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2.
Pan Afr Med J ; 33: 244, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692810

RESUMO

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.


Assuntos
Água Potável/normas , Saneamento/normas , Abastecimento de Água/normas , Camarões , Estudos Transversais , Países em Desenvolvimento , Desinfecção/métodos , Características da Família , Feminino , Humanos , Masculino , Inquéritos e Questionários , Toaletes/estatística & dados numéricos
3.
BMC Infect Dis ; 19(1): 804, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519160

RESUMO

BACKGROUND: Globally, diarrhea is the leading cause of morbidity and mortality among less than 5 years old children and it contributes to the deaths of approximately one million children every year. In Ethiopia, diarrhea is the second cause of under-five mortality and morbidity. However, in the study area, studies were limited. Therefore, this study has assessed the prevalence of diarrhea and associated factors among < 5 years of age in Jamma district, Northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from August 15 to September 15, 2017, in Jamma district, South Wello zone, northeast Ethiopia. A Systematic random sampling technique was used to select 614 households and a pretested structured questionnaire was used to collect the data. A multivariable logistic regression analysis was used to investigate factors associated with diarrheal disease. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) for variables with P-value < 0.05 was used to show statistically significant association. RESULTS: In this study, the prevalence of diarrhea among under-five children was 23.1% (95% CI: (19.4, 26.5). Child's age 6 to 23 months [AOR: 2.46, 95% CI: (1.49, 4.05)], Living in rural area [AOR: 2.75, 95% CI: (1.33,5.66)], absence of latrine [AOR: 4.80, 95% CI: (2.39,9.60)], absence of handwashing facility [AOR: 2.45, 95% CI: (1.53,3.93], unprotected drinking water source [AOR:2.68, 95% CI: (1.54,4.68)], and Improper waste disposal practices [AOR:3.86, 95% CI: (2.38,6.26)] were associated with diarrhea disease. CONCLUSION: There was a high prevalence of diarrheal disease among children in the study area. Child age, rural residence, availability of latrine and handwashing facility, source of drinking water, and improper waste disposal were notably associated with childhood diarrheal disease. Therefore, improving handwashing practices and pure water supply, proper waste disposal including the availability of latrines would minimize the burden of diarrheal disease.


Assuntos
Diarreia/epidemiologia , Meio Ambiente , Pré-Escolar , Estudos Transversais , Diarreia/mortalidade , Água Potável/normas , Etiópia/epidemiologia , Características da Família , Feminino , Desinfecção das Mãos , Habitação , Humanos , Lactente , Masculino , Razão de Chances , Prevalência , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Toaletes/estatística & dados numéricos
4.
BMC Public Health ; 19(1): 1066, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391023

RESUMO

BACKGROUND: Soil-transmitted helminth infection (STH) is one of the neglected tropical disease that affects approximately 2 billion people globally. School children represent the age group that is most commonly infected with STHs, resulting in poor school performance, impaired cognitive function, and many other detrimental effects. The transmission of STH is determined by many factors, such as hygiene and sanitation. Understanding the factors that influence disease transmission in a particular area is key to effective STH control. The objective of this study was to determine the prevalence of STH in North Sumatera and to identify the associated risk factors among school children. METHODS: A cross-sectional study was carried out among primary school children in Suka village, Tigapanah subdistrict. Stool samples were processed using a single Kato-Katz method. The potential risk factors analyzed were parent education and occupation, hand washing habits, latrine usage, footwear usage and contact with soil. The Chi-square test was performed to identify an association between risk factors and parasitological results. Logistic regression analysis was used to measure the strength of association. RESULTS: We enrolled 468 school children between 6 and 12 years of age. Among those children, 268 children (57.24%) were positive for one or more STH infections. Approximately 62.39% of children played with soil/dirt every day, and only 50% regularly washed their hands after activities. Most of the children wore shoes/slippers when going outside (87.82%) and used a latrine for defecation (85.04%). Playing with soil/dirt have been shown to increase the risk of STH infections 7.53 times, while hand washing habits and latrine usage decreased the risk of STH infections 0.16 times each. CONCLUSION: The prevalence of STH infection in school children in Suka village, Tigapanah subdistrict is still high. Playing with soil/dirt increased the risk of infection, while hand washing habits and latrine usage decreased the risk of infection. The combined strategies of improving the personal hygiene of children and biannual deworming can reduce the risk of STH infection in school children in Suka village, Tigapanah subdistrict.


Assuntos
Agricultura , Helmintíase/epidemiologia , Helmintíase/transmissão , Características de Residência/estatística & dados numéricos , Solo/parasitologia , Criança , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Higiene/normas , Indonésia/epidemiologia , Masculino , Prevalência , Fatores de Risco , Toaletes/estatística & dados numéricos
5.
Bull World Health Organ ; 97(8): 523-533A, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31384071

RESUMO

Objective: To evaluate the long-term impact of a community-led total sanitation campaign in rural India. Methods: Local organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016. Findings: In 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (-6.8 percentage points; 95% CI: -13.1 to -1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes. Conclusion: Future research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change.


Assuntos
Participação da Comunidade/métodos , Promoção da Saúde/métodos , População Rural , Saneamento/métodos , Toaletes/estatística & dados numéricos , Defecação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Pobreza , Características de Residência
6.
BMC Res Notes ; 12(1): 478, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375135

RESUMO

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.


Assuntos
Higiene/normas , Saúde Pública/normas , População Rural/estatística & dados numéricos , Saneamento/normas , Adulto , Estudos Transversais , Etiópia , Feminino , Desinfecção das Mãos/métodos , Desinfecção das Mãos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saneamento/métodos , Inquéritos e Questionários , Toaletes/normas , Toaletes/estatística & dados numéricos
7.
BMC Public Health ; 19(1): 626, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118013

RESUMO

BACKGROUND: Stunting is an indicator of the devastating result of malnutrition in early childhood. The effects of childhood stunting are irreparable physical and cognitive harm. It is an issue of the great public health importance throughout Sub-Saharan African countries including Ethiopia. Therefore, identification of the risk factors of child stunting from recent data is very important for timely intervention. METHODS: The 2016 Ethiopian Demographic and Health Survey data were used for this study. A generalized linear mixed model which is an extension of the general linear model was employed to identify socioeconomic, demographic, environmental and health related risk factors for stunted under-five children. RESULTS: The result shows that the age and sex of the child, preceding birth interval, mother's body mass index, household wealth index, mother's education level, breastfeeding period, type of toilet facility, use of internet and source of drinking water were the major determinants of stunting of under-five children in Ethiopia. CONCLUSION: The study indicated that children from undernourished mothers, who are not breastfeeding, from poor households, households that have no toilet facilities, who are male, older age (between 12 to 59 months), who have illiterate mother and short birth spacing were associated with stunting problems. Therefore, family planning education and policy is required for the country to improve on under-five age stunting problems.


Assuntos
Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , África do Norte , Intervalo entre Nascimentos/estatística & dados numéricos , Índice de Massa Corporal , Aleitamento Materno/estatística & dados numéricos , Pré-Escolar , Demografia , Etiópia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Lineares , Masculino , Mães/estatística & dados numéricos , Fatores de Risco , Toaletes/estatística & dados numéricos
8.
J Urol ; 202(5): 1008-1014, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31059664

RESUMO

PURPOSE: While lower urinary tract symptoms and bladder behaviors are known to be associated with certain occupations, little is known about restroom access or environmental factors which may contribute to this relationship. We aimed to characterize reasons that women limit restroom use at work. We also sought to determine whether women who limit use at work report more unhealthy bladder habits and lower urinary tract symptoms. MATERIALS AND METHODS: We performed a cross-sectional study of full-time working women in the United States. Women completed validated questionnaires recording toileting behaviors, lower urinary tract symptoms and perceptions of the occupational toilet environment. We compared women who limited restroom use at work most or all of the time to those who did not limit or did so occasionally or sometimes. RESULTS: Of the 3,062 women in the final analytical sample 11% reported limiting restroom use at work most or all of the time. This group reported lower satisfaction with restroom cleanliness and privacy in particular. They more frequently identified toilet factors of poor quality, limited accessibility and restricted use by employer. The prevalence of unhealthy bladder habits was significantly higher among women who limited restroom use, as was the prevalence of urgency, monthly urinary incontinence and infrequent voiding. CONCLUSIONS: In this cross-sectional study of women working full time those who limited restroom use at work reported a higher prevalence of unhealthy bladder habits and certain urinary disorders. Future studies should determine whether limited restroom use at work is a modifiable risk factor for unhealthy bladder habits and bladder health outcomes.


Assuntos
Hábitos , Sintomas do Trato Urinário Inferior/psicologia , Toaletes/estatística & dados numéricos , Micção/fisiologia , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
Malawi Med J ; 31(1): 12-18, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143391

RESUMO

Introduction: In Malawi, EcoSan sludge from ecological sanitation (EcoSan) latrines has been found to contain helminths, Salmonella and E. coli above WHO recommended levels making sludge unsuitable for direct handling and use on food crops. This research investigated survival of pathogens in EcoSan sludge with time after sealing the pit. Method: An observational longitudinal follow-up study was conducted where EcoSan latrines were followed from August 2015 to July 2016 in Blantyre and Chikwawa in Southern Malawi. The study enrolled 51 latrines in total with 35 latrines [13 fossa alterna (FAs) and 22 urine diverting dry latrines (UDDLs)] remaining at the end of study. Samples were collected five times from each latrine and examined for helminths, Salmonella and E. coli in the laboratory. Poisson regression was employed to assess factors that significantly contribute to pathogen die off at p<0.05. Results: Average concentrations of all pathogens investigated reduced over 12-month follow-up period except for Salmonella which increased. A. lumbricoides, increased to 2.3 viable eggs during the second sampling and decreased to 0.4 viable eggs per gram after 12 months of follow-up. Time was the only consistent predictor for concentration of helminths. Type of latrine and location were not significant predictors of helminths concentration (p>0.05). However, Salmonella and E. coli colonies were significantly higher in UDDLs (Blantyre) than FAs (Chikwawa) (p<0.05). Conclusion: Pathogen concentration was highest after recommended six months of storage posing a public health risk to those handling and using it for agriculture purposes. It is therefore recommended that the current guidelines be reviewed to suit Malawi context. A storage period of one year or more is recommended.


Assuntos
Infecções por Escherichia coli/epidemiologia , Helmintíase/epidemiologia , Saúde Pública , Saneamento/métodos , Esgotos/análise , Toaletes/estatística & dados numéricos , Animais , Escherichia coli/fisiologia , Infecções por Escherichia coli/microbiologia , Seguimentos , Helmintíase/parasitologia , Helmintos/fisiologia , Humanos , Estudos Longitudinais , Malaui/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-30970603

RESUMO

In this study, we aimed to assess the geographic inequalities in access to improved water and sanitation facilities among Nepalese households. We conducted this study based on cross-sectional data obtained from Nepal Demographic and Health Surveys. The quality of water sources and sanitation were defined by World Health Organization (WHO) guidelines. The geographic categories used in the analyses included developmental region, ecological zone, and urbanicity. Percentages of households having access to improved toilet (5.6% in 1996 vs. 40.5% in 2016) and water (19.3% in 1996 vs. 27% in 2016) facilities has been increasing steadily since 1996 with a great proportion of the households still lacking access to these services. The number of households sharing the same toilet and traveling time to reach water sources have also decreased at the same time. Households in Far Western and Mountains had the lowest odds of having access to improved toilet and water facilities. Noticeable progress has been achieved in improving WASH (water, sanitation, and hygiene) coverage at national level, however, it is uneven across developmental and ecological zones. Households in the Far Western and Mountain regions appeared to be the most geographically disadvantaged in terms of having access to improved water and sanitation facilities.


Assuntos
Saneamento/estatística & dados numéricos , Saneamento/normas , Toaletes/estatística & dados numéricos , Toaletes/normas , Abastecimento de Água/estatística & dados numéricos , Abastecimento de Água/normas , Estudos Transversais , Demografia , Geografia , Humanos , Nepal , Fatores Socioeconômicos
11.
Artigo em Inglês | MEDLINE | ID: mdl-30875779

RESUMO

Open defecation is still a major health problem in developing countries. While enormous empirical research exists on latrine coverage, little is known about households' latrine construction and usage behaviours. Using field observation and survey data collected from 1523 households in 132 communities in northern Ghana after 16 months of implementation of Community Led Total Sanitation (CLTS), this paper assessed the factors associated with latrine completion and latrine use. The survey tool was structured to conform to the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) model. In the analysis, we classified households into three based on their latrine completion level, and conducted descriptive statistics for statistical correlation in level of latrine construction and latrine use behaviour. The findings suggest that open defecation among households reduces as latrine construction approaches completion. Although the study did not find socio-demographic differences of household to be significantly associated with level of latrine completion, we found that social context is a significant determinant of households' latrine completion decisions. The study therefore emphasises the need for continuous sensitisation and social marketing to ensure latrine completion by households at lower levels of construction, and the sustained use of latrines by households.


Assuntos
Características da Família , População Rural/estatística & dados numéricos , Toaletes/estatística & dados numéricos , Adulto , Atitude , Defecação , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Saneamento/estatística & dados numéricos , Marketing Social
12.
BMC Public Health ; 19(1): 322, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885158

RESUMO

BACKGROUND: Despite health benefits of sanitation, an estimated 12% of the global population practices open defecation, including an estimated 50% of the population of India. Current estimates, however, do not include households that own toilets but do not use them, suggesting that the actual number of people defecating in the open is underestimated. This protocol describes a cluster randomized controlled trial to evaluate an intervention specifically designed to increase latrine use, including the safe disposal of child feces, in rural Odisha, India. METHODS: The trial engages 66 villages in Puri district, 33 randomly allocated to receive the intervention and 33 to serve as controls. The primary outcome is latrine use and is recorded at baseline and endline for all members of all households that own latrines in all trial vilalges. Additional data on determinants of latrine use and safe child feces disposal are also collected to assess change based on the intervetntion. A process evaluation assesses the delivery of the intervention and qualiative research takes place in non-trial villages as well as post-endline in trial villages to help explain trial findings. DISCUSSION: This is one of four trials taking place simultaneously in rural India with latrine use as the primary outcome. All four studies use the same outcome to gerenate comparable data across sites that can serve the government of India. The trial in Odisha is unique in that it collects latrine use data from all potential users in all households that own latrines, enabling a thorough view of the sanitation situation and factors that influence use at the community level. That latrine use is collected via self-report is a limitation, however any bias in reporting should be the same across villages and not impact the overall assessment of intervention impact. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov: NCT03274245 .


Assuntos
Eliminação de Resíduos/métodos , População Rural , Segurança , Saneamento , Toaletes/estatística & dados numéricos , Criança , Defecação , Características da Família , Fezes , Feminino , Humanos , Índia , Masculino , Análise Multinível , Pesquisa Qualitativa , Projetos de Pesquisa , População Rural/estatística & dados numéricos , Autorrelato
13.
Artigo em Inglês | MEDLINE | ID: mdl-30823504

RESUMO

In 2017, the Joint Monitoring Programme estimated that 520 million people in India were defecating in the open every day. This is despite efforts made by the government, Non-Governmental Organizations (NGOs), and multilaterals to improve latrine coverage throughout India. We hypothesize that this might be because current interventions focus mostly on individual-level determinants, such as attitudes and beliefs, instead of considering all possible social determinants of latrine ownership. Given this, we ask two questions: what is the association between the amount of dwelling space owned by households in rural India and their likelihood of toilet ownership and what proportion of the variation in household latrine ownership is attributable to villages and states? We used multilevel modeling and found significant associations between the amount of household dwelling space and the likelihood of latrine ownership. Furthermore, considerable variation in latrine ownership is attributable to villages and states, suggesting that additional research is required to elucidate the contextual effects of villages and states on household latrine ownership. Thus, sanitation interventions should consider household dwelling space and village and state context as important social determinants of latrine ownership in rural India. Doing so could bolster progress towards Sustainable Development Goal (SDG) 6.


Assuntos
Propriedade/estatística & dados numéricos , População Rural/estatística & dados numéricos , Saneamento/métodos , Toaletes/estatística & dados numéricos , Características da Família , Feminino , Humanos , Índia , Masculino , Desenvolvimento Sustentável
15.
J Environ Public Health ; 2019: 3075840, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30853996

RESUMO

This study examined sociocultural and economic factors determining open defecation in the Wa Municipality, Ghana. The study employed a mixed method approach involving questionnaire administration to 367 households systematically selected from 21 communities, observation, and eight key informant interviews. The mixed logit model was used to determine the factors that significantly influence open defecation. The findings revealed that 49.8% of households had no form of toilet facility at home and were either using communal/public toilets or practicing open defecation. Several sociocultural and economic reasons account for this. But for these households, having a toilet facility at home does not seem to be a priority. Six factors (education, household size, occupation, income, traditional norms, and beliefs and ownership of a toilet facility) were positively significant in determining open defecation. Fundamental to many of the significant factors is households' capacity to finance construction of home toilets. In addition to finding new and innovative approaches to public education, the principle of credit financing, that incorporates community-led initiatives, may be considered in assisting households to construct home toilets.


Assuntos
Defecação/fisiologia , Características da Família , Saneamento/estatística & dados numéricos , Feminino , Gana , Humanos , Modelos Logísticos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Toaletes/economia , Toaletes/estatística & dados numéricos
16.
Am J Trop Med Hyg ; 100(4): 1013-1021, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30793682

RESUMO

Latrine access alone may be insufficient to encourage households to dispose of young children's feces safely in a latrine, and little is known about the determinants of improved child feces disposal. We used longitudinal data collected at up to three timepoints for children less than 5 years of age from households in Odisha, India, which received a combined household-level piped water supply and sanitation intervention, but did not specifically promote the safe disposal of child feces. Among the 85% of intervention households who reported access to improved sanitation, we characterized child defecation and feces disposal practices by age, across time, and season, and assessed determinants of improved disposal. Feces from children less than 3 years of age was commonly picked up by caregivers but disposed of unsafely with garbage into open areas (56.3% of households) or in a drain/ditch (6.2%). Although children 3 and 4 years were more likely to use a latrine than younger children, their feces was also more likely to be left in the open if they did not defecate in a latrine. For children less than 5 years of age, most (84.7%) children's feces that was safely disposed of in a latrine was because of the children defecating in the latrine directly. Significant predictors for disposing of child feces in an improved latrine were the primary female caregiver reporting using a latrine to defecate, the child's age, and water observed at place for handwashing. These findings suggest that child feces interventions should focus on encouraging children to begin using a toilet at a younger age and changing the common behavior of disposing of young child's feces into open areas.


Assuntos
Defecação , Fezes , População Rural , Toaletes/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adolescente , Adulto , Cuidadores , Pré-Escolar , Família , Feminino , Humanos , Índia , Lactente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Saneamento/métodos , Inquéritos e Questionários , Adulto Jovem
17.
Am J Trop Med Hyg ; 100(4): 1005-1012, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30793687

RESUMO

In 2012, approximately 5.6 million Zambians did not have access to improved sanitation and around 2.1 million practiced open defecation. The Zambia Sanitation and Hygiene Program (ZSHP), featuring community-led total sanitation, began in November 2011 to increase the use of improved sanitation facilities and adopt positive hygiene practices. Using a pre- and post-design approach with a population-level survey, after 3 years of implementation, we evaluated the impact of ZSHP in randomly selected households in 50 standard enumeration areas (representing 26 of 65 program districts). We interviewed caregivers of children younger than 5 years old (1,204 and 1,170 female caregivers at baseline and end line, respectively) and inspected household toilet facilities and sites for washing hands. At end line, 80% of households had access to improved sanitation facilities versus 64.1% at baseline (prevalence ratio [PR] = 1.25; 95% CI: 1.18-1.31) and 14.1% did not have a toilet facility compared with 19.4% at baseline. At end line, 10.6% of households reported living in an open defecation-free certified village compared with 0.3% at baseline (PR = 32.0; 95% CI: 11.9-86.4). In addition, at end line, 33.4% of households had a specific place for washing hands and 61.4% of caregivers reported handwashing with a washing agent after defecation or before preparing food compared with 21.1% (PR = 1.59; 95% CI: 1.39-1.82) and 55.2% (PR = 1.11; 95% CI: 1.04-1.19) at baseline, respectively. Community-led total sanitation implementation in Zambia led to improvements in access to improved sanitation facilities, reduced open defecation, and better handwashing practices. There is however a need for enhanced investment in sanitation and hygiene promotion.


Assuntos
Participação da Comunidade , Higiene/normas , Saneamento/métodos , Adulto , Cuidadores/educação , Pré-Escolar , Defecação , Diarreia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Prevalência , População Rural/estatística & dados numéricos , Saneamento/normas , Toaletes/estatística & dados numéricos , Adulto Jovem , Zâmbia/epidemiologia
18.
BMC Public Health ; 19(1): 135, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704419

RESUMO

BACKGROUND: An estimated 14% of Kenyans practice open defecation. Poverty has been associated with open defecation. Kenya aims to achieve 100% open defecation free status by 2030 in line with sustainable development goal number 6. Using data from 3 national household surveys, this study sought to explore progress made in attaining this at the household level with a focus on poor households. METHODS: Kenya demographic and health survey for 2003, 2008 and 2014 respectively were analysed. Descriptive analysis and bivariate logistic regression was done with open defecation status as the dependent variable. Independent variables were poverty status, place of residence, region where household was located, absence of farm animals, gender and educational level of household head. RESULTS: The most common sanitation method nationally is a pit latrine without a slab. This ranged from 35.9-37.9%. Open defecation was 16.2, 12.1 and 9.9% in 2003, 2008 and 2014 respectively. Among households practicing open defecation, 81.8, 86 and 96% were classified as poor in 2003, 2008 and 2014 respectively. Poverty, educational level of household head and residing in a rural area were the most significant predictors of open defecation. Odds ratio for poverty was 9.4 (7-12.6 95% CI), 9.4(6.6-13.5 95% CI) and 29.2 (23.3-36.8 95% CI) for 2003, 2008 and 2014 respectively. The majority of richest households transitioned from using a pit latrine with a slab in 2003 to using a flush toilet connected to a sewer in 2008 and 2014. The majority of richer households transitioned from using a pit latrine without a slab in 2003 and 2008 to using a pit latrine with a slab in 2014. The majority of middle and poorer households stagnated at using a pit latrine without a slab across the similar period. The poorest households stagnated at the open defecation stage. CONCLUSION: The burden of open defecation has increased among poor households, more so among the poorest. This may be attributed to non-poor households exiting the open defecation stage at a higher rate compared to poor households. Poor households may need to be targeted more if Kenya is to attain open defecation free status by 2030.


Assuntos
Características da Família , Pobreza , Saneamento/métodos , Defecação , Demografia , Humanos , Quênia , Desenvolvimento Sustentável , Toaletes/estatística & dados numéricos
19.
BMC Public Health ; 19(1): 137, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704435

RESUMO

BACKGROUND: This article addresses the enjoyment of the human rights to water and sanitation (HRTWS), in particular access to toilets, in a public school in Bahia, Brazil. METHODS: Participant observation of the school's routine, focus groups with students in grades 8 and 9 of primary school (13 to 17 years old) and individual, semi-structured, interviews with members of school staff were applied, exploring access to water and sanitation by adolescent girls and boys. RESULTS: Students and school staff reported that the amount of toilets was insufficient and that their conditions were often inadequate because they were plugged or dirty. The impact on girls is greater as toilets do not offer a clean and healthy environment for menstrual hygiene management. Several elements of the normative content of the HRTWS, especially accessibility, acceptability, quality, safety and dignity, were largely not fulfilled. The study identified that, to comply with the HRTWS, it is necessary to go beyond infrastructure, as the lack of maintenance; cultural elements and student participation hinder the usage of sanitary facilities. Since schools can be privileged spaces to train critical and reflective citizens and to foster autonomy and emancipation, education oriented by human rights and citizenship is an opportunity for a more equitable society. By increasing access to social, economic and cultural rights in all phases and aspects of life, including when children and adolescents are in a school environment, people are able to enjoy better living conditions and a higher standard of health. CONCLUSIONS: The study raised the importance of considering each community's sociocultural aspects in analyzing access to sanitary facilities in schools, which are spaces where citizens' rights should be exercised and fulfilled.


Assuntos
Direitos Humanos , Saneamento , Instituições Acadêmicas , Toaletes/estatística & dados numéricos , Abastecimento de Água , Adolescente , Brasil , Cidades , Feminino , Grupos Focais , Humanos , Higiene , Masculino , Menstruação
20.
BMC Public Health ; 19(1): 90, 2019 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-30660198

RESUMO

BACKGROUND: Globally, diarrhea is a leading cause of child morbidity and mortality. Although latrines are integral for reducing enteric pathogen transmission, several studies have shown no evidence that latrine ownership improved child health. There are a number of explanations for these results. One explanation is that latrine access does not equate to latrine use. Latrine use, however, is difficult to accurately ascertain, as defecation behavior is often stigmatized. To address this measurement issue, we measure latrine use as a latent variable, indicated by a suite of psychosocial variables. METHODS: We administered a survey of 16 defecation-related psychosocial questions to 251 individuals living in rural Ecuador. We applied latent class analysis (LCA) to these data to model the probability of latrine use as a latent variable. To account for uncertainty in predicted latent class membership, we used a pseudo-class approach to impute five different probabilities of latrine use for each respondent. Via regression modeling, we tested the association between household sanitation and each imputed latrine use variable. RESULTS: The optimal model presented strong evidence of two latent classes (entropy = 0.86): consistent users (78%) and inconsistent users (22%), predicted by 5 of our 16 psychosocial variables. There was no evidence of an association between the probability of latrine use, predicted from the LCA, and household access to basic sanitation (OR = 1.1, 95% CI = 0.6-2.1). This suggests that home access to a sanitation facility may not ensure the use of the facility for every family member at all times. CONCLUSION: Effective implementation and evaluation of sanitation programs requires accurate measurement of latrine use. Psychosocial variables, such as norms, perceptions, and attitudes may provide robust proxy-measures. Future longitudinal studies will help to strengthen the use of these surrogate measures, as many of these factors may be subject to secular trends. Additionally, subgroup analyses will elucidate how our  proxy indicators of latrine defecation vary by individual-level characteristics.


Assuntos
Análise de Classes Latentes , Propriedade/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Toaletes/estatística & dados numéricos , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Defecação , Equador , Características da Família , Feminino , Humanos , Masculino , Probabilidade , População Rural/estatística & dados numéricos , Estereotipagem , Inquéritos e Questionários , Adulto Jovem
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