A Cross-Country Analyses of Water Service Provisions in Healthcare Facilities in Afghanistan, Uganda, Malawi and Haiti using the WASHCon Tool Open Access

Imaa, Jennifer (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/3n2040319?locale=en


Background: Inadequate water sanitation and hygiene (WASH) conditions have negative consequences to the health and well-being of a population. There is a need to assess WASH conditions in healthcare facilities (HCFs), particularly in low and middle-income countries since poor conditions have been associated with higher rates of healthcare acquired infections and low health delivery uptake.

Methods: A cross-sectional study was carried out in 334 HCFs across four countries: Afghanistan, Haiti, Uganda, and Malawi using the WASHCon tool. A subset of the data related to water supply and quality was used to determine water service levels. This was classified as basic service, limited or no service. Proportion of facilities meeting CDC and WHO guidelines for free chlorine and E. coli concentrations in water samples was determined. Logistic regression was employed to identify factors associated with facilities meeting basic water service levels and water quality standards.

Results: A majority of the HCFs surveyed had water service levels that met the definition for basic service, ranging from 55.9% of facilities in Uganda to 86.7%% of facilities in Haiti. In univariate regression analysis of HCFs in Uganda, there was a significant association between the managing body and basic water service. The odds for having basic water service was lower among governmental HCFs compared to non-governmental HCFs (NGOs, private, and faith-based) OR=0.25 (0.08, 0.70). There was also a statistically significant association found between water source and having water that meets the WHO guidelines for water microbial content.

Conclusion: Though a majority of the HCFs surveyed meet the definition for basic water service, there is still a substantial percentage of facilities in each country who have limited or no water service, with this proportion differing between countries. Further, our results indicated that in Uganda, there is an association between managing body and meeting basic water services. Associations were also found between water source and meeting WHO guidelines for water quality. This suggests there are inequalities within and between countries that need to be addressed and we need to consider characteristics of the HCFs as we prioritize regions for WASH interventions.

Table of Contents

Background/Literature Review.. 1

Global Water, Sanitation, and Hygiene (WASH) 1

Consequences of poor WASH in Healthcare Facilities. 2

Joint Monitoring Program, WASH in HCF.. 3

Assessment of WASH services in Healthcare Facilities. 4

Methods. 8

Data Source. 8

Recruitment and Site Selection. 8

Data Collection. 9

Data Analysis Plan. 10

Results. 15

Discussion. 25

Study Limitations. 27

Future Directions. 29

References. 30

Appendix. 34

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