Drivers of menstrual material disposal and washing practices: A systematic review.

BACKGROUND: Disposal and washing facilities and services for menstrual materials are often designed based upon technical specifications rather than an in-depth understanding of what drives peoples' choices of practices. OBJECTIVES AND DATA SOURCES: This systematic review identified and summarised the main behavioural drivers pertaining to the choice of disposal and washing practices of menstrual materials through the thematic content analysis and study appraisal of 82 publications (80 studies) on menstrual health and hygiene published since 1999, reporting the outcomes of primary research across 26 countries. RESULTS: Disposal and washing behaviours are primarily driven by the physical state of sanitation facilities; however, this is intrinsically linked to taboos surrounding and knowledge of menstruation. IMPLICATIONS: Using reasons given for disposal and washing practices by menstruators or those who know them well, or inferred by authors of the reviewed studies, we identify the key considerations needed to design facilities and services which best suit the desired behaviours of both planners and those who menstruate. INCLUSIVITY: The term menstruators is used throughout to encompass all those mentioned in the studies reviewed (girls and women); although no studies explicitly stated including non-binary or transgender participants, this review uses inclusive language that represents the spectrum of genders that may experience menstruation. REGISTRATION: The review protocol is registered on PROSPERO: 42019140029.

A 'Knowledge Ecologies' Analysis of Co-designing Water and Sanitation Services in Alaska.

Willingness to collaborate across disciplinary boundaries is necessary but not sufficient for project success. This is a case study of a transdisciplinary project whose success was constrained by contextual factors that ultimately favoured technical and scientific forms of knowledge over the cultural intelligence that might ensure technical solutions were socially feasible. In response to Alaskan Water and Sewer Challenge (AWSC), an international team with expertise in engineering, consultative design and public health formed in 2013 to collaborate on a two-year project to design remote area water and sanitation systems in consultation with two native Alaskan communities. Team members were later interviewed about their experiences. Project processes are discussed using a 'Knowledge Ecology' framework, which applies principles of ecosystems analysis to knowledge ecologies, identifying the knowledge equivalents of 'biotic' and 'abiotic' factors and looking at their various interactions. In a positivist 'knowledge integration' perspective, different knowledges are like Lego blocks that combine with other 'data sets' to create a unified structure. The knowledge ecology framework highlights how interactions between different knowledges and knowledge practitioners ('biotic factors') are shaped by contextual ('abiotic') factors: the conditions of knowledge production, the research policy and funding climate, the distribution of research resources, and differential access to enabling infrastructures (networks, facilities). This case study highlights the importance of efforts to negotiate between different knowledge frameworks, including by strategic use of language and precepts that help translate social research into technical design outcomes that are grounded in social reality.

Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?

The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.

["Emergency measures"]. / "Les mesures d'urgence".

This article deals with the impact of health crisis on governance of public health. It tries to show that, in accordance with the thought of Michel Foucault, emergency measures issued during health crisis are akin to those issued during wartime.

[Chikungunya and urban sprawl on Reunion Island]. / Le chikungunya et l'habitat informel a La Réunion.

The proportion of unsanitary housing in French overseas departments is much higher than in mainland France. Reunion Island is no exception to this fact. Between 80 and 90% of housing in Reunion Island was built by squatters with no legal claim or deed to the property. This has resulted in uncontrolled urban sprawl with living conditions reminiscent of those in developing countries. The absence of adequate drainage systems for sewage and rain water and the lack of properly organized garbage disposal that characterizes these sprawl areas constitutes a particularly favorable breeding ground for vector-borne diseases, especially chikungunya. Thus, implementing measures to control this type of settlement and to relocate of people out of existing sprawl areas constitutes a significant tool to control this epidemiological risk. Up to now, public officials have shown a clear reluctance to intervene in sprawl areas despite good knowledge of their location. On June 26th of this year, a law containing provisions relative to the control of urban sprawl and unsanitary housing in overseas departments and territories will come into effect. This law should provide public officials with the legal basis that has up until now been lacking to take action. Persistence in the "wait-and-see" attitude could lead to condemnation by French or European courts.

Agua y saneamiento: evidencias para políticas públicas con enfoque en derechos humanos y resultados en salud pública

Publicación de la Organización Mundial de la Salud, que aborda el tema del agua y el saneamiento como una prueba del enfoque de política pública para los derechos humanos en los resultados de salud pública y agua y saneamiento, y cómo cambiar las estadísticas con relación a la salud.

Ethical considerations of the short-term and long-term health impacts, costs, and educational value of sustainable development projects.

There are over 800 seventh to tenth grade students at the College d'Enseignment Generale (CEG) School in Azové, Benin. Like most children in the developing world, these students lack access to clean water and basic sanitation facilities. These students suffer from parasitic infection and health ailments which could be directly offset with short term aid to supply water and medical aid. Promoting proper sanitation and providing the technology to implement water and wastewater treatment in the community will decrease childhood and maternal disease and mortality rates in Azové. However, these measures may take several years to implement and will require a significant investment in the infrastructure of the school. Is it ethical to spend 10,000 dollars towards the long-term goals of providing water and sanitation to the students of CEG Azové, compared to spending the same amount on short-term relief efforts? This paper addresses the ethical dilemma of dealing with immediate medical needs in developing countries while trying to implement sustainable technologies. The views and frustration of students working on the project are discussed, as they realize the monetary and short-term impacts on human health when implementing sustainable technologies. The opportunity costs associated with the education principles of sustainable development were also considered. The anticipated costs and health impacts in the short-term and long-term will be evaluated for a period of 1, 2, 5 and 10 years. Sustainable development requires a new way of thinking, and a long-term approach. These problems will require the dedication of a new generation of engineers, working hand-in-hand with local communities and governments, social scientists, economists, businesses, human rights organizations, other non-government organizations, and international development organizations. Design projects encourage the professional and ethical development of engineers through hands-on involvement in national and international development projects.