Quantifying the relationships between WASH conditions and mental well-being in Amhara, Ethiopia Pubblico

Abstract

Water, sanitation, and hygiene (WASH) conditions are large contributors to illnesses and mortality across the world. Although the WHO’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” most current research focuses on the impact of WASH conditions on infectious disease. Few quantitative studies focus on WASH and mental well-being. Using data collected as a part of the Andilaye Trial, this study aims to quantify the relationships between household WASH conditions, insecurity, and mental well-being. Our sample includes respondents from 1,589 households from the Bahir Dar Zuria, Fogera, and Farta districts of Amhara, Ethiopia. We gathered seven household indicators from the WHO/UNICEF Joint Monitoring Programme’s targets for sustainable WASH development goals, as well as water and sanitation insecurity metrics from previously validated studies. Mental well-being was assessed using the Hopkins Symptom Checklist for anxiety, depression, and emotional distress symptoms, and the WHO-5 Well-Being Index. Our linear regression models demonstrate that poorer WASH conditions are associated with poorer mental well-being for almost all household indicators. Similarly, poorer WASH insecurity scores are universally associated with poorer mental well-being. We also find that the relationship between WASH conditions and mental well-being is mediated by WASH insecurity in unpredictable ways. Our results clearly show the adverse effects that poor WASH conditions have on mental well-being and the complex interactions between WASH factors and mental well-being. Future WASH research should focus on mental well-being outcomes as well as more nuanced definitions of WASH conditions and insecurity to holistically address health equity.

Table of Contents

Introduction...............................................................................................1 Methods....................................................................................................5 Setting and population...................................................................5 Aims...............................................................................................5 Data collection................................................................................6 Measures........................................................................................7 Data analysis..................................................................................11 Ethics..............................................................................................11 Results......................................................................................................12 Sample size and demographic characteristics...............................12 Household WASH conditions and mental well-being (Aim 1).........16 WASH insecurity and mental well-being (Aim 2)............................19 Mediation by WASH insecurity (Aim 3)...........................................21 Discussion.................................................................................................26 References................................................................................................29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Mental Health
Parola chiave	mental health sanitation hygiene WASH mental well-being water
Committee Chair / Thesis Advisor	Matthew Freeman, Emory University
Committee Members	Jedidiah Snyder, Emory University Maryann Delea, Emory University

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