Water, Sanitation, and Hygiene (WASH) Challenges and Non-WASH Challenges Western Ugandan Women Experience Utilizing Maternal Healthcare Facilities Open Access

LaGattuta, Natalie (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/qb98mg49w?locale=en


Background: Environmental conditions, such as the water, sanitation, and hygiene (WASH) infrastructure in the healthcare facilities (HCFs), have received little focus as it relates to HCF utilization among mothers. As the number of births in HCFs increase, there is a shift of attention to the quality of care and the impact of WASH conditions on mother’s utilization of health services.

Methods: In March 2018, researchers from the Makerere School of Public Health, used qualitative methods to explore the WASH status in HCFs and the factors that influenced mothers’ decisions for choice of delivery in the Kanungu and Rukungiri districts of Uganda. They also conducted a quantitative survey that assessed health seeking behaviors among women. This secondary data analysis was performed on data from the quantitative survey and the qualitative interviews. The quantitative analysis included generating frequency tables on sociodemographic data and performing chi square tests on HCF utilization to determine if there were any associations between non-WASH and WASH challenges experienced by mothers based on regional district or type of HCF. For the qualitative section, a thematic analysis was performed on select questions from the interviews that explored mothers’ perspectives on the challenges experienced while utilizing HCFs.

Results: Overall, cost of services was the most common challenge mothers experienced in utilizing health services. For women who delivered at a public HCF, there was a difference between districts in the reporting of poor WASH services (6% in Kanungu, 0% in Rukungiri; p=0.0285) vs expensive services (0% in Kanungu compared to 6.2% in the Rukungiri; p=0.0186). Also, four themes emerged from the qualitative data that included 1) awareness of WASH challenges 2) financial challenges 3) quality of care challenges 4) resource challenges.

Discussion: The secondary analysis of the quantitative data showed a significant relationship between the regional district and the report of poor WASH services. While the qualitative analysis did not fully illuminate why mothers reported poor WASH services, it is noted that the awareness of WASH challenges in HCFs is not uniform amongst mothers. More research needs to be conducted on physical resources in developing countries to understand the challenges women experience when utilizing HCFs.

Table of Contents

Table of Contents

Definition of Terms 1

Chapter 1: Introduction 4

Introduction, Rationale 4

Problem Statement 6

Project Context 7

Objective/Aims/Purpose Statement 7

Research Questions/Hypotheses 8

Chapter 2: Literature Review 9

Overview 9

Challenges with Utilization of Maternal Services throughout Sub-Saharan Africa 9

WASH Challenges in HCFs 13

WASH Challenges in HCFs and How they Affect Maternal Health 17

Maternal Mortality & Standards of Quality Care in HCFs 21

Chapter 3: Methodology 26

Introduction 26

Original Makerere Study: Geography & Study Sites 26

Research Design 28

Original Makerere Qualitative Study 28

Qualitative Study Population & Sample 28

Qualitative Study Procedures 29

Qualitative Study Data Collection Instruments 30

Original Makerere Quantitative Study 31

Quantitative Study Population & Sample 31

Quantitative Study Procedures 32

Quantitative Study Data Collection Instruments 32

Plans for Secondary Data Analysis of Quantitative Data 33

Plans for Secondary Data Analysis of Qualitative Data 36

Ethical Considerations (IRB) 36

Chapter 4: Results 38

Introduction 38

Quantitative Findings 38

Qualitative Findings 45

Chapter 5: Discussion 51

Introduction 51

Major Findings from Quantitative Analysis 52

Major Findings from Qualitative Analysis 55

Summary 57

Limitations 57

Chapter 6: Public Health Implications 59

References 60

Appendix 1: Structured Questionnaire 66

Appendix 2: In-depth Interview Guide 80

Appendix 3: Focus Group Discussion Guide 81

Appendix 4: Key Informant Interview Guide 82

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