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Sclar GD, Penakalapati G, Caruso BA, Rehfuess EA, Garn JV, Alexander KT, Freeman MC, Boisson S, Medlicott K, Clasen T. Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis. Soc Sci Med 2018; 217:121-134. [PMID: 30316053 DOI: 10.1016/j.socscimed.2018.09.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/16/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022]
Abstract
The WHO defines health not as the absence of disease but as a "state of complete physical, mental, and social well-being." To date, public health research on sanitation has focused mainly on the impact of sanitation on infectious diseases and related sequelae, such as diarrhea and malnutrition. This review focuses on the mental and social well-being implications of sanitation. We systematically searched leading databases to identify eligible studies. Qualitative studies were assessed using a 17-point checklist adapted from existing tools, while quantitative studies were assessed using the Liverpool Quality Appraisal Tool. We followed a best-fit framework synthesis approach using six a priori well-being dimensions (privacy, shame, anxiety, fear, assault, and safety), which were examined using line-by-line coding. Two additional dimensions (dignity and embarrassment) inductively emerged during coding for a total of eight well-being outcomes. We then synthesized coded text for each dimension into descriptive themes using thematic analysis. For quantitative studies, we extracted any measures of association between sanitation and well-being. We identified 50 eligible studies covering a variety of populations and sanitation contexts but many studies were conducted in India (N = 14) and many examined the sanitation experience for women and girls (N = 19). Our synthesis results in a preliminary conceptual model in which privacy and safety, including assault, are root well-being dimensions. When people perceive or experience a lack of privacy or safety during open defecation or when using sanitation infrastructure, this can negatively influence their mental and social well-being. We found that perceptions and experiences of privacy and safety are influenced by contextual and individual factors, such as location of sanitation facilities and user's gender identity, respectively. Privacy and safety require thorough examination when developing sanitation interventions and policy to ensure a positive influence on the user's mental and social well-being.
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Affiliation(s)
- G D Sclar
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - G Penakalapati
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - B A Caruso
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - E A Rehfuess
- Institute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J V Garn
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA; School of Community Health Sciences, University of Nevada Reno, 1664 N Virginia St, Reno, NV, 89557, USA
| | - K T Alexander
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA; CARE, 151 Ellis St NE, Atlanta, GA, USA, 30303
| | - M C Freeman
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - S Boisson
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1202, Genève, Switzerland
| | - K Medlicott
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Avenue Appia 20, 1202, Genève, Switzerland
| | - T Clasen
- Department of Environmental Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Bresee S, Caruso BA, Sales J, Lupele J, Freeman MC. 'A child is also a teacher': exploring the potential for children as change agents in the context of a school-based WASH intervention in rural Eastern Zambia. Health Educ Res 2016; 31:521-534. [PMID: 27206442 DOI: 10.1093/her/cyw022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
As part of water, sanitation and hygiene interventions in low-income settings, it is frequently assumed that pupils can disseminate information and catalyze change at home, yet this assumption has not been rigorously assessed. We employed qualitative research methods in two phases to assess the potential for children to be change agents in five schools in rural Zambia. Phase 1 included role-play and focus group discussions among pupils on their percieved ability to serve as change agents. Children were then given 'homework' that included information on health messages and on how to build a handwashing station, and were encouraged to engage their family. In Phase 2, we conducted separate focus group discussions with pupils and mothers on their experiences with the 'homework'. We found that, in general, pupils were enthusiastic about engaging with parents-typically male heads of household-and were successful at constructing handwashing stations. Mothers reported high levels of trust in children to relay health information learned at school. Pupils were able to enact small changes to behavior, but not larger infrastructure changes, such as construction of latrines. Pupils are capable of communicating knowledge and behaviors to family members; however, discrete activities and guidance is required.
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Affiliation(s)
- S Bresee
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - B A Caruso
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J Lupele
- Schools Promoting Learning Acheivement through Sanitation and Hygiene (SPLASH), Lusaka, Zambia
| | - M C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Stevenson EGJ, Ambelu A, Caruso BA, Tesfaye Y, Freeman MC. Community Water Improvement, Household Water Insecurity, and Women's Psychological Distress: An Intervention and Control Study in Ethiopia. PLoS One 2016; 11:e0153432. [PMID: 27124391 PMCID: PMC4849673 DOI: 10.1371/journal.pone.0153432] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/29/2016] [Indexed: 01/28/2023] Open
Abstract
Background Over 650 million people worldwide lack access to safe water supplies, and even among those who have gained access to ‘improved’ sources, water may be seasonally unreliable, far from homes, expensive, and provide insufficient quantity. Measurement of water access at the level of communities and households remains crude, and better measures of household water insecurity are urgently needed to inform needs assessments and monitoring and evaluation. We set out to assess the validity of a quantitative scale of household water insecurity, and to investigate (1) whether improvements to community water supply reduce water insecurity, (2) whether water interventions affect women’s psychological distress, and (3) the impacts of water insecurity on psychological distress, independent of socio-economic status, food security, and harvest quality. Methods and Findings Measures were taken before and one to six months after a community water supply improvement in three villages in rural northern Ethiopia. Villages similar in size and access to water sources and other amenities did not receive interventions, and served as controls. Household water insecurity was assessed using a 21-item scale based on prior qualitative work in Ethiopia. Women’s psychological distress was assessed using the WHO Self-Reporting Questionnaire (SRQ-20). Respondents were either female heads of household or wives of the heads of household (n = 247 at baseline, n = 223 at endline); 123 households provided data at both rounds. The intervention was associated with a decline of approximately 2 points on the water insecurity scale between baseline and endline compared to the control (beta -1.99; 95% CI’s -3.15, -0.84). We did not find evidence of impact of the intervention on women’s psychological distress. Water insecurity was, however, predictive of psychological distress (p <0.01), independent of household food security and the quality of the previous year’s harvest. Conclusion These results contribute to the construct validity of our water insecurity scale, and establish our approach to measuring water insecurity as a plausible means of evaluating water interventions. Improvements to community water supplies were effective in reducing household water insecurity, but not psychological distress, in this population. Water insecurity was an important predictor of psychological distress. This study contributes to an emerging literature on quantitative assessment of household water insecurity, and draws attention to the potential impact of improved access to water on women’s mental well-being.
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Affiliation(s)
- E. G. J. Stevenson
- Department of Anthropology, University College London, London, United Kingdom
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
- * E-mail:
| | - A. Ambelu
- Department of Environmental Health Sciences, Jimma University, Jimma, Ethiopia
| | - B. A. Caruso
- Department of Behavioral Science and Health Education, Emory University, Atlanta, GA, United States of America
| | - Y. Tesfaye
- Department of Anthropology, Oregon State University, Corvallis, OR, United States of America
| | - M. C. Freeman
- Department of Environmental Health, Emory University, Atlanta, GA, United States of America
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Freeman MC, Chard AN, Nikolay B, Garn JV, Okoyo C, Kihara J, Njenga SM, Pullan RL, Brooker SJ, Mwandawiro CS. Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors 2015; 8:412. [PMID: 26248869 PMCID: PMC4528701 DOI: 10.1186/s13071-015-1024-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
Background Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings. Methods We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models. Results Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. Conclusions No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean. Electronic supplementary material The online version of this article (doi:10.1186/s13071-015-1024-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M C Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA.
| | - A N Chard
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA.
| | - B Nikolay
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - J V Garn
- Department of Environmental Health, Emory University, Atlanta, Georgia, USA.
| | - C Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
| | - J Kihara
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
| | - S M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
| | - R L Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - S J Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - C S Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
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O'Reilly CE, Freeman MC, Ravani M, Migele J, Mwaki A, Ayalo M, Ombeki S, Hoekstra RM, Quick R. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect 2008; 136:80-91. [PMID: 17306051 PMCID: PMC2870759 DOI: 10.1017/s0950268807008060] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2007] [Indexed: 11/06/2022] Open
Abstract
Safe drinking water and hygiene are essential to reducing Kenya's diarrhoeal disease burden. A school-based safe water and hygiene intervention in Kenya was evaluated to assess its impact on students' knowledge and parents' adoption of safe water and hygiene practices. We surveyed 390 students from nine schools and their parents at baseline and conducted a final evaluation of 363 students and their parents. From baseline to final evaluation, improvement was seen in students' knowledge of correct water treatment procedure (21-65%, P<0.01) and knowing when to wash their hands. At final evaluation, 14% of parents reported currently treating their water, compared with 6% at baseline (P<0.01). From 2004 to 2005, school absenteeism in the September-November term decreased in nine project schools by 35% and increased in nine neighbouring comparison schools by 5%. This novel programme shows promise for reducing school absenteeism and promoting water and hygiene interventions in the home.
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Affiliation(s)
- C E O'Reilly
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Roy AH, Freeman MC, Freeman BJ, Wenger SJ, Ensign WE, Meyer JL. Investigating hydrologic alteration as a mechanism of fish assemblage shifts in urbanizing streams. ACTA ACUST UNITED AC 2005. [DOI: 10.1899/04-022.1] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
This is the report on a study of patients admitted to a Level I trauma center. For a description of a trauma unit and a detailed analysis of the perioperative nurse's role in caring for the trauma patient in the OR, please see the accompanying article, "Perioperative nursing care of the multiple trauma patient: When seconds count."
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Freeman MC, Flanagan ME, Champion HR. Perioperative nursing care of the multiple trauma patient. When seconds count. AORN J 1989; 50:40-1, 43-4, 46-50. [PMID: 2751299 DOI: 10.1016/s0001-2092(07)67634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Grossman GD, de Sostoa A, Freeman MC, Lobon-Cerviá J. Microhabitat use in a mediterranean riverine fish assemblage. Oecologia 1987; 73:490-500. [DOI: 10.1007/bf00379406] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/1987] [Indexed: 10/26/2022]
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Grossman GD, de Sostoa A, Freeman MC, Lobon-Cerviá J. Microhabitat use in a mediterranean riverine fish assemblage. Oecologia 1987; 73:501-512. [PMID: 28311965 DOI: 10.1007/bf00379407] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/1987] [Indexed: 10/26/2022]
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Freeman MC, Dupke KC, Croteau CM. Extinction of the estrogen-induced daily signal for LH release in the rat: a role for the proestrous surge of progesterone. Endocrinology 1976; 99:223-9. [PMID: 945763 DOI: 10.1210/endo-99-1-223] [Citation(s) in RCA: 93] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The heightened secretion of estrogen on diestrus-2 is required for the release of an ovulatory amount of LH on the following day, proestrus. Though these surges occur once every 4-5 days in cycling rats, the treatment of ovariectomized rats with a single injection of estrogen results in daily proestrus-like surges of LH. The present study was designed to test the possibility that progesterone, secreted on proestrus, prevents the daily expression of LH surges in cycling animals. The administration of estradiol benzoate (EB, 50 mug) to ovariectomized rats resulted in daily surges of LH secretion for 3 consecutive days. These surges were similar in the timing of onset and duration to the preovulatory surge of LH on proestrus. Serum LH concentrations were not increased on either the second or the third day when 5 mg of progesterone was given at 1600 h on the day of the first surge. These data suggest that progesterone blocks the expression of daily LH surges induced by estrogen. To determine whether this relationship obtains during the estrous cycle, groups of rats were treated with sodium pentobarbital (PB) at 1345 h during proestrus. This treatment postponed the proestrous surges of LH and progesterone for 24 h. When the surge of progesterone was simulated in PB-treated rats by the administration of 5 mg of the steroid at 1400 h during proestrus, a preovulatory surge of LH was not detected during either proestrous, estrus,, or diestrus-1. These data, taken together, suggest that estrogen turns on a "memory center" for the expression of daily LH surges and that one function of the increased secretion of progesterone on proestrus is to limit the expression of the "memory center" to this day.
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