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Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework.

Campbell, Oona M R; Benova, Lenka; Gon, Giorgia; Afsana, Kaosar; Cumming, Oliver
| Idioma(s): Inglés
OBJECTIVE: To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review. METHODS: We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically. RESULTS: The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. 'In-water' associations: (a) Inorganic contaminants, and (b) 'water-system' related infections, (c) 'water-based' infections, and (d) 'water borne' infections. 2. 'Behaviour' associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes. CONCLUSION: WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies.
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Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru.

Oswald, William E; Hunter, Gabrielle C; Kramer, Michael R; Leontsini, Elli; Cabrera, Lilia; Lescano, Andres G; Gilman, Robert H
| Idioma(s): Inglés
OBJECTIVES: To estimate the association between improved water and sanitation access and handwashing of mothers living in a peri-urban community of Lima, Peru. METHODS: We observed 27 mothers directly, before and after installation of private, piped water and sewerage connections in the street just outside their housing plots, and measured changes in the proportion of faecal-hand contamination and hand-to-mouth transmission events with handwashing. RESULTS: After provision of water and sewerage connections, mothers were approximately two times more likely to be observed washing their hands within a minute of defecation, compared with when they relied on shared, external water sources and non-piped excreta disposal (RR = 2.14, 95% CI = 0.99-4.62). With piped water and sewerage available at housing plots, handwashing with or without soap occurred within a minute after 48% (10/21) of defecation events and within 15 min prior to 8% (11/136) of handling food events. CONCLUSIONS: Handwashing increased following installation of private, piped water and sewerage connections, but its practice remained infrequent, particularly before food-related events. Infrastructural interventions should be coupled with efforts to promote hygiene and ensure access to water and soap at multiple on-plot locations convenient to mothers.
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The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings.

Dreibelbis, Robert; Winch, Peter J; Leontsini, Elli; Hulland, Kristyna R S; Ram, Pavani K; Unicomb, Leanne; Luby, Stephen P
| Idioma(s): Inglés
BACKGROUND: Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision-making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance. METHODS: We completed a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organization of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesized. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH). RESULTS: We identified 15 WASH-specific theoretical models, behaviour change frameworks, or programmatic models, of which 9 addressed our review questions. Existing models under-represented the potential role of technology in influencing behavioural outcomes, focused on individual-level behavioural determinants, and had largely ignored the role of the physical and natural environment. IBM-WASH attempts to correct this by acknowledging three dimensions (Contextual Factors, Psychosocial Factors, and Technology Factors) that operate on five-levels (structural, community, household, individual, and habitual). CONCLUSIONS: A number of WASH-specific models and frameworks exist, yet with some limitations. The IBM-WASH model aims to provide both a conceptual and practical tool for improving our understanding and evaluation of the multi-level multi-dimensional factors that influence water, sanitation, and hygiene practices in infrastructure-constrained settings. We outline future applications of our proposed model as well as future research priorities needed to advance our understanding of the sustained adoption of water, sanitation, and hygiene technologies and practices.
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Reflexões sobre água de abastecimento e saúde pública: um estudo de caso na amazônia brasileira/ Considerations about water supply and public health: a case study in the Brazilian Amazônia

Giatti, Leandro Luiz
| Idioma(s): Portugués
Embora a Amazônia ostente grandioso patrimônio ambiental e abundância de recursos hídricos, é na região Norte do Brasil, contida neste notável bioma, que se verificam os piores índices de acesso a serviços e saneamento e respectivos indicadores de saúde pública. Por meio de estudo de caso efetuado na cidade de São Gabriel da Cachoeira, localizada à noroeste do Estado do Amazonas, com aproximadamente 18.000 habitantes e substancial parcela de população indígena, verificou-se a complexidade de fatores relacionados ao provimento de água e à melhoria da saúde pública para núcleos urbanos da Amazônia. A ausência de políticas concisas, as peculiaridades ambientais, as dificuldades logísticas e financeiras somam-se a questões socioculturais, a aspectos migratórios e a processo de urbanização desordenada, associada a impactos ambientais. Para mehoria da saúde pública nessas circunstâncias torna-se necessária uma abordagem interdisciplinar, que possibilite a gestão dos recursos hídricos, a implementação de saneamento básico e, não obstante a promoção de adesão dos habitantes.
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From joint thinking to joint action: a call to action on improving water, sanitation, and hygiene for maternal and newborn health.

Velleman, Yael; Mason, Elizabeth; Graham, Wendy; Benova, Lenka; Chopra, Mickey; Campbell, Oona M R; Gordon, Bruce; Wijesekera, Sanjay; Hounton, Sennen; Esteves Mills, Joanna; Curtis, Val; Afsana, Kaosar; Boisson, Sophie; Magoma, Moke; Cairncross, Sandy; Cumming, Oliver
| Idioma(s): Inglés
Yael Velleman and colleagues argue for stronger integration between the water, sanitation, and hygiene (WASH) and maternal and newborn health sectors. Please see later in the article for the Editors' Summary.
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Água e saúde: bens públicos da humanidade/ Water and health: public goods of humanity

Cavalheiro, José da Rocha
| Idioma(s): Portugués
O desenvolvimento sustentável foi mais divulgado após a Rio-92. Nesse encontro foi criado o Dia Mundial da Água, celebrado anualmente. Em 2001, pela OMS, tivemos "Água para Saúde", que afirma que ambos são "bens públicos da humanidade". Em 2015, pelo PNUD, "Água e Desenvolvimento Sustentável" mostra que é uma constante associar água, saúde e desenvolvimento e comparar suas propostas aos Objetivos de Desenvolvimento do Milênio (ODM). Consideramos que os rumos globais, na atualidade, colocam em debate a propriedade privada no século XXI. Sustainable development was more widespread after Rio-92. This meeting was created World Water Day, celebrated annually. In 2001, the WHO had "Water for estudos avançados 29(84), 2015147Health" which states that both are "public goods of humanity". In 2015, UNDP, "Water and Sustainable Development" shows that it is a constant associate water, health and development and compare their proposals to the Millennium Development Goals (MDGs). We believe that the actual global debate puts in question the private property in the XXI century.
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Why "improved" water sources are not always safe.

Shaheed, Ameer; Orgill, Jennifer; Montgomery, Maggie A; Jeuland, Marc A; Brown, Joe
| Idioma(s): Inglés
Existing and proposed metrics for household drinking-water services are intended to measure the availability, safety and accessibility of water sources. However, these attributes can be highly variable over time and space and this variation complicates the task of creating and implementing simple and scalable metrics. In this paper, we highlight those factors - especially those that relate to so-called improved water sources - that contribute to variability in water safety but may not be generally recognized as important by non-experts. Problems in the provision of water in adequate quantities and of adequate quality - interrelated problems that are often influenced by human behaviour - may contribute to an increased risk of poor health. Such risk may be masked by global water metrics that indicate that we are on the way to meeting the world's drinking-water needs. Given the complexity of the topic and current knowledge gaps, international metrics for access to drinking water should be interpreted with great caution. We need further targeted research on the health impacts associated with improvements in drinking-water supplies.
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Habitação e saúde/ Housing and health

Pasternak , Suzana
| Idioma(s): Portugués
O artigo discute o conceito de moradia adequada, constatando que os indicadores utilizados no Brasil, embora adequados para o momento e o local, não cobrem todas as condições habitacionais para promover a saúde e o bem-estar dos moradores. Explicita a relação habitação-saúde através da análise de quatro dimensões: casa e doenças transmissíveis, casa e necessidades fisiológicas, casa e acidentes domésticos, casa e saúde mental. Utilizando informações do Censo de 2010 e estatísticas vitais de 2012, analisa as condições urbanas e domiciliares do município de São Paulo, observando que o padrão da mortalidade infantil e geral varia espacialmente. Finaliza o artigo com a descrição das condições ambientais das favelas paulistanas.... This paper discusses the concept of proper housing, showing that the indicators used in Brazil, although adequate for the time and place, do not cover all building conditions that promote health and well-being. It examines the relationship between health and housing by analyzing four dimensions: housing and transmissible diseases, housing and physiological needs, housing and domestic accidents, and housing and mental health. Using data from the 2010 Demographic Census and vital statistics for 2012, the article analyzes the environmental and urban conditions of the city of São Paulo, showing that infant and general mortality patterns vary spatially. The paper ends with a description of the environmental conditions of São Paulo's favelas (shantytowns)...
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[The quantitative classification and survey of sanitation of urban secondary water supply in Haidian district of Beijing].

Zhai, Miao-miao; Zheng, Yang; Liu, Yong-quan; Zhang, Jia-sheng; Yang, Xin; Hao, Shi-jia; Wang, Xu; Kang, Jun-jie
| Idioma(s):
OBJECTIVE: To investigate the sanitary status of urban secondary water supply facilities in Haidian district of Beijing. METHODS: Adopting the quantitative classification table drafted by the Bureau for Sanitation Inspection and Supervision of Haidian district, we carried quantitative classification (A, B, C grade) on all 1725 secondary water supply facilities in Haidian district for two times. At the same time, we collected 20 residential areas with stratified random sampling method. As the public points in the first quantitative classification, the effect of level publicity on changing the sanitary grade of the secondary water supply facilities were observed. RESULTS: In the first two times of quantitative classification, A-level and B-level secondary water supply facilities took up 81.04% (1398/1725) and 89.04% (1536/1725) of all secondary water supply facilities respectively; the ratio of effective sanitary permits achieved 86.14% (1486/1725) and 92.35% (1593/1725) respectively; and the ratio of effective water quality test reports achieved 86.60% (1494/1725) and 97.10% (1675/1725) respectively. There were 52 secondary water supply facilities in 20 collected areas, including 8 A-level, 27 B-level and 17 C-level secondary water supply facilities before level publicity, and 19, 29 and 4 after level publicity. The impact of level publicity on changing the sanitary grade of the secondary water supply facilities was statistically significant (χ(2) = 12.60, P = 0.002). CONCLUSION: The city secondary water supply facilities in Haidian district are overall in good sanitary conditions. Quantitative classification and level publicity can effectively improve the sanitary status of secondary water supply facilities.
Resultados  1-10 de 7.725