‘Everyone is exhausted and frustrated’: exploring psychosocial impacts of the lack of access to safe water and adequate sanitation in Usoma, Kenya

2016 ◽  
Vol 6 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Elijah Bisung ◽  
Susan J. Elliott
Keyword(s):  
Health Issues ◽  
Group Discussions ◽  
Water And Sanitation ◽  
Middle Income ◽  
Western Kenya ◽  
Safe Water ◽  
Middle Income Countries ◽  
Psychosocial Concerns ◽  
Psychosocial Impacts ◽  
Negative Identity

The lack of access to safe water and adequate sanitation pose significant health challenges for many individuals and communities in low and middle-income countries. Aside from direct health issues, the lack of access to safe water and adequate sanitation is increasingly associated with psychosocial concerns that affect the wellbeing of individuals and communities. However, the nature of these concerns has received little attention in peer-reviewed literature. This paper draws on environmental stress and ecosocial theories to explore psychosocial concerns related to water and sanitation in Usoma, a lakeshore community in Western Kenya. The study used qualitative key informant interviews (n = 9) and focus group discussions (n = 10). Results reveal deep feelings of anxiety and frustration, embarrassment, negative identity, feelings of marginalization, and lack of self-efficacy. These stressors were a byproduct of daily lived experiences associated with lack of access to safe water and adequate sanitation, as well as the coping strategies people adopted. The paper suggests that benefits of water interventions transcend disease reduction to improved wellbeing through complex social pathways. The findings contribute to knowledge gaps within the water–health nexus and direct policy responses toward largely unexplored psychosocial concerns associated with water and sanitation.

scholarly journals Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: a scoping review

2016 ◽  
Vol 15 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Elijah Bisung ◽  
Susan J. Elliott
Keyword(s):  
Scoping Review ◽  
Well Being ◽  
Psychosocial Burden ◽  
Social Stressors ◽  
Water And Sanitation ◽  
Middle Income ◽  
Safe Water ◽  
Middle Income Countries ◽  
Psychosocial Impacts ◽  
Low And Middle Income

The lack of access to safe water and adequate sanitation has implications for the psychosocial well-being of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.

Problems and Practice of Management on Menstruation by Adolescents Girls of Basic Schools of Chitwan, Nepal

2020 ◽  
Vol 8 ◽  
pp. 85-94
Author(s):  
Sudha Ghimire
Keyword(s):  
Current Practice ◽  
Quantitative Information ◽  
Community Schools ◽  
Mixed Method Research ◽  
Participatory Action ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Field Notes ◽  
Sanitary Pads

Managing menstruation in a hygienic way is a challenge in most of the low and middle-income countries (LMIC) including Nepal, where normal and natural physiological process of menstruation is considered as girls’ problem which is viewed as sinful, unholy and matter of shame. This paper explores the current practice and existing difficulties that adolescents girls encounter hygienic management of menstruation (MHM) especially during school days. The study was conducted on five purposively selected community schools of Chitwan district. The study adopted Participatory Action Research (PAR) as an approach, that is encapsulated with mixed method research design. For qualitative information observation, focus group discussions (FGD) and field notes were used, whereas for quantitative data self-administrative questionnaires were used. Quantitative information was collected from 205 girls students who were present at schools on the day of data collection. The finding shows that majority of the girls (93.7%) who encounter hygienic management of menstruation were of 10-14 years old age, whereas nearly one third of them were (29%) from grade eight. Similarly, among the total 205 girls, only 79 girls have already started their menstruation; among those who have started menstruation majority (78%) had heard about menstruation form their mothers. Likewise, 35% girls used homemade cotton pads and 40.5% of them changed pad three times a day. During FGD, adolescents girls shared that lack of water and soap in toilets, stress and lack of concentration during menstruation are the major difficulties which they encounter during days of menstruation. They suggested the concerned authorities to manage pad bank, make soap and water available, and develop skills for proper disposing of used sanitary pads for MHM at schools. 

scholarly journals The how tough is WASH framework for assessing the climate resilience of water and sanitation

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Guy Howard ◽  
Anisha Nijhawan ◽  
Adrian Flint ◽  
Manish Baidya ◽  
Maria Pregnolato ◽  
...  
Keyword(s):  
Climate Change ◽  
Rural Communities ◽  
Universal Access ◽  
Small Towns ◽  
Water And Sanitation ◽  
Middle Income ◽  
Sanitation Services ◽  
Middle Income Countries ◽  
Measurement Framework ◽  
Low And Middle Income

AbstractClimate change presents a major threat to water and sanitation services. There is an urgent need to understand and improve resilience, particularly in rural communities and small towns in low- and middle-income countries that already struggle to provide universal access to services and face increasing threats from climate change. To date, there is a lack of a simple framework to assess the resilience of water and sanitation services which hinders the development of strategies to improve services. An interdisciplinary team of engineers and environmental and social scientists were brought together to investigate the development of a resilience measurement framework for use in low- and middle-income countries. Six domains of interest were identified based on a literature review, expert opinion, and limited field assessments in two countries. A scoring system using a Likert scale is proposed to assess the resilience of services and allow analysis at local and national levels to support improvements in individual supplies, identifying systematic faults, and support prioritisation for action. This is a simple, multi-dimensional framework for assessing the resilience of rural and small-town water and sanitation services in LMICs. The framework is being further tested in Nepal and Ethiopia and future results will be reported on its application.

scholarly journals Decompressive craniotomy: an international survey of practice

2021 ◽  
Author(s):  
Midhun Mohan ◽  
◽  
Hugo Layard Horsfall ◽  
Davi Jorge Fontoura Solla ◽  
Faith C. Robertson ◽  
...  
Keyword(s):  
Public Health ◽  
Randomized Trial ◽  
Bone Flap ◽  
Acute Subdural Hematoma ◽  
International Survey ◽  
Global Public Health ◽  
Health Issues ◽  
Middle Income ◽  
Middle Income Countries ◽  
Decompressive Craniotomy

Abstract Background Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.

scholarly journals Determinants of Long Immunization Clinic Wait Times in a Sub-Saharan African Country

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110282
Author(s):  
Osayame Austine Ekhaguere ◽  
Rosena Olubanke Oluwafemi ◽  
Angela Oyo-Ita ◽  
Burke Mamlin ◽  
Paul Bondich ◽  
...  
Keyword(s):  
Focus Group ◽  
Critical Mass ◽  
Wait Time ◽  
Wait Times ◽  
Group Discussions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Group Data ◽  
Focus Group Data ◽  
Sub Saharan

The wait time clients spend during immunization clinic visits in low- and middle-income countries is a not well-understood reported barrier to vaccine completion. We used a prospective, observational design to document the total time from client arrival-to-discharge and all sequential provider-client activities in 1 urban, semi-urban, and rural immunization clinic in Nigeria. We also conducted caregiver and provider focus group discussions to identify perceived determinants of long clinic wait times. Our findings show that the time from arrival-to-discharge varied significantly by the clinic and ranged between 57 and 235 minutes, as did arrival-to-all providers-client activities. Focus group data attributed workflow delays to clinic staff waiting for a critical mass of clients to arrive for their immunization appointment before starting the essential health education talk or opening specific vaccine vials. Additionally, respondents indicated that complex documentation processes caused system delays. Research on clinic workflow transformation and simplification of immunization documentation is needed.

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

scholarly journals Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Healthcare Professionals ◽  
Health Workers ◽  
Poor Mental Health ◽  
Psychological Wellbeing ◽  
Health Issues ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

scholarly journals Why Do Farmers Grow Tobacco? A Qualitative Exploration of Farmers Perspectives in Indonesia and Philippines

2019 ◽  
Vol 16 (13) ◽  
pp. 2330 ◽  
Author(s):  
Adriana Appau ◽  
Jeffrey Drope ◽  
Firman Witoelar ◽  
Jenina Joy Chavez ◽  
Raphael Lencucha
Keyword(s):  
Institutional Factors ◽  
Interpretive Description ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Middle Income ◽  
Access To Credit ◽  
Middle Income Countries ◽  
Alternative Livelihood ◽  
Qualitative Exploration ◽  
Inductive Thematic Analysis

Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In order to implement successful and sustainable alternative livelihood interventions, it is important to understand why farmers continue to grow tobacco. This study explores this question from the perspective of farmers in Indonesia and Philippines. This study was informed by interpretive description methodology. Data was collected through focus group discussions (FGDs) (n = 7) with farmers (n = ~60). The FGDs were audio recorded, transcribed verbatim, and then translated into English. An inductive thematic analysis of the data was conducted to identify and categorize the reason provided by participants. We identified two overarching themes: (1) perceived viability (profitability, ready market, and environmental factors) and (2) financial context. Financial context included lumpsum payments and access to financial loans and credit facilities in light of their lack of capital. These results highlight that, in addition to identifying viable alternatives to tobacco, institutional factors such as improved access to credit and well-developed supply chains are key to the successful uptake of alternative livelihoods.

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