eight, and tenth week post-intervention. The data was analyzed using the GLMRM test. RESULTS There was a significant increase in the average score of self-efficacy in hand washing for the intervention group versus the control group. Moreover, there were significant differences in the results of average scores in which the intervention group showed much better self-efficacy improvement over the control group during the first, second, and final post-test after the intervention was given (p < 0.001). CONCLUSIONS An Android-based educational game can be an effective medium to improve hand washing self-efficacy among preschool children, thus helping to prevent diarrhea.
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Arbianingsih, Rustina Y, Krianto T, Ayubi D. Arbi Care: an innovative educational game to increase healthy behavior in diarrhea prevention among preschoolers. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30171-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Berendes D, Leon J, Kirby A, Clennon J, Raj S, Yakubu H, Robb K, Kartikeyan A, Hemavathy P, Gunasekaran A, Roy S, Ghale BC, Kumar JS, Mohan VR, Kang G, Moe C. Household sanitation is associated with lower risk of bacterial and protozoal enteric infections, but not viral infections and diarrhoea, in a cohort study in a low-income urban neighbourhood in Vellore, India. Trop Med Int Health 2017; 22:1119-1129. [PMID: 28653489 PMCID: PMC5601219 DOI: 10.1111/tmi.12915] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective This study examined associations between household sanitation and enteric infection – including diarrhoeal‐specific outcomes – in children 0–2 years of age in a low‐income, dense urban neighbourhood. Methods As part of the MAL‐ED study, 230 children in a low‐income, urban, Indian neighbourhood provided stool specimens at 14–17 scheduled time points and during diarrhoeal episodes in the first 2 years of life that were analysed for bacterial, parasitic (protozoa and helminths) and viral pathogens. From interviews with caregivers in 100 households, the relationship between the presence (and discharge) of household sanitation facilities and any, pathogen‐specific, and diarrhoea‐specific enteric infection was tested through mixed‐effects Poisson regression models. Results Few study households (33%) reported having toilets, most of which (82%) discharged into open drains. Controlling for season and household socio‐economic status, the presence of a household toilet was associated with lower risks of enteric infection (RR: 0.91, 95% CI: 0.79–1.06), bacterial infection (RR: 0.87, 95% CI: 0.75–1.02) and protozoal infection (RR: 0.64, 95% CI: 0.39–1.04), although not statistically significant, but had no association with diarrhoea (RR: 1.00, 95% CI: 0.68–1.45) or viral infections (RR: 1.12, 95% CI: 0.79–1.60). Models also suggested that the relationship between household toilets discharging to drains and enteric infection risk may vary by season. Conclusions The presence of a household toilet was associated with lower risk of bacterial and protozoal enteric infections, but not diarrhoea or viral infections, suggesting the health effects of sanitation may be more accurately estimated using outcome measures that account for aetiologic agents.
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Affiliation(s)
- David Berendes
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Juan Leon
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy Kirby
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Clennon
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suraja Raj
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katharine Robb
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arun Kartikeyan
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Priya Hemavathy
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Annai Gunasekaran
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Sheela Roy
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Ben Chirag Ghale
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - J Senthil Kumar
- Department of Community Health, Christian Medical College, Vellore, India
| | | | - Gagandeep Kang
- Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Christine Moe
- Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Bawankule R, Singh A, Kumar K, Shetye S. Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study? PLoS One 2017; 12:e0169713. [PMID: 28076428 PMCID: PMC5226778 DOI: 10.1371/journal.pone.0169713] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumonia and diarrhea occur either as complications or secondary infections in measles affected children. So, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD) by WHO and UNICEF includes measles vaccination as preventive measure in children. The objective of the study is to examine the effect of measles vaccination on Acute Respiratory Infection (ARI) and diarrhea in children in the Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan. METHODS We analyzed data from the most recent rounds of Demographic and Health Surveys (DHS) in the selected countries. We included children age 12-59 months in the analysis. We used multivariable binary logistic regression to examine the effect of measles vaccination on ARI and diarrhea in children. We also estimated Vaccination Effectiveness (VE). FINDINGS More than 60 percent of the children age 12-59 months were given measles vaccine before the survey in the Democratic Republic of Congo, Ethiopia, India and Pakistan. Children who were given the measles vaccine were less likely to suffer from ARI than unvaccinated children in India and Pakistan. Children who were given the measles vaccine had a lower risk of diarrhea than those who did not receive it in all the selected countries except Ethiopia. Measles vaccination was associated with reduction in ARI cases by 15-30 percent in India and Pakistan, and diarrhea cases by 12-22 percent in the Democratic Republic of Congo, India, Nigeria and Pakistan. CONCLUSION The receipt of the measles vaccine was associated with decrease in ARI and diarrhea in children. The immunization program must ensure that each child gets the recommended doses of measles vaccine at the appropriate age. The measles vaccination should be given more attention as a preventive intervention under the Global Action Plan for Pneumonia and Diarrhea (GAPPD) in all low and middle-income countries.
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Affiliation(s)
- Rahul Bawankule
- International Institute for Population Sciences, Mumbai, India
| | - Abhishek Singh
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Kaushalendra Kumar
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Fuller JA, Eisenberg JNS. Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions. Am J Trop Med Hyg 2016; 95:1201-1210. [PMID: 27601516 PMCID: PMC5094239 DOI: 10.4269/ajtmh.15-0677] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/20/2016] [Indexed: 11/07/2022] Open
Abstract
Herd immunity arises when a communicable disease is less able to propagate because a substantial portion of the population is immune. Nonimmunizing interventions, such as insecticide-treated bednets and deworming drugs, have shown similar herd-protective effects. Less is known about the herd protection from drinking water, sanitation, and hand hygiene (WASH) interventions. We first constructed a transmission model to illustrate mechanisms through which different WASH interventions may provide herd protection. We then conducted an extensive review of the literature to assess the validity of the model results and identify current gaps in research. The model suggests that herd protection accounts for a substantial portion of the total protection provided by WASH interventions. However, both the literature and the model suggest that sanitation interventions in particular are the most likely to provide herd protection, since they reduce environmental contamination. Many studies fail to account for these indirect effects and thus underestimate the total impact an intervention may have. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Just as it does in immunization policy, understanding the role of herd protection from WASH interventions can help inform coverage targets and strategies that indirectly protect those that are unable to be reached by WASH campaigns. Toward this end, studies are needed to confirm the differential role that herd protection plays across the WASH interventions suggested by our transmission model.
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Affiliation(s)
- James A Fuller
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
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Gretsch SR, Ampofo JA, Baker KK, Clennon J, Null CA, Peprah D, Reese H, Robb K, Teunis P, Wellington N, Yakubu H, Moe CL. Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana. JOURNAL OF WATER AND HEALTH 2016; 14:255-266. [PMID: 27105411 DOI: 10.2166/wh.2015.138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In low-income countries, rapid urbanization adds pressure to already stressed water and sanitation systems that are critical to the health of communities. Drainage networks, designed for stormwater but commonly used for disposing of waste, are rarely covered completely, allowing residents to easily come into contact with their contents. This study used spatial mapping, documentation of physical drain characteristics, microbiological analysis of drain samples, and behavioral observation to comprehensively examine drains as a route of exposure to fecal contamination in four low-income neighborhoods in Accra, Ghana. A stochastic model of six likely exposure scenarios was constructed to estimate children's exposure to drain water. Regardless of the age of the child, any exposure scenario considered resulted in exposure to a high level of fecal contamination. Fecal contamination levels in drains were high (Escherichia coli: geometric mean (GM), 8.60 cfu log(10)/100 mL; coliphage: GM, 5.56 pfu log(10)/100 mL), and did not differ by neighborhood or physical drain characteristics, indicating that frequency of contact with drains, and not drain type or location, drives exposure risk. To mitigate health risks associated with this exposure, drains should be covered, with priority given to large concrete and small to medium dirt-lined drains that children were most commonly observed entering.
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Affiliation(s)
- Stephanie R Gretsch
- Center for Global Safe Water, Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Joseph A Ampofo
- Council for Scientific and Industrial Research, Water Research Institute, Accra, Ghana
| | - Kelly K Baker
- Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA; Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Julie Clennon
- Center for Global Safe Water, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Clair A Null
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: ; Mathematica Policy Research, Princeton, NJ, USA; Radcliffe Institute for Advanced Study, Cambridge, MA, USA
| | - Dorothy Peprah
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Heather Reese
- Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Katharine Robb
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Peter Teunis
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: ; Radcliffe Institute for Advanced Study, Cambridge, MA, USA; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nii Wellington
- Training Research and Networking for Development (TREND Group), Accra, Ghana
| | - Habib Yakubu
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Christine L Moe
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
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Kone GK, Lalou R, Audibert M, Lafarge H, Dos Santos S, Ndonky A, Le Hesran JY. Use of health care among febrile children from urban poor households in Senegal: does the neighbourhood have an impact? Health Policy Plan 2015; 30:1307-19. [PMID: 25769739 DOI: 10.1093/heapol/czu144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/12/2022] Open
Abstract
Urban malaria is considered a major public health problem in Africa. The malaria vector is well adapted in urban settings and autochthonous malaria has increased. Antimalarial treatments prescribed presumptively or after rapid diagnostic tests are also highly used in urban settings. Furthermore, health care strategies for urban malaria must comply with heterogeneous neighbourhood ecosystems where health-related risks and opportunities are spatially varied. This article aims to assess the capacity of the urban living environment to mitigate or increase individual or household vulnerabilities that influence the use of health services. The data are drawn from a survey on urban malaria conducted between 2008 and 2009. The study sample was selected using a two-stage randomized sampling. The questionnaire survey covered 2952 households that reported a case of fever episode in children below 10 years during the month before the survey.Self-medication is a widespread practice for children, particularly among the poorest households in Dakar. For rich households, self-medication for children is more a transitional practice enabling families to avoid opportunity costs related to visits to health facilities. For the poorest, it is a forced choice and often the only treatment option. However, the poor that live in well-equipped neighbourhoods inhabited by wealthy residents tend to behave as their rich neighbours. They grasp the opportunities provided by the area and adjust their behaviours accordingly. Though health care for children is strongly influenced by household socio-economic characteristics, neighbourhood resources (facilities and social networks) will promote health care among the poorest and reduce access inequalities. Without being a key factor, the neighbourhood of residence-when it provides resources-may be of some help to overcome the financial hurdle. Findings suggest that the neighbourhood (local setting) is a relevant scale for health programmes in African cities.
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Affiliation(s)
- Georges Karna Kone
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR CHUM) et Université de Daloa (Cote d'ivoire), 850 rue saint Denis Montréal, Canada,
| | - Richard Lalou
- UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France
| | - Martine Audibert
- CERDI, CNRS, 65 Boulevard François Mitterrand, 63000 Clermont-Ferrand, France
| | - Hervé Lafarge
- University of Paris Dauphine 32, avenue Henri Varagnat 93143 Bondy cedex, France
| | - Stéphanie Dos Santos
- UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France
| | - Alphousseyni Ndonky
- UMR 151 IRD/AMU, Laboratoire Population-Environnement-Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France
| | - Jean-Yves Le Hesran
- University of Paris Dauphine 32, avenue Henri Varagnat 93143 Bondy cedex, France
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Sima LC, Ng R, Elimelech M. Modeling risk categories to predict the longitudinal prevalence of childhood diarrhea in Indonesia. Am J Trop Med Hyg 2013; 89:884-91. [PMID: 24019442 PMCID: PMC3820331 DOI: 10.4269/ajtmh.12-0540] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 07/30/2013] [Indexed: 11/07/2022] Open
Abstract
We present an innovative approach for analyzing diarrheal prevalence data that uses latent variables to model the relationships between multiple, interdependent environmental risk factors, and socioeconomic mediators. This strategy was applied to elucidate diarrheal longitudinal prevalence risk factors in children 1-4 years of age in low-income areas of Jakarta, Indonesia. Through a prospective cohort study, we identified 257 children who had at least one episode of diarrhea. At the onset of the study, we collected responses to 44 indicators, covering a wide range of previously identified diarrhea risk factors, including demographic and socioeconomic factors. We used exploratory factor analysis to uncover four latent categories of risk factors and their respective indicators from the initial pool of 44 indicators. Thereafter, we used structural equation modeling to model the relationships between the four risk categories and diarrheal longitudinal prevalence, controlling for socioeconomic and demographic covariates. Our final model elucidated several pathways to longitudinal diarrheal prevalence. Most notably, poverty exerts its effect on increased diarrheal prevalence via dual pathways: poor household hygiene and food quality, controlling for covariates. Implications of this and other findings for disease control in Jakarta are discussed.
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Affiliation(s)
| | | | - Menachem Elimelech
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut; School of Public Health, Yale University, New Haven, Connecticut
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Monahan LJ, Calip GS, Novo PM, Sherstinsky M, Casiano M, Mota E, Dourado I. Impact of the Family Health Program on gastroenteritis in children in Bahia, Northeast Brazil: an analysis of primary care-sensitive conditions. J Epidemiol Glob Health 2013; 3:175-85. [PMID: 23932060 PMCID: PMC3741617 DOI: 10.1016/j.jegh.2013.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 11/29/2022] Open
Abstract
In seeking to provide universal health care through its primary care-oriented Family Health Program, Brazil has attempted to reduce hospitalization rates for preventable illnesses such as childhood gastroenteritis. We measured rates of Primary Care-sensitive Hospitalizations and evaluated the impact of the Family Health Program on pediatric gastroenteritis trends in high-poverty Northeast Brazil. We analyzed aggregated municipal-level data in time-series between years 1999–2007 from the Brazilian health system payer database and performed qualitative, in-depth key informant interviews with public health experts in municipalities in Bahia. Data were sampled for Bahia’s Salvador microregion, a population of approximately 14 million. Gastroenteritis hospitalization rates among children aged less than 5 years were evaluated. Declining hospitalization rates were associated with increasing coverage by the PSF (P = 0.02). After multivariate adjustment for garbage collection, sanitation, and water supply, evidence of this association was no longer significant (P = 0.28). Qualitative analysis confirmed these findings with a framework of health determinants, proximal causes, and health system effects. The PSF, with other public health efforts, was associated with decreasing gastroenteritis hospitalizations in children. Incentives for providers and more patient-centered health delivery may contribute to strengthening the PSF’s role in improving primary health care outcomes in Brazil.
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Affiliation(s)
- Laura J Monahan
- Division of Pediatric Critical Care, New York University School of Medicine, 462 1st Avenue, Suite 8S7-8, New York, NY 10016, USA.
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