The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Thomas Clasen - One of the best experts on this subject based on the ideXlab platform.
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understanding and defining Sanitation insecurity women s gendered experiences of urination defecation and menstruation in rural odisha india
BMJ Global Health, 2017Co-Authors: Bethany A Caruso, Thomas Clasen, Craig Hadley, Kathryn M Yount, Regine Haardorfer, Manaswini Rout, Munmun Dasmohapatra, Hannah L F CooperAbstract:Background Research suggests that the lived experience of inadequate Sanitation may contribute to poor health outcomes above and beyond pathogen exposure, particularly among women. The goal of this research was to understand women’s lived experiences of Sanitation by documenting their urination-related, defecation-related and menstruation-related concerns, to use findings to develop a definition of Sanitation insecurity among women in low-income settings and to develop a conceptual model to explain the factors that contribute to their experiences, including potential behavioural and health consequences. Methods We conducted 69 Free-List Interviews and eight focus group discussions in a rural population in Odisha, India to identify women’s Sanitation concerns and to build an understanding of Sanitation insecurity. Findings We found that women at different life stages in rural Odisha, India have a multitude of unaddressed urination, defecation and menstruation concerns. Concerns fell into four domains: the sociocultural context, the physical environment, the social environment and personal constraints. These varied by season, time of day, life stage and toilet ownership, and were linked with an array of adaptations (ie, suppression, withholding food and water) and consequences (ie, scolding, shame, fear). Our derived definition and conceptual model of Sanitation insecurity reflect these four domains. Discussion To sincerely address women’s Sanitation needs, our findings indicate that more is needed than facilities that change the physical environment alone. Efforts to enable urinating, defecating and managing menstruation independently, comfortably, safely, hygienically, privately, healthily, with dignity and as needed require transformative approaches that also address the gendered, sociocultural and social environments that impact women despite facility access. This research lays the groundwork for future Sanitation studies to validate or refine the proposed definition and to assess women’s Sanitation insecurity, even among those who have latrines, to determine what may be needed to improve women’s Sanitation circumstances.
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the impact of Sanitation interventions on latrine coverage and latrine use a systematic review and meta analysis
International Journal of Hygiene and Environmental Health, 2017Co-Authors: Joshua V Garn, Gloria D Sclar, Matthew C Freeman, Gauthami Penakalapati, Kelly T Alexander, Patrick Brooks, Eva Rehfuess, Sophie Boisson, Kate Medlicott, Thomas ClasenAbstract:Abstract Background An estimated 2.4 billion people still lack access to improved Sanitation and 946 million still practice open defecation. The World Health Organization (WHO) commissioned this review to assess the impact of Sanitation on coverage and use, as part of its effort to develop a set of guidelines on Sanitation and health. Methods and findings We systematically reviewed the literature and used meta-analysis to quantitatively characterize how different Sanitation interventions impact latrine coverage and use. We also assessed both qualitative and quantitative studies to understand how different structural and design characteristics of Sanitation are associated with individual latrine use. A total of 64 studies met our eligibility criteria. Of 27 intervention studies that reported on household latrine coverage and provided a point estimate with confidence interval, the average increase in coverage was 14% (95% CI: 10%, 19%). The intervention types with the largest absolute increases in coverage included the Indian government's “Total Sanitation Campaign” (27%; 95% CI: 14%, 39%), latrine subsidy/provision interventions (16%; 95% CI: 8%, 24%), latrine subsidy/provision interventions that also incorporated education components (17%; 95% CI: −5%, 38%), sewerage interventions (14%; 95% CI: 1%, 28%), Sanitation education interventions (14%; 95% CI: 3%, 26%), and community-led total Sanitation interventions (12%; 95% CI: −2%, 27%). Of 10 intervention studies that reported on household latrine use, the average increase was 13% (95% CI: 4%, 21%). The Sanitation interventions and contexts in which they were implemented varied, leading to high heterogeneity across studies. We found 24 studies that examined the association between structural and design characteristics of Sanitation facilities and facility use. These studies reported that better maintenance, accessibility, privacy, facility type, cleanliness, newer latrines, and better hygiene access were all frequently associated with higher use, whereas poorer Sanitation conditions were associated with lower use. Conclusions Our results indicate that most Sanitation interventions only had a modest impact on increasing latrine coverage and use. A further understanding of how different Sanitation characteristics and Sanitation interventions impact coverage and use is essential in order to more effectively attain Sanitation access for all, eliminate open defecation, and ultimately improve health.
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shared Sanitation versus individual household latrines in urban slums a cross sectional study in orissa india
American Journal of Tropical Medicine and Hygiene, 2015Co-Authors: Marieke Heijnen, Parimita Routray, Belen Torondel, Thomas ClasenAbstract:A large and growing proportion of the global population rely on shared Sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared Sanitation versus IHLs in terms of demographics, Sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, Sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared Sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared Sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
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shared Sanitation versus individual household latrines a systematic review of health outcomes
PLOS ONE, 2014Co-Authors: Marieke Heijnen, Oliver Cumming, Thomas Clasen, Joe Brown, Rachel Peletz, Gabrielle Kaseen Chan, Kelly K BakerAbstract:Background More than 761 million people rely on shared Sanitation facilities. These have historically been excluded from international Sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared Sanitation versus individual household latrines. Methods and Findings Shared Sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared Sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared Sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76). Conclusion Evidence to date does not support a change of existing policy of excluding shared Sanitation from the definition of improved Sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared Sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared Sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.
Robert Dreibelbis - One of the best experts on this subject based on the ideXlab platform.
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shared Sanitation management and the role of social capital findings from an urban Sanitation intervention in maputo mozambique
International Journal of Environmental Research and Public Health, 2018Co-Authors: Tess Shiras, Oliver Cumming, Joe Brown, Becelar Muneme, Rassul Nala, Robert DreibelbisAbstract:Shared Sanitation-Sanitation facilities shared by multiple households-is increasingly common in rapidly growing urban areas in low-income countries. However, shared Sanitation facilities are often poorly maintained, dissuading regular use and potentially increasing disease risk. In a series of focus group discussions and in-depth interviews, we explored the determinants of shared Sanitation management within the context of a larger-scale health impact evaluation of an improved, shared Sanitation facility in Maputo, Mozambique. We identified a range of formal management practices users developed to maintain shared Sanitation facilities, and found that management strategies were associated with perceived latrine quality. However-even within an intervention context-many users reported that there was no formal system for management of Sanitation facilities at the compound level. Social capital played a critical role in the success of both formal and informal management strategies, and low social capital was associated with collective action failure. Shared Sanitation facilities should consider ways to support social capital within target communities and identify simple, replicable behavior change models that are not dependent on complex social processes.
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Sanitation related psychosocial stress a grounded theory study of women across the life course in odisha india
Social Science & Medicine, 2015Co-Authors: Krushna Chandra Sahoo, Kristyna R S Hulland, Bethany A Caruso, Rojalin Swain, Matthew Freeman, Pinaki Panigrahi, Robert DreibelbisAbstract:While Sanitation interventions have focused primarily on child health, women's unique health risks from inadequate Sanitation are gaining recognition as a priority issue. This study examines the range of Sanitation-related psychosocial stressors during routine Sanitation practices in Odisha, India. Between August 2013 and March 2014, we conducted in-depth interviews with 56 women in four life stages: adolescent, newly married, pregnant and established adult women in three settings: urban slums, rural villages and indigenous villages. Using a grounded theory approach, the study team transcribed, translated, coded and discussed interviews using detailed analytic memos to identify and characterize stressors at each life stage and study site. We found that Sanitation practices encompassed more than defecation and urination and included carrying water, washing, bathing, menstrual management, and changing clothes. During the course of these activities, women encountered three broad types of stressors—environmental, social, and sexual—the intensity of which were modified by the woman's life stage, living environment, and access to Sanitation facilities. Environmental barriers, social factors and fears of sexual violence all contributed to Sanitation-related psychosocial stress. Though women responded with small changes to Sanitation practices, they were unable to significantly modify their circumstances, notably by achieving adequate privacy for Sanitation-related behaviors. A better understanding of the range of causes of stress and adaptive behaviors is needed to inform context-specific, gender-sensitive Sanitation interventions.
Oliver Cumming - One of the best experts on this subject based on the ideXlab platform.
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shared Sanitation management and the role of social capital findings from an urban Sanitation intervention in maputo mozambique
International Journal of Environmental Research and Public Health, 2018Co-Authors: Tess Shiras, Oliver Cumming, Joe Brown, Becelar Muneme, Rassul Nala, Robert DreibelbisAbstract:Shared Sanitation-Sanitation facilities shared by multiple households-is increasingly common in rapidly growing urban areas in low-income countries. However, shared Sanitation facilities are often poorly maintained, dissuading regular use and potentially increasing disease risk. In a series of focus group discussions and in-depth interviews, we explored the determinants of shared Sanitation management within the context of a larger-scale health impact evaluation of an improved, shared Sanitation facility in Maputo, Mozambique. We identified a range of formal management practices users developed to maintain shared Sanitation facilities, and found that management strategies were associated with perceived latrine quality. However-even within an intervention context-many users reported that there was no formal system for management of Sanitation facilities at the compound level. Social capital played a critical role in the success of both formal and informal management strategies, and low social capital was associated with collective action failure. Shared Sanitation facilities should consider ways to support social capital within target communities and identify simple, replicable behavior change models that are not dependent on complex social processes.
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does global progress on Sanitation really lag behind water an analysis of global progress on community and household level access to safe water and Sanitation
PLOS ONE, 2014Co-Authors: Oliver Cumming, Mark Elliott, Alycia Overbo, Jamie BartramAbstract:Safe drinking water and Sanitation are important determinants of human health and wellbeing and have recently been declared human rights by the international community. Increased access to both were included in the Millennium Development Goals under a single dedicated target for 2015. This target was reached in 2010 for water but Sanitation will fall short; however, there is an important difference in the benchmarks used for assessing global access. For drinking water the benchmark is community-level access whilst for Sanitation it is household-level access, so a pit latrine shared between households does not count toward the Millennium Development Goal (MDG) target. We estimated global progress for water and Sanitation under two scenarios: with equivalent household- and community-level benchmarks. Our results demonstrate that the “Sanitation deficit” is apparent only when household-level Sanitation access is contrasted with community-level water access. When equivalent benchmarks are used for water and Sanitation, the global deficit is as great for water as it is for Sanitation, and Sanitation progress in the MDG-period (1990–2015) outstrips that in water. As both drinking water and Sanitation access yield greater benefits at the household-level than at the community-level, we conclude that any post–2015 goals should consider a household-level benchmark for both.
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shared Sanitation versus individual household latrines a systematic review of health outcomes
PLOS ONE, 2014Co-Authors: Marieke Heijnen, Oliver Cumming, Thomas Clasen, Joe Brown, Rachel Peletz, Gabrielle Kaseen Chan, Kelly K BakerAbstract:Background More than 761 million people rely on shared Sanitation facilities. These have historically been excluded from international Sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared Sanitation versus individual household latrines. Methods and Findings Shared Sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared Sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared Sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76). Conclusion Evidence to date does not support a change of existing policy of excluding shared Sanitation from the definition of improved Sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared Sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared Sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.
Marieke Heijnen - One of the best experts on this subject based on the ideXlab platform.
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shared Sanitation versus individual household latrines in urban slums a cross sectional study in orissa india
American Journal of Tropical Medicine and Hygiene, 2015Co-Authors: Marieke Heijnen, Parimita Routray, Belen Torondel, Thomas ClasenAbstract:A large and growing proportion of the global population rely on shared Sanitation facilities despite evidence of a potential increased risk of adverse health outcomes compared with individual household latrines (IHLs). We sought to explore differences between households relying on shared Sanitation versus IHLs in terms of demographics, Sanitation facilities, and fecal exposure. We surveyed 570 households from 30 slums in Orissa, India, to obtain data on demographics, water, Sanitation, and hygiene. Latrine spot-checks were conducted to collect data on indicators of use, privacy, and cleanliness. We collected samples of drinking water and hand rinses to assess fecal contamination. Households relying on shared Sanitation were poorer and less educated than those accessing IHLs. Individuals in sharing households were more likely to practice open defecation. Shared facilities were less likely to be functional, less clean, and more likely to have feces and flies. No differences in fecal contamination of drinking water or hand-rinse samples were found. Important differences exist among households accessing shared facilities versus IHLs that may partly explain the apparent adverse health outcomes associated with shared Sanitation. As these factors may capture differences in risk and promote sanitary improvements, they should be considered in future policy.
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shared Sanitation versus individual household latrines a systematic review of health outcomes
PLOS ONE, 2014Co-Authors: Marieke Heijnen, Oliver Cumming, Thomas Clasen, Joe Brown, Rachel Peletz, Gabrielle Kaseen Chan, Kelly K BakerAbstract:Background More than 761 million people rely on shared Sanitation facilities. These have historically been excluded from international Sanitation targets, regardless of the service level, due to concerns about acceptability, hygiene and access. In connection with a proposed change in such policy, we undertook this review to identify and summarize existing evidence that compares health outcomes associated with shared Sanitation versus individual household latrines. Methods and Findings Shared Sanitation included any type of facilities intended for the containment of human faeces and used by more than one household, but excluded public facilities. Health outcomes included diarrhoea, helminth infections, enteric fevers, other faecal-oral diseases, trachoma and adverse maternal or birth outcomes. Studies were included regardless of design, location, language or publication status. Studies were assessed for methodological quality using the STROBE guidelines. Twenty-two studies conducted in 21 countries met the inclusion criteria. Studies show a pattern of increased risk of adverse health outcomes associated with shared Sanitation compared to individual household latrines. A meta-analysis of 12 studies reporting on diarrhoea found increased odds of disease associated with reliance on shared Sanitation (odds ratio (OR) 1.44, 95% CI: 1.18–1.76). Conclusion Evidence to date does not support a change of existing policy of excluding shared Sanitation from the definition of improved Sanitation used in international monitoring and targets. However, such evidence is limited, does not adequately address likely confounding, and does not identify potentially important distinctions among types of shared facilities. As reliance on shared Sanitation is increasing, further research is necessary to determine the circumstances, if any, under which shared Sanitation can offer a safe, appropriate and acceptable alternative to individual household latrines.
Japheth Kwiringira - One of the best experts on this subject based on the ideXlab platform.
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descending the Sanitation ladder in urban uganda evidence from kampala slums
BMC Public Health, 2014Co-Authors: Japheth Kwiringira, Peter Atekyereza, Charles Niwagaba, Isabel GuntherAbstract:Background: While the Sanitation ladder is useful in analysing progressive improvements in Sanitation, studies in Uganda have not indicated the Sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain Sanitation infrastructure can lead to a reversal of the potential benefits that come with various Sanitation facilities. Methods: A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results. Results: Whether a shared Sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situatio nw orse. In this way, open defecation gradually substituted use of the available Sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection. Conclusion: Whereas most Sanitation campaigns are geared towards provision of improved Sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the Sanitation ladder. Understanding this reversal movement is critical in sustainable Sanitation services and should be a concern for all actors.
