Amy Guo Georgia Kayser Jamie Bartram Michael Bowling The Water Institute at UNC October 10 2016 Background Healthcare as a human right Basic WaSH is vital to provision of adequate healthcare ID: 694144
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Slide1
WaSH in rural health facilities in sub-Saharan Africa: a six-country cross-sectional study
Amy
Guo
Georgia
Kayser
, Jamie Bartram, Michael Bowling
The Water Institute at UNC
October 10, 2016Slide2
Background
Healthcare as a human right
Basic
WaSH is vital to provision of adequate healthcare:Water: adequate supply of clean waterSanitation: for both patients and staff, preferably on premisesHygiene: handwashing, safe disposal of medical waste, etc.WHO/UNICEF have recognized HCF as a high-impact site for WaSH improvementsSustainable Development Goals include improvements to WaSH in HCFs Slide3
Current activity
Little research on status of
WaSH
in healthcare facilitiesCurrent research:Little monitoring dedicated to WaSH in HCF existsPoor S, H infrastructure in HCF affects health-seeking behavior (Steinmann et al. 2015)Poor S associated with adverse pregnancy outcomes (Padhi et al. 2015)Gaps:Few harmonized cross-sectional studiesWater quality dataSlide4
Methods
Timeframe
June
2014 to January 2015CountriesEthiopia, Kenya, Mozambique, Rwanda, Uganda, and ZambiaMethodsRandom selection of health facilities in rural areas Interview: Health professionals in each health facility Questions on water (water source and service, quality, quantity, continuity, and reliability); sanitation (type, quantity, and quality); hand hygiene (types of materials, continuity)Water quality testingE. coli enumeration in Uganda and MozambiqueSlide5
Methods (cont.)
Sample sizes and sampling frame
Country
NGO sampleNGO frame
Non-NGO sample
Non-NGO frame
Total sample
Total frame
Ethiopia
281
520
253
418534938Kenya74745252126126Mozambique9910199101198202Rwanda4968254174109Uganda6371119172182243Zambia6363141141204204TOTAL62989768992513181822
Results from paper questionnaires double-entered
Weighted analysis in SAS 9.4 (SAS Institute Inc., Cary, NC
)Slide6
Results: Access to water
Over 74% used an improved water source
Boreholes (E, U, Z)
Rainwater (K)Piped water into the yard (R, M)62% (E) to 84% (Z) had continuous serviceWater quality
E
. coli presence in water samples from rural health facilities in Uganda and Mozambique.
Uganda (n=144)
Mozambique (n=172)
Low
risk
(<
1 MPN)84.7%70.4%Intermediate risk (1-10 MPN)7.3%10.7%High risk(10-100 MPN)8.0%18.9%Very high risk (>100 MPN)0.0%0.0%TOTAL100.0%100.0%Slide7
Results: Access to water (cont.)
Distance to water source?
Rwanda, Uganda, Zambia
Ethiopia, Kenya, MozambiqueImproved piped source on premises7% (U) to 57% (R)Pictured to right: Water tank and maternity ward at Mmambo health facility, Malawi. Photo taken by Camille Morgan (2013).Slide8
Results: Access to water (cont.)Slide9
Results: Availability of sanitationOver 66% had access to improved sanitation
Pit latrine with slab (E, K, R, M)
Ventilated improved pit latrine (U, Z)
Over 88% reported that sanitation was functionalQuality of service: indicates problems with privacy, cleanliness, and regular repair in over 22% of HCF in each countrySlide10
Results: Hand hygieneSlide11
Results: Hand hygiene (cont.)Slide12
Results: combined access to WaSH*
*Does not include analysis based on on-plot or functionality of sanitation
Country
Improved water, improved sanitation, AND soap and water always
Ethiopia
5%
Kenya
10%
Mozambique
5%
Rwanda
8%
Uganda5%Zambia19%Slide13
Discussion
Basic
WaSH
provision has not been achieved in HCF: <19% combinedOpportunities for interventionPiped water: on premises, high qualityTraining: for safe water handlingSanitation: maintain existing facilitiesHygiene: hand hygiene essentialetc.Future iterations (and improvements) in researchPolicy implicationsSlide14
AcknowledgementsSpecial thanks to
World Vision: esp. Jordan Smoke
UNC: team members Georgia
Kayser, J. Michael Bowling, Camille Morgan, and Ronna Chan, under PI Pete Kolsky; Jamie Bartram, Ryan CronkOdum Institute: for technical supportIn-country research teamsSlide15
Thank you / Q&A
For further questions, please contact me at
aguo@live.unc.edu
.Pictured to left: World Vision field officer by a water point at health facility in Chingale, Malawi. Photo taken by Camille Morgan (2013).