Accounting for Human Behavior and Pathogen Transmission in the Sanitation Paradigm: Opportunities for Improving Child Health

global health;sanitation;enteric infection;child diarrhea;child undernutrition;latrine use behavior;Public Health;Health Sciences;Epidemiological Science

Lopez, VelmaJones, Andrew ;

University of Michigan

关键词: global health;    sanitation;    enteric infection;    child diarrhea;    child undernutrition;    latrine use behavior;    Public Health;    Health Sciences;    Epidemiological Science;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/143912/lopezvel_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Access to sanitation reduces pathogen exposure to improve child health by reducing diarrhea and promoting physical growth. Globally, millions of children under five suffer from diarrheal disease and undernutrition, which are leading causes of child-mortality in low-resource settings and have long term consequences for children that do survive. Recent sanitation interventions, however, have shown no effect on improving child health outcomes. The null results of an established intervention, therefore, require further investigation into the mechanisms linking sanitation access to improved health outcomes. This dissertation seeks to highlight the role of human behavior as it relates to latrine access, as well as address how sanitation and nutrition intervention affect environmental and biological processes driving enteropathogen transmission. In chapter two, we use health behavior theory to identify determinants of latrine use behavior from a sanitation-related ethnography collected in rural, Ecuadorian communities. We then develop a quantitative survey tool to collect information on these determinants, and following primary data collection, apply data reduction approaches and regression analyses to select which determinants in the sample are reflective of self-reported consistent latrine use. We show that latrine use is influenced by a constellation of drivers, including social norms, attitudes about latrine cleanliness, and habitual latrine use behavior. In chapter three, which also uses primary data from rural Ecuador, we use a suite of determinants to predict an individual’s propensity to consistently use a latrine via latent class analysis modeling. We find that latrine use behavior is most accurately predicted by community-level norms reflecting other people’s latrine use and attitudes towards latrine sharing. We also illustrate that latrine access is not the primary driver of latrine use. In chapter four, we build a community-level environmental-mediated enteropathogen transmission model that reflects the biological interdependencies between enteric infection and undernutrition. By simulating enteric pathogen transmission among a cohort of children, we test the effect of sanitation and nutritional interventions on the overall transmission of disease. The mathematical modeling approach allows for exploration of underlying mechanism inherent in this system, which highlights opportunities to inform intervention design. Overall, in each chapter, we use a variety of methods to examine environmental, community, and individual-level processes at play in a system of latrine access, latrine use, and diarrhea-related morbidity. Towards the goal of implementing effective sanitation interventions, this dissertation argues for a need to improve measurement of sanitation behavior and incorporate enteric pathogen transmission dynamics in programmatic design, implementation, and evaluation.