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Waste Manag Res ; 35(6): 618-626, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28393635


In Nepal, full-fledged environmental legislation was rare before the democratic constitution of 1990. The first law covering the environment and sustainability was the Environment Protection Act 1997. While the Solid Waste Act was introduced in 1987, the problem of solid waste management still surfaces in Kathmandu. In order to understand the bedrock of this unrelenting failure in solid waste management, the manuscript digs deeper into policy implementation by dissecting solid waste rules, environmental legislations, relevant local laws, and solid waste management practices in Kathmandu, Nepal. A very rich field study that included surveys, interviews, site visits, and literature review provided the basis for the article. The study shows that volumes of new Nepalese rules are crafted without effective enforcement of their predecessors and there is a frequent power struggle between local government bodies and central authority in implementing the codes and allocating resources in solid waste management. The study concludes that Kathmandu does not require any new instrument to address solid waste problems; instead, it needs creation of local resources, execution of local codes, and commitment from central government to allow free exercise of these policies.

Política Ambiental , Resíduos Sólidos , Gerenciamento de Resíduos , Conservação dos Recursos Naturais , Nepal , Eliminação de Resíduos
PLoS One ; 12(1): e0170451, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28125625


BACKGROUND: According to the most recent estimates, 842,000 deaths in low- to middle-income countries were attributable to inadequate water, sanitation and hygiene in 2012. Despite billions of dollars and decades of effort, we still lack a sound understanding of which kinds of WASH interventions are most effective in improving public health outcomes, and an important corollary-whether the right things are being measured. The World Health Organization (WHO) has made a concerted effort to compile comprehensive data on drinking water quality and sanitation in the developing world. A recent 2014 report provides information on three phenotypes (responses): Unsafe Water Deaths, Unsafe Sanitation Deaths, Unsafe Hygiene Deaths; two grouped phenotypes: Unsafe Water and Sanitation Deaths and Unsafe Water, Sanitation and Hygiene Deaths; and six explanatory variables (predictors): Improved Sanitation, Unimproved Water Source, Piped Water To Premises, Other Improved Water Source, Filtered and Bottled Water in the Household and Handwashing. METHODS AND FINDINGS: Regression analyses were performed to identify statistically significant associations between these mortality responses and predictors. Good fitted-model performance required: (1) the use of population-normalized death fractions as opposed to number of deaths; (2) transformed response (logit or power); and (3) square-root predictor transformation. Given the complexity and heterogeneity of the relationships and countries being studied, these models exhibited remarkable performance and explained, for example, about 85% of the observed variance in population-normalized Unsafe Sanitation Death fraction, with a high F-statistic and highly statistically significant predictor p-values. Similar performance was found for all other responses, which was an unexpected result (the expected associations between responses and predictors-i.e., water-related with water-related, etc. did not occur). The set of statistically significant predictors remains the same across all responses. That is, Unsafe Water Source (UWS), Improved Sanitation (IS) and Filtered and Bottled Water in the Household (FBH) were the only statistically significant predictors whether the response was Unsafe Sanitation Death Fraction, Unsafe Hygiene Death Fraction or Unsafe Water Death Fraction. Moreover, the fraction of variance explained for all fitted models remained relatively high (adjusted R2 ranges from 0.7605 to 0.8533). We find that two of the statistically significant predictors-Improved Sanitation and Unimproved Water Sources-are particularly influential. We also find that some predictors (Piped Water to Premises, Other Improved Water Sources) have very little explanatory power for predicting mortality and one (Other Improved Water Sources) has a counterintuitive effect on response (Unsafe Sanitary Death Fraction increases with increases in OIWS) and one predictor (Hand Washing) to have essentially no explanatory usefulness. CONCLUSIONS: Our results suggest that a higher priority may need to be given to improved sanitation than has been the case. Nevertheless, while our focus in this paper is mortality, morbidity is a staggering consequence of inadequate water, sanitation and hygiene, and lower impact on mortality may not mean a similarly low impact on morbidity. More specifically, those predictors that we found uninfluential for predicting mortality-related responses may indeed be important when morbidity is the response.

Higiene , Saúde Pública , Saneamento/métodos , Qualidade da Água , Abastecimento de Água/normas , Países em Desenvolvimento , Desinfecção das Mãos , Humanos , Modelos Teóricos , Organização Mundial da Saúde