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Kepha S, Mazigo HD, Odiere MR, Mcharo C, Safari T, Gichuki PM, Omondi W, Wakesho F, Krolewiecki A, Pullan RL, Mwandawiro CS, Oswald WE, Halliday KE. Exploring factors associated with Trichuris trichiura infection in school children in a high-transmission setting in Kenya. IJID REGIONS 2024; 11:100352. [PMID: 38634069 PMCID: PMC11021359 DOI: 10.1016/j.ijregi.2024.03.007] [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: 12/02/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Objectives Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of Trichuris trichiura, there is a need to understand the drivers of persistent infection despite ongoing treatment programs. Methods This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for T. trichiura. After this, we conducted a nested case-control study wherein all children positive for T. trichiura (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with T. trichiura were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of T. trichiura were investigated through multilevel logistic regression, considering clustering of infection. Results Overall, 34.4% of the children were infected with at least one STH species; T. trichiura was the most common (28.3%), 89.1% of those with T. trichiura had light-intensity infections. The prevalence of T. trichiura was significantly higher in male children and was positively associated with younger age and number of people infected with T. trichiura in a household. The parasitological cure rate and egg reduction rate of T. trichiura were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and Ascaris lumbricoides (5.7%). Conclusions T. trichiura remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization-recommended thresholds. Because of the observed focal transmission of T. trichiura in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission.
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Affiliation(s)
- Stella Kepha
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Humphrey D. Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Maurice R. Odiere
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Carlos Mcharo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Th'uva Safari
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Paul M. Gichuki
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wykcliff Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Florence Wakesho
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Alejandro Krolewiecki
- Universidad Nacional de Salta, Instituto de Investigaciones de Enfermedades Tropicales/CONICET, Oran, Salta, Argentina
| | - Rachel L. Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles S. Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - William E. Oswald
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine E. Halliday
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Li J, Xu Z, Wang H, Li L, Zhu H. Geospatial analysis of spatial distribution, patterns, and relationships of health status in the belt and road initiative. Sci Rep 2024; 14:204. [PMID: 38168550 PMCID: PMC10761736 DOI: 10.1038/s41598-023-50663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
The Health Silk Road plays a crucial role in the Belt and Road Initiative, and comprehending the health status within the participating countries is fundamental for fostering cooperation in public health. This paper collected five health indicators to represent the health status of the Belt and Road countries. Employing spatial statistics, the spatial patterns of health indicators and the associations with influencing factors were investigated. The utilized spatial statistics encompass spatial autocorrelation methods, geographical detector and spatial lag model. The results revealed obvious disparities and significant positive spatial autocorrelation of health indicators within the Belt and Road countries. Specifically, countries in Sub-Saharan Africa exhibited significant clustering of limited health indicators, while countries in Europe and Central Asia demonstrated significant clustering of robust health indicators. Furthermore, the health indicators exhibited significant spatial heterogeneity and association with the influencing factors. Universal health coverage, household air pollution, and the prevalence of undernourishment emerge as influential factors affecting health indicators. Overall, our findings highlighted complex influencing factors that contributed to the profound health inequalities across the Belt and Road countries. These factors should be duly considered in public health collaborations within the Belt and Road Initiative.
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Affiliation(s)
- Jie Li
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China
- Key Laboratory of Philosophy and Social Sciences in Guangdong Province of Maritime Silk Road of Guangzhou University (GD22TWCXGC15), Guangzhou, 510006, China
| | - Zejia Xu
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China
| | - Hongxi Wang
- Guangdong Federation of Social Sciences, Guangzhou, 510000, China
| | - Lingling Li
- Guangdong Federation of Social Sciences, Guangzhou, 510000, China
| | - Hong Zhu
- School of Geographical Sciences and Remote Sensing, Guangzhou University, Guangzhou, 510006, China.
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Ahmed A, Sayeed A, Tanwi TS, Saha N, Hanson M, Protyai DA, Hossain AT, Ahmed A, Rahman F, Akter E, Nusrat N, Badsha MS, Rahman A, Islam MK, Alam MS, Nahar Q, Arifeen SE, Rahman AE, Tahsina T. Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys. BMC Res Notes 2023; 16:303. [PMID: 37908017 PMCID: PMC10619219 DOI: 10.1186/s13104-023-06555-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023] Open
Abstract
Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.
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Affiliation(s)
- Anisuddin Ahmed
- Department of Women's and Children's Health, Uppsala University, 75205, Uppsala, Sweden.
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
| | - Abu Sayeed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tania Sultana Tanwi
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nondo Saha
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Molly Hanson
- Department of Women's and Children's Health, Uppsala University, 75205, Uppsala, Sweden
| | | | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ali Ahmed
- Western Sydney University, Penrith Campus, Sydney, Australia
| | - Fariya Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ema Akter
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nowrin Nusrat
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Md Shawon Badsha
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Afruna Rahman
- Infectious Disease Division (IDD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - Md Shah Alam
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Quamrun Nahar
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Essuman MA, Storph RP, Ahinkorah BO, Budu E, Yaya S. Hygienic Disposal of Children's Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa. ENVIRONMENTAL HEALTH INSIGHTS 2023; 17:11786302231204764. [PMID: 37899844 PMCID: PMC10605691 DOI: 10.1177/11786302231204764] [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: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results The overall prevalence of hygienic disposal of children's stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child's diarrhoea stool hygienically than their counterparts. Conclusion The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children's stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children's defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Geleijnse J, Rutten M, de Villiers D, Bamwenda JT, Abraham E. Enhancing water access monitoring through mapping multi-source usage and disaggregated geographic inequalities with machine learning and surveys. Sci Rep 2023; 13:13433. [PMID: 37596313 PMCID: PMC10439218 DOI: 10.1038/s41598-023-39917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023] Open
Abstract
Monitoring safe water access in developing countries relies primarily on household health survey and census data. These surveys are often incomplete: they tend to focus on the primary water source only, are spatially coarse, and usually happen every 5-10 years, during which significant changes can happen in urbanisation and infrastructure provision, especially in sub Saharan Africa. In this work, we present a data-driven approach that utilises and compliments survey based data of water access, to provide context-specific and disaggregated monitoring. The level of access to improved water and sanitation has been shown to vary with geographical inequalities related to the availability of water resources and terrain, population density and socio-economic determinants such as income and education. We use such data and successfully predict the level of water access in areas for which data is lacking, providing spatially explicit and community level monitoring possibilities for mapping geographical inequalities in access. This is showcased by applying three machine learning models that use such geographical data to predict the number of presences of water access points of eight different access types across Uganda, with a 1km by 1km grid resolution. Two Multi-Layer-Perceptron (MLP) models and a Maximum Entropy (MaxEnt) model are developed and compared, where the former are shown to consistently outperform the latter. The best performing Neural Network model achieved a True Positive Rate of 0.89 and a False Positive Rate of 0.24, compared to 0.85 and 0.46 respectively for the MaxEnt model. The models improve on previous work on water point modeling through the use of neural networks, in addition to introducing the True Positive - and False Positive Rate as better evaluation metrics to also assess the MaxEnt model. We also present a scaling method to move from predicting only the relative probability of water point presences, to predicting the absolute number of presences. To challenge both the model results and the more standard health surveys, a new household level survey is carried out in Bushenyi, a mid-sized town in the South-West of Uganda, asking specifically about the multitude of water sources. On average Bushenyi households reported to use 1.9 water sources. The survey further showed that the actual presence of a source, does not always imply that it is used. Therefore it is no option to rely solely on models for water access monitoring. For this, household surveys remain necessary but should be extended with questions on the multiple sources that are used by households.
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Affiliation(s)
- Jan Geleijnse
- Department of Water Management, Delft University of Technology, Mekelweg, 2628 CD, Delft, The Netherlands.
- UNICEF, Nairobi, Kenya.
| | - Martine Rutten
- Department of Water Management, Delft University of Technology, Mekelweg, 2628 CD, Delft, The Netherlands
| | - Didier de Villiers
- Department of Water Management, Delft University of Technology, Mekelweg, 2628 CD, Delft, The Netherlands
| | | | - Edo Abraham
- Department of Water Management, Delft University of Technology, Mekelweg, 2628 CD, Delft, The Netherlands
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An Epidemiological Survey of Intestinal Parasitic Infection and the Socioeconomic Status of the Ethnic Minority People of Moken and Orang Laut. Trop Med Infect Dis 2023; 8:tropicalmed8030161. [PMID: 36977162 PMCID: PMC10055958 DOI: 10.3390/tropicalmed8030161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Ethnic minority groups are often subjected to exclusion, social and healthcare marginalization, and poverty. There appears to be important linkages between ethnic minority groups, poor socioeconomic status, and a high prevalence of parasitic infection. Data regarding the prevalence and health effects of IPIs are necessary in the development and implementation of targeted prevention and control strategies to eradicate intestinal parasitic infection in the high-risk population. Thus, we investigated for the first time the intestinal parasitic infection status (IPIs), the socioeconomic status, and sanitary condition in the communities of Moken and Orang Laut, the ethnic minority peoples living on the coast of southwest Thailand. A total of 691 participants participated in the present study. The information concerning socioeconomic status and sanitary condition of the study population was obtained by personal interviews using a picture questionnaire. Stool samples were collected and examined for intestinal parasitic infection using direct wet smear and formalin-ethyl acetate concentration techniques. The results revealed that 62% of the study population were infected with one or more types of intestinal parasites. The highest prevalence of intestinal parasitic infections was found in the 11–20-year-old age range group. A statistically significant difference of IPIs among the three communities were observed (p < 0.0001). There was a statistical difference concerning 44 multiple infections of soil-transmitted helminths (STHs) (p < 0.001), whereas no statistically significant difference in multiple infections of protozoa was observed (p > 0.55). The results also displayed the significant difference in socioeconomic status and sanitary condition among the Moken living in Ranong and Phang Nga and the Orang Laut living in the Satun province (p < 0.001). Our study found no direct association between parasitic infection status and ethnic/geographic features; however, socioeconomic status is the key factor associated with prevalence of intestinal parasitic infection, with the observation that the higher prevalence of IPIs is due to a low socioeconomic status, consequently leading to poor hygiene and sanitation practices. The picture questionnaire played a major role in information gathering, especially from those of low or no education. Lastly, data pertaining to the species of the parasites and the mode of transmission assisted in the identification of group-specific vulnerabilities and shortcomings that can be utilized in education and corrected to reduce the prevalence of infection in the study areas.
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Challenges of sanitation in developing counties - Evidenced from a study of fourteen towns, Ethiopia. Heliyon 2023; 9:e12932. [PMID: 36747957 PMCID: PMC9898597 DOI: 10.1016/j.heliyon.2023.e12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/25/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Rapid urbanization and population growth in the past few decades has been worsening the water supply and sanitation problems in Ethiopia putting the current water supply deficit of the country at a staggering 41%. Using Ethiopia as a case of rapidly growing countries in the Global South and struggling with water supply and sanitation management, the objective of this study was to examine the challenges of sanitation in Ethiopia by selecting 14 towns located under different climatic conditions and administrative regions with diversified culture, ethnicity, and religion. Data from these towns were collected through household survey, Focus Group Discussion (FGD), Key Informant Interview (KII) and site visits. The field observation was conducted with representatives from the municipality who have knowledge on the existing sanitation and associated problems. Analysis of the collected data shows that poor water supply, inadequate toilet facilities, poor toilet facility emptying practices, poor community perceptions on sanitation management and inadequate emptying services were major challenges associated with sanitation. Moreover, absence of wastewater dumping site, lack of integration among the different components of sanitation, insufficient collaboration among potential stakeholders and gaps between the existing population and sanitation services were the other key challenges of sanitation exacerbated by inadequate financial resources. From the 14 studied towns the average water deficit was found 35%, and the average households with no toilet facilities were 17%. Only about 20% households have flushed toilets and about 5% practiced open defecation. While 42% of the households use vacuum trucks for emptying wastewaters and about 37% of the households dump wastewater outside of their premises. Among the studied 14 towns, only four towns have their own vacuum trucks, no town possesses wastewater dumping site. The different components of sanitation were managed separately without integration. Moreover, the collaboration among the potential stakeholders of sanitation management was found poor and fragmented. Also, sanitation services have not developed along with the population growth as the finance allocated to sanitation management is much lower compared to other municipal services. Thus, sanitation in the studied towns is poor, though there are progresses when compared with previous decades. To improve the sanitation condition in these towns the water supply should be improved together with raising the perception of the local community. The present study recommends further studies to be conducted on the feasibility of sustainable sanitation and "country-wide comprehensive" study on water supply, sanitation and open defecation in Ethiopian in particular and in developing countries as a whole.
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Belay H, Chernet M, Anjulo U, Mengistu B, Salasibew M, Tasew G, Anderson R. Association between water, sanitation, and hygiene access and the prevalence of soil-transmitted helminth and schistosome infections in Wolayita, Ethiopia. Parasit Vectors 2022; 15:410. [DOI: 10.1186/s13071-022-05465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
The Geshiyaro project is a 5-year intervention to assess the impact of community- and school-based water, sanitation, and hygiene (WaSH) interventions on reducing infection with soil-transmitted helminths (STH) and schistosome parasites in combination with deworming in Wolayita zone, Ethiopia.
Methods
A population-based, cross-sectional census and parasitological mapping activity was conducted between 2018 and 2019. Individuals in the census were identified using either a registered study ID card or biometric fingerprint to enable linkage of their household WaSH data with baseline STH and schistosome prevalence for risk analysis.
Results
Prevalence of STH was 15.5% for any STH species, 9.47% for Ascaris lumbricoides, 1.78% for Trichuris trichiura, and 7.24% for hookworm. Intestinal schistosomiasis (Schistosoma mansoni) infection prevalence was 0.85% by Kato Katz, 21.6% by POC-CCA trace positive (Tr +), and 13.3% trace negative (Tr-). Microhaematuria was 2.77%, with 0.13% of people examined with S. haematobium eggs detected by urine filtration. At the household level, increased (> 30 min) time taken to collect drinking water, sharing a latrine, and lack of handwashing facilities were all associated with a greater risk of A. lumbricoides, hookworm, and S. mansoni infection. Not disposing of infant stool at the household and clothes washing/recreational freshwater contact were significantly associated with higher risk of schistosomiasis infection. Aggregating WaSH data at the community level showed odds of A. lumbricoides, hookworm, and T. trichiura infection were significantly lower as both community sanitation coverage and access to improved drinking water improved.
Conclusions
The principal finding of this study is that lack of access to WaSH, such as improved drinking water and shared toilet and hand-washing facilities, were linked to an increased risk of infection with STH and schistosome parasites. These associations are difficult to establish at an individual household level because of wide variability in access between houses but are detectable when coverage is aggregated at the community level. Maintenance of WaSH facilities as well as increased access within the whole community is important in influencing the community-wide prevalence of infection with STH and schistosome parasites.
Graphical Abstract
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Tetteh JD, Templeton MR, Cavanaugh A, Bixby H, Owusu G, Yidana SM, Moulds S, Robinson B, Baumgartner J, Annim SK, Quartey R, Mintah SE, Bawah AA, Arku RE, Ezzati M, Agyei-Mensah S. Spatial heterogeneity in drinking water sources in the Greater Accra Metropolitan Area (GAMA), Ghana. POPULATION AND ENVIRONMENT 2022; 44:46-76. [PMID: 35974746 PMCID: PMC9371963 DOI: 10.1007/s11111-022-00407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Universal access to safe drinking water is essential to population health and well-being, as recognized in the Sustainable Development Goals (SDG). To develop targeted policies which improve urban access to improved water and ensure equity, there is the need to understand the spatial heterogeneity in drinking water sources and the factors underlying these patterns. Using the Shannon Entropy Index and the Index of Concentration at the Extremes at the enumeration area level, we analyzed census data to examine the spatial heterogeneity in drinking water sources and neighborhood income in the Greater Accra Metropolitan Area (GAMA), the largest urban agglomeration in Ghana. GAMA has been a laboratory for studying urban growth, economic security, and other concomitant socio-environmental and demographic issues in the recent past. The current study adds to this literature by telling a different story about the spatial heterogeneity of GAMA's water landscape at the enumeration area level. The findings of the study reveal considerable geographical heterogeneity and inequality in drinking water sources not evidenced in previous studies. We conclude that heterogeneity is neither good nor bad in GAMA judging by the dominance of both piped water sources and sachet water (machine-sealed 500-ml plastic bag of drinking water). The lessons from this study can be used to inform the planning of appropriate localized solutions targeted at providing piped water sources in neighborhoods lacking these services and to monitor progress in achieving universal access to improved drinking water as recognized in the SDG 6 and improving population health and well-being.
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Affiliation(s)
- Jacob Doku Tetteh
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
| | - Michael R. Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | | | - Honor Bixby
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - George Owusu
- Institute of Statistical Social and Economic Research, University of Ghana, Accra, Ghana
| | | | - Simon Moulds
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Brian Robinson
- Department of Geography, McGill University, Montreal, Canada
| | - Jill Baumgartner
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | | | | | - Ayaga Agula Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Raphael E. Arku
- Department of Environmental Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Majid Ezzati
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon-Accra, Ghana
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Tseole NP, Mindu T, Kalinda C, Chimbari MJ. Barriers and facilitators to Water, Sanitation and Hygiene (WaSH) practices in Southern Africa: A scoping review. PLoS One 2022; 17:e0271726. [PMID: 35917339 PMCID: PMC9345477 DOI: 10.1371/journal.pone.0271726] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
A healthy and a dignified life experience requires adequate water, sanitation, and hygiene (WaSH) coverage. However, inadequate WaSH resources remain a significant public health challenge in many communities in Southern Africa. A systematic search of peer-reviewed journal articles from 2010 –May 2022 was undertaken on Medline, PubMed, EbscoHost and Google Scholar from 2010 to May 2022 was searched using combinations of predefined search terms with Boolean operators. Eighteen peer-reviewed articles from Southern Africa satisfied the inclusion criteria for this review. The general themes that emerged for both barriers and facilitators included geographical inequalities, climate change, investment in WaSH resources, low levels of knowledge on water borne-diseases and ineffective local community engagement. Key facilitators to improved WaSH practices included improved WaSH infrastructure, effective local community engagement, increased latrine ownership by individual households and the development of social capital. Water and sanitation are critical to ensuring a healthy lifestyle. However, many people and communities in Southern Africa still lack access to safe water and improved sanitation facilities. Rural areas are the most affected by barriers to improved WaSH facilities due to lack of WaSH infrastructure compared to urban settings. Our review has shown that, the current WaSH conditions in Southern Africa do not equate to the improved WaSH standards described in SDG 6 on ensuring access to water and sanitation for all. Key barriers to improved WaSH practices identified include rurality, climate change, low investments in WaSH infrastructure, inadequate knowledge on water-borne illnesses and lack of community engagement.
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Affiliation(s)
- Nkeka P. Tseole
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa
- * E-mail:
| | - Tafadzwa Mindu
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, South Africa
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Kigali, Rwanda
- Institute of Global Health Equity Research (IGHER), University of Global Health Equity (UGHE), Kigali, Rwanda
| | - Moses J. Chimbari
- Department of Behavioural Science, Medical and Health Sciences, Great Zimbabwe University, Masvingo, Zimbabwe
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11
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Spatiotemporal Analysis of the Proportion of Unimproved Drinking Water Sources in Rural Ethiopia: Evidence from Ethiopian Socioeconomic Surveys (2011 to 2019). JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2968756. [PMID: 35342435 PMCID: PMC8942695 DOI: 10.1155/2022/2968756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Abstract
Currently, around 36% of the rural Ethiopian population is accessing drinking water from unimproved sources and it is unevenly distributed through time and geographic regions. Therefore, this study aimed to analyze the spatiotemporal patterns of unimproved drinking water sources and identify hotspot areas in rural Ethiopia. Ethiopian Socioeconomic Survey (ESS) data obtained from the Central Statistical Agency were used. It was conducted in four waves from 2011 to 2019. A two-stage probability sampling design was applied. The sample of enumeration areas and households were taken as the first and second stages of sampling, respectively. A total of 3912, 3775, 3698, and 3115 sample households with complete information on drinking water sources were taken in each wave of ESS data, respectively. Weighted proportions, autocorrelation (Moran's “I”) statistic, and hotspot analyses were applied to estimate the prevalence, test the presence of clustering, and identify vulnerable areas with unimproved drinking water sources. The STATA version 14, Excel, and ArcGIS 10.6 were used to manage and analyze data. The proportions of households with unimproved drinking water sources were 0.497, 0.385, 0.298, and 0.363 in consecutive waves of ESS data. The results also revealed the existence of geographical and temporal variations of access to drinking water from unimproved sources, and the most recent vulnerable (hotspot) areas in the borders of the West and East Gojjam zones in the western Amhara region, Zone one in southern Afar region, and Liben, Afder, Shebelle, Korahe, and Nobob zones in Somali region were identified. In conclusion, this study reveals significant geographic inequalities in the use of improved drinking water sources. This may be necessary for policies and coverage targeting the most vulnerable regions. The presented map and analytical approaches can provide a mechanism to monitor future reductions in inequality within countries by reflecting resource allocation priorities.
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12
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Zou S, Qi X, Marshall K, Bhura M, Takesue R, Tang K. Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on Andersen behavioural model. BMC Health Serv Res 2022; 22:144. [PMID: 35120503 PMCID: PMC8815172 DOI: 10.1186/s12913-022-07530-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC. METHODS Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further. RESULTS The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009). CONCLUSION Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.
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Affiliation(s)
- Siyu Zou
- Vanke School of Public Health, Tsinghua University, Beijing, 100191, China.,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xinran Qi
- School of Nursing, Capital Medical University, Beijing, China
| | - Keiko Marshall
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Maria Bhura
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rie Takesue
- Health Section Programme Division, UNICEF Headquarters, New York, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, 100191, China.
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13
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Lord J, Thomas A, Treat N, Forkin M, Bain R, Dulac P, Behroozi CH, Mamutov T, Fongheiser J, Kobilansky N, Washburn S, Truesdell C, Lee C, Schmaelzle PH. Global potential for harvesting drinking water from air using solar energy. Nature 2021; 598:611-617. [PMID: 34707305 PMCID: PMC8550973 DOI: 10.1038/s41586-021-03900-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/11/2021] [Indexed: 11/09/2022]
Abstract
Access to safely managed drinking water (SMDW) remains a global challenge, and affects 2.2 billion people1,2. Solar-driven atmospheric water harvesting (AWH) devices with continuous cycling may accelerate progress by enabling decentralized extraction of water from air3-6, but low specific yields (SY) and low daytime relative humidity (RH) have raised questions about their performance (in litres of water output per day)7-11. However, to our knowledge, no analysis has mapped the global potential of AWH12 despite favourable conditions in tropical regions, where two-thirds of people without SMDW live2. Here we show that AWH could provide SMDW for a billion people. Our assessment-using Google Earth Engine13-introduces a hypothetical 1-metre-square device with a SY profile of 0.2 to 2.5 litres per kilowatt-hour (0.1 to 1.25 litres per kilowatt-hour for a 2-metre-square device) at 30% to 90% RH, respectively. Such a device could meet a target average daily drinking water requirement of 5 litres per day per person14. We plot the impact potential of existing devices and new sorbent classes, which suggests that these targets could be met with continued technological development, and well within thermodynamic limits. Indeed, these performance targets have been achieved experimentally in demonstrations of sorbent materials15-17. Our tools can inform design trade-offs for atmospheric water harvesting devices that maximize global impact, alongside ongoing efforts to meet Sustainable Development Goals (SDGs) with existing technologies.
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Affiliation(s)
- Jackson Lord
- X, The Moonshot Factory, Mountain View, CA, USA.
| | | | - Neil Treat
- X, The Moonshot Factory, Mountain View, CA, USA
| | | | - Robert Bain
- WHO/UNICEF Joint Monitoring Programme, Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA
| | | | | | | | | | | | | | | | - Clare Lee
- X, The Moonshot Factory, Mountain View, CA, USA
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14
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Cha S, Jin Y, Elhag MS, Kim Y, Ismail HAHA. Unequal geographic distribution of water and sanitation at the household and school level in Sudan. PLoS One 2021; 16:e0258418. [PMID: 34653204 PMCID: PMC8519438 DOI: 10.1371/journal.pone.0258418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
The Sudanese Government launched the National SDG-6 Plan and commences its implementation to achieve and sustain universal and equitable access to basic WASH services by 2030. It is critical to understand the geographical heterogeneity of Sudan and patterns in the inequality of access to safe drinking water and sanitation. Through such research, the disease control strategy can be optimized, and resource allocation can be prioritized. We explored spatial heterogeneity and inequality in access to improved water and sanitation across Sudan by mapping the coverage at both the state and district levels. We decomposed the inequality across Sudan into within-state, between-state, within-district, and between-state inequalities using the Theil L and Theil T indices. We calculated the Gini coefficient to assess the inequality of access to improved water and sanitation, based on the deviation of the Lorenz curve from the line of perfect equality. The study population was 105,167 students aged 8–13 at 1,776 primary schools across the country. Geographical heterogeneity was prominent in the Central Darfur, South Darfur, East Darfur, Kassala, West Kordofan, and Blue Nile States, all of which showed severe inequality in access to an improved latrine at the household level in terms of the Theil T or Theil L index. The overall inequality in the coverage of improved sanitation went beyond the warning limit of 0.4 for the Gini coefficient. The inequality in terms of the Theil L and Theil T indices, as well as the Gini coefficient, was always higher for improved sanitation than for improved water at the household level. Within-state inequality accounted for 66% or more of national inequalities in the distribution of improved sanitation and drinking water for both the Theil L and Theil T indices. This is the first study to measure geographical heterogeneity and inequalities in improved water and sanitation coverage across Sudan. The study may help to prioritize resource allocation to areas with the greatest water and sanitation needs.
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Affiliation(s)
- Seungman Cha
- Department of Disease Control, 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
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Mousab Siddig Elhag
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Youngjin Kim
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
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15
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Oskam MJ, Pavlova M, Hongoro C, Groot W. Socio-Economic Inequalities in Access to Drinking Water among Inhabitants of Informal Settlements in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910528. [PMID: 34639828 PMCID: PMC8507892 DOI: 10.3390/ijerph181910528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/28/2022]
Abstract
While evidence from several developing countries suggests the existence of socio-economic inequalities in the access to safe drinking water, a limited number of studies have been conducted on this topic in informal settlements. This study assessed socio-economic inequalities in the use of drinking water among inhabitants of informal settlements in South Africa. The study used data from “The baseline study for future impact evaluation for informal settlements targeted for upgrading in South Africa.” Households eligible for participation were living in informal settlements targeted for upgrading in all nine provinces of South Africa. Socio-economic inequalities were assessed by means of multinomial logistic regression analyses, concentration indices, and concentration curves. The results showed that the use of a piped tap on the property was disproportionately concentrated among households with higher socio-economic status (concentration index: +0.17), while households with lower socio-economic status were often limited to the use of other inferior (less safe or distant) sources of drinking water (concentration index for nearby public tap: −0.21; distant public tap: −0.17; no-tap water: −0.33). The use of inferior types of drinking water was significantly associated with the age, the marital status, the education status, and the employment status of the household head. Our results demonstrate that reducing these inequalities requires installing new tap water points in informal settlements to assure a more equitable distribution of water points among households. Besides, it is recommended to invest in educational interventions aimed at creating awareness about the potential health risks associated with using unsafe drinking water.
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Affiliation(s)
- Marieke J. Oskam
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616 6200MD Maastricht, The Netherlands; (M.P.); (W.G.)
- Correspondence:
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616 6200MD Maastricht, The Netherlands; (M.P.); (W.G.)
| | - Charles Hongoro
- Peace and Sustainable Security (PaSS), Developmental, Capable and Ethical State Division, Human Sciences Research Council, 134 Pretorius Street, Private Bag X41, Pretoria 0001, South Africa;
- School of Health Systems and Public Health, University of Pretoria, Private Bag X323, Pretoria 0001, South Africa
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616 6200MD Maastricht, The Netherlands; (M.P.); (W.G.)
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16
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Dacal E, Bermejo-Peláez D, Lin L, Álamo E, Cuadrado D, Martínez Á, Mousa A, Postigo M, Soto A, Sukosd E, Vladimirov A, Mwandawiro C, Gichuki P, Williams NA, Muñoz J, Kepha S, Luengo-Oroz M. Mobile microscopy and telemedicine platform assisted by deep learning for the quantification of Trichuris trichiura infection. PLoS Negl Trop Dis 2021; 15:e0009677. [PMID: 34492039 PMCID: PMC8448303 DOI: 10.1371/journal.pntd.0009677] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 09/17/2021] [Accepted: 07/21/2021] [Indexed: 11/18/2022] Open
Abstract
Soil-transmitted helminths (STH) are the most prevalent pathogens among the group of neglected tropical diseases (NTDs). The Kato-Katz technique is the diagnosis method recommended by the World Health Organization (WHO) although it often presents a decreased sensitivity in low transmission settings and it is labour intensive. Visual reading of Kato-Katz preparations requires the samples to be analyzed in a short period of time since its preparation. Digitizing the samples could provide a solution which allows to store the samples in a digital database and perform remote analysis. Artificial intelligence (AI) methods based on digitized samples can support diagnosis by performing an objective and automatic quantification of disease infection. In this work, we propose an end-to-end pipeline for microscopy image digitization and automatic analysis of digitized images of STH. Our solution includes (a) a digitization system based on a mobile app that digitizes microscope samples using a 3D printed microscope adapter, (b) a telemedicine platform for remote analysis and labelling, and (c) novel deep learning algorithms for automatic assessment and quantification of parasitological infections by STH. The deep learning algorithm has been trained and tested on 51 slides of stool samples containing 949 Trichuris spp. eggs from 6 different subjects. The algorithm evaluation was performed using a cross-validation strategy, obtaining a mean precision of 98.44% and a mean recall of 80.94%. The results also proved the potential of generalization capability of the method at identifying different types of helminth eggs. Additionally, the AI-assisted quantification of STH based on digitized samples has been compared to the one performed using conventional microscopy, showing a good agreement between measurements. In conclusion, this work has presented a comprehensive pipeline using smartphone-assisted microscopy. It is integrated with a telemedicine platform for automatic image analysis and quantification of STH infection using AI models.
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Affiliation(s)
| | | | - Lin Lin
- Spotlab, Madrid, Spain
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Charles Mwandawiro
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Paul Gichuki
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Nana Aba Williams
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Stella Kepha
- Eastern and Southern Africa Center for International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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17
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Mapping socioeconomic inequalities in malaria in Sub-Sahara African countries. Sci Rep 2021; 11:15121. [PMID: 34302015 PMCID: PMC8302762 DOI: 10.1038/s41598-021-94601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/13/2021] [Indexed: 01/05/2023] Open
Abstract
Despite reductions in malaria incidence and mortality across Sub-Saharan (SSA) countries, malaria control and elimination efforts are currently facing multiple global challenges such as climate and land use change, invasive vectors, and disruptions in healthcare delivery. Although relationships between malaria risks and socioeconomic factors have been widely demonstrated, the strengths and variability of these associations have not been quantified across SSA. In this study, we used data from population-based malaria indicator surveys in SSA countries to assess spatial trends in relative and absolute socioeconomic inequalities, analyzed as social (mothers’ highest educational level—MHEL) and economic (wealth index—WI) inequalities in malaria prevalence. To capture spatial variations in socioeconomic (represented by both WI and MHEL) inequalities in malaria, we calculated both the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) in each administrative region. We also conducted cluster analyses based on Local Indicator of Spatial Association (LISA) to consider the spatial auto-correlation in SII and RII across regions and countries. A total of 47,404 participants in 1874 Primary Sampling Units (PSU) were analyzed across the 13 SSA countries. Our multi-country assessment provides estimations of strong socioeconomic inequalities between and within SSA countries. Such within- and between- countries inequalities varied greatly according to the socioeconomic metric and the scale used. Countries located in Eastern Africa showed a higher median Slope Index of Inequality (SII) and Relative Index of Inequality (RII) in malaria prevalence relative to WI in comparison to countries in other locations across SSA. Pockets of high SII in malaria prevalence in relation to WI and MHEL were observed in the East part of Africa. This study was able to map this wide range of malaria inequality metrics at a very local scale and highlighted the spatial clustering patterns of pockets of high and low malaria inequality values.
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18
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Legge H, Halliday KE, Kepha S, Mcharo C, Witek-McManus SS, El-Busaidy H, Muendo R, Safari T, Mwandawiro CS, Matendechero SH, Pullan RL, Oswald WE. Patterns and Drivers of Household Sanitation Access and Sustainability in Kwale County, Kenya. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:6052-6064. [PMID: 33826310 PMCID: PMC8154356 DOI: 10.1021/acs.est.0c05647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 05/08/2023]
Abstract
Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.
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Affiliation(s)
- Hugo Legge
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Katherine E. Halliday
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Stella Kepha
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Carlos Mcharo
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Stefan S. Witek-McManus
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Hajara El-Busaidy
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Redempta Muendo
- Department
of Health, County Government of Kwale, P.O. Box 4-80403, Kwale, Kenya
| | - Th’uva Safari
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Charles S. Mwandawiro
- Eastern
and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840-00200, Nairobi, Kenya
| | - Sultani H. Matendechero
- Division
of Vector Borne and Neglected Tropical Diseases Unit, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya
| | - Rachel L. Pullan
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - William E. Oswald
- Faculty
of Infectious and Tropical Diseases, London
School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
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19
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Swe KT, Rahman MM, Rahman MS, Teng Y, Abe SK, Hashizume M, Shibuya K. Impact of poverty reduction on access to water and sanitation in low- and lower-middle-income countries: country-specific Bayesian projections to 2030. Trop Med Int Health 2021; 26:760-774. [PMID: 33813768 DOI: 10.1111/tmi.13580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In 2017, 785 million people globally lacked access to basic services of drinking water and 2 billion people lived without basic sanitation services. Most of these people live in low- and lower-middle-income countries in South Asia, Southeast Asia and sub-Saharan Africa. To monitor the progress towards universal access to water and sanitation, this study aimed to predict the coverage of access to basic drinking water supply and sanitation (WSS) services as well as the reduction in the practice of open defecation by 2030, under two assumptions: following the current trends and accelerated poverty reduction. METHODS AND FINDINGS Households reporting access to basic WSS services and those practising open defecation were extracted from 210 nationally representative Demographic Health Surveys and Multiple Cluster Indicator Surveys (1994-2016) from 51 countries. A Bayesian hierarchical mixed effect linear regression model was developed to predict the indicators in 2030 at national, urban-rural and wealth-specific levels. A Bayesian regression model with accelerated reduction in poverty by 2030 was applied to assess the impact of poverty reduction on these indicators. Out of 51 countries, only nine (Bangladesh, Bhutan, Ghana, India, Nepal, Pakistan, The Philippines, Togo and Vietnam) were predicted to reach over 90% coverage in access to basic services of drinking water by 2030. However, none of the countries were projected to achieve equivalent coverage for access to basic sanitation services. By 2030, 21 countries were projected to achieve the target of less than 10% households practising open defecation. Urban-rural and wealth-derived disparities in access to basic WSS services, especially sanitation, were more pronounced in sub-Saharan Africa than South Asia and Southeast Asia. Access to basic sanitation services was projected to benefit more from poverty reduction than access to basic drinking water services. Households residing in rural settings were predicted to receive greater benefit from poverty reduction than urban populations in access to both basic WSS services. CONCLUSION Achieving poverty eradication targets may have a substantial positive impact on access to basic water supply and sanitation services. However, many low- and lower-middle-income countries will struggle to achieve the goal of universal access to basic services, especially in the sanitation sector.
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Affiliation(s)
- Khin Thet Swe
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.,Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Md Mizanur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Md Shafiur Rahman
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research Centre for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yvonne Teng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sarah Krull Abe
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Andualem Z, Dagne H, Azene ZN, Taddese AA, Dagnew B, Fisseha R, Muluneh AG, Yeshaw Y. Households access to improved drinking water sources and toilet facilities in Ethiopia: a multilevel analysis based on 2016 Ethiopian Demographic and Health Survey. BMJ Open 2021; 11:e042071. [PMID: 33737423 PMCID: PMC7978246 DOI: 10.1136/bmjopen-2020-042071] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to assess households access to improved drinking water sources and sanitation facilities and their associated factors in Ethiopia. DESIGN Cross-sectional study. SETTING Ethiopia. PARTICIPANTS Household heads. PRIMARY OUTCOMES Access to improved drinking water sources and toilet facilities. METHODS We conducted an in-depth secondary data analysis of 2016 Ethiopian Demographic and Health Survey. Data from a total of 16 650 households and 645 clusters were included in the analysis. The households were selected using a stratified two-stage cluster sampling technique. Multilevel binary logistic regression analyses were performed to identify factors associated with access to an improved drinking water source and toilet facilities. Adjusted OR with a 95% CI was reported with p value <0.05 was used to declare a significant association between the covariates and the outcome variables. RESULTS The proportions of households' access to improved sources of drinking water and toilet facilities were 69.94% (95% CI: 69.23% to 70.63%) and 25.36% (95% CI: 24.69% to 26.03%), respectively. Households headed by women and households with a better wealth index were positively associated with access to improved drinking water sources. Whereas rural households, ≥30 min round trip to obtain drinking water and region were factors negatively associated with households access to improved drinking water sources. A higher probability of having access to improved toilet facilities: households with heads who had attained higher education, households having better access to improved sources of drinking water and households with better wealth index. While the following households were less likely to have access to improved toilet facilities: households with heads were widowed, households with four to six members, rural households and region. CONCLUSION The study found that the proportions of households' access to improved drinking water sources and toilet facilities in Ethiopia were relatively low, which demands the need to tailor strategies to increase the coverage of access to improved drinking water sources and toilet facilities.
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Affiliation(s)
- Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Zelalem Nigussie Azene
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Asefa Adimasu Taddese
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196 Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196 Gondar, Ethiopia
| | - Roman Fisseha
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196 Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196 Gondar, Ethiopia
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Dongzagla A, Jewitt S, O'Hara S. Seasonality in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 752:141846. [PMID: 32892045 DOI: 10.1016/j.scitotenv.2020.141846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
This paper examines seasonal variations in faecal contamination of drinking water sources in the Jirapa and Kassena-Nankana Municipalities of Ghana. Data collection involved a survey of 568 households, testing of faecal coliform concentrations in drinking water source samples (141 in the rainy season, 128 in the dry season), in-depth interviews with key water stakeholders, and field observation to identify sources of faecal contamination. From the water quality testing, faecal coliforms were detected in all source types, including 'treated' pipe-borne water. Contamination was significantly higher in the rainy season than in the dry season (P < 0.05) with 51.8% of water samples in the rainy season and 27.3% in the dry season failing to meet the World Health Organisation and Ghana Standard Authority guideline on faecal coliform concentrations in drinking water sources. The proportion of population at risk of faecal contamination in the rainy season was 41.5% compared to 33.1% in the dry season. We argue that in Ghana and Sub-Saharan Africa at large, water surveillance agencies risk underestimating population exposed to faecal contamination through drinking water sources if monitoring is only done in the dry season. To avoid this, we recommend seasonal monitoring of faecal concentration in drinking water sources. However, in periods of limited resources, monitoring is most appropriate in the rainy season when the risk of contamination is high.
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Affiliation(s)
- Alfred Dongzagla
- Department of Planning, Faculty of Planning and Land Management, University for Development Studies, Tamale, Ghana.
| | - Sarah Jewitt
- School of Geography, University of Nottingham, NG7 2RD Nottingham, United Kingdom.
| | - Sarah O'Hara
- School of Geography, University of Nottingham, NG7 2RD Nottingham, United Kingdom. sarah.o'
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Damtew YT, Geremew A. Households with unimproved water sources in Ethiopia: spatial variation and point-of-use treatment based on 2016 Demographic and Health Survey. Environ Health Prev Med 2020; 25:81. [PMID: 33287699 PMCID: PMC7722338 DOI: 10.1186/s12199-020-00921-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Improved water sources are not equally available in all geographical regions. Populations dependent on unsafe water sources are recommended to treat their water at point-of-use using adequate methods to reduce associated health problems. In Ethiopia, the spatial distribution of households using unimproved water sources have been incomplete or ignored in most of the studies. Moreover, evidence on the point-of-use water treatment practice of households dependent on such water sources is scarce. Therefore, the current study is intended to analyze the spatial distribution of unimproved water sources by wealth quintiles at country level and point-of-use treatment (POU) practices using nationally representative data. Method The data of 2016 Ethiopian Demographic and Health Survey (EDHS) conducted on 16650 households from 643 clusters were used for the analysis. For spatial analysis, the raw and spatially smoothed coverage data was joined to the geographic coordinates based on EDHS cluster identification code. Global spatial autocorrelation was performed to analyze whether the pattern of unimproved water coverage is clustered, dispersed, or random across the study areas. Once a positive global autocorrelation was confirmed, a local spatial autocorrelation analysis was applied to detect local clusters. The POU water treatment is analyzed based on reported use of either boiling, chlorine (bleach), filtration, or solar disinfection (SODIS). Results There were 5005 households using unimproved water sources for drinking purposes. Spatial variation of unimproved water coverage was observed with high coverage observed at Amhara, Afar, Southern Nations Nationalities and People and Somalia regions. Disparity in unimproved water coverage between wealth quintiles was also observed. The reported point-of-use water treatment practice among these households is only 6.24%. The odds of POU water treatment among household heads with higher education status is 2.5 times higher (95% CI = 1.43-4.36) compared to those who did not attend education. Conclusion An apparent clustering trend with high unimproved water coverage was observed between regions and among wealth quintiles hence indicates priority areas for future resource allocation and the need for regional and national policies to address the issue. Promoting households to treat water prior to drinking is essential to reduce health problems.
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Affiliation(s)
- Yohannes Tefera Damtew
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Abraham Geremew
- Department of Environmental Health, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
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Atabati H, Kassiri H, Shamloo E, Akbari M, Atamaleki A, Sahlabadi F, Linh NTT, Rostami A, Fakhri Y, Khaneghah AM. The association between the lack of safe drinking water and sanitation facilities with intestinal Entamoeba spp infection risk: A systematic review and meta-analysis. PLoS One 2020; 15:e0237102. [PMID: 33147225 PMCID: PMC7641376 DOI: 10.1371/journal.pone.0237102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intestinal protozoa infections are responsible for considerable morbidity and mortality, especially where the exposed population suffers from a lack of drinking water and sanitation facilities. In this study, the association between the lack of safe drinking water and sanitation (toilet) facilities with intestinal Entamoeba spp infection in the children (5-11 years), adult (18-55 years), and all age (5-55 years) were assessed. For this purpose, some of the international databases such as Scopus, PubMed, Web of Science, and Embase were screened to up to 7 June 2019 in order to retrieve the related citations. Also, the pooled odds ratios (ORs) following 95% confidence intervals (CIs) were calculated using a random-effects model. Twenty-nine articles with 36 studies were included while the OR extracted or calculated by using 2 × 2 contingency tables. However, the ingestion of contaminated water insignificantly can increase the odds ratio (OR) of Entamoeba spp infection (OR 1.01, (95% confidence interval [CI] 0.58 to 1.43), no access to sanitation (toilet) facilities significantly can increase odds of Entamoeba spp infection (OR 1.18, 95% CI 1.05 to 1.32). The meta-regression analysis showed that over time, odds of intestinal Entamoeba spp infection increased in both lack of safe drinking water (Coefficient: 3.24, P-value < 0.01) and sanitation (toilet) facilities (Coefficient: 2.36, P-value < 0.05) subgroups. Considering the findings, lack of safe drinking water resulted in a further increase in intestinal Entamoeba spp infection among adult (OR: 2.76), children (OR = 0.57) and all age groups (OR: 1.50), and also lack of sanitation (toilet) facilities resulted in further increase intestinal Entamoeba spp infection in children (OR: 1.06), adult (OR: 1.26) and all age (OR: 1.16). In this context, the lack of safe drinking water and sanitation facilities (toilet) was associated with a high risk of intestinal Entamoeba spp infection. Further attempts to providing public health facilities can control the prevalence of intestinal Entamoeba spp.
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Affiliation(s)
- Hamid Atabati
- Department of the environment faculty of fishery and environment, Gorgan University of agriculture and natural resources sciences, Golestan Province, Gorgan, Iran
| | - Hamid Kassiri
- Department of Medical Entomology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Shamloo
- Noncommunicable Diseases Research Center, Department of Food Science and Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mitra Akbari
- Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Ali Atamaleki
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sahlabadi
- Department of Environmental Health Engineering, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nguyen Thi Thuy Linh
- Institute of Research and Development, Duy Tan University, Danang, Vietnam
- Faculty of Environmental and Chemical Engineering, Duy Tan University, Danang, Vietnam
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadolah Fakhri
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science, Faculty of Food Engineering, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Socio-Economic Factors Related to Drinking Water Source and Sanitation in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217933. [PMID: 33137998 PMCID: PMC7672613 DOI: 10.3390/ijerph17217933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022]
Abstract
Access to improved water and sanitation is essential. We describe these practices in Malaysia using data from a nationwide community survey and used logistic regression to assess the determinants. Of the 7978 living quarters (LQs), 58.3% were in urban areas. About 2.4%, 0.5% and 27.4% of LQs had non-improved water sources, non-improved toilet types and improper domestic waste disposal, respectively. Open burning was practiced by 26.1%. Water source was a problem for long houses (10.5%), squatters (8.5%) and shared houses (4.0%). Non-improved toilet types were 11.9% for squatters and 4.8% for shared houses. Improper domestic waste disposal practices were higher for occupants of village houses (64.2%), long houses (54.4%), single houses (45.8%) and squatters (35.6%). An increase in education or income level was associated with a decrease in improper domestic waste disposal methods. House type significantly affected water and sanitation after adjusting for the effects of other variables. Lower household income was associated with non-improved toilet types and improper domestic waste disposal. Lower education and rural location influenced domestic waste disposal. The water and toilet facilities in Malaysia were generally good, while domestic waste management practices could be improved. There remain pockets of communities with environmental challenges for the nation.
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Cassivi A, Tilley E, Waygood EOD, Dorea C. Trends in access to water and sanitation in Malawi: progress and inequalities (1992-2017). JOURNAL OF WATER AND HEALTH 2020; 18:785-797. [PMID: 33095201 DOI: 10.2166/wh.2020.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Billions of people globally gained access to improved drinking water sources and sanitation in the last decades, following effort towards achieving the Millennium Development Goals. Global progress remains a general indicator as it is unclear if access is equitable across groups of the population. Agenda 2030 calling for `leaving no one behind', there is a need to focus on the variations of access in different groups of the population, especially in the context of low- and middle-income countries including Malawi. We analyzed data from Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) to describe emerging trends on progress and inequalities in water supply and sanitation services over a 25-year period (1992-2017), as well as to identify the most vulnerable populations in Malawi. Data were disaggregated with geographic and socio-economic characteristics including regions, urban and rural areas, wealth and education level. Analysis of available data revealed progress in access to water and sanitation among all groups of the population. The largest progress was generally observed in the groups that were further behind at the baseline year, which likely reflects good targeting in interventions/improvements to reduce the gap in the population. Overall, results demonstrated that some segments of the population - foremost poorest Southern rural populations - still have limited access to water and are forced to practise open defecation. Finally, we suggest including standardized indicators that address safely managed drinking water and sanitation services in future surveys and studies to increase the accuracy of national estimates.
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Affiliation(s)
- Alexandra Cassivi
- Department of Civil Engineering, Engineering and Computer Science (ECS) 304, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8 W 2Y2, Canada E-mail:
| | - Elizabeth Tilley
- Department of Environmental Health, University of Malawi, The Polytechnic, Malawi and Eawag: Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | | | - Caetano Dorea
- Department of Civil Engineering, Engineering and Computer Science (ECS) 304, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8 W 2Y2, Canada E-mail:
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Applying the Water-Energy Nexus for Water Supply—A Diagnostic Review on Energy Use for Water Provision in Africa. WATER 2020. [DOI: 10.3390/w12092560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This work explores the application of the Water-Energy Nexus concept for water supply in the African context, where its operationalization is quite limited compared to developed regions. Furthermore, water supply and demand drivers and their influence on energy use are examined. This study found that there is limited literature available on the operationalization of the concept, and energy use is not considered a key performance indicator by water regulators and utilities. Regionally, most of the studies were carried out in the northern and southern Africa, where energy demand for water supply through desalination is high. An analysis of water supply and demand drivers show diminishing quantities of available freshwater, and increased anthropogenic pollutant loads in some areas are projected. Consequently, utilities will likely consider alternative energy-intensive water supply options. Increased population growth with the highest global urban growth rate is projected, with about 60% of the total population in Africa as urban dwellers by 2050. This implies huge growth in water demand that calls for investment in technology, infrastructure, and improved understanding of energy use and optimization, as the largest controllable input within utilities boundaries. However, it requires a data-driven understanding of the operational drivers for water supply and incorporation of energy assessment metrics to inform water-energy policies and to exploit the nexus opportunities.
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Deshpande A, Miller-Petrie MK, Lindstedt PA, Baumann MM, Johnson KB, Blacker BF, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abegaz KH, Abejie AN, Abreu LG, Abrigo MR, Abualhasan A, Accrombessi MMK, Adamu AA, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhikari TB, Afarideh M, Agudelo-Botero M, Ahmadi M, Ahmadi K, Ahmed MB, Ahmed AE, Akalu TY, Akanda AS, Alahdab F, Al-Aly Z, Alam S, Alam N, Alamene GM, Alanzi TM, Albright J, Albujeer A, Alcalde-Rabanal JE, Alebel A, Alemu ZA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amit AML, Amul GGH, Andrei CL, Anjomshoa M, Ansariadi A, Antonio CAT, Antony B, Antriyandarti E, Arabloo J, Aref HMA, Aremu O, Armoon B, Arora A, Aryal KK, Arzani A, Asadi-Aliabadi M, Asmelash D, Atalay HT, Athari SM, Athari SS, Atre SR, Ausloos M, Awasthi S, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azman AS, Babaee E, Badawi A, Bagherzadeh M, Bakkannavar SM, Balakrishnan S, Banach M, Banoub JAM, Barac A, Barboza MA, Bärnighausen TW, Basu S, Bay VD, Bayati M, Bedi N, Beheshti M, Behzadifar M, Behzadifar M, Bejarano Ramirez DF, Bell ML, Bennett DA, Benzian H, Berbada DA, Bernstein RS, Bhat AG, Bhattacharyya K, Bhaumik S, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biswas RK, Bohlouli S, Boufous S, Brady OJ, Briko AN, Briko NI, Britton GB, Brown A, Burugina Nagaraja S, Butt ZA, Cámera LA, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car J, Cárdenas R, Carvalho F, Castañeda-Orjuela CA, Castro F, Cerin E, Chalise B, Chattu VK, Chin KL, Christopher DJ, Chu DT, Cormier NM, Costa VM, Cromwell EA, Dadi AFF, Dahiru T, Dahlawi SMA, Dandona R, Dandona L, Dang AK, Daoud F, Darwesh AM, Darwish AH, Daryani A, Das JK, Das Gupta R, Dash AP, Dávila-Cervantes CA, Davis Weaver N, De la Hoz FP, De Neve JW, Demissie DB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Dipeolu IO, Do HT, Dolecek C, Doyle KE, Dubljanin E, Duraes AR, Edinur HA, Effiong A, Eftekhari A, El Nahas N, El Sayed Zaki M, El Tantawi M, Elhabashy HR, El-Jaafary SI, El-Khatib Z, Elkout H, Elsharkawy A, Enany S, Endalew DA, Eshrati B, Eskandarieh S, Etemadi A, Ezekannagha O, Faraon EJA, Fareed M, Faro A, Farzadfar F, Fasil AF, Fazlzadeh M, Feigin VL, Fekadu W, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Flohr C, Foigt NA, Folayan MO, Foroutan M, Franklin RC, Frostad JJ, Fukumoto T, Gad MM, Garcia GM, Gatotoh AM, Gayesa RT, Gebremedhin KB, Geramo YCD, Gesesew HA, Gezae KE, Ghashghaee A, Ghazi Sherbaf F, Gill TK, Gill PS, Ginindza TG, Girmay A, Gizaw Z, Goodridge A, Gopalani SV, Goulart BNG, Goulart AC, Grada A, Green MS, Gubari MIM, Gugnani HC, Guido D, Guimarães RA, Guo Y, Gupta R, Gupta R, Ha GH, Haagsma JA, Hafezi-Nejad N, Haile DH, Haile MT, Hall BJ, Hamidi S, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassen HY, Hayelom DH, Hegazy MI, Heibati B, Heidari B, Hendrie D, Henok A, Herteliu C, Heydarpour F, Hidru HDD, Hird TR, Hoang CL, Hollerich GI, Hoogar P, Hossain N, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Hussen MAA, Ibitoye SE, Ilesanmi OS, Ilic MD, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam SMS, Ivers RQ, Iwu CJ, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kanchan T, Karch A, Karki S, Kasaeian A, Kasahun GG, Kasaye HK, Kassa GG, Kassa GM, Kayode GA, Kebede MM, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalilov R, Khan EA, Khan J, Khan MN, Khatab K, Khater MM, Khater AM, Khayamzadeh M, Khazaei M, Khosravi MH, Khubchandani J, Kiadaliri A, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kochhar S, Kolola T, Komaki H, Kosen S, Koul PA, Koyanagi A, Krishan K, Kuate Defo B, Kugbey N, Kumar P, Kumar GA, Kumar M, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lam H, Lami FH, Lansingh VC, Lasrado S, Lebedev G, Lee PH, LeGrand KE, Leili M, Lenjebo TL, Leshargie CT, Levine AJ, Lewycka S, Li S, Linn S, Liu S, Lopez JCF, Lopukhov PD, Magdy Abd El Razek M, Mahadeshwara Prasad D, Mahasha PW, Mahotra NB, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Mansournia MA, Mapoma CC, Martinez G, Martini S, Martins-Melo FR, Mathur MR, Mayala BK, Mazidi M, McAlinden C, Meharie BG, Mehndiratta MM, Mehrabi Nasab E, Mehta KM, Mekonnen T, Mekonnen TC, Meles GG, Meles HG, Memiah PTN, Memish ZA, Mendoza W, Menezes RG, Mereta ST, Meretoja TJ, Mestrovic T, Metekiya WM, Metekiya WM, Miazgowski B, Miller TR, Mini GK, Mirrakhimov EM, Moazen B, Mohajer B, Mohammad Y, Mohammad DK, Mohammad Gholi Mezerji N, Mohammadibakhsh R, Mohammed S, Mohammed JA, Mohammed H, Mohebi F, Mokdad AH, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moraga P, Morales L, Mosapour A, Mosser JF, Mouodi S, Mousavi SM, Mozaffor M, Munro SB, Muriithi MK, Murray CJL, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Naik G, Nangia V, Nascimento BR, Nazari J, Ndwandwe DE, Negoi I, Netsere HB, Ngunjiri JW, Nguyen CT, Nguyen HLT, Nguyen QP, Nigatu SG, Ningrum DNA, Nnaji CA, Nojomi M, Norheim OF, Noubiap JJ, Oancea B, Ogbo FA, Oh IH, Olagunju AT, Olusanya JO, Olusanya BO, Onwujekwe OE, Ortega-Altamirano DV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pana A, Park EK, Patel SK, Pathak A, Patle A, Paulos K, Pepito VCF, Perico N, Pervaiz A, Pescarini JM, Pesudovs K, Pham HQ, Pigott DM, Pilgrim T, Pirsaheb M, Poljak M, Pollock I, Postma MJ, Pourmalek F, Pourshams A, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi S, Rahimi-Movaghar V, Rahman MA, Rahman MHU, Rajati F, Ranabhat CL, Rao PC, Rasella D, Rath GK, Rawaf S, Rawal L, Rawasia WF, Remuzzi G, Renjith V, Renzaho AM, Resnikoff S, Riahi SM, Ribeiro AI, Rickard J, Roever L, Ronfani L, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Saeedi Moghaddam S, Safari Y, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Saleem A, Salem H, Salem MR, Salimi Y, Salimzadeh H, Samy AM, Sanabria J, Santos IS, Santric-Milicevic MM, Sao Jose BP, Saraswathy SYI, Sarrafzadegan N, Sartorius B, Sathian B, Sathish T, Satpathy M, Sawhney M, Sayyah M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shafieesabet A, Shaheen AA, Shahid I, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharma R, Sheikh A, Shetty BSK, Shiferaw WS, Shigematsu M, Shin JI, Shiri R, Shirkoohi R, Shivakumar KM, Si S, Siabani S, Siddiqi TJ, Silva DAS, Singh V, Singh NP, Singh BBS, Singh JA, Singh A, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Soares Filho AM, Sobhiyeh MR, Sokhan A, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tabarés-Seisdedos R, Tabuchi T, Tadesse DB, Tarigan IU, Taye B, Tefera YM, Tehrani-Banihashemi A, Tekelemedhin SW, Tekle MG, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, ThekkePurakkal AS, Thomas N, Thompson RL, Thomson AJ, Topor-Madry R, Tovani-Palone MR, Traini E, Tran BX, Tran KB, Ullah I, Unnikrishnan B, Usman MS, Uthman OA, Uzochukwu BSC, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, W/hawariat FG, Waheed Y, Wallin MT, Wang YP, Wang Y, Wangdi K, Weiss DJ, Weldesamuel GT, Werkneh AA, Westerman R, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wolde HF, Wondafrash DZ, Wonde TE, Worku GT, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yatsuya H, Yeshaneh A, Yilma MT, Yip P, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zadey S, Zahirian Moghadam T, Zaidi Z, Zaman SB, Zamani M, Zandian H, Zar HJ, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Zuniga YMH, Hay SI, Reiner RC. Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17. Lancet Glob Health 2020; 8:e1162-e1185. [PMID: 32827479 PMCID: PMC7443708 DOI: 10.1016/s2214-109x(20)30278-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. METHODS We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. FINDINGS Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. INTERPRETATION Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. FUNDING Bill & Melinda Gates Foundation.
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Cetrulo TB, Ferreira DFC, Marques RC, Malheiros TF. Water utilities performance analysis in developing countries: On an adequate model for universal access. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2020; 268:110662. [PMID: 32383644 DOI: 10.1016/j.jenvman.2020.110662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
The results of the analysis of water utility performance studies based on data envelopment analysis (DEA) can be very sensitive to the methodological approach and the variables employed. This study investigates approaches and variables for developing countries in order to identify an adequate model for universal access. Three models were developed and compared. The first used traditional variables, the second considered the quality of service variables, and the last are expanded on the second by incorporating the realization of the human right to water into efficiency estimation. Methodological approaches comprising the variable returns to scale DEA (most common for developing countries) and slack-based directional distance function (employed in this study) were also compared. The case study of 77 Brazilian water utilities suggests that a model that incorporates the objective of universal access in the efficiency estimation changes substantialy utility efficiency scores. Therefore, utilities that make investments to reach the universal access can be penalized since traditional models incorporate the expenses, but fail to capture the results. The research conclusions suggest that approaches and variable choices are likely to impact on the analysis results, misrepresenting them regardless of the purpose for using DEA in the study.
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Affiliation(s)
- Tiago B Cetrulo
- Department of Hydraulics and Sanitation, University of São Paulo, Brazil.
| | - Diogo F C Ferreira
- Department of Civil Engineering, Architecture and Geo-resources at the Instituto Superior Técnico (IST), University of Lisbon, Brazil.
| | - Rui C Marques
- Department of Civil Engineering, Architecture and Geo-resources at the Instituto Superior Técnico (IST), University of Lisbon, Brazil.
| | - Tadeu F Malheiros
- Department of Hydraulics and Sanitation, University of São Paulo, Brazil.
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Cetrulo TB, Marques RC, Malheiros TF, Cetrulo NM. Monitoring inequality in water access: Challenges for the 2030 Agenda for Sustainable Development. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 727:138746. [PMID: 32498195 DOI: 10.1016/j.scitotenv.2020.138746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
The diffusion of the indicators for monitoring sustainable development goals (SDG) has conceptual and symbolic uses far beyond their instrumental uses. Despite its value in dismantling social and economic inequalities, the goal regarding guaranteed of water and sanitation for all did not specify any indicators for this purpose. This research contributes to the discussions on the best way to monitor inequality in access to water by the SDG. Inequality measures established in other areas of study and specific to the access to water were analyzed as their applicability for this purpose. Our study finds that current United Nations strategy does not allow for robust conclusions and does not respect some economical axioms. Furthermore, we show the potentialities and inconveniences of the most important metrics, but it can be concluded that if the objective is merely to measure inequality and communicate easily, the concentration index is the most appropriate measure. These results may contribute to a more refined discussion of how the SDGs can measures progress towards equality in water access and provides information to guide governments agendas for equality in water access.
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Affiliation(s)
- Tiago B Cetrulo
- Department of Hydraulics and Sanitation, University of São Paulo, Brazil.
| | - Rui C Marques
- Department of Civil Engineering, Architecture and Geo-resources at the Instituto Superior Técnico (IST), University of Lisbon, Portugal.
| | - Tadeu F Malheiros
- Department of Hydraulics and Sanitation, University of São Paulo, Brazil.
| | - Natália M Cetrulo
- School of Arts, Science and Humanities, University of São Paulo, Brazil.
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Basnet S, Frongillo EA, Nguyen PH, Moore S, Arabi M. Associations of maternal resources with care behaviours differ by resource and behaviour. MATERNAL & CHILD NUTRITION 2020; 16:e12977. [PMID: 32216037 PMCID: PMC7296814 DOI: 10.1111/mcn.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
Care is important for children's growth and development, but lack or inadequacy of resources for care can constrain appropriate caregiving. The objectives of this study were to examine whether maternal resources for care are associated with care behaviours specifically infant and young child feeding, hygiene, health-seeking, and family care behaviours. The study also examined if some resources for care are more important than others. This study used baseline Alive & Thrive household surveys from Bangladesh, Vietnam, and Ethiopia. Measures of resources for care were maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental support. Multiple regression analyses were conducted to examine the associations of resources for care with child-feeding practices (exclusive breastfeeding, minimum meal frequency, dietary and diversity), hygiene practices (improved drinking water source, improved sanitation, and cleanliness), health-seeking (full immunization), and family care (psychosocial stimulation and availability of adequate caregiver). The models were adjusted for covariates at child, parents, and household levels and accounted for geographic clustering. All measures of resources for care had positive associations with care behaviours; in a few instances, however, the associations between the resources for care and care behaviours were in the negative direction. Improving education, knowledge, nutritional status, mental well-being, autonomy, and social support among mothers would facilitate provision of optimal care for children.
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Affiliation(s)
- Sulochana Basnet
- Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Phuong Hong Nguyen
- Poverty, Health, and Nutrition DivisionInternational Food Policy Research InstituteWashingtonDCUSA
| | - Spencer Moore
- Department of Health Promotion, Education, and BehaviorUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Mandana Arabi
- Global Technical ServicesNutrition InternationalOttawaCanada
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Bogale GG. Hotspots of unimproved sources of drinking water in Ethiopia: mapping and spatial analysis of Ethiopia demographic and health survey Data 2016. BMC Public Health 2020; 20:878. [PMID: 32513128 PMCID: PMC7278129 DOI: 10.1186/s12889-020-08957-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/19/2020] [Indexed: 11/23/2022] Open
Abstract
Background More than 35% of the Ethiopian population are using drinking water from unimproved sources. As per the United Nations’ Sustainable Development Goals, Ethiopia is aspiring to achieve universal and equitable access to safe and affordable drinking water for all by 2030. For these goals to be accomplished, it is important to map the country’s hotspot areas of unimproved source of drinking-water so that resource allocation and disease control can be optimized there. Therefore, the objective of this study is to map and identify hotspot areas of unimproved sources of drinking water in Ethiopia. Methods A population based cross-sectional study was conducted in Ethiopia from January 18 to June 27, 2016. Data were collected from 10,064 households using a pretested and structured questionnaire. A stratified two-stage cluster sampling was employed where the enumeration areas were primary sampling units and households were secondary sampling units. Systematic sampling with probability proportional to size was employed to select samples. Datasets were cleaned and entered into SaTScan and ArcGIS software for mapping and analysis. The Global Moran’s I and spatial scan statistical tests (Bernoulli model) were done to explore the presence of clustering in the study area and local spatial clusters (hotspots) of unimproved sources of drinking water using ArcGIS version 10.3 and Kuldorff’s SaTScan version 9.4 software, respectively. Results Unimproved sources of drinking water were spatially clustered in the study area (Moran’s I: 0.35, p < 0.05). A total of 143 significant clusters was identified. Of which, eight were most likely (primary) clusters and the other 135 were secondary clusters. The first spatial window which contains primary clusters was located in Amhara and Afar regions (LLR: 78.89, at p < 0.001). The other 33 spatial windows which contain secondary clusters were found in all regions, except Gambela region and Addis Abeba city administration (with a range of LLR: 10.09–78.89, p < 0.001). Conclusions This study allowed the identification of important non-random clusters and hotspots of unimproved sources of drinking water. Therefore, these results will be determinant to help decision makers in their geographical interventions to combat problems related to drinking water quality.
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Affiliation(s)
- Getahun Gebre Bogale
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, P.O.B.1145, Dessie, Ethiopia.
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Anthonj C, Tracy JW, Fleming L, Shields KF, Tikoisuva WM, Kelly E, Thakkar MB, Cronk R, Overmars M, Bartram J. Geographical inequalities in drinking water in the Solomon Islands. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 712:135241. [PMID: 31843312 DOI: 10.1016/j.scitotenv.2019.135241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 06/10/2023]
Abstract
Sustainable Development Goal 6.1 seeks to "by 2030, achieve universal and equitable access to safe and affordable drinking water", which is challenging particularly in Small Island Developing States (SIDS) and Pacific Island Countries (PIC). We report drinking water sources and services in the Solomon Islands and examine geographical inequalities. Based on two quantitative baseline datasets of n = 1,598 rural and n = 1,068 urban households, we analyzed different drinking water variables (source type, collection time, amount, use, perceived quality, storage, treatment) and a composite index, drinking water service level. We stratified data by urban and rural areas and by province, mapped, and contextualized them. There are substantive rural-urban drinking water inequalities in the Solomon Islands. Overall, urban households are more likely to: use improved drinking water sources, need less time to collect water, collect more water, store their water more safely, treat water prior to consumption, perceive their water quality as better and have an at least basic drinking water service than rural households. There are also provincial and center-periphery inequalities in drinking water access, with more centrally located provinces using piped water supplies and more distant and remote provinces using rainwater and surface water as their primary source. There are also inter-national inequalities. Out of all PICs, the Solomon Islands have among the lowest access to basic drinking water services: 92% of urban and 55% of rural households. Of all SIDS, PICs are least serviced. This study shows that drinking water inequality is a critical issue, and highlights that all identified dimensions of inequality - rural-urban, provincial, center-periphery and inter-national - need to be explicitly recognized and addressed and included in pro-equity monitoring, policy and programming efforts by the Solomon Islands Government and stakeholders to reduce inequalities as per the Agenda 2030.
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Affiliation(s)
- Carmen Anthonj
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - J Wren Tracy
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Lisa Fleming
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Katherine F Shields
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Department of Geography, University of Oregon, Eugene, OR, United States
| | - Waqairapoa M Tikoisuva
- UNICEF Pacific, Fiji Development Bank Building, 360 Victoria Parade, Suva, Fiji, United States
| | - Emma Kelly
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Mamita Bora Thakkar
- UNICEF Solomon Islands, ANZ Haus, Kukum Highway, Ranadi, Honiara P.O Box 1786 Solomon Islands
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Marc Overmars
- UNICEF Pacific, Fiji Development Bank Building, 360 Victoria Parade, Suva, Fiji, United States
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; School of Civil Engineering, University of Leeds, United Kingdom
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New Approaches to Monitor Inequalities in Access to Water and Sanitation: The SDGs in Latin America and the Caribbean. WATER 2020. [DOI: 10.3390/w12040931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the 2030 Agenda for Sustainable Development, Targets 6.1 and 6.2 show, in their formulation, some alignment with the normative content of the human rights to water and sanitation (HRWS). However, the principle of equality and non-discrimination, which applies to all human rights, was not clearly incorporated into the indicators adopted to assess and monitor these targets. This paper contributes to bridging this gap by proposing two methodological strategies to address inequalities in analyses of access to water and sanitation services. The first consists in adjusting the indicators of access to these services according to inequality. The second proposes an assessment of intersecting forms of inequality. An application of these methods in Latin America and the Caribbean highlights significant regional heterogeneity and elevated inequality in access to services in the countries of this region. The methods demonstrate their potential in contributing to assessment and monitoring of the SDGs, but outdated or lacking data are obstacles to more in-depth analyses.
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Inequality in access to improved drinking water sources and childhood diarrhoea in low- and middle-income countries. Int J Hyg Environ Health 2020; 226:113493. [PMID: 32155581 DOI: 10.1016/j.ijheh.2020.113493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/20/2022]
Abstract
In addition to the conventional wisdom of categorizing countries based on nationally-averaged coverage in access to improved drinking water sources (IDWS), this study incorporated sub-national inequality into a novel categorisation framework. The association between access to IDWS and the incidence of childhood diarrhoea (ICD) was also quantified. Information from 1.63 million households obtained through nationally representative and cross-sectional demographic and health survey (DHS) and multiple indicator cluster survey (MICS) from 81 countries were analysed. Sub-national inequalities in the access to IDWS were measured using proportional variability (PV). Most studied countries with low coverage and high inequalities in accessing IDWS were from Sub-Saharan Africa (SSA). Wealth status of households showed a higher variability in the IDWS than the variability across locations. Significant negative associations between accessing IDWS and ICD were observed for regional models, except for SSA. This study adds knowledge towards understanding the state of sustainable development goal achievements in terms of accessing IDWS. The knowledge may be helpful in designing country-specific, achievable, short- and long-term strategies. The non-decisive relation between access to IDWS and ICD indicates the adoption of additional measures in the modelling mechanism.
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Lee EC, Azman AS, Kaminsky J, Moore SM, McKay HS, Lessler J. The projected impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: A modeling study. PLoS Med 2019; 16:e1003003. [PMID: 31825965 PMCID: PMC6905526 DOI: 10.1371/journal.pmed.1003003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/15/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cholera causes an estimated 100,000 deaths annually worldwide, with the majority of burden reported in sub-Saharan Africa. In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize the chances of success. METHODS AND FINDINGS We compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, and disability-adjusted life years and the cost-effectiveness of these campaigns with models that accounted for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI 33.2%-34.8%). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI 270,319-277,002) and 109,817 (95% CI 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs US$1,843 (95% CI 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach does not project annual changes in baseline cholera risk or directly incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors. CONCLUSIONS Our study suggests that geographic targeting substantially improves the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near term, without rapid progress in developing water and sanitation services or dramatic increases in OCV supply, our results suggest that vaccine use alone is unlikely to allow us to achieve the 2030 goal.
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Affiliation(s)
- Elizabeth C. Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joshua Kaminsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sean M. Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Heather S. McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Interdisciplinary Critical Geographies of Water: Capturing the Mutual Shaping of Society and Hydrological Flows. WATER 2019. [DOI: 10.3390/w11101973] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In light of recent calls for an increased commitment to interdisciplinary endeavors, this paper reflects on the implications of a critical geography of water that crosses social and natural sciences. Questions on how to best research the relationship between water and society have been raised both in the field of critical geographies of water and sociohydrology. Yet, there has been little crossover between these disciplinary perspectives. This, we argue, may be partly explained by the fact that interdisciplinary research is both advocated and antagonized. On the one hand, interdisciplinarity is argued to deliver more in terms of effectively informing policy processes and developing theoretical perspectives that can reform and regenerate knowledge. On the other hand, natural and social sciences are often presented as ontologically, epistemologically, and methodologically incompatible. Drawing on our own research experience and expertise, this paper focuses on the multiple ways in which critical geographies of water and sociohydrology are convergent, compatible, and complementary. We reflect on the existing theoretical instruments to engage in interdisciplinary research and question some of the assumptions on the methodological and epistemological incompatibility between natural and social sciences. We then propose that an interdisciplinary resource geography can further understandings of how power and the non-human co-constitute the social world and hydrological flows and advance conceptualizations of water as socionatures.
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Ezbakhe F, Giné-Garriga R, Pérez-Foguet A. Leaving no one behind: Evaluating access to water, sanitation and hygiene for vulnerable and marginalized groups. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 683:537-546. [PMID: 31146059 DOI: 10.1016/j.scitotenv.2019.05.207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Achieving equitable access to water, sanitation and hygiene (WASH) services requires paying special attention to the most disadvantaged segments of the population. Yet, despite all the progress made to evaluate the access of vulnerable and marginalized groups, important knowledge gaps still remain with respect to identifying their specific barriers and needs. At the global level, for example, the two monitoring mechanisms for SDG 6 - the Joint Monitoring Programme (JMP) and Global Analysis and Assessment of Sanitation and drinking-water (GLAAS) - face difficulties in understanding how, and to what extent, vulnerable and marginalized groups access WASH services. In this context, this work examines the UNECE/WHO-Europe 'Equitable Access Score-card' for assessing the access to WASH services by vulnerable and marginalized groups. In particular, we: (i) analyse its strengths and limitations as a tool for revealing the needs of these groups in accessing WASH services; and (ii) propose an extended variant of the score-card that addresses these limitations. We test this version in two local-level case studies: Lima (Peru) and Castelló de la Plana (Spain). The score-card diagnosis is found to be particularly useful for collecting information on the level of access of the different vulnerable and marginalized groups, as well as the specific public policies and funding mechanisms in place that address and support their needs. However, the score-card should be complemented with specific assessments of all five normative dimensions of the human rights to water and sanitation (access, availability, quality, acceptability and affordability) in order to have a better understanding of the concerns for service delivery for the different vulnerable and marginalized groups.
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Affiliation(s)
- F Ezbakhe
- Department of Civil and Environmental Engineering (DECA), Engineering Sciences and Global Development (Esc&GD), Barcelona School of Civil Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain.
| | - R Giné-Garriga
- Stockholm International Water Institute, Stockholm, Sweden.
| | - A Pérez-Foguet
- Department of Civil and Environmental Engineering (DECA), Engineering Sciences and Global Development (Esc&GD), Barcelona School of Civil Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain.
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Millogo O, Doamba JEO, Sié A, Utzinger J, Vounatsou P. Geographical variation in the association of child, maternal and household health interventions with under-five mortality in Burkina Faso. PLoS One 2019; 14:e0218163. [PMID: 31260473 PMCID: PMC6602179 DOI: 10.1371/journal.pone.0218163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Background Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We estimated the association of child, maternal, and household interventions with U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. Methods Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation in the association of the health interventions with U5MR. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. Findings The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3 immunization and baby post-natal check within 24 hours after birth had the most important association with U5MR (hazard rates ratio (HRR) = 0.89, 95% Bayesian credible interval (BCI): 0.86–0.98 and HRR = 0.89, 95% BCI: 0.86–0.92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention that had a statistically important association with child survival in the region of Hauts Bassins. Interpretation The geographical variation in the magnitude and statistical importance of the association between health interventions and U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level.
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Affiliation(s)
- Ourohiré Millogo
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Azman AS, Moore SM, Lessler J. Surveillance and the global fight against cholera: Setting priorities and tracking progress. Vaccine 2019; 38 Suppl 1:A28-A30. [PMID: 31266671 PMCID: PMC7054831 DOI: 10.1016/j.vaccine.2019.06.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/23/2019] [Accepted: 06/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Sean M Moore
- Department of Biological Sciences, University of Notre Dame, USA; Eck Institute for Global Health, University of Notre Dame, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Saenz V, Mazzanti di Ruggiero MDLA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. PERSONA Y BIOÉTICA 2019. [DOI: 10.5294/pebi.2019.23.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Este artículo de revisión se centra en el tema de las enfermedades infecciosas desatendidas (EID), grupo de 18 patologías de carácter incapacitante, a veces mortales y frecuentemente deformantes, que prevalecen en poblaciones de Asia, África y en las zonas tropicales de Sur América. Mediante una revisión bibliográfica se plantean los elementos que se relacionan con estas enfermedades, se categorizan y se analizan a la luz de la Declaración Universal sobre Bioética y Derechos Humanos de 2005, en cuanto a igualdad, justicia y equidad, el enfoque de no discriminación y estigmatización, responsabilidad social y salud. A lo largo de la revisión se concluye que la problemática alrededor de las EID es multifactorial y se presentan propuestas, desde una mirada de la bioética centrada en el respeto por la dignidad de la persona y de las poblaciones afectadas, para mitigar y solucionar la atención a partir de estrategias posibles que aborden determinantes sociales. Se propone incluir la bioética en el debate sobre la atención de las EID para analizar los problemas y examinar soluciones por medio de proyectos de investigación transdisciplinaria que impliquen un trabajo colaborativo y formativo entre las comunidades afectadas, entidades gubernamentales y profesionales de la salud y de las ciencias veterinarias.
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Kulinkina AV, Kosinski KC, Adjei MN, Osabutey D, Gyamfi BO, Biritwum NK, Bosompem KM, Naumova EN. Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors. Acta Trop 2019; 194:195-203. [PMID: 30871989 DOI: 10.1016/j.actatropica.2019.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/23/2019] [Accepted: 03/10/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions. METHODS Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities. Logistic regression was also used to assess associations between community water characteristics, self-reported water-related behaviors and S. haematobium infection. Communities were subsequently categorized as candidates for three types of interventions: provision of additional safe water sources, provision of groundwater treatment, and health education about water-related disease risk, depending on their water profile. RESULTS Microhematuria presence measured with a reagent strip was a good proxy of eggs in urine at individual (Kendall's τb = 0.88, p < 0.001) and at school-aggregated (Spearman's rs = 0.96, p < 0.001) levels. Self-reported macrohematuria and swimming were significantly associated (p < 0.05) with egg presence, but self-reported fetching was not. Of the community water characteristics, greater surface water access and presence of groundwater quality problems were significantly associated with increased likelihood of fetching, swimming, and S. haematobium infection. Access to improved water sources did not exhibit an association with any of these outcomes. CONCLUSIONS The study illustrates that in presence of regular school-based treatment with praziquantel, microhematuria assessed via reagent strips remains an adequate proxy for S. haematobium infection in primary schoolchildren. Community water profiles, in combination with self-reported water-related behaviors, can help elucidate reasons for some endemic communities continuing to experience ongoing transmission and tailor interventions to these local contexts to achieve sustainable control.
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Affiliation(s)
| | | | | | - Dickson Osabutey
- University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Bernard O Gyamfi
- University College of Agriculture and Environmental Studies, Bunso, Ghana
| | | | - Kwabena M Bosompem
- Community Directed Development Foundation, Accra, Ghana; University of Ghana, Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Elena N Naumova
- Tufts University School of Engineering, Medford, MA, USA; Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA, USA
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Yu W, Wardrop NA, Bain RES, Alegana V, Graham LJ, Wright JA. Mapping access to domestic water supplies from incomplete data in developing countries: An illustrative assessment for Kenya. PLoS One 2019; 14:e0216923. [PMID: 31100084 PMCID: PMC6524943 DOI: 10.1371/journal.pone.0216923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
Water point mapping databases, generated through surveys of water sources such as wells and boreholes, are now available in many low and middle income countries, but often suffer from incomplete coverage. To address the partial coverage in such databases and gain insights into spatial patterns of water resource use, this study investigated the use of a maximum entropy (MaxEnt) approach to predict the geospatial distribution of drinking-water sources, using two types of unimproved sources in Kenya as illustration. Geographic locations of unprotected dug wells and surface water sources derived from the Water Point Data Exchange (WPDx) database were used as inputs to the MaxEnt model alongside geological/hydrogeological and socio-economic covariates. Predictive performance of the MaxEnt models was high (all > 0.9) based on Area Under the Receiver Operator Curve (AUC), and the predicted spatial distribution of water point was broadly consistent with household use of these unimproved drinking-water sources reported in household survey and census data. In developing countries where geospatial datasets concerning drinking-water sources often have necessarily limited resolution or incomplete spatial coverage, the modelled surface can provide an initial indication of the geography of unimproved drinking-water sources to target unserved populations and assess water source vulnerability to contamination and hazards.
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Affiliation(s)
- Weiyu Yu
- University of Southampton, Southampton, Hampshire, United Kingdom
| | | | - Robert E. S. Bain
- Division of Data, Research and Policy, United Nations Children's Fund (UNICEF), New York, New York, United States of America
| | - Victor Alegana
- University of Southampton, Southampton, Hampshire, United Kingdom
- Population Health Unit, Kenya Medical Research Institute—Wellcome Trust Research Programme, Nairobi, Kenya
| | - Laura J. Graham
- University of Southampton, Southampton, Hampshire, United Kingdom
| | - Jim A. Wright
- University of Southampton, Southampton, Hampshire, United Kingdom
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Geographic Inequalities in Accessing Improved Water and Sanitation Facilities in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071269. [PMID: 30970603 PMCID: PMC6479325 DOI: 10.3390/ijerph16071269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
In this study, we aimed to assess the geographic inequalities in access to improved water and sanitation facilities among Nepalese households. We conducted this study based on cross-sectional data obtained from Nepal Demographic and Health Surveys. The quality of water sources and sanitation were defined by World Health Organization (WHO) guidelines. The geographic categories used in the analyses included developmental region, ecological zone, and urbanicity. Percentages of households having access to improved toilet (5.6% in 1996 vs. 40.5% in 2016) and water (19.3% in 1996 vs. 27% in 2016) facilities has been increasing steadily since 1996 with a great proportion of the households still lacking access to these services. The number of households sharing the same toilet and traveling time to reach water sources have also decreased at the same time. Households in Far Western and Mountains had the lowest odds of having access to improved toilet and water facilities. Noticeable progress has been achieved in improving WASH (water, sanitation, and hygiene) coverage at national level, however, it is uneven across developmental and ecological zones. Households in the Far Western and Mountain regions appeared to be the most geographically disadvantaged in terms of having access to improved water and sanitation facilities.
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Establishing Sustainable Development Goal Baselines for Household Drinking Water, Sanitation and Hygiene Services. WATER 2018. [DOI: 10.3390/w10121711] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), through the Joint Monitoring Programme (JMP), are responsible for global monitoring of the Sustainable Development Goal (SDG) targets for drinking water, sanitation and hygiene (WASH). The SDGs represent a fundamental shift in household WASH monitoring with a new focus on service levels and the incorporation of hygiene. This article reflects on the process of establishing SDG baselines and the methods used to generate national, regional and global estimates for the new household WASH indicators. The JMP 2017 update drew on over 3000 national data sources, primarily household surveys (n = 1443), censuses (n = 309) and administrative data (n = 1494). Whereas most countries could generate estimates for basic drinking water and basic sanitation, fewer countries could report on basic handwashing facilities, water quality and the disposal of waste from onsite sanitation. Based on data for 96 and 84 countries, respectively, the JMP estimates that globally 2.1 billion (29%) people lacked safely managed drinking water services and 4.5 billion (61%) lacked safely managed sanitation services in 2015. The expanded JMP inequalities database also finds substantial disparities by wealth and sub-national regions. The SDG baselines for household WASH reveal the scale of the challenge associated with achieving universal safely managed services and the substantial acceleration needed in many countries to achieve even basic services for everyone by 2030. Many countries have begun to localise the global SDG targets and are investing in data collection to address the SDG data gaps, whether through the integration of new elements in household surveys or strengthening collection and reporting of information through administrative and regulatory systems.
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Armah FA, Ekumah B, Yawson DO, Odoi JO, Afitiri AR, Nyieku FE. Access to improved water and sanitation in sub-Saharan Africa in a quarter century. Heliyon 2018; 4:e00931. [PMID: 30480156 PMCID: PMC6240801 DOI: 10.1016/j.heliyon.2018.e00931] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/09/2018] [Accepted: 11/08/2018] [Indexed: 11/13/2022] Open
Abstract
The realization of the scale, magnitude, and complexity of the water and sanitation problem at the global level has compelled international agencies and national governments to increase their resolve to face the challenge. There is extensive evidence on the independent effects of urbanicity (rural-urban environment) and wealth status on access to water and sanitation services in sub-Saharan Africa. However, our understanding of the joint effect of urbanicity and wealth on access to water and sanitation services across spatio-temporal scales is nascent. In this study, a pooled regression analysis of the compositional and contextual factors that systematically vary with access to water and sanitation services over a 25-year time period in fifteen countries across sub-Saharan Africa (SSA) was carried out. On the whole, substantial improvements have been made in providing access to improved water sources in SSA from 1990 to 2015 unlike access to sanitation facilities over the same period. Households were 28.2 percent and 125.2 percent more likely to have access to improved water sources in 2000–2005 and 2010–2015 respectively, than in 1990–1995. Urban rich households were 329 percent more likely to have access to improved water sources compared with the urban poor. Although access to improved sanitation facilities increased from 69 percent in 1990–1995 and 74 percent in 2000–2005 it declined significantly to 53 percent in 2010–2015. Urban rich households were 227 percent more likely to have access to improved sanitation facilities compared with urban poor households. These results were mediated and attenuated by biosocial, socio-cultural and contextual factors and underscore the fact that the challenge of access to water and sanitation in sub-Saharan Africa is not merely scientific and technical but interwoven with environment, culture, economics and human behaviour necessitating the need for interdisciplinary research and policy interventions.
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Affiliation(s)
- Frederick Ato Armah
- Department of Environmental Science, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
| | - Bernard Ekumah
- Department of Environmental Science, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
| | - David Oscar Yawson
- Department of Environmental Science, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
| | | | - Abdul-Rahaman Afitiri
- Department of Environmental Science, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Ghana
| | - Florence Esi Nyieku
- Regional Water and Environmental Sanitation Centre Kumasi (RWESCK), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Luo Q, Zhang M, Yao W, Fu Y, Wei H, Tao Y, Liu J, Yao H. A Spatio-Temporal Pattern and Socio-Economic Factors Analysis of Improved Sanitation in China, 2006⁻2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112510. [PMID: 30423966 PMCID: PMC6266269 DOI: 10.3390/ijerph15112510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
Abstract
Ensuring an adequate and safe access to sanitation is essential to prevent diseases. Using provincial spatial panel data reported in the China Health Statistical Yearbook and the China Statistical Yearbook, this paper analyzed the spatio-temporal characteristics of improved rural sanitation in 30 Chinese provinces during the period 2006⁻2015, and analyzed factors that may affect improved sanitation rates in rural China. Spatial autocorrelations of improved sanitation rates were computed via Global and Local Moran's I firstly, and then, inter-provincial disparities of improved sanitation were assessed by using the Theil index estimator; finally, the spatial panel model was employed to examine the potential socio-economic factors. Spatial autocorrelations results suggested that the provincial improved sanitation rates changes affect both the provinces themselves and the adjacent regions; Analysis of the spatial panel model revealed that factors such as GDP per capita, investment proportion ratio, centralized water supply, rural residents' expenditure were positively associated with improved sanitation rates, and illiteracy rate of people older than 15 was negatively related with improved sanitation rates. Socio-economic factors had affected the improved sanitation rates in 30 provinces in rural China. Thus, a series of policies, socio-economic measures and personal latrine literacy education should be given to improve the status of improved sanitation rates in rural China.
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Affiliation(s)
- Qing Luo
- Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Mengjie Zhang
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
| | - Wei Yao
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
| | - Yanfen Fu
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
| | - Haichun Wei
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
| | - Yong Tao
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention, Beijing 102200, China.
| | - Jianjun Liu
- Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Hongyan Yao
- Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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Yourkavitch J, Burgert-Brucker C, Assaf S, Delgado S. Using geographical analysis to identify child health inequality in sub-Saharan Africa. PLoS One 2018; 13:e0201870. [PMID: 30157198 PMCID: PMC6114521 DOI: 10.1371/journal.pone.0201870] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/24/2018] [Indexed: 01/24/2023] Open
Abstract
One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations. Analyzing health indicators in small geographic units aids the identification of hotspots where coverage lags behind neighboring areas. The purpose of these analyses is to identify areas of low coverage or high need in order to inform effective resource allocation to reduce child health inequity between and within countries. Using data from The Demographic and Health Survey Program surveys conducted in 27 selected African countries between 2010 and 2014, we computed estimates for six child health indicators for subnational regions. We calculated Global Moran's I statistics and used Local Indicator of Spatial Association analysis to produce a spatial layer showing spatial associations. We created maps to visualize sub-national autocorrelation and spatial clusters. The Global Moran's I statistic was positive for each indicator (range: 0.41 to 0.68), and statistically significant (p <0.05), suggesting spatial autocorrelation across national borders, and highlighting the need to examine health indicators both across countries and within them. Patterns of substantial differences among contiguous subareas were apparent; the average intra-country difference for each indicator exceeded 20 percentage points. Clusters of cross-border associations were also apparent, facilitating the identification of hotspots and informing the allocation of resources to reduce child health inequity between and within countries. This study exposes differences in health indicators in contiguous geographic areas, indicating that specific regional and subnational, in addition to national, strategies to improve health and reduce health inequalities are warranted.
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Affiliation(s)
| | | | - Shireen Assaf
- The DHS Program, ICF, Rockville, Maryland, United States of America
| | - Stephen Delgado
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, Mengel M, Dunoyer J, M'bangombe M, Lee EC, Djingarey MH, Sudre B, Bompangue D, Fraser RSM, Abubakar A, Perea W, Legros D, Azman AS. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet 2018; 391:1908-1915. [PMID: 29502905 PMCID: PMC5946088 DOI: 10.1016/s0140-6736(17)33050-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions. METHODS We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence. FINDINGS We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538-146 505) were reported per year. 4·0% (95% CrI 1·7-16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population. INTERPRETATION Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sean M Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA; Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epicentre, Paris, France
| | - Heather S McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Myriam Henkens
- Médecins Sans Frontières International Office, Brussels, Belgium
| | | | - Jessica Dunoyer
- UNICEF West and Central Africa Regional Office, Dakar, Senegal
| | | | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Infectious Diseases, Georgetown University, Washington, DC, USA
| | | | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Didier Bompangue
- Ministry of Health, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Robert S M Fraser
- International Federation for the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | | | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Médecins sans Frontières, Geneva, Switzerland
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M'bangombe M, Pezzoli L, Reeder B, Kabuluzi S, Msyamboza K, Masuku H, Ngwira B, Cavailler P, Grandesso F, Palomares A, Beck N, Shaffer A, MacDonald E, Senbete M, Lessler J, Moore SM, Azman AS. Oral cholera vaccine in cholera prevention and control, Malawi. Bull World Health Organ 2018; 96:428-435. [PMID: 29904226 PMCID: PMC5996210 DOI: 10.2471/blt.17.207175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/27/2022] Open
Abstract
Problem With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed. Approach In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and international organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use. Local setting Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s. Relevant changes The government’s application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017–2018. Lessons learnt Augmenting advanced mapping techniques with local information helped us extend priority areas beyond those identified as high-risk based on cholera incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission.
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Affiliation(s)
| | - Lorenzo Pezzoli
- Department of Infections Hazard Management, World Health Organization, Geneva, Switzerland
| | - Bruce Reeder
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | | | | | | | | | | | | | - Namseon Beck
- International Vaccine Institute, Seoul, South Korea
| | - Allison Shaffer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street E6003 Baltimore, MD, USA
| | - Sean M Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street E6003 Baltimore, MD, USA
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