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1.
Trop Med Int Health ; 23(12): 1350-1363, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30286270

RESUMO

OBJECTIVE: To assess the prevalence of menstrual hygiene management (MHM) knowledge and practices among adolescent schoolgirls in Indonesia, and assess factors associated with poor MHM and school absenteeism due to menstruation. METHODS: A cross-sectional survey enrolled a representative sample of urban and rural school-going girls aged 12-19 years in four provinces of Indonesia. A semi-structured, self-administered questionnaire obtained socio-demographic characteristics, knowledge, practices and attitudes related to menstruation, MHM and school absenteeism. School water, sanitation and hygiene (WASH) facilities were also assessed. Univariate weighted population prevalence was estimated and multivariable logit regression analyses applied to explore associations. RESULTS: A total of 1159 adolescent girls with a mean age of 15 years (SD = 1.8) participated. Most girls (90.8%, 95% confidence interval (95% CI) = 79.7-96.1) had reached menarche. Over half (64.1%, 95% CI = 49.9-76.2) reported poor MHM practices, and 11.1% (95% CI = 8.1-15.2) had missed one or more days of school during their most recent menstrual period. Poor MHM practices were associated with rural residence (Adjusted odds ratio (AOR) = 1.73, 95% CI = 1.13-2.64), province (various AOR), lower school grade (AOR = 1.69, 95% CI = 1.05-2.74) and low knowledge of menstruation (AOR = 3.49, 95% CI = 1.61-7.58). Absenteeism was associated with living in rural areas (AOR = 3.96, 95% CI = 3.02-5.18), province (various AOR), higher school grade (AOR = 3.02, 95% CI = 2.08-4.38), believing menstruation should be kept secret (AOR = 1.47, 95% CI = 1.03-2.11), experiencing serious menstrual pain (AOR = 1.68, 95% CI = 1.06-2.68) and showed mixed associations with school WASH facilities. CONCLUSIONS: High prevalence of poor MHM and considerable school absenteeism due to menstruation among Indonesian girls highlight the need for improved interventions that reach girls at a young age and address knowledge, shame and secrecy, acceptability of WASH infrastructure and menstrual pain management.


Assuntos
Absenteísmo , Comportamento do Adolescente/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Higiene , Menstruação/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Indonésia , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
2.
Am J Trop Med Hyg ; 99(2): 546-551, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29943724

RESUMO

Provision of basic water, sanitation, and hygiene (WASH) services in health-care facilities is gaining increased attention, given growing acceptance of its importance to the maternal and newborn quality of care agenda and the universal health coverage framework. Adopting and contextualizing an emerging World Health Organization/United Nations Children's Fund Joint Program Monitoring service ladder approach to national data collected in 2010/2011, we estimated the national coverage of primary health centers (PHCs) (N = 8,831), auxiliary PHCs (N = 22,853), village health posts (N = 28,692), and village maternity clinics (N = 14,396) with basic WASH services in Indonesia as part of a Sustainable Development Goal baseline assessment. One quarter of PHCs did not have access to a combination of basic water and sanitation (WatSan) services (23.6%) with significant regional variation (10.6-59.8%), whereas more than two-third of PHCs (72.0%) lacked handwashing facility with soap in all three locations (general consulting room, immunization room, and delivery room). More than a half of the three lower health service level facility types lacked basic WatSan services. National health facility monitoring systems need to be urgently strengthened for tracking the progress and addressing gaps in basic WASH services in health facilities in Indonesia.


Assuntos
Água Potável , Instalações de Saúde/normas , Higiene , Saúde Pública/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Pré-Escolar , Feminino , Metas , Desinfecção das Mãos , Humanos , Indonésia , Lactente , População Rural , Desenvolvimento Sustentável , Nações Unidas , Abastecimento de Água/estatística & dados numéricos , Organização Mundial da Saúde
3.
Artigo em Inglês | MEDLINE | ID: mdl-29240667

RESUMO

Community Approaches to Total Sanitation (CATS) programmes, like the Sanitasi Total Berbasis Masyarakat (STBM) programme of the Government of Indonesia, have played a significant role in reducing open defecation though still little is known about the sustainability of the outcomes. We assessed the sustainability of verified Open Defecation Free (ODF) villages and explored the association between slippage occurrence and the strength of social norms through a government conducted cross-sectional data collection in rural Indonesia. The study surveyed 587 households and held focus group discussions (FGDs) in six ODF villages two years after the government's ODF verification. Overall, the slippage rate (i.e., a combination of sub-optimal use of a latrine and open defecation at respondent level) was estimated to be 14.5% (95% CI 11.6-17.3). Results of multivariate logistic regression analyses indicated that (1) weaker social norms, as measured by respondents' perceptions around latrine ownership coverage in their community, (2) a lack of all-year round water access, and (3) wealth levels (i.e., not being in the richest quintile), were found to be significantly associated with slippage occurrence. These findings, together with qualitative analysis, concluded that CATS programmes, including a combination of demand creation, removal of perceived constraints through community support mechanisms, and continued encouragement to pursue higher levels of services with post-ODF follow-up, could stabilize social norms and help to sustain longer-term latrine usage in study communities. Further investigation and at a larger scale, would be important to strengthen these findings.


Assuntos
Defecação , Programas Governamentais , Saneamento/tendências , Normas Sociais , Toaletes/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Características da Família , Feminino , Grupos Focais , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Propriedade , Percepção , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
4.
Int J Hyg Environ Health ; 220(7): 1141-1151, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28743592

RESUMO

There remains a pressing need for systematic water quality monitoring strategies to assess drinking water safety and to track progress towards the Sustainable Development Goals (SDG). This study incorporated water quality testing into an existing national socioeconomic survey in Yogyakarta province, Indonesia; the first such study in Indonesia in terms of SDG tracking. Multivariate regression analysis assessed the association between faecal and nitrate contamination and drinking water sources household drinking water adjusted for wealth, education level, type of water sources and type of sanitation facilities. The survey observed widespread faecal contamination in both sources for drinking water (89.2%, 95%CI: 86.9-91.5%; n=720) and household drinking water (67.1%, 95%CI: 64.1-70.1%; n=917) as measured by Escherichia coli. This was despite widespread improved drinking water source coverage (85.3%) and commonly self-reported boiling practices (82.2%). E.coli concentration levels in household drinking water were associated with wealth, education levels of a household head, and type of water source (i.e. vender water or local sources). Following the proposed SDG definition for Target 6.1 (water) and 6.2 (sanitation), the estimated proportion of households with access to safely managed drinking water and sanitation was 8.5% and 45.5%, respectively in the study areas, indicating substantial difference from improved drinking water (82.2%) and improved sanitation coverage (70.9%) as per the MDGs targets. The greatest contamination and risk factors were found in the poorest households indicating the urgent need for targeted and effective interventions here. There is suggested evidence that sub-surface leaching from on-site sanitation adversely impacts on drinking water sources, which underscores the need for further technical assistance in promoting latrine construction. Urgent action is still needed to strengthen systematic monitoring efforts towards tracking SDG Goal 6.


Assuntos
Água Potável/microbiologia , Escherichia coli/isolamento & purificação , Poluentes Químicos da Água/análise , Qualidade da Água , Cloretos/análise , Conservação dos Recursos Naturais , Água Potável/análise , Fezes/microbiologia , Metas , Humanos , Indonésia , Nitratos/análise , Pobreza , Análise de Regressão , Saneamento/métodos , Fatores Socioeconômicos , Inquéritos e Questionários , Microbiologia da Água , Abastecimento de Água
5.
Int J Hyg Environ Health ; 220(3): 539-550, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28238610

RESUMO

Water, sanitation, and hygiene (WASH) in schools are important for child health, development, and educational performance; yet coverage in Indonesian schools remains low. To address this deficiency, UNICEF and partners conducted a WASH intervention in 450 schools across three provinces in Indonesia. A survey evaluating the sustainability of infrastructure and behavioral interventions in comparison to control districts was conducted one year after completion of the intervention. The survey data were also compared with national government data to assess the suitability of government data to report progress on the Sustainable Development Goals (SDGs). Logistic regression was used to explore associations between WASH conditions and behaviors. Intervention schools were more likely to have handwashing stations with soap and water. In multivariable analyses, schools with a toilet operation and maintenance fund were more likely to have functional toilets. Students who learn hygiene skills from their teachers were less likely to defecate openly, more likely to share hygiene knowledge with their parents, and more likely to wash their hands. Survey data were comparable with government data, suggesting that Indonesian government monitoring may be a reliable source of data to measure progress on the SDGs. This research generates important policy and practice findings for scaling up and sustaining WASH in schools and may help improve WASH in schools programs in other low-resource contexts.


Assuntos
Higiene , Saneamento , Instituições Acadêmicas , Abastecimento de Água , Comportamento , Criança , Conservação dos Recursos Naturais , Governo Federal , Feminino , Órgãos Governamentais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indonésia , Modelos Logísticos , Masculino , Inquéritos e Questionários
6.
Artigo em Inglês | MEDLINE | ID: mdl-27598178

RESUMO

Handwashing with soap is recognized as a cost-effective intervention to reduce morbidity and mortality associated with enteric and respiratory infections. This study analyzes rural Indonesian households' hygiene behaviors and attitudes to examine how motivations for handwashing, locations of handwashing space in the household, and handwashing moments are associated with handwashing with soap as potential determinants of the behavior. The analysis was conducted using results from a UNICEF cross-sectional study of 1700 households in six districts across three provinces of Indonesia. A composite measure of handwashing with soap was developed that included self-reported handwashing, a handwashing demonstration, and observed handwashing materials and location of facilities in the home. Prevalence ratios were calculated to analyze associations between handwashing with soap and hypothesized determinants of the behavior. Our results showed that determinants that had a significant association with handwashing with soap included: (1) a desire to smell nice; (2) interpersonal influences; (3) the presence of handwashing places within 10 paces of the kitchen and the toilet; and (4) key handwashing moments when hands felt dirty, including after eating and after cleaning child stools. This study concludes that handwashing with soap may be more effectively promoted through the use of non-health messages.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Higiene das Mãos/estatística & dados numéricos , Educação em Saúde/métodos , Sabões , Adolescente , Adulto , Infecções Bacterianas/microbiologia , Análise Custo-Benefício , Estudos Transversais , Características da Família , Feminino , Desinfecção das Mãos/economia , Desinfecção das Mãos/métodos , Higiene das Mãos/economia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Motivação , Prevalência , População Rural , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-26978379

RESUMO

Indonesia still faces several challenges in the areas of water, sanitation, and hygiene (WASH). Diarrhea remains a major killer of children and it is important to understand the local diarrhea transmission pathways to prioritise appropriate WASH interventions to reduce diarrhea burden. This study used a cross-sectional data set from a recent national household survey (the 2012 Indonesia Demographic and Health Survey) to examine the associations between diarrhea in children aged less than 24 months with WASH interventions and population characteristics. Unsafe disposal of child feces was strongly associated with an increased odds of child diarrhea (OR: 1.46; 95% CI: 1.18-1.82, p = 0.001). However, other WASH practices were not found to be associated. The findings underline the dangers of unsafe disposal of child feces and highlight the need for strengthening the related policies and program strategies and their implementation.


Assuntos
Diarreia Infantil/etiologia , Comportamentos Relacionados com a Saúde , Higiene , Eliminação de Resíduos/métodos , Segurança/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Diarreia Infantil/epidemiologia , Diarreia Infantil/prevenção & controle , Fezes , Feminino , Inquéritos Epidemiológicos , Humanos , Indonésia/epidemiologia , Lactente , Recém-Nascido , Masculino , Eliminação de Resíduos/estatística & dados numéricos , Fatores de Risco
8.
BMJ Open ; 5(2): e005180, 2015 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-25678539

RESUMO

OBJECTIVES: Increasing evidence suggests that water, sanitation and hygiene (WASH) practices affect linear growth in early childhood. We determined the association between household access to water, sanitation and personal hygiene practices with stunting among children aged 0-23 months in rural India. SETTING: India. PARTICIPANTS: A total of 10 364, 34 639 and 1282 under-2s who participated in the 2005-2006 National Family Health Survey (NFHS-3), the 2011 Hunger and Malnutrition Survey (HUNGaMA) and the 2012 Comprehensive Nutrition Survey in Maharashtra (CNSM), respectively, were included in the analysis. PRIMARY OUTCOME MEASURES: The association between WASH indicators and child stunting was assessed using logistic regression models. RESULTS: The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16-39% reduced odds of stunting among children aged 0-23 months, after adjusting for all potential confounders (NHFS-3 (OR=0.84, 95% CI 0.71 to 0.99); HUNGaMA (OR=0.84, 95% CI 0.78 to 0.91); CNSM (OR=0.61, 95% CI 0.44 to 0.85)). Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver's self-reported practices of washing hands with soap before meals (OR=0.85, 95% CI 0.76 to 0.94) or after defecation (OR=0.86, 95% CI 0.80 to 0.93) were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water (all interaction terms, p<0.05). CONCLUSIONS: Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.


Assuntos
Estatura , Características da Família , Transtornos do Crescimento/etiologia , Desinfecção das Mãos , Higiene , Saneamento , Toaletes , Criança , Estudos Transversais , Coleta de Dados , Defecação , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Refeições , Estado Nutricional , Razão de Chances , População Rural , Sabões , Abastecimento de Água
9.
J Water Health ; 7(4): 557-68, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19590123

RESUMO

A WHO methodology is used for the first time to estimate the burden of disease directly associated with incomplete water and sanitation provision in refugee camps in sub-Saharan African countries. In refugee camps of seven countries, containing just fewer than 1 million people in 2005, there were 132,000 cases of diarrhoea and over 280,000 reported cases of malaria attributable to incomplete water and sanitation provision. In the period from 2005 to 2007 1,400 deaths were estimated to be directly attributable to incomplete water and sanitation alone in refugee camps in Ethiopia, Kenya and Tanzania. A comparison with national morbidity estimates from WHO shows that although diarrhoea estimates in the camps are often higher, mortality estimates are generally much lower, which may reflect on more ready access to medical aid within refugee camps. Despite the many limitations, these estimates highlight the burden of disease connected to incomplete water and sanitation provision in refugee settings and can assist resource managers to identify camps requiring specific interventions. Additionally the results reinforce the importance of increasing dialogue between the water, sanitation and health sectors and underline the fact that efforts to reduce refugee morbidity would be greatly enhanced by strengthening water and sanitation provision.


Assuntos
Diarreia/epidemiologia , Diarreia/microbiologia , Malária/epidemiologia , Malária/microbiologia , Microbiologia da Água , Abastecimento de Água , África ao Sul do Saara/epidemiologia , Bases de Dados Factuais , Diarreia/prevenção & controle , Humanos , Malária/prevenção & controle , Malária/transmissão , Refugiados , Saneamento , Organização Mundial da Saúde
10.
J Water Health ; 5(3): 441-54, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17878559

RESUMO

By 2010 Africa's urban population will have grown to over 420 million with on-site sanitation the predominant excreta disposal option. The use of on-site sanitation has important public health benefits but can result in large faecally derived loadings of nitrogen and chloride to groundwater resources. Nitrate is of particular concern, with elevated concentrations linked to potentially serious health problems. N and Cl can derive from natural sources so it is important to quantify the additional impact of human activities. Several authors have used empirical relationships between nitrate and chloride concentrations to assess the extent to which excreta influences groundwater quality. However, these relationships have assumed fixed loadings from excreta. Relationships between N and Cl have been extended here by adding country-specific estimates of average annual per capita nitrogen and chloride content of, and loading from, excreta. The results are compared with groundwater monitoring results from two very different mid-sized African cities (Timbuktu, Mali and Lichinga, Mozambique) where the vast majority of residents use on-site sanitation and are dependent on the subsurface water for drinking purposes. The results illustrate the impact of urbanisation on groundwater quality. They are compared with data from other African cities to allow the calculation of a general nitrate and chloride relationship for unsewered African urban areas. Potential interventions to help arrest rising nitrate levels and so provide a public health benefit are also examined.


Assuntos
Cloretos/análise , Nitratos/análise , Saneamento/métodos , Urbanização , Poluentes Químicos da Água/análise , Abastecimento de Água/análise , Cidades , Monitoramento Ambiental , Fezes/química , Humanos , Mali , Moçambique , Nitrogênio/análise , Proteínas/análise
11.
J Water Health ; 4(3): 333-45, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17036841

RESUMO

Microbiological water quality monitoring in Niassa province, Northern Mozambique, shows groundwater is not, in general, grossly contaminated though contamination levels are strongly linked to season and to risks observable at the wellhead, especially risks dealing with wellhead hygiene and maintenance. Diarrhea incidence, in general, is greatest in the rainy season suggesting poor wellhead protection as a potential mechanism for well contamination. Comparison of source water and stored water in the home shows that significant deterioration in source water quality can occur once transport and storage in the home is undertaken but that this deterioration is also related to the quality of the source water. This study shows that a structured approach to water quality monitoring, with targeted observations and an examination of the relationships between risk and water quality, is important to identify the priority interventions to be undertaken.


Assuntos
Monitoramento Ambiental , Saneamento/métodos , Poluentes da Água/análise , Abastecimento de Água/análise , Abastecimento de Água/normas , Diarreia , Condutividade Elétrica , Fezes , Moçambique , Chuva , Medição de Risco , Saneamento/normas , Temperatura Ambiente , Fatores de Tempo , Poluentes da Água/isolamento & purificação
12.
J Water Health ; 3(2): 129-38, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16075939

RESUMO

Health-based monitoring of the Caspian Sea in Turkmenistan and Iran suggests that bathers are intermittently subject to increased levels of faecal pollution which may lead to gastrointestinal illness. This is the first co-ordinated monitoring programme of recreational waters in the Caspian region and highlights the need to extend such a programme to all countries bordering the Caspian Sea. The novel approach of monitoring that combines risk assessment (water quality monitoring plus a sanitary survey) and risk management, as applied here, allows the identification of possible sources of pollution and the levels of microbiological risk that bathers are subject to. Hence, this allows suitable management interventions to be identified and implemented in the long-term.


Assuntos
Atividades de Lazer , Água do Mar/microbiologia , Microbiologia da Água , Monitoramento Ambiental/métodos , Humanos , Irã (Geográfico) , Oceanos e Mares , Projetos Piloto , Medição de Risco , Turcomenistão
13.
Water Res ; 37(2): 339-52, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12502063

RESUMO

Development of urban groundwater has historically been constrained by concerns about its quality. Rising urban water tables and overabstraction from rural aquifers in the UK have led to a renewed interest in urban groundwater, particularly the possibility of finding water of acceptable quality at depth. This study assessed the microbial quality of groundwater collected from depth-specific intervals over a 15-month period within the Permo-Triassic Sherwood Sandstone aquifers underlying the cities of Nottingham and Birmingham. Sewage-derived bacteria (thermotolerant coliforms, faecal streptococci and sulphite-reducing clostridia) and viruses (enteroviruses, Norwalk-like viruses, coliphage) were regularly detected to depths of 60 m in the unconfined sandstone and to a depth of 91 m in the confined sandstone. Microbial concentrations varied temporally and spatially but increased frequency of contamination with depth coincided with geological heterogeneities such as fissures and mudstone bands. Significantly, detection of Norwalk-like viruses and Coxsackievirus B4 in groundwater corresponded with seasonal variations in virus discharge to the sewer system. The observation of low levels of sewage-derived microbial contaminants at depth in the Triassic Sandstone aquifer is explained by the movement of infinitesimal proportions of bulk (macroscopic) groundwater flow along preferential pathways (e.g., fissures, bedding planes). The existence of very high microbial populations at source (raw sewage) and their extremely low detection limits at the receptor (multilevel piezometer) enable these statistically extreme (microscopic) flows to be traced. Rapid penetration of microbial contaminants into sandstone aquifers, not previously reported, highlights the vulnerability of sandstone aquifers to microbial contamination.


Assuntos
Microbiologia da Água , Abastecimento de Água , Cidades , Inglaterra , Enterovirus/isolamento & purificação , Monitoramento Ambiental , Fenômenos Geológicos , Geologia , Norovirus/isolamento & purificação , Estações do Ano , Esgotos
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