scholarly journals The WASH Benefits and SHINE Trials. Interpretation of Findings on Linear Growth and Diarrhoea and Implications for Policy: Perspective of the Investigative Teams (P10-136-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jean Humphrey ◽  
Amy Pickering ◽  
Clair Null ◽  
Peter Winch ◽  
Goldberg Mangwadu ◽  
...  
Keyword(s):  
Low Income ◽  
Strong Association ◽  
Child Growth ◽  
Message Delivery ◽  
Household Level ◽  
Funding Sources ◽  
Household Water ◽  
Substantial Investment ◽  
Water Chlorination ◽  
Gates Foundation

Abstract Objectives We recently completed 3 efficacy trials (Bangladesh, Kenya, Zimbabwe) testing the independent and combined effects of improved complementary feeding (CF) and intensive household water quality, sanitation, and hygiene (WASH) on child diarrhea and length-for-age-Z-score (LAZ) at 18 to 24 mo. Intervention uptake was high. In all three trials: CF increased LAZ but WASH had no effect on LAZ. WASH reduced diarrhea in Bangladesh but not in Kenya or Zimbabwe. We present a synthesis of trial findings and their implications. Methods Reviews of the literature and reanalyses of trial data were conducted. Results WASH and stunting: Copious observational studies have demonstrated a strong association between household-level WASH and child LAZ. We conducted an observational anlaysis (nested birth cohort) from our control arms. In adjusted analyses of all three trials, having an improved latrine when the pregnant woman was enrolled was associated with ∼0.2LAZ increase in her child at 18–24 mo. The frequently reported association between household WASH indicators and child growth may be confounded and drawing causal inferance misguided. WASH and diarrhea: Promoters visited intervention households 6 times per month in Bangladesh and monthly in Kenya and Zimbabwe. We conducted a systematic literature review: virtually all evidence that household water chlorination and handwashing reduce diarrhea comes from studies with daily to fortnightly intervention contact. In studies with follow-up after the trial ending, behaviors steeply declined and the effect on child diarrhea disappeared. Household water chlorination and handwashing promotion implemented through sporadic message delivery may not reduce child diarrhea. Enteropathogen transmission: Despite achieving substantial contrast between WASH and non-WASH households, children in the WASH arms still experienced high enteropathogen transmission, illustrating the recalcitrance of pervasive fecal contamination in rural low-income communities to even intense intervention. Conclusions Household WASH interventions are unlikely to reduce child stunting and may not reduce child diarrhea. We call for substantial investment in research to identify and in programming to deliver much more efficacious interventions. Funding Sources Bill & Melinda Gates Foundation, USAID, DFID/UKAID, Wellcome Trust.

scholarly journals Maternal Functional Health Literacy Does Not Predict Child Growth, Development, or Illness from 6 to 18 Mo of Age in Malawi (P11-004-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Katherine Cox ◽  
Ulla Ashorn ◽  
John Phuka ◽  
Kenneth Maleta ◽  
John Sadalaki ◽  
...  
Keyword(s):  
Health Literacy ◽  
Child Growth ◽  
Functional Health ◽  
Growth Charts ◽  
Functional Health Literacy ◽  
Funding Sources ◽  
Nutrient Supplements ◽  
Z Scores ◽  
Growth Development ◽  
Gates Foundation

Abstract Objectives To examine the association of maternal functional health literacy (FHL), a mother's ability to understand health information written in words and pictures, with child health, growth, and development in rural Malawi. Methods Maternal FHL was measured at six months postpartum among 671 participants in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD-M trial in Malawi. Field staff asked comprehension questions about written health materials that were common in Malawi, such as medication instructions, breastfeeding information, and growth charts. Outcomes were child length-for-age (LAZ) and weight-for-length (WLZ) z scores at age 6 and 18 mo, change in LAZ and WLZ from 6 to 18 mo, motor and language development at 18 mo, and illness monitored weekly from birth to 18 mo (highest quartile prevalence of diarrhea, highest quartile prevalence of malaria or undefined fever, and incidence of acute respiratory infection). In Model 1, we examined the unadjusted association between maternal FHL and each outcome. In Model 2, we adjusted for household and parental background characteristics collected at baseline, child age and sex, and trial group. In Model 3, we added maternal cognition, depression, and caregiving characteristics collected after baseline. Results Over 90% of participants understood the growth charts, immunization record, and breastfeeding information in the health passport. Understanding of medication instructions was lower, with 72% understanding malaria, 81% Panadol, and 63% erythromycin instructions (Figure 1). Maternal FHL z score significantly predicted motor (β ± SE = 0.087 ± 0.040, P = 0.029) and language z scores (β ± SE = 0.093 ± 0.040, P = 0.020) at 18 mo in unadjusted models. However, after adjusting for covariates, these associations were not significant. Maternal FHL was not significantly associated with any other outcomes. Conclusions Revision of written medication instructions in Malawi may be needed to increase mothers’ understanding of how to deliver medication to their children. However, in this sample, maternal FHL was not associated with indicators of child growth, development, or illness after adjusting for parental, household, and caregiving characteristics. Funding Sources This publication is based on research funded by a grant to the University of California, Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

scholarly journals Point-of-use chlorination of turbid water: results from a field study in Tanzania

2014 ◽  
Vol 13 (2) ◽  
pp. 544-552 ◽  
Author(s):  
Hussein Mohamed ◽  
Joe Brown ◽  
Robert M. Njee ◽  
Thomas Clasen ◽  
Hamisi M. Malebo ◽  
...  
Keyword(s):  
Potable Water ◽  
Double Dose ◽  
Limited Data ◽  
Household Water Treatment ◽  
Household Level ◽  
Chlorine Disinfection ◽  
Point Of Use ◽  
Household Water ◽  
Rural Water ◽  
Water Chlorination

Household-based chlorine disinfection is widely effective against waterborne bacteria and viruses, and may be among the most inexpensive and accessible options for household water treatment. The microbiological effectiveness of chlorine is limited, however, by turbidity. In Tanzania, there are no guidelines on water chlorination at household level, and limited data on whether dosing guidelines for higher turbidity waters are sufficient to produce potable water. This study was designed to assess the effectiveness of chlorination across a range of turbidities found in rural water sources, following local dosing guidelines that recommend a ‘double dose’ for water that is visibly turbid. We chlorinated water from 43 sources representing a range of turbidities using two locally available chlorine-based disinfectants: WaterGuard and Aquatabs. We determined free available chlorine at 30 min and 24 h contact time. Our data suggest that water chlorination with WaterGuard or Aquatabs can be effective using both single and double doses up to 20 nephelometric turbidity units (NTU), or using a double dose of Aquatabs up to 100 NTU, but neither was effective at turbidities greater than 100 NTU.

scholarly journals Integration of Household Water Filters with Community-Based Sanitation and Hygiene Promotion—A Process Evaluation and Assessment of Use among Households in Rwanda

2021 ◽  
Vol 13 (4) ◽  
pp. 1615
Author(s):  
Abigail Bradshaw ◽  
Lambert Mugabo ◽  
Alemayehu Gebremariam ◽  
Evan Thomas ◽  
Laura MacDonald
Keyword(s):  
Drinking Water ◽  
Low Income ◽  
Diarrheal Disease ◽  
Health Impact ◽  
Product Distribution ◽  
Household Level ◽  
Water Filter ◽  
Sanitation And Hygiene ◽  
Household Water ◽  
Water Filters

Unsafe drinking water contributes to diarrheal disease and is a major cause of morbidity and mortality in low-income contexts, especially among children under five years of age. Household-level water treatment interventions have previously been deployed in Rwanda to address microbial contamination of drinking water. In this paper, we describe an effort to integrate best practices regarding distribution and promotion of a household water filter with an on-going health behavior messaging program. We describe the implementation of this program and highlight key roles including the evaluators who secured overall funding and conducted a water quality and health impact trial, the promoters who were experts in the technology and behavioral messaging, and the implementers who were responsible for product distribution and education. In January 2019, 1023 LifeStraw Family 2.0 household water filters were distributed in 30 villages in the Rwamagana District of Rwanda. Approximately a year after distribution, 99.5% of filters were present in the household, and water was observed in 95.1% of filters. Compared to another recent water filter program in Rwanda, a lighter-touch engagement with households and supervision of data collection was observed, while also costing approximately twice per household compared to the predecessor program.

scholarly journals Health and Housing Energy Expenditures: A Two-Part Model Approach

Processes ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 943
Author(s):  
Fátima Lima ◽  
Paula Ferreira ◽  
Vítor Leal
Keyword(s):  
Low Income ◽  
Health Expenditures ◽  
Household Level ◽  
Energy Expenditures ◽  
Health And Wellbeing ◽  
Health Gains ◽  
Key Factor ◽  
Using Data ◽  
Part Model ◽  
Model Approach

Interest in the interaction between energy and health within the built environment has been increasing in recent years, in the context of sustainable development. However, in order to promote health and wellbeing across all ages it is necessary to have a better understanding of the association between health and energy at household level. This study contributes to this debate by addressing the case of Portugal using data from the Household Budget Survey (HBS) microdata database. A two-part model is applied to estimate health expenditures based on energy-related expenditures, as well as socioeconomic variables. Additional statistical methods are used to enhance the perception of relevant predictors for health expenditures. Our findings suggest that given the high significance and coefficient value, energy expenditure is a relevant explanatory variable for health expenditures. This result is further validated by a dominance analysis ranking. Moreover, the results show that health gains and medical cost reductions can be a key factor to consider on the assessment of the economic viability of energy efficiency projects in buildings. This is particularly relevant for the older and low-income segments of the population.

scholarly journals The Effect of Social Behavior on Residential Water Consumption

Water ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1184
Author(s):  
Daniel Morales Martínez ◽  
Alexandre Gori Maia
Keyword(s):  
Water Consumption ◽  
Spatial Dependence ◽  
Regression Models ◽  
Innovative Strategy ◽  
Peer Effect ◽  
Household Level ◽  
Level Data ◽  
Household Water ◽  
Residential Water Consumption ◽  
Residential Water

We analyze how residential water consumption is influenced by the consumption of households belonging to the same social group (peer effect). Analyses are based on household-level data provided by the Brazilian Household Budget Survey and use an innovative strategy that estimates the spatial dependence of water consumption while simultaneously controlling for potential sources of sample selectivity and endogeneity. The estimates of our quantile regression models highlight that, conditional on household characteristics, the greater the household water consumption, the greater the peer effect. In other words, the overconsumption of residential water seems to be influenced mainly by the behavior of social peers.

The Role of Women in Improving Access to Food at the Household Level in Mandeni Local Municipality, KwaZulu-Natal, South Africa

2021 ◽  
Vol 10 (2) ◽  
pp. 135-155
Author(s):  
Nondumiso Thabisile Mpanza ◽  
Mfaniseni Wiseman Mbatha
Keyword(s):  
Food Security ◽  
Low Income ◽  
Home Gardens ◽  
Household Food Security ◽  
Exploratory Research ◽  
Structured Interviews ◽  
Household Level ◽  
Role Of Women ◽  
Access To Food

This paper censoriously assesses the role of women in improving access to food at the household level. The role of women is essential in the production of food as caretakers of household food security. However, their role is not well recognised, more especially in policymaking and resource allocation. This study was conducted through a qualitative approach with an exploratory research design. The participants were sampled with convenience sampling and interviewed with semi-structured interviews. Content analysis was employed as a tool for data analysis. The study adopted feminisation of poverty as a primary theory of this paper. Certain aspects of the study reveal that women have been struggling to access food from the diversity of retail vents that are obtainable in town because of low income and limitations of transport service. This is a constraint to women who depend on the off-farm sources of income because their household’s livelihood depends on purchasing food from retail vents. Those who rely on home gardens were experiencing low productivity and the unsustainability of their gardens. This has been caused by water scarcity and climate change. Therefore, women must be provided with training that seeks to develop their skills on how to make effective use of home gardens so that food security can be ensured.

scholarly journals Crop diversity is associated with higher child diet diversity in Ethiopia, particularly among low-income households, but not in Vietnam

2021 ◽  
pp. 1-12
Author(s):  
Erin E Esaryk ◽  
Sarah Anne Reynolds ◽  
Lia CH Fernald ◽  
Andrew D Jones
Keyword(s):  
Low Income ◽  
Dietary Diversity ◽  
Positive Association ◽  
Household Wealth ◽  
Crop Diversity ◽  
Food Groups ◽  
Crop Species ◽  
Diet Diversity ◽  
Household Level ◽  
Functional Richness

Abstract Objectives: To examine associations of household crop diversity with school-aged child dietary diversity in Vietnam and Ethiopia and mechanisms underlying these associations. Design: We created a child diet diversity score (DDS) using data on seven food groups consumed in the last 24 h. Generalised estimating equations were used to model associations of household-level crop diversity, measured as a count of crop species richness (CSR) and of plant crop nutritional functional richness (CNFR), with DDS. We examined effect modification by household wealth and subsistence orientation, and mediation by the farm’s market orientation. Setting: Two survey years of longitudinal data from the Young Lives cohort. Participants: Children (aged 5 years in 2006 and 8 years in 2009) from rural farming households in Ethiopia (n 1012) and Vietnam (n 1083). Results: There was a small, positive association between household CNFR and DDS in Ethiopia (CNFR–DDS, β = 0·13; (95 % CI 0·07, 0·19)), but not in Vietnam. Associations of crop diversity and child diet diversity were strongest among poor households in Ethiopia and among subsistence-oriented households in Vietnam. Agricultural earnings positively mediated the crop diversity–diet diversity association in Ethiopia. Discussion: Children from households that are poorer and those that rely more on their own agricultural production for food may benefit most from increased crop diversity.

scholarly journals Role of Poverty in California Teenagers’ Fatal Traffic Crash Risk

2009 ◽  
Vol 7 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Mike Males
Keyword(s):  
Traffic Safety ◽  
Low Income ◽  
Motor Vehicle ◽  
Strong Association ◽  
Motor Vehicle Crash ◽  
Motor Vehicle Crashes ◽  
Crash Risk ◽  
Vehicle Crashes ◽  
Fatal Crash ◽  
Adolescent Risk

Teenagers’ high rates of motor vehicle crashes, accounting for 40% of external deaths among 16-19 yearolds, have been ascribed largely to inherent “adolescent risk-taking” and developmental hazards. However, the fact that compared to adults 25 and older, teenagers are twice as likely to live in poverty and low-income areas, risk factors for many types of violent death, has not been assessed. This paper uses Fatality Analysis Reporting System data on 65,173 fatal motor vehicle crashes by drivers in California’s 35 most populous counties for 1994-2007 to analyze fatal crash involvements per 100 million miles driven by driver age, county, poverty status, and 15 other traffic safety-related variables. Fatal crash rates were substantially higher for every driver age group in poorer counties than in richer ones. Multivariate regression found socioeconomic factors, led by the low levels of licensing and high unemployment rates prevalent in low-income areas, were associated with nearly 60% of the variance in motor vehicle crash risks, compared to 3% associated with driver age. The strong association between fatal crash risk and poverty, especially for young drivers who are concentrated in high-poverty brackets and low-income areas, suggests that factors related to poorer environments constitute a major traffic safety risk requiring serious attention.

CHILD NUTRITIONAL STATUS IN EGYPT: A COMPREHENSIVE ANALYSIS OF SOCIOECONOMIC DETERMINANTS USING A QUANTILE REGRESSION APPROACH

2018 ◽  
Vol 51 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Mesbah Fathy Sharaf ◽  
Elhussien Ibrahim Mansour ◽  
Ahmed Shoukry Rashad
Keyword(s):  
Nutritional Status ◽  
Quantile Regression ◽  
Low Income ◽  
Child Growth ◽  
Social Characteristics ◽  
Socioeconomic Determinants ◽  
Socioeconomic Gradient ◽  
Regression Approach ◽  
Heterogeneous Effect ◽  
Child Nutritional Status

SummaryThis study examined the underlying demographic and socioeconomic determinants of child nutritional status in Egypt using data from the most recent round of the Demographic and Health Survey. The height-for-age Z-score (HAZ) was used as a measure of child growth. A quantile regression approach was used to allow for a heterogeneous effect of each determinant along different percentiles of the conditional distribution of the HAZ. A nationally representative sample of 13,682 children aged 0–4 years was drawn from the 2014 Egypt DHS. The multivariate analyses included a set of HAZ determinants commonly used in the literature. The conditional and unconditional analyses revealed a socioeconomic gradient in child nutritional status, in which children of low income/education households have a worse HAZ than those from high income/education households. The results also showed significant disparities in child nutritional status by demographic and social characteristics. The quantile regression results showed that the association between the demographic and socioeconomic factors and HAZ differed along the conditional HAZ distribution. Intervention measures need to consider the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution. There is no one-size-fits-all policy to combat child malnutrition; a multifaceted approach and targeted policy interventions are required to address this problem effectively.

Using a Trauma-Informed, Socially Just Research Framework with Marginalized Populations: Practices and Barriers to Implementation

2020 ◽  
Vol 44 (3) ◽  
pp. 169-181
Author(s):  
Laura A Voith ◽  
Tyrone Hamler ◽  
Meredith W Francis ◽  
Hyunjune Lee ◽  
Amy Korsch-Williams
Keyword(s):  
Social Work ◽  
Low Income ◽  
African American Men ◽  
Strong Association ◽  
Marginalized Populations ◽  
Unequal Distribution ◽  
Social Work Research ◽  
Social Justice Orientation ◽  
Trauma Informed ◽  
Barriers To Implementation

Abstract Social workers, including social work researchers, are called on to challenge social injustices and pursue social change. Research has shown a strong association between trauma and adversity and marginalized populations, exposing the unequal distribution of trauma and its effects throughout society. Given the focus on marginalized populations in social work, the social justice orientation of the field, and the intersection of trauma with marginalized populations, a framework to guide social work researchers in conducting trauma-informed, socially just research with marginalized populations is warranted. Therefore, this article provides a framework integrating trauma theory, trauma-informed principles, and intersectionality as a guide for social work research. The proposed framework is illustrated using a case study of low-income, predominantly African American men recruited from a criminal justice setting, acknowledging facilitators and barriers to implementation. The article concludes with a discussion of the implications for researchers and doctoral student training.

Sign in / Sign up

Export Citation Format

Share Document