Impact of Human Movement on Water and Sanitation Practices and Diarrhea Risk Open Access

Bohnert, Kate (2015)

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Background: Even though there has been a global effort to reduce diarrheal diseases, they are still the second leading cause of death among children under the age of five years old (Lanata et al. 2013). Improving water, sanitation, and hygiene (WASH) practices has been shown to reduce diarrhea; yet, these household interventions have recently been scrutinized for their effectiveness and issues with uptake/compliance.

Purpose: In order to design more optimal WASH interventions, future research needs to investigate large-scale factors that influence the transmission of enteric diseases. The goal of the proposed research was to understand risk factors for diarrheal disease in order to provide data that could be subsequently incorporated into potential strategies for countrywide WASH interventions. This objective was achieved through five specific aims: 1) investigate changes in water and sanitation practices with short- and long-term travel, 2) compare water and sanitation conditions in urban versus rural areas, 3) identify whether water and sanitation practices are risk factors for the transmission of diarrheal disease, 4) identify whether water and sanitation practices are risk factors for transmission of rotavirus, and 5) identify whether water and sanitation practices are risk factors for transmission of parasites.

Methods: These aims were addressed through a classic epidemiological case-control study design, matching for age. Data on human movement and water and sanitation practices were also collected.

Results: There were significant differences with water sources between home and traveling. There were significant differences in both water and sanitation sources at home between rural and urban areas. However, these differences mostly disappeared when comparing between cases and controls. Treating water was protective against diarrheal diseases, which corroborates existing literature on the benefits of treating water.

Conclusion: The significant results from this study suggest that water and sanitation systems can only truly be effective when used properly. Instead of proposing more countrywide strategies, more immediate efforts can be directed towards education about water and sanitation systems, specifically about water treatment methods.

Table of Contents

List of Tables and Figures. ii

Introduction. 1

Introduction and Rationale. 1

Problem Statement. 2

Purpose of Study. 3

Specific Aims. 4

Significance Statement. 4

Definition of Terms. 4

Literature Review. 6

Background on Diarrheal Disease. 6

Epidemiological Risk Factors for Diarrhea. 11

Control Efforts for Diarrhea. 13

Research Gaps and the Relevance. 14

Methodology. 16

Introduction. 16

Study Region.17

Research Design. 17

Population and Sample. 18

Instruments. 19

Procedures. 20

Data Analysis Plan. 22

Ethical Considerations. 24

Results. 26

Demographics. 33

Socioeconomic Status. 33

Medical History. 33

Water and Sanitation Practices. 34

Travel. 35

Comparison of Water and Sanitation Practices. 36

Risk Factors for Diarrheal Disease, Parasites, and Rotavirus. 38

Discussion, Conclusion, and Recommendations. 39

References. 44

Appendix A. 49

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