1
|
Buchwald AG, Thomas E, Karnauskas KB, Grover E, Kotloff K, Carlton EJ. The Association Between Rainfall, Temperature, and Reported Drinking Water Source: A Multi-Country Analysis. GEOHEALTH 2022; 6:e2022GH000605. [PMID: 36381499 PMCID: PMC9662587 DOI: 10.1029/2022gh000605] [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: 02/10/2022] [Revised: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
Climate change may alter access to safe drinking water, with important implications for health. We assessed the relationship between temperature and rainfall and utilization of basic drinking water (BDW) in The Gambia, Mozambique, Pakistan, and Kenya. The outcomes of interest were (a) whether the reported drinking water source used in the past 2 weeks met the World Health Organization definition of BDW and (b) use of a BDW source that was always available. Temperature and precipitation data were compiled from weather stations and satellite data and summarized to account for long- and short-term weather patterns and lags. We utilized random forests and logistic regression to identify key weather variables that predicted outcomes by site and the association between important weather variables and BDW use. Higher temperatures were associated with decreased BDW use at three of four sites and decreased use of BDW that is always available at all four sites. Increasing rainfall, both in the long- and short-term, was associated with increased BDW use in three sites. We found evidence for interactions between household wealth and weather variables at two sites, suggesting lower wealth populations may be more sensitive to weather-driven changes in water access. Changes in temperature and precipitation can alter safe water use in low-resource settings-investigating drivers for these relationships can inform efforts to build climate resilience.
Collapse
Affiliation(s)
- Andrea G. Buchwald
- Department of Environmental and Occupational HealthColorado School of Public HealthAuroraCOUSA
| | - Evan Thomas
- Mortenson Center in Global EngineeringUniversity of Colorado BoulderBoulderCOUSA
| | - Kristopher B. Karnauskas
- Department of Environmental and Occupational HealthColorado School of Public HealthAuroraCOUSA
- Department of Atmospheric and Oceanic SciencesCooperative Institute for Research in Environmental SciencesUniversity of Colorado BoulderBoulderCOUSA
| | - Elise Grover
- Department of Environmental and Occupational HealthColorado School of Public HealthAuroraCOUSA
| | - Karen Kotloff
- Center for Vaccine Development and Global HealthUniversity of Maryland School of MedicineMDBaltimoreUSA
| | - Elizabeth J. Carlton
- Department of Environmental and Occupational HealthColorado School of Public HealthAuroraCOUSA
| |
Collapse
|
2
|
Singh S, Jayaram R. Attainment of water and sanitation goals: a review and agenda for research. SUSTAINABLE WATER RESOURCES MANAGEMENT 2022; 8:146. [PMID: 36033358 PMCID: PMC9396604 DOI: 10.1007/s40899-022-00719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
One-fourth of the global population is without basic drinking water and half of the global population lacks sanitation facilities. The attainment of water and sanitation targets is difficult due to administrative, operational, political, transborder, technical, and policy challenges. Conducted after 5 years from the adoption of sustainable development goals by the United Nations reviews the initiatives for improving access, quality, and affordability of water and sanitation. The bibliometric and thematic analyses are conducted to consolidate the outcomes of scientific papers on sustainable development goal 6 (SDG 6). Africa is struggling in relation with water and sanitation goals, having 17 countries with less than 40% basic drinking water facilities and 16 countries with less than 40% basic sanitation facilities. Globally, the attainment of water and sanitation goals will be depended on economic development, the development of revolutionary measures for wastewater treatment, and creating awareness related to water usage, water recycling, water harvesting, hygiene, and sanitation. Behavioral changes are also required for a new water culture and the attainment of water and sanitation goals by 2030.
Collapse
Affiliation(s)
- Sanjeet Singh
- University Centre for Research and Development, Chandigarh University, Gharuan, Mohali, Punjab 140413 India
- University School of Business, Chandigarh University, Gharuan, Mohali, Punjab 140413 India
| | - R. Jayaram
- University School of Business, Chandigarh University, Gharuan, Mohali, Punjab 140413 India
| |
Collapse
|
3
|
Lowe J, Ercumen A, Prottas C, Harris AR. Exploring the determinants and indicators of poultry feces management behaviors in rural Western Uganda. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155202. [PMID: 35421491 DOI: 10.1016/j.scitotenv.2022.155202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
Animal ownership has reported financial and nutritional benefits but has also been associated with enteric and respiratory infections, and inadequate sanitation and hygiene can lead to children touching and ingesting animal fecal matter. We identified key indicators for poultry feces management and investigated their social determinants using data from a baseline survey of a randomized-controlled trial of a poultry management training program in rural Western Uganda. The baseline survey was conducted in the Masindi and Kiryandongo districts of Uganda in September 2019, and data collected from 609 households were used. We evaluated indicators for poultry feces management behaviors using scale development methods, including descriptive statistics, bivariate correlation analyses, and Factor Analysis of Mixed Data. We also investigated social determinants of key poultry feces management behaviors using logistic and multinomial logistic regression models. A significant increase in odds of having free-roaming poultry was found for each additional poultry owned (OR = 1.18, P < 0.001). The odds of a household having an observed enclosure for poultry increased by 5% with each incremental poultry owned (OR = 1.05, P < 0.001), and by 4% with increasing wealth with each additional point on the poverty probability index score (OR = 1.04, P < 0.001). Our results also suggest enclosures are intermittently used and constructing them without further intervention likely will not be sufficient for effectively managing animal fecal contamination. We recommend that future studies on animal feces management measure indicators for corralling and feces disposal practices and evaluate their relationship to enteric pathogen exposure and health outcomes. Insights from this work can inform the development of robust indicators of poultry feces management behaviors that can be used for monitoring and evaluation purposes.
Collapse
Affiliation(s)
- Jeremy Lowe
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, NC State University, Raleigh, NC, United States.
| | | | - Angela R Harris
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
| |
Collapse
|
4
|
Novotný J, Mamo BG. Household-level sanitation in Ethiopia and its influencing factors: a systematic review. BMC Public Health 2022; 22:1448. [PMID: 35906616 PMCID: PMC9338532 DOI: 10.1186/s12889-022-13822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Within the past two decades, Ethiopia has achieved one of the fastest reductions of open defecation worldwide. This change can be attributed to the implementation of a national sanitation strategy that focused on facilitating community demand for latrine adoption and use of basic self-constructed latrines but less on other preconditions of hygienic sanitation. Recognition of sanitation by policymakers also catalyzed primary research in this area. As such, the synthesis of the available evidence is both warranted and possible. In this article, we thus decided to assess available primary evidence on the household-level sanitation in Ethiopia and its influencing factors. METHODS We searched primary studies that present findings on the role of factors influencing household-level sanitation outcomes in Ethiopia. We typologically classified sanitation outcomes analyzed in identified literature and computed pooled estimates for the most prevalent ones (measures of latrine availability and use). We characterized thematic types (themes and sub-themes) of influential sanitation drivers and used network analysis to examine the relational patterns between sanitation outcomes and their influencing factors. FINDINGS We identified 37 studies that met our inclusion criteria-all but one published after 2009. The general latrine coverage pooled across 23 studies was 70% (95% CI: 62-77%), the share of improved latrines pooled across 15 studies was 55% (95% CI: 41-68%), and latrine use pooled across 22 studies was 72% (95% CI: 64-79%). Between-study heterogeneity was high, and no time trends were identified. The identified sanitation outcomes were classified into eight types and factors reported to influence these outcomes were classified into 11 broader themes and 43 more specific sub-themes. Factors around the quality of latrines represented the most frequent sub-theme of consequential drivers. We found that the available research focused predominantly on outcomes concerning the initial adoption and use of basic latrines, emulating the main focus of national sanitation strategy. By contrast, research on drivers of the sustainability of sanitation change and, in particular, on the upgrading of latrines, has been rare despite its urgency. There is a high need to redirect the focus of sanitation research in Ethiopia towards understanding these factors on both the demand and supply side.
Collapse
Affiliation(s)
- Josef Novotný
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, 12800 Czechia
| | - Biruk Getachew Mamo
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, 12800 Czechia
| |
Collapse
|
5
|
Kamara D, Bah D, Sesay M, Maruta A, Sesay BP, Fofanah BD, Kamara IF, Kanu JS, Lakoh S, Molleh B, Guth J, Sagili KD, Tavernor S, Wilkinson E. Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6650. [PMID: 35682235 PMCID: PMC9180853 DOI: 10.3390/ijerph19116650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of Escherichia coli (E. coli) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with E. coli, and all five wells and 25% of standpipes had at least an intermediate risk level of E. coli. There was no antimicrobial resistance detected in the E. coli tested. The nitrate level exceeded the WHO’s recommended standard (>10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (>10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce E. coli contamination. Further research is required to identify where contamination of the water in standpipes is occurring.
Collapse
Affiliation(s)
- Dauda Kamara
- Water Sanitation and Hygiene (WASH) Program, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Doris Bah
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Momodu Sesay
- Directorate of Environmental Health & Sanitation, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (D.B.); (M.S.)
| | - Anna Maruta
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bockarie Pompey Sesay
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Bobson Derrick Fofanah
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization (WHO) Country Office, Freetown 00232, Sierra Leone; (A.M.); (B.P.S.); (B.D.F.); (I.F.K.)
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Freetown 00232, Sierra Leone;
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown 00232, Sierra Leone
| | - Sulaiman Lakoh
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Bailah Molleh
- Sustainable Health Systems Sierra Leone, 34 Military Research Center, Freetown 00232, Sierra Leone;
| | - Jamie Guth
- Global Health Connections, Center Barnstead, Barnstead, NH 03225, USA;
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), South East Asia Office, New Delhi 110016, India;
| | - Simon Tavernor
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK;
| | - Ewan Wilkinson
- Institute of Medicine, University of Chester, Chester CH2 1BR, UK;
| |
Collapse
|
6
|
Anthonj C, Setty KE, Ferrero G, A Yaya AM, Mingoti Poague KIH, Marsh AJ, Augustijn EW. Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 819:152902. [PMID: 34998758 DOI: 10.1016/j.scitotenv.2021.152902] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 05/26/2023]
Abstract
Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.
Collapse
Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Karen E Setty
- ICF, Durham, NC, USA; The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA
| | - Giuliana Ferrero
- WASH consulting, Delft, the Netherlands; IHE Delft Institute for Water Education, Delft, the Netherlands
| | - Al-Mounawara A Yaya
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Alan J Marsh
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ellen-Wien Augustijn
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| |
Collapse
|
7
|
Effects of community-led total sanitation and hygiene implementation on diarrheal diseases prevention in children less than five years of age in South Western Ethiopia: A quasi- experimental study. PLoS One 2022; 17:e0265804. [PMID: 35468143 PMCID: PMC9037915 DOI: 10.1371/journal.pone.0265804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Lack of improved sanitation is the most important contributing factor to diarrheal disease among under-five children in low and middle-income countries. There was no study to identify the effect of Community-Led Total Sanitation and Hygiene intervention on diarrheal diseases in the study area. Hence, this study was designed with the aim of finding the effects of Community-led Total Sanitation and Hygiene implementation for preventing diarrhea among under-five children. Methods A community-based Quasi-Experimental study was conducted among a sample of 846 households selected from intervention (kersa) and comparison (mana) districts using the four-stage random cluster-sampling method. A Semi-structured questionnaire was used to collect data. The collected data was cleaned, coded, and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Difference-in Difference method with McNemar’s tests was used to compare the prevalence of diarrhea between the intervention and comparison districts, and the significance of change between the pre-test and post-test was declared at p-value less than 0.05 with 95% confidence interval. Results The intervention led to decreased diarrhea prevalence [pp = -8.2, 95% CI: -15.9, -0.5], increased latrine ownership [pp = 5.6, 95% CI: 0.5, 10.8], and increased latrine utilization [pp = 10.7, 95% CI: 4.7, 16.6] in intervention district at post-test compared to the baseline; while the presence of handwashing facility near the latrine, home-based water treatment, and proper water storage and handling practice were decreased at post-test compared to the baseline. Conclusion Implementation of Community-Led Total Sanitation improved sanitation and hygiene status of community that resulted in the reduction of diarrhea diseases in under-five children. Further implementation, evaluation, and scale-up of the interventions are needed to reduce diarrheal disease in under-five children.
Collapse
|
8
|
Gemeda ST, Springer E, Gari SR, Birhan SM, Bedane HT. The importance of water quality in classifying basic water services: The case of Ethiopia, SDG6.1, and safe drinking water. PLoS One 2021; 16:e0248944. [PMID: 34351947 PMCID: PMC8341575 DOI: 10.1371/journal.pone.0248944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Sustainable Development Goal (SDG) 6 aims to coordinate international efforts toward “clean water and sanitation.” However, water contaminated with pathogenic bacteria or thermotolerant coliforms (TTC) will not achieve the SDG target of clean water in the lives of people around the world. The aim of this study is to assess the water quality parameters of basic water services in Amhara and Afar regions of Ethiopia as well as the role and importance of local managerial committees in ensuring basic water functionality. Methods This mixed methods research, conducted in January-June 2019, sampled 22 districts from food-insecure areas in the Amhara and Afar regions of Ethiopia. From the 22 districts, which represent nearly one third of all districts in each region, 111 water services classified as “basic” were randomly selected. For each selected water service, research included: water quality sample testing, visual observation of water services, interviews and focus group discussions with the associated water managerial committee members. Descriptive statistics frequency, percent, mean, median, standard deviations, normal tables, cross-tables and graphs are used to present the data. Results Although the international water standard for thermotolerant coliform (TTC) levels is 0 CFU/100ml, in our sample of 111 water services, the maximum TTC counts were 71 CFU/100 ml and the mean was 4 CFU/100 ml. Thermotolerant coliform counts were above the permissible standard values for nearly 40% (n = 111) of the basic water services. TTC was detected in 44 (39.64%) (n = 111) basic water services. Of these, 38 (34.23%) were operationally functional while 6 (5.41%) were not functional. Approximately one third of the basic water services sampled, deemed “functional” by international standards, do not provide potable water due to thermotolerant coliform (TTC) levels. Conclusion Our findings from the Amhara and Afar regions of Ethiopia demonstrate that water quality parameters are not currently considered in classifying basic water services. This suggests that international efforts to address SDG 6 should incorporate water quality as a key parameter to better track international progress toward “clean water and sanitation” efforts. We discuss two potential pathways for stronger inclusion of water quality parameters in international definitions: (1) to mandate water quality within “functional” and “non-functional” definitions or (2) to add a ladder rung titled “safe basic water services” to the international drinking water ladder. Our findings from Ethiopia suggest that additional research should be undertaken in development contexts to assess whether or not “functional” basic water services provide safe drinking water to users.
Collapse
Affiliation(s)
- Shibabaw Tadesse Gemeda
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Emily Springer
- Social Justice & Human Rights, School of Social and Behavioral Sciences, New College of Interdisciplinary Arts and Sciences, Arizona State University, Glendale, Arizona, United States of America
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Hailu Tolasa Bedane
- Doctor of Transformational Leadership Programme, Bakke Graduate University, Dallas, Texas, United States of America
| |
Collapse
|
9
|
Apanga PA, Weber AM, Darrow LA, Riddle MS, Tung WC, Liu Y, Garn JV. The interrelationship between water access, exclusive breastfeeding and diarrhea in children: a cross-sectional assessment across 19 African countries. J Glob Health 2021. [PMID: 33828842 PMCID: PMC8005312 DOI: 10.7189/jogh-11-04001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Access to an improved water supply and practicing exclusive breastfeeding are essential for improving maternal and child health outcomes. However, few studies have been equipped to assess the interdependencies between access to improved water, practicing exclusive breastfeeding, and child health. The primary aim of our study was to assess whether access to an improved water supply and water-fetching were associated with mothers’ practice of exclusive breastfeeding. Methods We analyzed data on 247 090 mothers with children 5 months old or less using Multiple Indicator Cluster Surveys from 19 African countries. Multivariable logistic regression was used to estimate the relationship between our exposures and exclusive breastfeeding practice, while meta-analytic methods were used to pool adjusted estimates across 19 countries. Results The prevalence of exclusive breastfeeding ranged from 22% in Nigeria to 70% in Malawi. Pooled results showed water-fetching was not associated with exclusive breastfeeding (adjusted prevalence odds ratios (aPOR) = 1.04, 95% confidence interval (CI) = 0.89, 1.21). Access to an improved water source was also not associated with exclusive breastfeeding (aPOR = 1.06, 95% CI = 0.94, 1.21). Across all countries many women were spending a significant amount of time water-fetching each day (mean time varied from 20 minutes in Ghana to 115 minutes in Mauritania). Exclusively breastfed children had 33% lower odds of diarrhea than those who were not exclusively breastfed (aPOR = 0.67, 95% CI = 0.56, 0.78). Conclusion Our study is the first to assess the relationship between access to improved water supply, water-fetching and exclusive breastfeeding. We found that access to water supply and time spent by mothers fetching water were not associated with exclusive breastfeeding practice, even though mothers spent significant time fetching water.
Collapse
Affiliation(s)
- Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Mark S Riddle
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Wei-Chen Tung
- The Valley Foundation of School of Nursing, San Jose State University, San Jose, California, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| |
Collapse
|
10
|
Apanga PA, Weber AM, Darrow LA, Riddle MS, Tung WC, Liu Y, Garn JV. The interrelationship between water access, exclusive breastfeeding and diarrhea in children: a cross-sectional assessment across 19 African countries. J Glob Health 2021; 11:04001. [PMID: 33828842 PMCID: PMC8005312 DOI: 10.7189/jogh.11.04001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Access to an improved water supply and practicing exclusive breastfeeding are essential for improving maternal and child health outcomes. However, few studies have been equipped to assess the interdependencies between access to improved water, practicing exclusive breastfeeding, and child health. The primary aim of our study was to assess whether access to an improved water supply and water-fetching were associated with mothers' practice of exclusive breastfeeding. METHODS We analyzed data on 247 090 mothers with children 5 months old or less using Multiple Indicator Cluster Surveys from 19 African countries. Multivariable logistic regression was used to estimate the relationship between our exposures and exclusive breastfeeding practice, while meta-analytic methods were used to pool adjusted estimates across 19 countries. RESULTS The prevalence of exclusive breastfeeding ranged from 22% in Nigeria to 70% in Malawi. Pooled results showed water-fetching was not associated with exclusive breastfeeding (adjusted prevalence odds ratios (aPOR) = 1.04, 95% confidence interval (CI) = 0.89, 1.21). Access to an improved water source was also not associated with exclusive breastfeeding (aPOR = 1.06, 95% CI = 0.94, 1.21). Across all countries many women were spending a significant amount of time water-fetching each day (mean time varied from 20 minutes in Ghana to 115 minutes in Mauritania). Exclusively breastfed children had 33% lower odds of diarrhea than those who were not exclusively breastfed (aPOR = 0.67, 95% CI = 0.56, 0.78). CONCLUSION Our study is the first to assess the relationship between access to improved water supply, water-fetching and exclusive breastfeeding. We found that access to water supply and time spent by mothers fetching water were not associated with exclusive breastfeeding practice, even though mothers spent significant time fetching water.
Collapse
Affiliation(s)
- Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Mark S Riddle
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Wei-Chen Tung
- The Valley Foundation of School of Nursing, San Jose State University, San Jose, California, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| |
Collapse
|
11
|
Musacchio A, Andrade L, O'Neill E, Re V, O'Dwyer J, Hynds PD. Planning for the health impacts of climate change: Flooding, private groundwater contamination and waterborne infection - A cross-sectional study of risk perception, experience and behaviours in the Republic of Ireland. ENVIRONMENTAL RESEARCH 2021; 194:110707. [PMID: 33428910 DOI: 10.1016/j.envres.2021.110707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
The frequency and severity of flooding events will increase over the coming decades due to global climate change. While close attention has typically been paid to infrastructural and environmental outcomes of flood events, the potential adverse human health consequences associated with post-event consumption from private groundwater sources have received minimal attention, leading to a poor understanding of private well users' preparedness and the drivers of positive behavioural adoption. The current study sought to quantify the capacity of private well users to cope with flood-triggered contamination risks and identify the social psychological determinants of proactive attitudes in the Republic of Ireland, using a cross-sectional questionnaire incorporating two distinct models of health behaviour, the Health Belief Model and Risk-Attitude-Norms-Ability-Self Regulation model. Adoption of healthy behaviours prior to flooding was evaluated with respect to respondents' risk exposure, risk experience and risk perception, in addition to systematic supply stewardship under normal conditions. Associations between adoption of protective behaviours and perception, experience and socio-demographic factors were evaluated through multinomial and multiple logistic regressions, while a multi-model inferential approach was employed with the predictors of health behaviour models. Findings suggest that floods are not considered likely to occur, nor were respondents worried about their occurrence, with 72.5% of respondents who reported previous flooding experience failing to adopt protective actions. Prior experience of well water contamination increased adoption of proactive attitudes when flooding occurred (+47%), with a failure to adopt healthy behaviours higher among rural non-agricultural residents (136%). Low levels of preparedness to deal with flood-related contamination risks are a side-effect of the general lack of appropriate well stewardship under normal conditions; just 10.1% of respondents adopted both water treatment and frequent testing, in concurrence with limited risk perception and poor awareness of the nexus between risk factors (e.g. floods, contamination sources) and groundwater quality. Perceived risk, personal norms and social norms were the best predictors of protective behaviour adoption and should be considered when developing future awareness campaigns.
Collapse
Affiliation(s)
- Arianna Musacchio
- Department of Earth and Environmental Sciences, University of Pavia, Pavia, Italy.
| | - Luisa Andrade
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - Eoin O'Neill
- School of Architecture, Planning and Environmental Policy, University College Dublin, Dublin, Ireland; UCD Earth Institute, University College Dublin, Dublin, Ireland
| | - Viviana Re
- Department of Earth Sciences, University of Pisa, Pisa, Italy
| | - Jean O'Dwyer
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
| | - Paul Dylan Hynds
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Achore M, Bisung E, Kuusaana ED. Coping with water insecurity at the household level: A synthesis of qualitative evidence. Int J Hyg Environ Health 2020; 230:113598. [PMID: 32862072 DOI: 10.1016/j.ijheh.2020.113598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
Water insecurity is a key public health and developmental challenge for many communities across the world. Using a meta-ethnographic synthesis, this study examines how households cope with water insecurity, as well as the socio-economic consequences and determinants of water insecurity coping strategies. A systematized keyword search was conducted in various electronic databases (PubMed, CINAHL EBSCOHost, Embase Ovid, Science Direct, Medline, Global Health, SCOPUS, Google and Google scholar). Out of 1352 potential articles, 21 studies were selected for review. Households employed nine key coping strategies. These strategies include water storage, construction of alternative water source, water sharing and borrowing from social networks, buying water from private vendors, water management and reuse, illegal connections to public water networks, water harvesting, fetching water from distant sources, and water treatment to improve the quality. Some of these coping strategies had far-reaching health and economic consequences, including the risk of water contamination, adverse psychosocial health, and impacts on household savings. We found that poor households, due to their over-reliance on short term labour-intensive and time-consuming coping strategies, are further economically disadvantaged by water insecurity. From a policy perspective, we recommend that investments in effective and efficient water supply infrastructure are needed to help alleviate the day-to-day hassles of water users. While policymakers are looking for long term solutions to these problems, some of the coping strategies identified in this synthesis, such as water conservation, water reuse, and purification of water before consumption, could be encouraged as supplementary strategies to meet households' immediate water needs.
Collapse
Affiliation(s)
- Meshack Achore
- School of Kinesiology and Health Studies, Queen's University Kingston, ON, Canada.
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen's University Kingston, ON, Canada
| | - Elias D Kuusaana
- Department of Real Estate and Land Management, University for Development Studies, Wa Upper West Region, Ghana
| |
Collapse
|
14
|
Nunbogu AM, Harter M, Mosler HJ. Factors Associated with Levels of Latrine Completion and Consequent Latrine Use in Northern Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E920. [PMID: 30875779 PMCID: PMC6466048 DOI: 10.3390/ijerph16060920] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households' latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households' latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households.
Collapse
Affiliation(s)
- Abraham Marshall Nunbogu
- Department of Environmental and Social Science Research, Swiss Federal Institute of Aquatic Science and Technology, Urberlandstrasse 133, 8600 Dubendorf, Switzerland.
- Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - Miriam Harter
- Department of Environmental and Social Science Research, Swiss Federal Institute of Aquatic Science and Technology, Urberlandstrasse 133, 8600 Dubendorf, Switzerland.
| | - Hans-Joachim Mosler
- Department of Environmental and Social Science Research, Swiss Federal Institute of Aquatic Science and Technology, Urberlandstrasse 133, 8600 Dubendorf, Switzerland.
| |
Collapse
|
15
|
Wolf J, Johnston R, Hunter PR, Gordon B, Medlicott K, Prüss-Ustün A. A Faecal Contamination Index for interpreting heterogeneous diarrhoea impacts of water, sanitation and hygiene interventions and overall, regional and country estimates of community sanitation coverage with a focus on low- and middle-income countries. Int J Hyg Environ Health 2019; 222:270-282. [PMID: 30503228 PMCID: PMC6417992 DOI: 10.1016/j.ijheh.2018.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The impact on diarrhoea of sanitation interventions has been heterogeneous. We hypothesize that this is due to the level of prevailing faecal environmental contamination and propose a Faecal Contamination Index (FAECI) of selected WASH indicators (objective 1). Additionally, we provide estimates of the proportion of the population living in communities above certain sanitation coverage levels (objective 2). METHODS Objective 1: Faecal contamination post-intervention was estimated from WASH intervention reports. WASH indicators composing the FAECI included eight water, sanitation and hygiene practice indicators, which were selected for their relevance for health and data availability at study- and country-level. The association between the estimated level of faecal environmental contamination and diarrhoea was examined using meta-regression. Objective 2: A literature search was conducted to identify health-relevant community sanitation coverage thresholds. To estimate total community coverage with basic sanitation in low- and middle-income countries, at relevant thresholds, household surveys with data available at primary sampling unit (PSU)-level were analysed according to the identified thresholds, at country-, regional- and overall level. RESULTS Objective 1: We found a non-linear association between estimated environmental faecal contamination and sanitation interventions' impact on diarrhoeal disease. Diarrhoea reductions were highest at lower faecal contamination levels, and no diarrhoea reduction was found when contamination increased above a certain level. Objective 2: Around 45% of the population lives in communities with more than 75% of coverage with basic sanitation and 24% of the population lives in communities above 95% coverage, respectively. CONCLUSIONS High prevailing faecal contamination might explain interventions' poor effectiveness in reducing diarrhoea. The here proposed Faecal Contamination Index is a first attempt to estimate the level of faecal contamination in communities. Much of the world's population currently lives in faecally contaminated environments as indicated by low community sanitation coverage.
Collapse
Affiliation(s)
- Jennyfer Wolf
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Richard Johnston
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, UK; Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa.
| | - Bruce Gordon
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Kate Medlicott
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Annette Prüss-Ustün
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| |
Collapse
|
16
|
Abstract
This study examines the patterns, trends, and factors associated with functional community water points in rural Ethiopia and identifies potential areas of improvement in terms of practitioner response to functionality and functionality monitoring. It was part of an integrated WaSH and nutrition program implemented by UNICEF Ethiopia and the Government of Ethiopia. Cross-sectional surveys were conducted to collect WaSH-related data in communities and WaSH committees from four community-based nutrition (CBN) program groupings in Ethiopia. In all areas, CBN was implemented, but only in less than half of the areas, a WaSH intervention was implemented. Seventy-three representative kebeles, comprising 30 intervention and 43 control communities, were surveyed. Two structured surveys were conducted. The ‘community survey’ addressed community water points and their functionality and the main areas for improvement needed. The ‘WaSH committee survey’ investigated technical and management aspects of water points and their functionality. Data were analyzed using bivariate regression to identify community characteristics and management practices associated with functionality of water points and explore opportunities to improve water point functionality and monitoring. In the communities, 65% of water points were functional. Eighty percent of communities had a WaSH committee. The WaSH committee members reported that the most used water point types were protected dug wells and boreholes, and that 80% of their water points were functional. India Mark II pumps were more likely to be functional and communities with longer established WaSH committees had higher water point functionality. Communities suggested that the key factors for water point sustainability were improving water quality and water pressure, reducing water collection time, and speeding up repair times. Taking community leaders’ ‘priority lists’ into consideration offers sustainable opportunities for demand-driven, adaptive and targeted design and implementation of rural water supply programs, which, if they include the grassroots level as key informants and actors of change, can succeed. Interventions should integrate the ‘voice’ of the community, the WaSH committees, and other stakeholders and thereby facilitate transdisciplinary approaches at different stages of program management (planning, monitoring, and evaluation). This would help closing the knowledge to action gap and improve policy, programming, practice, and service delivery.
Collapse
|