RESUMO
Background: Coronavirus (COVID-19) is a virus that occurred in Wuhan, China, in December 2019 and has spread to several countries. Although interventions in water, sanitation, and hygiene (WASH) for COVID-19 are likely a pre-existing response to childhood diarrhea, evidence of the effects of COVID-19 preventative strategies on childhood diarrhea has been lacking. This study aimed to assess the implications of COVID-19 prevention for the occurrence of childhood diarrhea in rural communities of Ethiopia. Methods: A community-based cross-sectional study was conducted from 10 May 2020 to 30 July 2020 involving selected households in the Semen Bench district, Bench Sheko zone, southwestern Ethiopia. A single population proportion formula was used to obtain a total of 768 sample sizes. Data were collected from selected households using a simple random sampling technique. Epidata 3.1 was used to enter the data and then exported to Stata 14 for analysis. Descriptive statistics along with binary and multivariable logistic regression analyses were used to identify factors of COVID-19 knowledge and practices related to childhood diarrhea. The chi-squared test was used to check the association between COVID-19 prevention and childhood diarrhea reduction. Results: A total of 720 (93.75%) households participated in the study to achieve the study objectives. Approximately 55% of the participants had a good understanding of COVID-19 prevention, while only 48.5% had good COVID-19 prevention practices. The prevalence of childhood diarrhea was 19.3% which was more common among households with poor practices of COVID-19 prevention. The respondents with poor COVID-19 prevention knowledge were 42% (AOR = 0.58, 95% CI: 0.398, 0.847, P = 0.005) less likely to develop childhood diarrhea than those who had good COVID-19 prevention knowledge. Households with poor practices for COVID-19 prevention were 75.1% more likely to develop childhood diarrhea than those who had good preventive practices for COVID-19 prevention (AOR = 1.751, 95% CI: 1.193, 2.571, P = 0.004). The lower risk of childhood diarrhea is significantly related to good COVID-19 prevention practices. However, households with no formal education and a lack of WASH facilities have a higher likelihood of having childhood diarrhea in the household. Conclusion: COVID-19 preventative strategies help reduce the prevalence of diarrhea in children. More research using prospective study designs and advanced statistical models is needed to better understand the implication of COVID-19 preventative efforts in reducing childhood diarrhea.
Assuntos
COVID-19 , Diarreia , População Rural , Humanos , Etiópia/epidemiologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Diarreia/epidemiologia , Diarreia/prevenção & controle , Estudos Transversais , Masculino , Feminino , Adulto , População Rural/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Características da Família , Criança , Pessoa de Meia-Idade , Pré-Escolar , SARS-CoV-2 , Saneamento/estatística & dados numéricos , Adolescente , Lactente , Adulto Jovem , HigieneRESUMO
BACKGROUND: Environmental factors greatly impact infectious disease-related mortality, yet there's a lack of comprehensive global studies on the contemporary burden and trends. This study aims to evaluate the global burden and trends of infectious disease mortality caused by air pollution, unsafe water, poor sanitation, and non-optimal temperature across Socio-Demographic Index (SDI) regions from 1990 to 2019. METHODS: This observational study utilized data from the Global Burden of Diseases Study to examine mortality rates from infectious diseases attributed to environmental risk factors between 1990 and 2019, including air pollution, unsafe water, sanitation, handwashing facilities (UWSH), and non-optimal temperatures. Age-standardized mortality rates (ASMRs) and estimated annual percentage change (EAPC) were utilized to present infectious disease mortality, and its trajectory influenced by environmental risk factors over the years. Nonlinear regression was conducted to explore the association between the SDI and ASMRs across regions from 1990 to 2019. RESULTS: In 2019, global infectious disease deaths linked to air pollution, UWSH, and non-optimal temperature reached a startling 2,556,992. Disease mortality varied widely across SDI regions, with the highest number of deaths due to air pollution and UWSH in Low SDI regions, and deaths from non-optimal temperature primarily in High SDI regions. Age disparities emerged, with children under five and the elderly most affected. However, an increasing mortality trend was observed among seniors (65-69, 75-79, and over 80) in High SDI regions due to enteric infections linked to UWSH. Globally, a consistent decrease in ASMR was seen from 1990 to 2019 for all diseases connected to these factors, except for respiratory infections linked to non-optimal temperature. CONCLUSIONS: Our study underscores the significant impact of air pollution, UWSH, and non-optimal temperatures on global infectious disease mortality, particularly among vulnerable groups such as children and the elderly. It's important to tackle these challenges with targeted interventions aiming to enhance environmental quality, improve water and sanitation systems, and control extreme temperatures. In addition, international cooperation is essential for bridging regional disparities and driving global public health initiatives forward, thereby helping achieve Sustainable Development Goals more effectively.
Assuntos
Poluição do Ar , Doenças Transmissíveis , Higiene , Saneamento , Temperatura , Humanos , Saneamento/estatística & dados numéricos , Doenças Transmissíveis/mortalidade , Doenças Transmissíveis/etiologia , Poluição do Ar/estatística & dados numéricos , Poluição do Ar/efeitos adversos , Saúde Global/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Idoso , Pré-Escolar , CriançaRESUMO
BACKGROUND: Undernutrition among children younger than 5 years is a subtle indicator of a country's health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.
Assuntos
Saneamento , Humanos , Índia/epidemiologia , Saneamento/normas , Saneamento/estatística & dados numéricos , Feminino , Masculino , Pré-Escolar , Lactente , Transtornos do Crescimento/epidemiologia , Análise Espaço-Temporal , Características da Família , Inquéritos Epidemiológicos , Transtornos da Nutrição Infantil/epidemiologiaRESUMO
BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
Assuntos
Higiene , Saneamento , Humanos , Estudos Transversais , Saneamento/normas , Saneamento/estatística & dados numéricos , Feminino , Masculino , Adulto , Higiene/normas , California , Abuso de Substâncias por Via Intravenosa/epidemiologia , Pessoa de Meia-Idade , México , Abastecimento de Água/normas , Água Potável/normas , Adulto JovemRESUMO
Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.
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Crianças com Deficiência , Acessibilidade aos Serviços de Saúde , Higiene , Saneamento , Humanos , Uganda , Estudos Transversais , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Masculino , Criança , Crianças com Deficiência/estatística & dados numéricos , Estado Nutricional , Lactente , Características da Família , Adolescente , Análise de Dados SecundáriosRESUMO
Tungiasis is caused by the flea tunga penetrans and results in painful skin lesions, skin infections, and permanent disability. However, limited information is available that shows the magnitude of the problem and its risk factors that help for intervention in Ethiopia. The goal of this study was to determine the prevalence and risk factors of tungiasis in children aged 5 to 14 in Mettu woreda in 2020. A community based cross sectional study was conducted among randomly selected kebeles of Mettu woreda, in Southwest Ethiopia. To select study participants, multistage sampling was used. The data were collected through physical examination of the children, interview of parents/guardians of the children, and observation of the home environment using checklists and questionnaires. The descriptive analysis was done for socio-demographic characteristics, prevalence of tungiasis, and housing conditions. A logistic regression analysis was performed, and variables in multivariable regression reported odds ratios and their 95% confidence intervals once the variables were identified using a p-value of 0.05 as a risk factor of statistical significance. The prevalence of tungiasis among children 5-14 years of age in Mettu rural woreda was 52 percent (n = 821). As a risk factor, large family size (AOR: 2.9, 95% CI: 2.13, 4.40); school attendance (AOR: 1.5, 95% CI: 1.02, 2.18), floor inside the house (AOR: 3.8, 95% CI: 1.76, 8.43); having sleeping bed (AOR: 0.16, 95% CI: 0.03, 0.82); access to protected water sources (AOR: 0.24, 95% CI: 0.15, 0.39); access to improved toilet facilities(AOR: 0.63: 95% CI: 0.44, 0.89); access to electric services (AOR: 0.30, 95% CI: 0.15, 0.62); and lack of own farmland (AOR: 0.36, 95% CI: 0.26, 0.50) were found. Therefore, planning and implementation of interventions focus on those risk factors that are particularly important. Water, sanitation and hygiene interventions, and livelihood improvement interventions are required to solve the problem in the setting.
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Promoção da Saúde/métodos , Higiene/normas , Tungíase/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Etiópia/epidemiologia , Características da Família , Feminino , Humanos , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Saneamento/normas , Saneamento/estatística & dados numéricosRESUMO
In low- and middle-income countries, poor autonomy prevents women from making financial decisions, which may impact their access to improved sanitation facilities. Inadequate access to improved sanitation disproportionately affects women's and children's health and wellbeing. Although socio-cultural factors are known contributors to gender inequity, social beliefs that potentially motivate or dissuade women from making sanitation-related household decisions are not well understood. These beliefs may vary across settlement types. To empower more women to make sanitation-related decisions, the relevant socio-cultural norms and underlying social beliefs need to be addressed. In this mixed methods study, we explored women's role in sanitation-related decision making in three settlement types, urban slums, peri-urban, and rural communities in Bihar. Trained qualitative researchers conducted six focus group discussions with women of two age groups: 18-30 years old, and 45-65 years old to understand the norm-focused factors around women's role in getting a toilet for their household. Using insights generated from these group discussions, we developed and conducted a theory-driven survey in 2528 randomly selected participants, to assess the social beliefs regarding women making toilet construction decisions in these communities. Overall, 45% of the respondents reported making joint decisions to build toilets that involved both men and women household members. More women exclusively led this decision-making process in peri-urban (26%) and rural areas (35%) compared to urban slums (12%). Social beliefs that men commonly led household decisions to build toilets were negatively associated with women's participation in decision making in urban slums (adjusted prevalence ratio, aPR: 0.53, 95% CI: 0.42, 0.68). Qualitative insights highlighted normative expectations to take joint decisions with elders, especially in joint family settings. Surrounding norms that limited women's physical mobility and access to peers undermined their confidence in making large financial decisions involved in toilet construction. Women were more likely to be involved in sanitation decisions in peri-urban and rural contexts. Women's involvement in such decisions was perceived as widely acceptable. This highlights the opportunity to increase women's participation in sanitation decision making, particularly in urban contexts. As more women get involved in decisions to build toilets, highlighting this norm may encourage gender-equitable engagement in sanitation-related decisions in low-resource settings.
Assuntos
Grupos Focais/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Idoso , Aparelho Sanitário/estatística & dados numéricos , Tomada de Decisões , Características da Família , Feminino , Identidade de Gênero , Papel de Gênero , Serviços de Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Índia , Pessoa de Meia-Idade , Áreas de Pobreza , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: Stunting is still a major public health problem in low- and middle-income countries, including Indonesia. Previous studies have reported the complexities associated with understanding the determinants of stunting. This study aimed to examine the household-, subdistrict- and province-level determinants of stunting in Indonesia using a multilevel hierarchical mixed effects model. METHODS: We analyzed data for 8045 children taken from the 2007 and 2014 waves of the Indonesian Family and Life Surveys (IFLS). We included individual-, family-/household- and community-level variables in the analyses. A multilevel mixed effects model was employed to take into account the hierarchical structure of the data. Moreover, the model captured the effect of unobserved household-, subdistrict- and province-level characteristics on the probability of children being stunted. RESULTS: Our findings showed that the odds of childhood stunting vary significantly not only by individual child- and household-level characteristics but also by province- and subdistrict-level characteristics. Among the child-level covariates included in our model, dietary habits, neonatal weight, a history of infection, and sex significantly affected the risk of stunting. Household wealth status and parental education are significant household-level covariates associated with a higher risk of stunting. Finally, the risk of stunting is higher for children living in communities without access to water, sanitation and hygiene. CONCLUSIONS: Stunting is associated with not only child-level characteristics but also family- and community-level characteristics. Hence, interventions to reduce stunting should also take into account family and community characteristics to achieve effective outcomes.
Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Criança , Escolaridade , Família , Características da Família , Feminino , Humanos , Higiene , Renda/estatística & dados numéricos , Indonésia/epidemiologia , Masculino , Pais , Saúde Pública/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
BACKGROUND: Quality water, sanitation, and hygiene facilities act as barricades to the transmission of COVID-19 in health care facilities. These facilities ought to also be available, accessible, and functional in temporary treatment centers. Despite numerous studies on health care facilities, however, there is limited information on the status of WASH facilities in such centers. METHODS: The assessment of health care facilities for the COVID-19 response checklist and key informant interviews, were used for data collection. 35 treatment centers in Southern Ethiopia were surveyed. Eightkey informants were interviewed to gain an understanding of the WASH conditions in the treatment centers. The Quantitative data was entered using EPI-INFO 7 and exported to SPSS 20 for analysis. Results are presented using descriptive statistics. Open Code 4.02 was used for the thematic analysis of the qualitative data. RESULTS: Daily water supply interruptions occurred at 27 (77.1%) of the surveyed sites. Only 30 (85.72%) had bathrooms that were segregated for personnel and patients, and only 3 (3.57%) had toilets that were handicapped accessible. 20(57.2%) of the treatment centers did not have a hand hygiene protocol that satisfied WHO guidelines. In terms of infection prevention and control, 16 (45.71%) of the facilities lacked adequate personal protective equipment stocks. Between urban and rural areas, there was also a significant difference in latrine maintenance, hand hygiene protocol design and implementation, and incineration capacity. CONCLUSION: The results reveal crucial deficiencies in the provision of WASH in the temporary COVID-19 treatment centers. Efforts to improve WASH should offer priority to hygiene service interventions to minimize the risk of healthcare-acquired infections. The sustainable provision of hygiene services, such as hand washing soap, should also be given priority.
Assuntos
COVID-19/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Higiene , Quarentena/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Qualidade da Água , COVID-19/prevenção & controle , Etiópia , Instalações de Saúde/normas , Humanos , Garantia da Qualidade dos Cuidados de Saúde , Quarentena/normas , Saneamento/normasRESUMO
Contamination of contact surfaces with SARS-CoV-2 has been reported as a potential route for the transmission of COVID-19. This could be a major issue in developing countries where access to basic sanitation is poor, leading to the sharing of toilet facilities. In this study, we report SARS-CoV-2 contamination of key contact surfaces in shared toilets and the probabilistic risks of COVID-19 infections based on detection and quantification of the nucleic acid on the surfaces. We observed that 54-69% of the contact surfaces were contaminated, with SARS-CoV-2 loads ranging from 28.1 to 132.7 gene copies per cm2. Toilet seats had the highest contamination, which could be attributed to shedding of the virus in feces and urine. We observed a significant reduction in viral loads on the contaminated surfaces after cleaning, showing the potential of effective cleaning on the reduction of contamination. The pattern of contamination indicates that the most contaminated surfaces are those that are either commonly touched by users of the shared toilets or easily contaminated with feces and urine. These surfaces were the toilet seats, cistern handles and tap handles. The likelihood (probability) of infection with COVID-19 on these surfaces was highest on the toilet seat (1.76 × 10-4(1.58 × 10-6)) for one time use of the toilet. These findings highlight the potential risks for COVID-19 infections in the event that intact infectious viral particles are deposited on these contact surfaces. Therefore, this study shows that shared toilet facilities in densely populated areas could lead to an increase in risks of COVID-19 infections. This calls for the implementation of risk reduction measures, such as regular washing of hands with soap, strict adherence to wearing face masks, and effective and regular cleaning of shared facilities.
Assuntos
COVID-19/transmissão , RNA Viral/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Saneamento/estatística & dados numéricos , Banheiros/estatística & dados numéricos , Contaminação de Equipamentos , HumanosRESUMO
BACKGROUND: Unhygienic disposal of children's stools affects children's health in terms of their susceptibility to many diseases. However, there are no existing studies into the impact of unhygienic stool disposal in Cambodia. Therefore, this study aimed to identify factors associated with the unhygienic disposal of children's stools among children under the age of five in Cambodia. METHODS: An analytical cross-sectional study was conducted using data from the Cambodia Demographic and Health Survey (CDHS) 2014. A multivariable binary logistic regression was conducted using Stata to analyze factors associated with the unhygienic disposal of children's stools. RESULTS: Overall, the prevalence of practicing unhygienic disposal of children's stools was 29.27% (95%CI: 27.51%- 31.09%). Factors statistically associated with this practice were: living in the Central Plain, Plateau and Mountains, Coastal and Sea regions (AOR = 1.65; 95% CI: 1.33-2.04), (AOR = 2.53; 95% CI: 1.98-3.24) and (AOR = 4.16; 95% CI: 3.15-5.48) respectively, poor household wealth (AOR = 1.58; 95% CI: 1.31-1.91), the mother having no education (AOR = 1.45; 95% CI: 1.14-1.85), a high number of children aged under five (AOR = 1.11; 95% CI: 1.03-1.20), being in the "other" religious category (AOR = 1.77; 95% CI: 1.25-2.51), living in a household with unimproved toilet facilities (AOR = 1.22; 95% CI: 1.11-1.34), living in a household with inadequate hygiene (AOR = 1.33; 95% CI: 1.12-1.59), and the household not being visited by a family planning worker in the last year (AOR = 1.45; 95% CI: 1.19-1.77). However, an increase in the child's age by even a month had significant negative associations with unhygienic practice (AOR = 0.65; 95% CI: 0.60-0.70), even when controlling for other covariates. CONCLUSION: Almost one third of the mothers do not practice hygienic disposal of children's stools in Cambodia. Unhygienic practices were more prevalent in certain regions, and were also associated with low wealth, lack of education, an increase in the number of children under five in the household, religion, lack of sanitation and access to healthcare professionals. Conversely, the child's age was found to be positively associated with the hygienic disposal of children's stools.
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Fezes , Eliminação de Resíduos/normas , Saneamento/estatística & dados numéricos , Adulto , Camboja , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Logísticos , Masculino , Mães/psicologia , Razão de Chances , Pobreza , Saneamento/normas , Banheiros/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: To evaluate the relationship between mouthing of soil and living in unsanitary conditions and child cognitive development in urban Bangladesh. STUDY DESIGN: This prospective cohort study of 224 children under 5 years of age was conducted in urban Dhaka, Bangladesh. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 12-month follow-up visit. RESULTS: Children who had caregiver reports of puting soil in their mouths at the majority of surveillance visits had significantly lower combined EASQ Z scores (coefficient, -0.53; 95% CI, -0.83 to -0.22) at the 12-month follow-up visit. Children who had caregiver reports of putting visibly dirty objects in their mouths at the majority of visits had significantly lower combined EASQ Z scores (-0.50; 95% CI, -0.79 to -0.22). Children in households with unimproved sanitation had significantly lower combined EASQ Z scores (-0.63; 95% CI, -1.11 to -0.16). CONCLUSIONS: Children found to frequently put soil and visibly dirty objects in their mouths, and those who resided in households using unimproved sanitation, had lower subsequent cognitive developmental outcomes. These findings demonstrate the importance of interventions targeting child mouthing behaviors and sanitation infrastructure to decrease exposure to fecal pathogens and improve child cognitive developmental outcomes.
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Deficiências do Desenvolvimento/etiologia , Exposição Ambiental/efeitos adversos , Fômites/microbiologia , Saneamento/estatística & dados numéricos , Microbiologia do Solo , Bangladesh/epidemiologia , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pobreza , Estudos Prospectivos , População UrbanaRESUMO
Access to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6-59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in children living in households with an unimproved latrine than those with an improved latrine (adjusted odds ratio: 1.60; 95% CI: 1.11-2.31). Children in households with unimproved latrines and households that practiced open defection had approximate 0.15 cm reduced MUAC compared with those in households with an improved latrine. There was a small, but statistically significant, association between improved latrine and nutritional status in preschool children as measured by MUAC.
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Características da Família , Higiene/normas , Estado Nutricional , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Saneamento/normas , Burkina Faso , Pré-Escolar , Família , Feminino , Humanos , Lactente , Masculino , Razão de Chances , Inquéritos e Questionários , Banheiros/normasRESUMO
The paper assessed access to WASH service in the Jariban district of Somalia. One hundred and sixty-seven households were sampled to administer a questionnaire. Central tendency and logistical regression were used to analyse the data in SPSS 26. The findings show that access to safe drinking water sources is 57.5%. Of the 42.5% of respondents who did not access safe drinking water source, only 10.8% confirmed that they treat drinking water at the point of use. The main reason for household water treatment was the positive mindset (.272) of the household head towards water treatment. The majority (80.2%) of the respondents access approximately 13 litres per person per day. Woman-headed households were more likely to treat water before drinking than male-headed households. Only 26.9% of the respondents accessed basic sanitation. Of the respondents, 55.7% did not share latrines, while 44.3% share resulting in open defecation. WASH access in the study area remains low, resulting in health-related risks, including diarrhoeal disease. The limitation is that the paper only focused on access to WASH facilities in fragile contexts. A cross-sectional analysis of biological, physical and chemical properties of water at the source and point of use is recommended for further research.
Assuntos
Purificação da Água/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Água/química , Características da Família , Feminino , Humanos , Higiene , Masculino , Saneamento/estatística & dados numéricos , Fatores Socioeconômicos , Somália , Inquéritos e Questionários/estatística & dados numéricos , Banheiros/estatística & dados numéricosRESUMO
BACKGROUND: Malaria is one of the most prevalent and deadliest illnesses in sub-Saharan Africa. Despite recent gains made towards its control, many African countries still have endemic malaria transmission. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory Water, Sanitation and Hygiene (WASH) Action programme. METHODS: Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (a WASH action site) and Kasangulu (a WASH control site) in DRC between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys were conducted with the use of World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action programme aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among the respondents. Furthermore, a six-month hospital-based epidemiological study was conducted at selected referral hospitals at each site from 1 January through June 2017 to determine malaria trend. RESULTS: Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%); 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) reported at least one episode occurring in the previous six months; of them only 66.5% received malaria care at a health setting. In the Action Research, mean incident household malaria cases decreased significantly at WASH action site (2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases, respectively; p < 0.05), whereas it remained unchanged at the Control site. Similar findings were observed with RDT results. Data collected from referral hospitals showed high malaria incidence rate, 67.4%. Low household income (ORa = 2.37; 95%CI: 1.05-3.12; p < 0.05), proximity to high risk area for malaria (ORa = 5.13; 95%CI: 2-29-8.07; p < 0.001), poor WASH (ORa = 4.10; 95%CI: 2.11-7.08; p < 0.001) were predictors of household malaria. CONCLUSION: This research showed high prevalence of positive malaria RDT among the responders and high household malaria incidence, which were reduced by a 6-month WASH intervention. DRC government should scale up malaria control strategy by integrating efficient indoor and outdoor preventive measures and improve malaria care accessibility.
Assuntos
Controle de Doenças Transmissíveis/estatística & dados numéricos , Participação da Comunidade/estatística & dados numéricos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Características da Família , Malária/epidemiologia , Adulto , República Democrática do Congo/epidemiologia , Feminino , Humanos , Higiene , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Saneamento/estatística & dados numéricos , Água , Adulto JovemRESUMO
BACKGROUND: Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994-2012), at a national and subnational level. METHODS: The series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes. RESULTS: From 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage. CONCLUSIONS: The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.
Assuntos
Disparidades em Assistência à Saúde , Serviços de Saúde Materno-Infantil , Serviços de Saúde Reprodutiva , Saneamento , Criança , Estudos Transversais , Equador , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Gravidez , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
BACKGROUND: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. OBJECTIVE: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. METHODS: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. RESULTS: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information. CONCLUSIONS: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene/normas , Informática Médica , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Indonésia/epidemiologia , LactenteRESUMO
BACKGROUND: Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels. METHODS: The current analysis selected 4 indicators from the WASH Benefits trial- presence of water and soap in household handwashing stations, observed mother's hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline. RESULTS: For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (- 4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, - 25% (- 35, - 15) Q2: - 34% (- 44, - 23%)] than the wealthiest household [Q5 DID: - 1% (- 11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1-4 DID: 50-54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). CONCLUSION: By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. TRIAL REGISTRATION: WASH Benefits Bangladesh: ClinicalTrials.gov , identifier: NCT01590095 . Date of registration: April 30, 2012 'Retrospectively registered'.
Assuntos
Desinfecção das Mãos , Comportamentos Relacionados com a Saúde , Gestantes/psicologia , População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Sabões , Banheiros/estatística & dados numéricos , Adulto , Bangladesh , Criança , Feminino , Humanos , Masculino , GravidezRESUMO
Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700). The search terms returned 15,351 articles for screening, with 46 articles included. This is indicative of a limited body of knowledge; however, the number of publications on this topic has been increasing, suggesting burgeoning field of interest. Targeted research on the governance of WASH through the identification of the various role players and stakeholders at various levels, while understanding the policy environment in relation to particular health-related outcomes is imperative to address the burden of child undernutrition.
Assuntos
Higiene/normas , Desnutrição/epidemiologia , Políticas , Saneamento/normas , Abastecimento de Água/normas , África Subsaariana/epidemiologia , Desenvolvimento Infantil/fisiologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Recém-Nascido , Desnutrição/fisiopatologia , Desnutrição/prevenção & controle , Estado Nutricional/fisiologia , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricosRESUMO
This study aims to evaluate the level of technical efficiency of companies that perform the integrated management of basic sanitation in Brazilian municipalities. A Multiple Data Envelopment Analysis (M-DEA) model was applied to estimate the performance of water supply and sewage services in 1628 municipalities covering more than 56% of the Brazilian population, identifying the factors that most influence the efficiency of the sector in the years 2008 and 2016. The M-DEA methodology is an extension of Data Envelopment Analysis (DEA) with multiple DEA executions considering all combinations of inputs and outputs to calculate efficiency scores. The methodology reduces possible biases in the selection of resources and products of the model, ability to support decision-making in favor of improvements in the sector's efficiency based on national regulatory framework. The analyses show that the companies analyzed can increase their operating results and attendance coverage by more than 60%, given the current levels of infrastructure, human and financial resources in the sector. Based on the simulation of potential efficiency gains in Brazilian basic sanitation companies, the estimates show that the coverage of the population with access to sanitary sewage would go from the current 59.9% to 76.5%. The evidence found provides indications to subsidize sanitation management in the country at the micro-analytical level, enabling a better competitive position in the sector for the integrated management of basic sanitation and its universalization in Brazil.