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Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual- and household-level access between people with and without disabilities in the Tanahun district of Nepal.

ABSTRACT: BACKGROUND:The critical importance of safe and affordable access to water, sanitation and hygiene (WASH) is highlighted in Goal 6 of the Sustainable Development Goals, which seeks to achieve universal and equitable access for all by 2030. However, people with disabilities-who comprise 15% of the global population-frequently face difficulties meeting their WASH needs. Unmet WASH needs amongst people with disabilities may not be captured through current approaches to tracking progress towards Goal 6, which focus on household- rather than individual-level access. OBJECTIVE:To evaluate access to safe water, sanitation and hygiene (WASH), at the individual- and household-level, amongst people with disabilities in the Tanahun district of Nepal. METHODS:A population-based survey of disability was conducted from August-October 2016 to evaluate access to improved water and sanitation facilities between households with members with disabilities (n = 198) and those without (n = 1,265) in the Tanahun district of Nepal. A nested case-control then compared individual-level access between cases aged 15 and above with disabilities (n = 192) and age-sex-location matched controls without disabilities (n = 189), using the newly developed 21-item "Quality of WASH Access" questionnaire. Multivariate regression was used to compare household- and individual-level indicators between people and households with and without disabilities. In-depth interviews with 18 people with disabilities and their caregivers was conducted to assess the acceptability and appropriateness of the "Quality of WASH Access" questionnaire. FINDINGS:There were no significant differences between households with and without members with disabilities in access to an improved sanitation facility or water source. However, at the individual-level, people with disabilities experienced significantly greater difficulties accessing water, sanitation and hygiene compared to people without disabilities (p<0.001 for all three scores). Amongst people with disabilities, water difficulty scores were associated with having a physical impairment and greater disability severity; sanitation difficulty scores were associated with lower socioeconomic status and physical or self-care limitations; and hygiene difficulty scores were positively associated with self-care limitations and lower socioeconomic status, and inversely associated with hearing impairments. Qualitative research found the "Quality of WASH Access" questionnaire was well understood by participants and captured many of the challenges they faced. Additional challenges not covered by the tool included: (1) time spent on WASH, (2) consistency of access, (3) sufficiency of access, and (4) dignity of access. CONCLUSION:People with disabilities face substantial challenges to meeting their WASH needs, particularly in using services autonomously, consistently, hygienically, with dignity and privacy, and without pain or fear of abuse. These challenges are not captured through household-level data, and so individual-level WASH access are needed to monitor progress towards universal WASH access. The Quality of WASH Access questionnaire may provide a useful data collection tool.

SUBMITTER: Banks LM

PROVIDER: S-EPMC6788693 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual- and household-level access between people with and without disabilities in the Tanahun district of Nepal.

Banks Lena Morgon LM White Sian S Biran Adam A Wilbur Jane J Neupane Shailes S Neupane Saurav S Sharma Aditi A Kuper Hannah H

PloS one 20191011 10

<h4>Background</h4>The critical importance of safe and affordable access to water, sanitation and hygiene (WASH) is highlighted in Goal 6 of the Sustainable Development Goals, which seeks to achieve universal and equitable access for all by 2030. However, people with disabilities-who comprise 15% of the global population-frequently face difficulties meeting their WASH needs. Unmet WASH needs amongst people with disabilities may not be captured through current approaches to tracking progress towa ...[more]

PMID: 31603926

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Project description:ObjectivesTo assess access to adequate water, sanitation and hygiene (WASH) among people with disabilities at the household and individual level.DesignCross-sectional surveys.SettingData were included from five district-level or regional-level surveys: two in Bangladesh (Bangladesh-1, Bangladesh-2), and one each in Cameroon, Malawi and India.Participants99 252 participants were sampled across the datasets (range: 3567-75 767), including 2494 with disabilities (93-1374).OutcomePrevalence of access to WASH at household and individual level.Data analysisAge/sex disaggregated disability prevalence estimates were calculated accounting for survey design. The Unicef/WHO Joint Monitoring Programme definitions were used to classify facilities as improved/unimproved. Multivariable logistic regression was undertaken to compare between households with/without a person with a disability, and to identify predictors of access among people with disabilities.ResultsThere were no differences in access to improved sanitation or water sources between households with/without members with disabilities across the datasets. In Bangladesh-2, households including a person with a disability were more likely to share facilities with other households (OR 1.3, 95% CI 1.1 to 1.5). Households with people with disabilities were more likely to spend >30 min (round-trip) collecting drinking water than households without in both Cameroon (OR 1.8, 95% CI 1.0 to 3.4) and India (OR 2.3, 95% CI 1.2 to 4.7). Within households, people with disabilities reported difficulties collecting water themselves (23%-80% unable to) and accessing the same sanitation facilities as other household members, particularly without coming into contact with faeces (up to 47% in Bangladesh-2). These difficulties were most marked for people with more severe impairments.ConclusionsPeople with disabilities may not have poorer access to WASH at the household level, but may have poorer quality of access within their households. Further programmatic work is needed to ensure WASH facilities are inclusive of people with disabilities.

Project description:BackgroundThe district of Manang (2000 - 6000 m) is located in the Central Himalayas, Nepal. The majority of local inhabitants of the area are Gurungs, of Tibetan origin. The remoteness of the region has resulted in continued use of plants as medicine in an area where the ethnobotany has sparsely been documented.MethodsInterviews were conducted with amchi (Tibetan medicinal practitioners), local healers (including priests locally known as 'lamas'), plant traders, and knowledgeable villagers (including herders) regarding local plant names and their medicinal uses during several field visits (2002-2005). When convenient to the locals, a jungle or forest walk was done with the healers, allowing for both plant collection and detailed information gathering.ResultsThis present research documented 91 ethnomedicinal plant species, belonging to 40 families under 73 genera, and 45 new ethnomedicinal plant species are added. These 91 locally used medicinal plants are found to treat 93 ailments. This study provides information on 45 plant species previously unknown for their medicinal uses in Manang. The indication for use, mode of preparation, dose and administration of medicine are described in detail for each species.ConclusionThis wealth of ethnobotanical knowledge persists, and is being transferred to the next generation in some areas in upper Manang, in a country where this is often not the case. The senior amchi of the area (Karma Sonam Lama), who has been practicing Tibetan medicine for three generations, feels that it is of utmost importance to conserve the traditional healing system and to pass his knowledge on to the local community about the importance of medicinal plants. He hopes that this will lead to the conservation and sustainable management of medicinal plants in the villages. Over the duration of this research, the prices of several rare medicinal plants of Manang increased dramatically, highlighting both the scarcity and the quick disappearance of the species. This is only one example of a worrying trend of over harvesting of medicinal plants, and highlights the need for conservation and management of medicinal plants of Manang district.

Project description:Community-led total sanitation (CLTS) is embraced as a key strategy to achieve universal sanitation coverage (Sustainable Development Goal 6.2). Although inclusion is identified as a predictor of CLTS success, people living with disabilities are often excluded from community sanitation programmes and there is limited research exploring CLTS participation amongst people living with disabilities. This study aims to explore the extent to which people living with disabilities participated in a CLTS intervention delivered in rural Malawi using standard approaches. This cross-sectional study was conducted in the Chiradzulu district of Malawi. A household questionnaire was administered to collect information about CLTS participation. Multivariable logistic regression was performed to compare participation in different CLTS activities between households with (n = 80) and without a member with a disability (n = 167), and between household members with (n = 55) and without a disability (n = 226). No difference in CLTS participation was observed at the household-level, but there were marked differences in CLTS participation between household members with and without a disability. Household members without a disability felt they could give more input in triggering activities (OR = 3.72, 95%CI 1.18-11.73), and reported higher participation in the transect walk (OR = 4.03, 95%CI 1.45-11.18), community action planning (OR = 2.89, 95%CI 1.36-6.13), and follow-up visits (OR = 3.37, 95%CI 1.78-6.40) compared to household members with disabilities. There was no difference in the likelihood of being invited to triggering (OR = 0.98, 95%CI 0.41-2.36), attending triggering (OR = 2.09, 95%CI 0.98-4.46), or participating in community mapping (OR = 2.38, 95%CI 0.71-7.98) between household members with and without a disability. This study revealed intra-household inequalities in CLTS participation. To improve participation in CLTS interventions, facilitators should be trained on action steps to make CLTS more inclusive. Further research could include an in-depth analysis of predictors of CLTS participation amongst people living with disabilities, including disability types, severity and age.

Project description:IntroductionSub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa.MethodsWe carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child's status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression.ResultsThe analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24-6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51-58.78), 28.18% (95% CI = 27.74-28.63), and 17.06% (95% CI = 16.71-17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04-1.16) or surface water (aOR = 1.11; 95% CI = 1.03-1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04-1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality.ConclusionInterventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.

Dataset Information

Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual- and household-level access between people with and without disabilities in the Tanahun district of Nepal.

Publications

Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual- and household-level access between people with and without disabilities in the Tanahun district of Nepal.

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