Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review.

Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.

Association between water and sanitation and soil-transmitted helminthiases: Analysis of the Brazilian National Survey of Prevalence (2011-2015).

BACKGROUND: Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units. METHODS: Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7-17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011-2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis. RESULTS: Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983-0.996; RR 0.988, CI 95 % 0.977-0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979-0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982-0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models. CONCLUSIONS: Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.