The Water and Health Conference, hosted by the Water Institute at the University of North Carolina (UNC), was held in Chapel Hill, NC from October 16-20, 2017. Dr. Kellogg Schwab, Dr. Natalie Exum, Alec Shannon, and Katie Overbey from Performance Monitoring and Accountability 2020 (PMA2020) attended to present water, sanitation, and hygiene data from the PMA2020 surveys. Below are an overview of the presentations and posters that were shared.
Monday, October 16th
Poster Presentation: Handwashing Stations in Health Care Facilities Lack Sufficient Conditions to Control Infections across 10 Countries in Africa and Asia
Presenter: Dr. Natalie Exum
This research utilized PMA2020 service delivery point data from 10 PMA2020 countries to characterize the conditions of handwashing stations within health care facilities (HCFs). HCFs in low and middle income countries often lack resources and infrastructure for staff to practice adequate handwashing in between patient care. The number of nurses and midwives present at a HCF compared to the number of sinks that met the criteria for an adequate hand washing facility (soap and water located near a sanitation facility) ranged from 7:1 (nurses/midwives to sinks) in Burkina Faso to 92:1 in Ethiopia. In addition, the ratio of sinks with the provision of improved water and soap near a sanitation area to patient-beds was 1:178. This is well below the WHO recommendation of a sink/patient-bed ratio of at least 1:10. These results lead to the conclusion that infection control will be difficult under these conditions. PMA2020 WASH can serve as a robust monitoring tool to measure progress in achieving universal WASH coverage in HCFs by 2030.
Tuesday, October 17th
Side Session: Routine Use of Multiple Household Water Sources
Convened by University of Alabama, Johns Hopkins University, Stanford University, University of Technology Sydney, The Water Institute at UNC
Speaker: Dr. Kellogg Schwab
During this session, Dr. Schwab highlighted the challenges facing data collection when survey platforms only collect data on one water and sanitation source, ignoring regular use of other sources of drinking water or sanitation facilities. Using PMA2020 WASH data, he focused on high risk practices, including both main and regular use of unimproved drinking water sources and the practice of open defecation. When accounting for regular use, it is possible to quantify the underreporting that occurs when you only account for the main water source. PMA2020 was highlighted as an important survey platform for tracking regular use of water and sanitation sources going forward. PMA2020 is faster to implement and provides data for rapid policy making.
Tuesday, October 17th
Poster Presentation: Population-Level Assessment of Menstrual Hygiene Management Practices in Rajasthan, India
Presenter: Alec Shannon
This research utilized PMA2020 Menstrual Hygiene Management (MHM)data from Rajasthan, India in 2017 to provide the first population-level indicators on how menstruation in managed by women in Rajasthan, India. In this presentation, she shared results from the Rajasthan MHM module, stratifying by age to compare females ages 15 – 19 to older females (45-59 years old) including: where women are managing their menstruation (e.g. where they were changing used menstrual absorbents); what absorbent materials women are using; and, how women are disposing of their used absorbent materials. Researchers found that most women report changing their used absorbents at household sanitation facilities, as well as in the backyard. A higher percentage of older women report changing in the bush/field than those in the 15-19 category. In addition, we see that 15- 19 year olds are more likely to be report using sanitary pads as their menstrual absorbent material, while older women report higher use of cloths. Disposal practices were similar across age groups, with women reporting disposal of used absorbents in either latrines or waste bins. These data are an important first look into the baseline MHM practices in Rajasthan and could have important implications for monitoring under India’s National MHM Guidelines.
Thursday, October 19th
Poster Presentation: Optimal Recall Period for Caregiver Reported Diarrhea in Children Under Five: Evidence from a Multi-Country Monitoring and Evaluation Tool
Presenter: Katie Overbey
This research utilized PMA2020 WASH data from Kenya, Ethiopia, Ghana, Uganda, and DRC to examine the effects of using a one-week recall period for caregiver reported childhood diarrhea outcomes. Literature has suggested that one week is the optimal time period for caregiver reported childhood diarrheal outcomes and that longer recall times may be subject to reporting bias. Childhood diarrhea prevalence in the PMA2020 data was compared to Demographic Health Survey (DHS) data, which utilizes a two weeks recall. It was found that this two-week recall period underestimates the prevalence of childhood diarrhea when compared to the PMA2020 data using a one-week recall. Additionally, the PMA2020 data was used to identify household level WASH risk factors associated with diarrheal illness in children under five years old. These trends were compared to those from DHS data and some differences were observed. Using the PMA2020 data, it appears that not only does a two week recall underestimate diarrheal prevalence in children, but that data utilizing a two week recall period may be yielding inaccurate information about relationships between household level WASH and diarrhea outcomes.
Monday, October 16, 2017