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Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys.

ABSTRACT: Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty-seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% of countries, children with off-premises water access had significantly increased odds of anemia. In over a quarter of countries, children exposed to surface water had higher odds of anemia. In Burundi, children were 1.65 times more likely to be anemic when reported to be living in households using surface water. However, in India, a protective effect was noted (adjusted OR: 0.70, P < 0.001) for surface water. In 60% and 65% of countries, women and children exposed to an open sanitation facility had higher odds of being anemic, respectively. There is evidence of an association between selected water and sanitation indicators and anemia. Promoting policies, practices and research that strengthen access to improved WASH should be considered for reducing anemia prevalence alongside standard nutrition interventions.

SUBMITTER: Kothari MT

PROVIDER: S-EPMC6771505 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys.

Kothari Monica T MT Coile Amanda A Huestis Arja A Pullum Tom T Garrett Dean D Engmann Cyril C

Annals of the New York Academy of Sciences 20190624 1

Globally, no countries are on track to achieve the adopted global nutrition targets set for anemia in 2025. Given the linkages between water, sanitation, and hygiene (WASH) and nutrition, this secondary data analysis explores potential associations with anemia. Forty-seven demographic and health surveys were used to explore the association between unimproved water and sanitation and anemia in women and children with adjusted odds ratios (ORs) calculated by country and cumulatively. In over 60% o ...[more]

PMID: 31232465

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Project description:ObjectiveThe government of Ghana has targeted universal access to safe drinking water by 2025 and elimination of open defecation by year 2030. This study explored the use of unimproved drinking water and unimproved sanitation and assessed their association with demographic factors.DesignThis was a secondary data analysis of the 2017 Ghana Maternal Health Survey, a nationally representative cross-sectional survey. Open defecation households were mapped to show regional differences. Weighted logistic regression was used to assess the association of demographic variables with use of unimproved drinking water and unimproved toilet facilities.SettingGhana.ParticipantsA total of 26 324 households were included in the analysis.Primary and secondary outcome measuresUse of unimproved drinking water and unimproved toilet facilities.ResultsOut of the 26 324 households, 8.9% used unimproved drinking water while 81.6% used unimproved sanitation. Open defecation was practised by 15.2% of Ghanaian households, with a prevalence of 58.8%, 6.7% and 12.5% in the Northern, Middle and Coastal zones, respectively. In the multivariate analysis, rural households (p<0.001), households with more than five members (p<0.001), households with heads less than 25 years (p=0.018), male-headed households (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with drinking unimproved water. Also, rural households (p=0.002), households in the Northern zone (p<0.001), single-member households (p<0.001), households with heads less than 25 years (p<0.001) and household heads with no/low level of education (p<0.001) were significantly associated with using unimproved toilet facilities.ConclusionThe target of universal access to safe drinking water by 2025 and elimination of open defecation by 2030 seems impossible to be achieved if appropriate measures are not implemented. We recommend that state authorities, health partners and non-governmental organisations support local-level sanitation plans and strategies.

Project description:BackgroundTo improve schistosomiasis control programs in Uganda, where intestinal schistosomiasis is a widespread public health problem, a country-wide assessment of the disease prevalence among all age ranges is needed. Few studies have aimed to quantify the relationships between disease prevalence and water and sanitation characteristics across Uganda to understand the potential to interrupt disease transmission with an integrated package of interventions.Methodology/principal findingsA nationally representative survey was undertaken that included a household and individual questionnaire followed by disease testing based on detection of worm antigens (circulating cathodic antigen-CCA), diagnosis and treatment. A comprehensive set of questions was asked of randomly sampled individuals, two years of age and above, to understand their water and sanitation infrastructure, open defecation behaviors, exposure to surface water bodies, and knowledge of schistosomiasis. From a set of 170 randomly sampled, geographically diverse enumeration areas, a total of 9,183 study participants were included. After adjustment with sample weights, the national prevalence of schistosomiasis was 25.6% (95% confidence interval (CI): 22.3, 29.0) with children ages two to four most at risk for the disease with 36.1% infected (95% CI: 30.1, 42.2). The defecation behaviors of an individual were more strongly associated with infection status than the household water and sanitation infrastructure, indicating the importance of incorporating behavior change into community-led total sanitation coverage.Conclusions/significanceOur results highlight the importance of incorporating monitoring and evaluation data into control programs in Uganda to understand the geographic distribution of schistosomiasis prevalence outside of communities where endemicity is known to be high. The high prevalence of schistosomiasis among the youngest age group, ineligible to receive drug treatment, shows the imperative to develop a child-appropriate drug protocol that can be safely administered to preschool-aged children. Water and sanitation interventions should be considered an essential investment for elimination alongside drug treatment.

Project description:BackgroundThe 2030 Sustainable Development Goals (SDGs) set an ambitious new benchmark for safely managed drinking water services (SMDWs), but many countries lack national data on the availability and quality of drinking water.ObjectivesWe quantified the availability and microbiological quality of drinking water, monitored SMDWs, and examined risk factors for Escherichia coli (E. coli) contamination in 27 low-and middle-income countries (LMICs).MethodsA new water quality module for household surveys was implemented in 27 Multiple Indicator Cluster Surveys. Teams used portable equipment to measure E. coli at the point of collection (PoC, n=61,170) and at the point of use (PoU, n=64,900) and asked respondents about the availability and accessibility of drinking water. Households were classified as having SMDW services if they used an improved water source that was free of E. coli contamination at PoC, accessible on premises, and available when needed. Compliance with individual SMDW criteria was also assessed. Modified Poisson regression was used to explore household and community risk factors for E. coli contamination.ResultsE. coli was commonly detected at the PoC (range 16-90%) and was more likely at the PoU (range 19-99%). On average, 84% of households used an improved drinking water source, and 31% met all of the SMDW criteria. E. coli contamination was the primary reason SMDW criteria were not met (15 of 27 countries). The prevalence of E. coli in PoC samples was lower among households using improved water sources [risk ratio (RR)=0.74; 95% confidence interval (CI): 0.64, 0.85] but not for households with water accessible on premises (RR=0.99; 95% CI: 0.94, 1.05) or available when needed (RR=0.95; 95% CI: 0.88, 1.02). E. coli contamination of PoU samples was less common for households in the richest vs. poorest wealth quintile (RR=0.70; 95% CI: 0.55, 0.88) and in communities with high (>75%) improved sanitation coverage (RR=0.94; 95% CI: 0.90, 0.97). Livestock ownership (RR=1.08; 95% CI: 1.04, 1.13), rural vs. urban residence (RR=1.10; 95% CI: 1.04, 1.16), and wet vs. dry season sampling (RR=1.07; 95% CI: 1.01, 1.15) were positively associated with contamination at the PoU.DiscussionCross-sectional water quality data can be collected in household surveys and can be used to assess inequalities in service levels, to track the SDG indicator of SMDWs, and to examine risk factors for contamination. There is an urgent need for better risk management to reduce widespread exposure to fecal contamination through drinking water services in LMICs. https://doi.org/10.1289/EHP8459.

Project description:ObjectiveTo assess national and regional trends and causes-specific distribution of maternal mortality in India.DesignNationally representative cross-sectional surveys.SettingAll of India from 1997 to 2020.SampleAbout 10 000 maternal deaths among 4.3 million live births over two decades.MethodsWe analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country.Main outcome measuresMaternal mortality burden and distribution of causes.ResultsThe MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%).ConclusionsIndia could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.Tweetable abstractWe estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Project description:BackgroundCharacterizing prediabetes phenotypes may be useful in guiding diabetes prevention efforts; however, heterogeneous criteria to define prediabetes have led to inconsistent prevalence estimates, particularly in low- and middle-income countries. Here, we estimated trends in prediabetes prevalence in Mexico across different prediabetes definitions and their association with prevalent cardiometabolic conditions.MethodsWe conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2022), totalling 22 081 Mexican adults. After excluding individuals with diagnosed or undiagnosed diabetes, we defined prediabetes using ADA (impaired fasting glucose [IFG] 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (IFG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%). Prevalence trends of prediabetes over time were evaluated using weighted Poisson regression and its association with prevalent cardiometabolic conditions with weighted logistic regression.FindingsThe prevalence of prediabetes (either IFG or high HbA1c [ADA]) in Mexico was 20.9% in 2022. Despite an overall downward trend in prediabetes (RR 0.973, 95% CI 0.957-0.988), this was primarily driven by decreases in prediabetes by ADA-IFG (RR 0.898, 95% CI 0.880-0.917) and WHO-IFG criteria (RR 0.919, 95% CI 0.886-0.953), while prediabetes by ADA-HbA1c (RR 1.055, 95% CI 1.033-1.077) and IEC-HbA1C criteria (RR 1.085, 95% CI 1.045-1.126) increased over time. Prediabetes prevalence increased over time in adults >40 years, with central obesity, self-identified as indigenous or living in urban areas. For all definitions, prediabetes was associated with an increased risk of cardiometabolic conditions.InterpretationPrediabetes rates in Mexico from 2016 to 2022 varied based on defining criteria but consistently increased for HbA1c-based definitions and high-risk subgroups.FundingThis research was supported by Instituto Nacional de Geriatría in Mexico. JAS was supported by NIH/NIDDK Grant# K23DK135798.

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Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys.

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Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys.

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