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Cole S, Tallman P, Salmon-Mulanovich G, Rusyidi B. Water insecurity is associated with gender-based violence: A mixed-methods study in Indonesia. Soc Sci Med 2024; 344:116507. [PMID: 38340386 DOI: 10.1016/j.socscimed.2023.116507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/30/2023] [Accepted: 12/10/2023] [Indexed: 02/12/2024]
Abstract
Gender Based Violence (GBV) is a global pandemic and water insecurity is increasing in intensity and extent. This study explores the association between these two global health threats. Cross-sectional, quantitative data were collected via surveys (n = 365 adult women) to measure household water insecurity (HWI) and women's experiences of GBV in the last year. Qualitative data were collected from semi-structured interviews (n = 24 men and women), two focus group discussions (n = 25 men and women) and a multi-stakeholder meeting (n = 35 men and women) to explore experiences, attitudes and risk factors associated with HWI and GBV. Multivariate logistic regression analysis showed that women in water insecure households were more than twice as likely to report experiencing GBV in the last year (OR = 2.2, CI: 1.0-4.9, p = 0.051). Examining household water insecurity scores as a continuous variable revealed an increased odds of reporting GBV with each increase in the HWISE score (OR = 1.1, CI: 1.0; 1.1, p < 0.001). Qualitative data indicates that the intersection between HWI, a patriarchal social organization and a caste system produced water-related conflicts between intimate partners, between daughters-in-law and their in-laws, and between masters and enslaved women. These results are presented using an integrated theoretical framework - a Feminist Political Ecology of Health (FPEH) - to illustrate the many ways women encounter and experience multi-dimensional forms of violence across scales in connection to water insecurity. The combination of robust qualitative and quantitative data presented in this study suggests that HWI may be causally related to GBV in this context.
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Affiliation(s)
| | - Paula Tallman
- Department of Anthropology, Loyola University Chicago, Chicago, IL, USA
| | | | - Binahayati Rusyidi
- Department of Social Welfare, Faculty of Social and Political Sciences, Universitas Padjadjaran, Indonesia
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Jain A, Kumar A, Kim R, Subramanian SV. Prevalence of zero-sanitation in India: Patterns of change across the states and Union Territories, 1993-2021. J Glob Health 2023; 13:04082. [PMID: 37497738 PMCID: PMC10373110 DOI: 10.7189/jogh.13.04082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Background Ensuring universal access to safe sanitation by 2030 is a development priority for India. Doing so can help ensure improved physical and mental health outcomes. While the proportion of people in India with safe sanitation has risen dramatically over the past thirty years, much less is known about who has been most at risk for not having access to safe sanitation across India's states and Union Territories (UT) over this time period. We introduce the concept of zero-sanitation to fill this gap. Methods Data from five National Family Health Surveys (NFHS) conducted in 1993, 1999, 2006, 2016, and 2021 from 36 states and UT were used for this study. The study population consisted for all household individuals regardless of age in each survey round. Zero-sanitation was defined as those who have no access to a household toilet, and thus defecate in the open. We analyzed the percent prevalence of zero-sanitation in every state / UT at each time period in both urban and rural communities, as well as the population headcount burden in 2021. We calculated the absolute change on an annual basis to assess the change in percentage points of zero-sanitation across time periods at the all-India and state / UT levels. Results The all-India prevalence of zero-sanitation declined from 70.3% (95% confidence interval (CI) = 70.2%-70.5%) in 1993 to 17.8% (95% CI = 17.7%-17.9%) in 2021. The median percent prevalence of zero-sanitation across states and UTs was 65.9% in 1993. By 2021, the median percent prevalence of zero-sanitation across states and UTs was 5.7%. This reduction corresponded with a reduction in the between state / UT inequality in zero-sanitation. Nevertheless, as of 2021, the prevalence of zero-sanitation was still above 20% in Bihar, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, and Uttar Pradesh. Additionally, as of 2021, almost 92% of individuals who were defecating in the open were experiencing zero-sanitation. Zero-sanitation remains most common in states such as Bihar, Punjab, Uttar Pradesh, and Assam. Nevertheless, at this current rate of improvement, every state and UT except for Sikkim and Chandigarh are on track to end open defecation by 2030. Conclusions The concept of zero-sanitation is a useful tool in helping policy makers assess the extent to which sanitation coverage remains incomplete. When viewed through this lens, we see that open defecation remains most common among those who do not have a toilet. Addressing the myriad social determinants of sanitation access can help fill these gaps and ensure equitable sanitation coverage throughout India.
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Affiliation(s)
- Anoop Jain
- Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Akhil Kumar
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts, USA
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Nunbogu AM, Elliott SJ. Towards an integrated theoretical framework for understanding water insecurity and gender-based violence in Low-and middle-income countries (LMICs). Health Place 2021; 71:102651. [PMID: 34388581 DOI: 10.1016/j.healthplace.2021.102651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
Disparities in access to basic needs and resources such as water is largely borne out of power imbalance across scale. In examining these power dynamics in the context of health inequalities, scholars have deployed Feminist political ecology analytical framework to situate gender and other forms of vulnerability as emerging from unequal power relations, and political ecology of health to emphasise the health implications of inherent relational power in the distribution of resources. Although appealing, the two theoretical frameworks over time have proven to be limiting in the study of intersectional vulnerabilities such as gender-based violence and water insecurity which reflect multiple dimensions of unequal power structures. This study expands the theoretical space for the study of inequalities in health geography by demonstrating the utility of incorporating feminist political ecology with political ecology of health to form an integrated theoretical framework - Feminist Political Ecology of Health (FPEH). This proposed theoretical framework gives guidance for engaging with a suite of questions and methods related to multifaceted problems such as water insecurity and gender based-violence. The paper highlights these theoretical issues and then discusses how FPEH can enrich research on water security and gender-based violence in Low-and middle-income countries (LMICs).
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Affiliation(s)
- Abraham Marshall Nunbogu
- Department of Geography and Environmental Management, Faculty of Environment, University of Waterloo, 200 University Avenue West Waterloo, ON, N2L 3G1, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, Faculty of Environment, University of Waterloo, 200 University Avenue West Waterloo, ON, N2L 3G1, Canada
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Malik MI, Nawaz SMN, Nadeem M. Overcoming open defecation for healthier environment in case of Pakistan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:19179-19185. [PMID: 33394408 DOI: 10.1007/s11356-020-11919-1] [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: 12/10/2019] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
With the growing awareness of the linkage among open defecation (OD), environment, and health, it is important to understand the factors responsible for OD. It is a necessary step toward developing a strategy to end open defecation for ensuring a better environment and human health. There is no such study available for Pakistan. The study, therefore, aims to bridge this gap. Using household data of Pakistan Demographic and Health Survey (PDHS) 2017-2018, an association of OD with potential predictors, analysis of variance, and a logistic regression model are employed to develop the evidence. The results suggest that place of residence, education, poverty status, social norms, geopolitical regions, and living space significantly predict the OD behavior in Pakistan. This study recommends two things: first is to facilitate the households and communities to own latrines, second is to change the behavior through intervention. However, political commitment and effective administration will be key to ascertain ending OD.
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Affiliation(s)
- Muhammad Irfan Malik
- Department of Economics and Business Administration, University of Education, Lahore (Faisalabad Campus), Faisalabad, Pakistan.
- Punjab Economic Research Institute (PERI), Lahore, Pakistan.
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De Shay R, Comeau DL, Sclar GD, Routray P, Caruso BA. Community Perceptions of a Multilevel Sanitation Behavior Change Intervention in Rural Odisha, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4472. [PMID: 32580310 PMCID: PMC7345262 DOI: 10.3390/ijerph17124472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023]
Abstract
While latrine coverage is increasing in India, not all household members use their latrines. Cost-effective, culturally appropriate, and theory-informed behavior change interventions are necessary to encourage sustained latrine use by all household members. We qualitatively examined community perceptions of sanitation interventions broadly, along with specific impressions and spillover of community-level activities of the Sundara Grama latrine use behavior change intervention in rural Odisha, India. We conducted sixteen sex-segregated focus group discussions (n = 152) in three intervention and three nonintervention villages and thematically analyzed the data. We found Sundara Grama was well-received by community members and considered educative, but perceptions of impact on latrine use were mixed and varied by activity. Intervention recruitment challenges prevented some, such as women and households belonging to lower castes, from attending activities. Spillover occurred in one of two nonintervention villages, potentially due to positive relations within and between the nonintervention village and nearby intervention village. Community-level sanitation initiatives can be hindered by community divisions, prioritization of household sanitation over community cleanliness, and perceptions of latrine use as a household and individual issue, rather than common good. Community-centered sanitation interventions should assess underlying social divisions, norms, and perceptions of collective efficacy to adapt intervention delivery and activities.
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Affiliation(s)
- Renee De Shay
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.D.S.); (D.L.C.)
| | - Dawn L. Comeau
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.D.S.); (D.L.C.)
| | - Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | | | - Bethany A. Caruso
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Jain A, Wagner A, Snell-Rood C, Ray I. Understanding Open Defecation in the Age of Swachh Bharat Abhiyan: Agency, Accountability, and Anger in Rural Bihar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1384. [PMID: 32098057 PMCID: PMC7068267 DOI: 10.3390/ijerph17041384] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/09/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022]
Abstract
Swachh Bharat Abhiyan, India's flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents' preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and "behavior change" campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts.
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Affiliation(s)
- Anoop Jain
- Civil & Environmental Engineering, Stanford University, Palo Alto, CA 94305, USA
| | - Ashley Wagner
- School of Public Health, U.C. Berkeley, Berkeley, CA 74707, USA; (A.W.); (C.S.-R.)
- Department of City and Regional Planning, U.C. Berkeley, Berkeley, CA 94704, USA
| | - Claire Snell-Rood
- School of Public Health, U.C. Berkeley, Berkeley, CA 74707, USA; (A.W.); (C.S.-R.)
| | - Isha Ray
- Energy & Resources Group, U.C. Berkeley, Berkeley, CA 94704, USA;
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Busienei PJ, Ogendi GM, Mokua MA. Latrine Structure, Design, and Conditions, and the Practice of Open Defecation in Lodwar Town, Turkana County, Kenya: A Quantitative Methods Research. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219887960. [PMID: 31908471 PMCID: PMC6935769 DOI: 10.1177/1178630219887960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Poor latrine conditions, structure, and design may deter latrine use and provoke reversion to open defecation (OD). Statistics show that only 18% of the households in Turkana County, Kenya, have access to a latrine facility with most of these facilities in poor structural designs and poor hygienic conditions, which encourages rampant OD practices. AIM This article reports on quantitative aspects of a larger cross-sectional survey to assess latrine structure, design, and conditions, and the practice of OD in Lodwar. METHODS An observational study was carried out to examine latrine conditions, structure, and design in Lodwar, Kenya. A standardized questionnaire was also used to collect quantitative data. Stratified random sampling technique was employed to select respondents for this study with the sample drawn from 4 administrative units of Lodwar town covering the low-, medium-, and high-income households. Data were managed using Statistical Packages for Social Science (SPSS) software. RESULTS Nineteen percent of the sampled households did not possess a latrine facility at their homesteads with 73% of the latrines constructed using poor materials (mud, mats, polythene bags, and grass). Twenty percent of the respondents were scared of using a latrine with the main reason being loose soils that do not support strong constructions. Eighty-seven percent of the respondents agreed that the presence of feces on the latrine floor encouraged the practice of OD and 321 (80%) respondents stated that the latrine construction materials influenced latrine ownership and its subsequent use. CONCLUSIONS Respondents attributed rampant OD practices to poor latrine structure, design, and conditions. In addition, rampant cases of latrine sharing result in latrine filthiness, which eventually encourages OD practice. Inequality in sanitation, among counties, should be addressed in Kenya. The government should take charge of provision of good-quality communal latrines to the less-privileged societies like Turkana. Community empowerment and introduction of a small fee for cleaning and maintenance of these facilities will also improve their conditions. Ending the practice of OD will lead to increased positive public health and environmental outcomes in the study area.
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Affiliation(s)
- PJ Busienei
- Department of Environmental Science, Egerton University, Nakuru, Kenya
| | - GM Ogendi
- Department of Environmental Science, Egerton University, Nakuru, Kenya
- Dryland Research Training and Ecotourism Centre, Chemeron, Egerton University, Nakuru, Kenya
| | - MA Mokua
- Department of Environmental Science, Egerton University, Nakuru, Kenya
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Busienei PJ, Ogendi GM, Mokua MA. Open Defecation Practices in Lodwar, Kenya: A Mixed-Methods Research. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219828370. [PMID: 30814843 PMCID: PMC6381438 DOI: 10.1177/1178630219828370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND As of the year 2014, about 2.5 billion people globally lacked access to improved sanitation. The situation is even worse in the sub-Saharan African countries including Kenya. The practice of open defecation (OD) peaks beyond 72% of the population in Turkana County, Kenya, despite various interventions to end it. METHODS This article reports on both qualitative and quantitative aspects of a cross-sectional study. A partially mixed sequential dominant (quantitative) status was used to understand various socioeconomic factors associated with OD practice in Lodwar's human settlements, Turkana County. Simple random sampling technique was chosen to select participants for this study with the sample drawn from various administrative units of Lodwar. Standardized questionnaires, focus group discussions, and key informant interviews were used to collect data. RESULTS The quantitative findings revealed that culture was the leading factor as to why people practiced OD with a frequency of 44%. The findings further revealed that poverty was the major influencing factor for latrine ownership among the households (frequency 27%). Pearson χ2 tests revealed that there was a significant association between latrine presence and education level of the household head (χ2 = 107.317; P < .05), latrine sharing (χ2 = 403; P < .05), and occupation of the household head (χ2 = 74.51; P < .05). The quantitative findings showed that culture was by far the most common factor that contributed to the OD practice with a theme intensity of 31.1%. Further analyses identified 5 major cultural aspects that were associated with OD practice. This included sexual immorality, OD as a common habit, nomadic pastoralism, bride's dignity and mixing of feces. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (theme intensity 31.3%) followed closely by nomadic pastoralism kind of life among the residents that limit latrine construction (theme intensity 28.1%). CONCLUSIONS In addition to cultural aspects, high poverty levels influence latrine adoption and consequently OD practices. Future sanitation interventions addressing OD should assess and factor in these cultural aspects in such communities to come up with appropriate eradication measures which have otherwise been difficult to solve through poverty eradication and sanitation campaigns that have been in existence.
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Affiliation(s)
| | - George Morara Ogendi
- Department of Environmental Science, Egerton University, Egerton, Kenya
- Dryland Research Training and Ecotourism Centre, Chemeron, Kenya
| | - Millicent A Mokua
- Department of Environmental Science, Egerton University, Egerton, Kenya
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Novotný J, Ficek F, Hill JKW, Kumar A. Social determinants of environmental health: A case of sanitation in rural Jharkhand. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 643:762-774. [PMID: 29958166 DOI: 10.1016/j.scitotenv.2018.06.239] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/05/2023]
Abstract
An estimated 56% of households in rural India defecated in the open in 2015, making India the most significant contributor to the global sanitation burden. This cross-sectional study uses data collected in 2016 from 499 households in rural Jharkhand to understand the constraints of latrine adoption and drivers of sanitation preferences (plans to adopt toilets and willingness to pay for toilets). Focusing on a region with a large tribal population, the study examines two types of predictors, namely structural factors (objective socioeconomic, sociocultural and ecological characteristics) and psychosocial drivers (perceived unaffordability of toilet, hygiene and sanitation knowledge, perceived health risks, attitudes, both descriptive and injunctive social norms, and perceived water stress). We find that structural constraints related to educational, economic and sociocultural inequalities predict toilet ownership. Low sanitation rates can neither be attributed to a lack of expressed demand nor lack of recognition of the disadvantages of open defecation. Similarly, variations in sanitation preferences are neither explained by differences in hygiene and sanitation knowledge nor by understandings of sanitation health risks. We find that perceived unaffordability, attitudes (perceived benefits of toilet and disadvantages of OD) and perceived descriptive social norms are of key importance. This implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if they simultaneously address perceptions around financial unaffordability of toilets and around the benefits of toilets. Importantly, however, attempts to change sanitation preferences by acting on forces of social (dis)approval (i.e. through perceived injunctive social norms) may be ineffective and generate negative unintended consequences.
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Affiliation(s)
- Josef Novotný
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague 12843, Czechia.
| | - František Ficek
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague 12843, Czechia.
| | - Joseph K W Hill
- Xavier Institute of Social Service, Purulia Road, Ranchi, Jharkhand 834001, India.
| | - Anant Kumar
- Xavier Institute of Social Service, Purulia Road, Ranchi, Jharkhand 834001, India.
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Baker KK, Story WT, Walser-Kuntz E, Zimmerman MB. Impact of social capital, harassment of women and girls, and water and sanitation access on premature birth and low infant birth weight in India. PLoS One 2018; 13:e0205345. [PMID: 30296283 PMCID: PMC6175511 DOI: 10.1371/journal.pone.0205345] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child morbidity and mortality. Inadequate water and sanitation access (WASH) are risk factors for PTB and LBW in low-income countries. Physical stress from carrying water and psychosocial stress from addressing sanitation needs in the open may be mechanisms underlying these associations. If so, then living in a community with strong social capital should be able to buffer the adverse effects of WASH on birth outcomes. The objective of this study is to assess the relationships between WASH access and social conditions (including harassment and social capital) on PTB and LBW outcomes among Indian women, and to test whether social conditions modified the association between WASH and birth outcomes. METHODS AND FINDINGS This cohort study examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012 Waves of the India Human Development Survey. PTB and LBW occurred in 14.9% and 15.5% of women, respectively. After adjusting for maternal biological and socioeconomic conditions, PTB was associated with sharing a building/compound latrine (Odds Ratio (OR) = 1.55; 95% Confidence Interval (CI) = 1.01, 2.38) versus private latrine access, but suggested an effect in the opposite direction for sharing a community/public latrine (OR = 0.67; CI = 0.45, 1.01). Open defecation, type of drinking water source, minutes per day spent fetching water, and one-way time to a drinking water source were not associated with PTB. LBW was associated with spending more than two hours per day fetching water compared to less than two hours (OR = 1.33; CI = 1.05, 1.70) and suggested an association with open defecation (OR = 1.22; CI = 1.00, 1.48), but was not associated with other types of sanitation, type of drinking water source, or time to a drinking water source. Harassment of women and girls in the community was associated with both PTB (OR = 1.33; CI = 1.09, 1.62) and LBW (OR = 1.26; CI = 1.03, 1.54). The data also showed a possible association of local crime with LBW (OR = 1.30; CI = 1.00, 1.68). Statistically significant (p<0.05) evidence of effect modification was only found for collective efficacy on the association between type of sanitation access and PTB. In addition, stratified analyses identified differences in effect size for walking time to the primary drinking water source and PTB by crime, sanitation access and PTB by harassment, and total hours per day fetching water and LBW by collective efficacy. Limitations of this observational study include risk of bias, inability to confirm causality, reliance on self-reported outcomes, and limited sub-group sample sizes for testing effect modification. CONCLUSIONS The relationship between adverse birth outcomes and sanitation access, domestic water fetching, crime, and gender-based harassment suggests physical and psychosocial stress are possible mechanisms by which WASH access affects PTB and LBW among Indian women. Interventions that reduce domestic responsibilities related to water and sanitation and change social norms related to gender-based harassment may reduce rates of PTB and LBW in India.
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Affiliation(s)
- Kelly K. Baker
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, IA, United States of America
| | - William T. Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, IA, United States of America
| | - Evan Walser-Kuntz
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
| | - M. Bridget Zimmerman
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
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Abubakar IR. Exploring the determinants of open defecation in Nigeria using demographic and health survey data. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 637-638:1455-1465. [PMID: 29801238 DOI: 10.1016/j.scitotenv.2018.05.104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
There is increasing global attention to the threats of open defecation (OD) to human health and dignity, and the environment. With at least a quarter of Nigerians (25.1%) or 46 million people practicing OD in 2015, Nigeria ranks third in the world in OD prevalence after India and China. This study explores the socio-economic, demographic and geographic factors that influence and determine the practice of OD among Nigerian households. Data was obtained from 2013 Nigeria Demographic and Health Survey and analyzed using descriptive and inferential statistics. The results indicate that about 32% of Nigerian households, 8% in urban areas and 24% in rural areas, practiced OD in 2013. The practice is significantly influenced (p < 0.001) by households' place of residence (χ2 (1) = 2126.2), geo-political region (χ2 (5) = 1962.6) and wealth index (χ2 (4) = 4622.7), as well as by household head's education level (χ2 (3) = 1253.3), ethnicity (χ2 (3) = 1926.2) and gender (t = -7.1992). The article also discusses the implications of the findings for environmental and public health and recommends that facilitating ownership of latrines by households and communities, and behavioral change interventions are necessary towards substantially reducing or eliminating OD in Nigeria.
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Affiliation(s)
- Ismaila Rimi Abubakar
- College of Architecture and Planning, Imam Abdulrahman Bin Faisal University (formerly University of Dammam), P.O. Box 2397, Dammam 31451, Saudi Arabia.
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Delea MG, Sclar GD, Woreta M, Haardörfer R, Nagel CL, Caruso BA, Dreibelbis R, Gobezayehu AG, Clasen TF, Freeman MC. Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2139. [PMID: 30274212 PMCID: PMC6211028 DOI: 10.3390/ijerph15102139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 02/04/2023]
Abstract
Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)-perceptions regarding a group's ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming.
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Affiliation(s)
- Maryann G Delea
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Mulat Woreta
- Emory Ethiopia, Bahir Dar, Addis Ababa, Ethiopia.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Robert Dreibelbis
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | | | - Thomas F Clasen
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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13
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The Role of Perceived Social Norms in Rural Sanitation: An Explorative Study from Infrastructure-Restricted Settings of South Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070794. [PMID: 28714920 PMCID: PMC5551232 DOI: 10.3390/ijerph14070794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/04/2022]
Abstract
The perception of social sanitation norms (PSSNs) around unacceptability of open defecation has been a key aspect of recent sanitation interventions. However, underlying mechanisms through which “reconstructed” PSSNs affect sanitation outcomes have been a black box. This explorative cross-sectional study examines direct and indirect links between PSSNs and sanitation safety using data from structured interviews and observations in 368 households in rural South Ethiopia. In addition to a positive association between PSSNs and sanitation safety, we propose and examine the following two mechanisms: First, we confirm a potentially adverse feedback of PSSNs on future sanitation safety by enhancing the emotional satisfaction with current sanitation practice (satisfaction independent of the functionality of sanitation facilities). Second, inspired by the social amplification/attenuation of risk framework, we demonstrate that PSSNs work as a “social filter” that can amplify or attenuate the effects of other variables targeted in sanitation interventions such as perceived health-related and non-health risks and benefits associated with open defecation and private latrine ownership, respectively, and factual hygiene and sanitation knowledge. These findings imply that PSSNs are not only important per se, but they are also important instrumentally because sanitation outcomes depend upon the capacity of social influences to shape the perception of sanitation risks and benefits and sanitation-related awareness in desirable ways. The mechanisms outlined in this paper as well as the sustainability of sanitation outcomes depend on whether and how social sanitation norms are internalized.
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