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1.
PLoS One ; 15(3): e0227611, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32196493

RESUMEN

This paper presents country-level estimates of water, sanitation and hygiene (WASH)-related mortality and the economic losses associated with poor access to water and sanitation infrastructure in sub-Saharan Africa (SSA) from 1990 to 2050. We examine the extent to which the changes that accompany economic growth will "solve" water and sanitation problems in SSA and, if so, how long it will take. Our simulations suggest that WASH-related mortality will continue to differ markedly across countries in sub-Saharan Africa. In many countries, expected economic growth alone will not be sufficient to eliminate WASH-related mortality or eliminate the economic losses associated with poor access to water and sanitation infrastructure by 2050. In other countries, WASH-related mortality will sharply decline, although the economic losses associated with the time spent collecting water are forecast to persist. Overall, our findings suggest that in a subset of countries in sub-Saharan Africa (e.g., Angola, Niger, Sierra Leone, Chad and several others), WASH-related investments will remain a priority for decades and require a long-term, sustained effort from both the international community and national governments.


Asunto(s)
Desarrollo Económico/tendencias , Higiene/normas , Mortalidad/tendencias , Saneamiento/normas , Calidad del Agua/normas , África del Sur del Sahara/epidemiología , Predicción , Humanos , Higiene/economía , Saneamiento/economía , Desarrollo Sostenible/economía , Desarrollo Sostenible/tendencias , Abastecimiento de Agua/economía , Abastecimiento de Agua/normas
2.
Am J Trop Med Hyg ; 102(2): 260-261, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31701856

RESUMEN

Most health impact trials of water, sanitation, and hygiene use caregiver-reported diarrhea in children as the primary outcome; this measure is known to be subject to considerable bias, especially when used in unblinded trials. Detection of enteric pathogens in stool or fecal waste via multiplex molecular methods may offer advantages over-and is complementary to-caregiver-reported diarrhea because these measures are objective, on the causal pathway from exposures of interest to disease outcomes, and increasingly feasible in high-burden countries.


Asunto(s)
Heces/microbiología , Higiene/normas , Saneamiento/normas , Calidad del Agua/normas , Abastecimiento de Agua/normas , Humanos , Evaluación de Resultado en la Atención de Salud
3.
J Water Health ; 17(6): 896-909, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31850897

RESUMEN

Sanitation planners make complex decisions in the delivery of sanitation services to achieve health outcomes. We present findings from a stakeholder engagement workshop held in Kampala, Uganda, to educate, interact with, and solicit feedback from participants on how the relevant scientific literature on pathogens can be made more accessible to practitioners to support decision-making. We targeted Water, Sanitation and Hygiene (WASH) practitioners involved in different levels of service delivery. Practitioners revealed that different sanitation planning tools are used to inform decision-making; however, most of these tools are not user-friendly or adapted to meet their needs. Most stakeholders (68%) expressed familiarity with pathogens, yet less than half (46%) understood that fecal coliforms were bacteria and used as indicators for fecal pollution. A number of stakeholders were unaware that fecal indicator bacteria do not behave and persist the same as helminths, protozoa, or viruses, making fecal indicator bacteria inadequate for assessing pathogen reductions for all pathogen groups. This suggests a need for awareness and capacity development around pathogens found in excreta. The findings underscore the importance to engage stakeholders in the development of support tools for sanitation planning and highlighted broader opportunities to bridge science with practice in the WASH sector.


Asunto(s)
Toma de Decisiones , Higiene , Saneamiento/normas , Microbiología del Agua , Calidad del Agua/normas , Abastecimiento de Agua/normas , Animales , Conocimientos, Actitudes y Práctica en Salud , Uganda , Agua
4.
BMC Public Health ; 19(1): 1680, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842809

RESUMEN

BACKGROUND: Access to usable water, sanitation and hygiene provision in schools is included within indicators in the Sustainable Development Goals. Progress towards these indicators is dependent on developing an understanding of which intervention components are most effective to operate and maintain usable services. This study aimed to determine the impact of a school toilet operation and management intervention in the Philippines on toilet usability and student and teacher satisfaction, adjusted for clustering at school level. METHODS: In a non-blinded cluster randomised controlled trial, we compared improvements in usability and cleanliness of school toilets among those schools receiving a low-cost, replicable intervention. Toilet usability was measured based on Sustainable Development Goal indicators related to school sanitation defined by the UNICEF/WHO Joint Monitoring Programme for Water, Sanitation and Hygiene. Intervention schools received consumables, support kits, and structured tools designed to facilitate operation and maintenance of sanitation facilities. The primary outcome, toilet usability and cleanliness, was compared through a difference-in-difference analysis of toilet usability. Secondary outcomes of student and teacher satisfaction were measured through a survey at endline. All outcomes were adjusted for clustering at school level. RESULTS: 20 eligible schools in the Batangas region of the Philippines were randomly selected and allocated to either control or intervention group. We found that non-classroom toilets were 48% more likely to meet quality benchmarks in intervention schools, but this was not statistically significant. When including in-classroom toilets in the analysis, there were no significant differences in toilet usability - defined as accessible, functional, private and of high quality - between intervention and control schools. When stratified by toilet location, children in the intervention group clusters expressed a minor, but statistically significant increase in overall satisfaction with sanitation facilities (p = 0.035). CONCLUSION: Water, sanitation and hygiene interventions in schools focusing on operation and maintenance showed potential to improve toilet usability, but universal achievement of SDG targets may require additional efforts addressing toilet infrastructure. TRIAL REGISTRATION: ClinicalTrials.gov NCT03204175, June 2017 prior to participant enrolment.


Asunto(s)
Servicios de Salud Escolar/organización & administración , Cuartos de Baño/normas , Niño , Femenino , Humanos , Higiene/normas , Masculino , Satisfacción Personal , Filipinas , Evaluación de Programas y Proyectos de Salud , Saneamiento/normas , Maestros/psicología , Instituciones Académicas , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Desarrollo Sostenible , Abastecimiento de Agua/normas
5.
PLoS One ; 14(12): e0226548, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31841540

RESUMEN

BACKGROUND: Poor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations' Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system. METHODS: We adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability. RESULTS: We present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals' overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees. CONCLUSION: We propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.


Asunto(s)
Desinfección de las Manos/métodos , Desinfección de las Manos/normas , Higiene de las Manos/normas , Saneamiento/normas , Encuestas y Cuestionarios/normas , Purificación del Agua/normas , Organización Mundial de la Salud , Infección Hospitalaria/prevención & control , Estudios de Factibilidad , Salud Global , Implementación de Plan de Salud/normas , Hospitales , Humanos , Guías de Práctica Clínica como Asunto/normas , Mejoramiento de la Calidad , Saneamiento/métodos , Factores de Tiempo , Purificación del Agua/métodos , Abastecimiento de Agua/normas
6.
Pan Afr Med J ; 33: 244, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692810

RESUMEN

Introduction: Access to drinking water and sanitation has been a long-standing issue between many States. However, it represents a daily struggle for hundreds of thousands of city dwellers who live mainly in the developing countries. The government of Cameroon with the assistance of providers of funds have implemented strategies to make sanitation and access to safe drinking water a reality. We have therefore decided to assess sanitation and access to drinking water in Douala V sub division. Method: We conducted a cross-sectional descriptive study from May to June 2018. We used a two-stage random sampling. Data were collected using a questionnaire. The analysis was conducted using Epi Info Version 7.1.3.3. Results: Our study shows that 22.47% of subjects discharged waters into the natural environment after use. Then, 65,55% (493/752) of households consumed borehole water; 53.69% of households rode between 1 to 5 km, 49.25% walked more than 15 minutes to collect water and 85,50% of households did not use a water treatment method. Only 14.49% of subjects used a water treatment method. No household used solar water disinfection (SODIS); 2/752 households (0.26%) had no latrine. Most of the households (54.52%; 410/752) discharged domestic wastes onto the street. Conclusion: The creation of decentralized units: the drillings, waste disposal systems and water treatment education to meet basic needs are essential.


Asunto(s)
Agua Potable/normas , Saneamiento/normas , Abastecimiento de Agua/normas , Camerún , Estudios Transversales , Países en Desarrollo , Desinfección/métodos , Composición Familiar , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Cuartos de Baño/estadística & datos numéricos
7.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 525-528, 2019 Oct 12.
Artículo en Chino | MEDLINE | ID: mdl-31713385

RESUMEN

OBJECTIVE: To investigate the related factors of soil-transmitted nematode infections in Chongqing City, so as to provide the basis for scientific prevention and treatment of the infections. METHODS: From 2011 to 2015, the stool samples of residents of the surveillance sites in Chongqing City were collected every year, and the soil-transmitted nematode eggs were examined by the modified Kato-Katz thick smear method (three smears for a single stool sample). The respondents were surveyed by questionnaires, and the factors affecting soil-transmitted nematode infections were identified. RESULTS: The prevalence of human soil-transmitted nematode infections were 6.44%, 7.30%, 6.85%, 6.93% and 5.56% in Chongqing City from 2011 to 2015, respectively. The more unclean drinking water and the lower frequency of washing hands after using the toilet were the risk factors for Ascaris lumbricoides infection. The more harmless toilets, the higher level of fertilizer application, the lower frequency of drinking raw water, and the lower frequency of food without washing were the protective factors for A. lumbricoides infection. CONCLUSIONS: The local soil-transmitted nematode infections are at a low epidemic level in Chongqing City, and it is necessary to ad-here to the classified guidance, comprehensive prevention and further monitoring on the basis of health education, water and toilet improvement, and environmental sanitation improvement in order to consolidate the prevention and control achievements.


Asunto(s)
Infecciones por Nematodos , Suelo , Animales , China/epidemiología , Humanos , Infecciones por Nematodos/epidemiología , Prevalencia , Factores de Riesgo , Saneamiento/normas , Suelo/parasitología , Encuestas y Cuestionarios
8.
Cien Saude Colet ; 24(11): 4325-4334, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31664404

RESUMEN

Deliberation in municipal councils of sanitation and health is the object of this study. Deliberation is understood as decision making and argumentative process, from the formulations of Rousseau, Habermas and Cohen. The proposed objective was to evaluate the effectiveness of the deliberative action of the councils of Belo Horizonte (MG) and Belém (PA). The evaluation included the study of variables defining the degree of institutionalization of the councils and revealing the dynamics of the deliberative process developed in them. The internal regulations of each council and the minutes and resolutions produced by them during the 2012-2014 triennium were consulted. The results showed that the four councils, in the period and according to the defined criteria of analysis, are far from the degree of deliberative effectiveness desired, considering the purposes of the social control in sanitation and in health, arranged by the specific legislation of each area. Even with broader experience, considering their years of participatory pedagogical exercise, health councils were no more effective than neophyte sanitation councils.


Asunto(s)
Toma de Decisiones , Consejos de Planificación en Salud/organización & administración , Saneamiento/normas , Control Social Formal , Brasil , Humanos , Gobierno Local
9.
Parasit Vectors ; 12(1): 503, 2019 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-31665080

RESUMEN

BACKGROUND: National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission. METHODS/DESIGN: Two interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80-90% treatment coverage ("expanded MDA"); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC. DISCUSSION: The study has the potential to define an 'End Game' for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.


Asunto(s)
Albendazol/administración & dosificación , Antihelmínticos/administración & dosificación , Helmintiasis/prevención & control , Praziquantel/administración & dosificación , Esquistosomiasis/prevención & control , Adolescente , Niño , Preescolar , Análisis Costo-Beneficio , Estudios Transversales , Demografía , Etiopía/epidemiología , Conductas Relacionadas con la Salud , Helmintiasis/epidemiología , Helmintiasis/transmisión , Humanos , Higiene/normas , Lactante , Estudios Longitudinales , Administración Masiva de Medicamentos/economía , Modelos Biológicos , Enfermedades Desatendidas/prevención & control , Prevalencia , Saneamiento/normas , Esquistosomiasis/epidemiología , Esquistosomiasis/transmisión , Instituciones Académicas , Suelo/parasitología , Encuestas y Cuestionarios , Abastecimiento de Agua/normas
10.
Artículo en Inglés | MEDLINE | ID: mdl-31652683

RESUMEN

A school-based water, sanitation, and hygiene (WASH) intervention in the Philippines was evaluated. Students and households from four schools that received the WASH intervention (intervention schools) were compared with four schools that had not (comparison schools). Knowledge of critical handwashing times was high across all schools, but higher in intervention schools. Students reported higher rates of handwashing after toilet use (92% vs. 87%; RR = 1.06; p = 0.003) and handwashing with soap (83% vs. 60%; RR = 1.4; p < 0.001) in intervention versus comparison schools. In intervention schools, 89% of students were directly observed to handwash after toilet use versus 31% in comparison schools (RR = 2.84; p < 0.0001). Observed differences in handwashing with soap after toilet use were particularly marked (65% vs. 10%; RR = 6.5; p < 0.0001). Reported use of school toilets to defecate (as opposed to use of toilet elsewhere or open defecation) was higher among intervention versus comparison schools (90% vs. 63%; RR = 1.4; p < 0.001). Multilevel modelling indicated that students from intervention schools reported a 10-fold reduction in odds (p < 0.001) of school absence due to diarrhoea. In addition to school-based findings, self-reported handwashing at critical times was found to be higher among household members of students from intervention schools. This school-based WASH program appeared to increase knowledge and hygiene behaviours of school students, reduce absences due to diarrhoea, and increase handwashing at critical times among household members.


Asunto(s)
Diarrea/prevención & control , Higiene/educación , Saneamiento/normas , Niño , Diarrea/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Higiene/normas , Masculino , Filipinas/epidemiología , Servicios de Salud Escolar , Estudiantes
11.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 865-870, 2019 Sep 06.
Artículo en Chino | MEDLINE | ID: mdl-31474065

RESUMEN

According to different epochs and development needs, a series of practices on environmental health and sanitary engineering were carried out, which played significant roles in promoting national economic and social developments and protecting the public health. This paper reviewed the main achievements in the past 70 years infields of patriotic health campaign, water sanitation and toilet improvement in rural areas, surveillance and investigation, health standard system, sanitary engineering equipment, stove improvement etc., and then proposed several prospects in the future.


Asunto(s)
Salud Ambiental , Población Rural , Ingeniería Sanitaria , Saneamiento , China , Salud Ambiental/normas , Salud Ambiental/tendencias , Humanos , Salud Pública/normas , Ingeniería Sanitaria/tendencias , Saneamiento/normas , Saneamiento/tendencias , Cuartos de Baño/normas
12.
BMC Res Notes ; 12(1): 478, 2019 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-31375135

RESUMEN

OBJECTIVE: Absence of latrine remains a common public health problem in most of the Sub-Saharan Africa countries. A cross-sectional study was conducted to assess the effect of community-led total sanitation and hygiene approach implementation and associated factors among villages of Laelai Maichew District, Tigray, and North Ethiopia. RESULTS: This study revealed that the rate of latrine use in the rural community of Laelai-Maichew district was about 46.8%. The majority, 71.1% of households in CLTSH implemented Villages and 93.5% of households in CLTSH non-implemented Villages did not have hand washing facility around their latrine. Community-led to total sanitation and hygiene non-implemented villages were 49% times less likely to utilize their latrine compared to those community-led total sanitation implemented villages [AOR = 0.51 95% CI (0.35, 0.75)]. Households owned latrines for two and above years were 1.5 more likely to utilize their latrine [AOR = 1.50 95% CI (1.21, 2.59)] than those of owning latrines for less than 2 years. In this study, latrine use rate was low. As a result, the local, national governmental and non-governmental organization should design programs to create behavioral changes on the community's attitude towards latrine utilization.


Asunto(s)
Higiene/normas , Salud Pública/normas , Población Rural/estadística & datos numéricos , Saneamiento/normas , Adulto , Estudios Transversales , Etiopía , Femenino , Desinfección de las Manos/métodos , Desinfección de las Manos/normas , Humanos , Masculino , Persona de Mediana Edad , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Saneamiento/métodos , Encuestas y Cuestionarios , Cuartos de Baño/normas , Cuartos de Baño/estadística & datos numéricos
13.
Health Res Policy Syst ; 17(1): 77, 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31382967

RESUMEN

The Sanitation and Hygiene Applied Research for Equity (SHARE) Research Programme consortium is a programme funded by the United Kingdom Department for International Development (DFID) that aims to contribute to achieving universal access to effective, sustainable, and equitable sanitation and hygiene worldwide. The capacity development component is an important pillar for this programme and different strategies were designed and implemented during the various phases of SHARE. This paper describes and reflects on the capacity-building strategies of this large multi-country research consortium, identifying lessons learnt and proposing recommendations for future global health research programmes. In the first phase, the strategy focused on increasing the capacity of individuals and institutions from low- and middle-income countries in conducting their own research. SHARE supported six PhD students and 25 MSc students, and organised a wide range of training events for different stakeholders. SHARE peer-reviewed all proposals that researchers submitted through several rounds of funding and offered external peer-review for all the reports produced under the partner's research platforms. In the second phase, the aim was to support capacity development of a smaller number of African research institutions to move towards their independent sustainability, with a stronger focus on early and mid-career scientists within these institutions. In each institution, a Research Fellow was supported and a specific capacity development plan was jointly developed.Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans. The key lessons learnt were that research capacity-building programmes need to be driven by local initiatives tailored with support from partners. We recommend that future programmes seeking to strengthen research capacity should consider targeted strategies for individuals at early, middle and later career stages and should be sensitive to other institutional operations to support both the research and management capacities.


Asunto(s)
Academias e Institutos/organización & administración , Creación de Capacidad/organización & administración , Higiene/normas , Investigación/organización & administración , Saneamiento/métodos , África , Asia , Países en Desarrollo , Conocimientos, Actitudes y Práctica en Salud , Humanos , Cooperación Internacional , Saneamiento/normas , Reino Unido
14.
Artículo en Inglés | MEDLINE | ID: mdl-31412661

RESUMEN

BACKGROUND: Young children exhibit a high susceptibility to several diarrhoea-causing bacterial microorganisms. In this study, the prevalence of fecal contamination on children's toys was determined using total coliform and E. coli as bacterial fecal indicators. The prevalence of diarrhoeagenic E. coli strains were used as an indication of the potential health risks. MATERIALS AND METHODS: A cross-sectional descriptive study was carried out for 3 months in rural communities in the Vhembe district, Limpopo province of South Africa. Nonporous plastic toys (n = 137) used by children under 5 years of age in households and day care centres (DCCs) from rural villages were collected for assessment. New toys (n = 109) were provided to the households and DCCs and collected again after 4 weeks. Microbiological assessment was carried out using the Colilert® Quanti-Tray/2000 system. Diarrhoeagenic E. coli strains were identified using a published multiplex PCR protocol. RESULTS: Water, sanitation and hygiene (WASH) conditions of the children in the households and DCCs were assessed. Statistical analysis was used to identify the relationship between fecal contamination of the existing and introduced toys. All the existing and introduced toy samples, both from DCCs and households, tested positive for total coliform counts and 61 existing and introduced toy samples tested positive for E. coli counts. Diarrhoeagenic E. coli strains identified included EHEC, ETEC, EPEC, EIEC and EAEC. CONCLUSIONS: The results indicated that water, sanitation and hygiene conditions could be responsible in the contamination of children's toys and the transmission of diarrhoea to young children.


Asunto(s)
Jardines Infantiles , Diarrea/epidemiología , Infecciones por Escherichia coli/epidemiología , Composición Familiar , Heces , Juego e Implementos de Juego , Preescolar , Estudios Transversales , Diarrea/microbiología , Infecciones por Escherichia coli/microbiología , Heces/microbiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Población Rural , Saneamiento/normas , Sudáfrica
15.
BMC Public Health ; 19(1): 1028, 2019 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-31366398

RESUMEN

BACKGROUND: The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery. METHODS: Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed. RESULTS: A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others. CONCLUSION: This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.


Asunto(s)
Cólera/prevención & control , Diarrea/terapia , Higiene/normas , Desarrollo de Programa , Saneamiento/normas , Telemedicina/organización & administración , Calidad del Agua/normas , Bangladesh , Composición Familiar , Estudios de Factibilidad , Femenino , Desinfección de las Manos , Hospitales , Humanos , Masculino , Proyectos Piloto , Investigación Cualitativa , Proyectos de Investigación , Jabones
16.
PLoS One ; 14(8): e0220114, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31369595

RESUMEN

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women's experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Higiene/normas , Productos para la Higiene Menstrual/normas , Menstruación/psicología , Saneamiento/normas , Apoyo Social , Abastecimiento de Agua/métodos , Adolescente , Adulto , Anciano , Femenino , Grupos Focales , Humanos , Higiene/educación , India , Productos para la Higiene Menstrual/provisión & distribución , Persona de Mediana Edad , Población Rural , Adulto Joven
17.
BMC Public Health ; 19(1): 970, 2019 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-31331313

RESUMEN

BACKGROUND: Infant and young children stools are often considered innocuous, and are not disposed of safely despite having a higher pathogen load than adult feces. In Ethiopia, sanitary management of young children's stool is often overlooked and transmission of fecal-oral diseases is still a significant health burden. The study, therefore, describes the prevalence and associated factors of safe and improved child stool disposal. METHODS: Data from the fourth round of the Ethiopian Health and Demographic Survey (EDHS) conducted in 2016 was used for this analysis. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with safe and improved child stool disposal. RESULTS: The prevalence of safe and improved child stool disposal in Ethiopia was 36.9% (95%CI: 33.4-40.5%) and 5.3% (95%CI: 4.3-6.5%) respectively. There was regional variation in the prevalence of safe and improved child stool disposal. The odds of safe stool disposal among households with richest wealth index had 4.54 (AOR: 4.54; 95%CI: 2.89-7.12), richer 3.64 (AOR: 3.64; 95%CI: 2.46-5.38), middle 3.26 (AOR: 2.26; 95%CI: 2.27-4.68), and poorer 1.93 (AOR: 1.93; 95%CI: 1.39-2.68) times higher odds of practicing safe child stool disposal than households with poorest wealth index. Similarly, households found in richest, richer, middle, and poorer wealth index had also (AOR: 20.23; 95%CI: 8.59-47.66), (AOR: 12.53; 95%CI: 5.59-28.10) (AOR: 4.91; 95%CI: 1.92-12.55), and (AOR: 4.50; 95%CI: 2.06-9.84) higher odds of practicing improved child stool disposal than households from poorest wealth index respectively. The odds of safe child stool disposal were higher among households whose children age between 6 and 11 months (AOR: 1.57; 95%CI: 1.17-2.09), 12-17 months (AOR: 1.39; 95%CI: 1.00-1.95), and 18-23 months (AOR: 1.43; 95%CI: 1.03-1.99) than households whose children age between 0 and 5 months. The odds of safe child stool disposal were 1.31 (AOR: 1.31; 95%CI: 1.00-1.72) and 1.44 (AOR: 1.44; 95%CI: 1.04-2.01) times higher among mothers whose age between 25 and 34 and greater than 34 years compared to mothers whose age between 15 and 24 years, respectively. In addition, children's stools are more likely to be disposed of safely in urban households than in rural households (AOR: 3.12; 95%CI: 1.86-5.22). The present study also revealed households with access to improved sanitation facilities fail to use them for disposal of child stool (AOR: 0.99; 95% CI: 0.67-1.45). CONCLUSIONS: The prevalence of safe and improved child stool disposal in Ethiopia was found to be very low. Household socio-demographic and economic determinate were the key factors associated with child stool disposal. Appropriate strategic interventions to ensure safe and improved child stool disposal in Ethiopia is necessary. In addition, integrating child stool management into the existing sanitation interventions programs should be strongly recommended.


Asunto(s)
Heces , Seguridad/estadística & datos numéricos , Saneamiento/normas , Adolescente , Adulto , Demografía , Etiopía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Madres/estadística & datos numéricos , Prevalencia , Factores Socioeconómicos , Adulto Joven
18.
J Glob Health ; 9(2): 020402, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31360445

RESUMEN

Background: Water, sanitation, and hygiene (WASH) in schools is promoted by development agencies as a modality to improve school attendance by reducing illness. Despite biological plausibility, the few rigorous studies that have assessed the effect of WASH in schools (WinS) interventions on pupil health and school attendance have reported mixed impacts. We evaluated the impact of the Laos Basic Education, Water, Sanitation and Hygiene Programme - a comprehensive WinS project implemented by UNICEF Lao People's Democratic Republic (Lao PDR) in 492 primary schools nationwide between 2013 and 2017 - on pupil education and health. Methods: From 2014-2017, we conducted a cluster-randomized trial among 100 randomly selected primary schools lacking functional WASH facilities in Saravane Province, Lao PDR. Schools were randomly assigned to either the intervention (n = 50) or comparison (n = 50) arm. Intervention schools received a school water supply, sanitation facilities, handwashing facilities, drinking water filters, and behavior change education and promotion. Comparison schools received the intervention after research activities ended. At unannounced visits every six to eight weeks, enumerators recorded pupils' roll-call absence, enrollment, attrition, progression to the next grade, and reported illness (diarrhea, respiratory infection, conjunctivitis), and conducted structured observations to measure intervention fidelity and adherence. Stool samples were collected annually prior to de-worming and analyzed for soil-transmitted helminth (STH) infection. In addition to our primary intention-to-treat analysis, we conducted secondary analyses to quantify the role of intervention fidelity and adherence on project impacts. Results: We found no impact of the WinS intervention on any primary (pupil absence) or secondary (enrollment, dropout, grade progression, diarrhea, respiratory infection, conjunctivitis, STH infection) impacts. Even among schools with the highest levels of fidelity and adherence, impact of the intervention on absence and health was minimal. Conclusions: While WinS may create an important enabling environment, WinS interventions alone and as currently delivered may not be sufficient to independently impact pupil education and health. Our results are consistent with other recent evaluations of WinS projects showing limited or mixed effects of WinS.


Asunto(s)
Absentismo , Diarrea/prevención & control , Helmintiasis/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Servicios de Salud Escolar , Animales , Niño , Diarrea/epidemiología , Heces/parasitología , Femenino , Helmintiasis/epidemiología , Helmintiasis/transmisión , Helmintos/aislamiento & purificación , Humanos , Higiene/educación , Higiene/normas , Laos/epidemiología , Masculino , Evaluación de Programas y Proyectos de Salud , Infecciones del Sistema Respiratorio/epidemiología , Saneamiento/normas , Suelo/parasitología , Abastecimiento de Agua/normas
19.
Artículo en Inglés | MEDLINE | ID: mdl-31311186

RESUMEN

Nearly 90% of diarrhea-related mortalities are the result of unsafe drinking water, poor sanitation, and insufficient hygiene. Although "Water, Sanitation, and Hygiene" (WASH) interventions may significantly reduce the risk of diarrheal disease, it is currently unclear which interventions are the most effective. In this study, we aim to determine the importance of contextualizing a WASH intervention to the local context and the needs for increasing impact (Clinicaltrials.gov NCT03709368). A total of 1500 households in rural Tanzania will participate in this cluster randomized controlled trial. Households will be randomized into one of three cohorts: (1) a control group receiving a basic intervention and 1 placebo household visit, (2) an intervention group receiving a basic intervention + 9 additional household visits which are contextualized to the setting using the RANAS approach, and (3) an intervention group receiving a basic intervention + 9 additional household visits, which are not contextualized, i.e., a general intervention. Assessments will take place at a baseline, 1 and 2 years after the start of the intervention, and 1 year after the completion of the intervention. Measurements involve questionnaires and spot checks. The primary outcome is hand-washing behavior, secondary objectives include, the impact on latrine use, health, WASH infrastructure, quality of life, and cost-effectiveness.


Asunto(s)
Desinfección de las Manos/métodos , Promoción de la Salud/métodos , Servicios de Salud Rural , Salud Rural , Saneamiento/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos Clínicos , Femenino , Estudios de Seguimiento , Desinfección de las Manos/normas , Conductas Relacionadas con la Salud , Promoción de la Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proyectos de Investigación , Servicios de Salud Rural/normas , Saneamiento/normas , Método Simple Ciego , Tanzanía , Adulto Joven
20.
BMC Res Notes ; 12(1): 399, 2019 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-31300042

RESUMEN

OBJECTIVE: Food borne diseases are predominant in all parts of the world especially in urban areas and are the main source for food borne illness. The aim of this study is to assess sanitation status and its determinants among food establishments in Adwa town, North Ethiopia from March to June 2017. RESULTS: A total of 391 (95.4%) subjects were included in this study. Around 53.3% of food establishments in the study area were in a poor sanitary status. Presence of trained managers on hygiene and sanitation (AOR = 2.6, 95% CI 1.7-4.1); inspection by regulatory personnel (AOR = 1.95, 95% CI 1.36-22.4) and being licensed (AOR = 1.2 95% CI 1.11-2.51) were associated factors which affect sanitary status sanitary of the establishments. The overall sanitary status of the establishments in the study area was found unhygienic. Managers should gain trainings on food hygiene and sanitation to follow and improve the sanitary status of the establishments.


Asunto(s)
Manipulación de Alimentos/normas , Enfermedades Transmitidas por los Alimentos/diagnóstico , Desinfección de las Manos/normas , Saneamiento/normas , Adulto , Anciano , Estudios Transversales , Etiopía/epidemiología , Femenino , Alimentos/normas , Alimentos/estadística & datos numéricos , Manipulación de Alimentos/métodos , Manipulación de Alimentos/estadística & datos numéricos , Servicios de Alimentación/legislación & jurisprudencia , Servicios de Alimentación/normas , Servicios de Alimentación/estadística & datos numéricos , Enfermedades Transmitidas por los Alimentos/epidemiología , Desinfección de las Manos/métodos , Humanos , Higiene/normas , Modelos Logísticos , Masculino , Persona de Mediana Edad , Saneamiento/estadística & datos numéricos , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos
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