Estimating access to drinking water and sanitation: The need to account for uncertainty in trend analysis.

Nationally representative household surveys are the main source of data for tracking drinking water, sanitation and hygiene (WASH) coverage. However, all survey point estimates have a certain degree of error that must be considered when interpreting survey results for policy and decision making. In this article, we develop an approach to characterize and quantify uncertainty around WASH estimates. We apply it to four countries - Bolivia, Gambia, Morocco and India - representing different regions, number of data points available and types of trajectories, in order to illustrate the importance of communicating uncertainty for temporal estimates, as well as taking into account both the compositional nature and non-linearity of JMP data. The approach is found to be versatile and particularly useful in the WASH sector, where the dissemination and analysis of standard errors lag behind. While it only considers the uncertainty arising from sampling, the proposed approach can help improve the interpretation of WASH data when evaluating trends in coverage and informing decision making.

Leaving no one behind: Evaluating access to water, sanitation and hygiene for vulnerable and marginalized groups.

Achieving equitable access to water, sanitation and hygiene (WASH) services requires paying special attention to the most disadvantaged segments of the population. Yet, despite all the progress made to evaluate the access of vulnerable and marginalized groups, important knowledge gaps still remain with respect to identifying their specific barriers and needs. At the global level, for example, the two monitoring mechanisms for SDG 6 - the Joint Monitoring Programme (JMP) and Global Analysis and Assessment of Sanitation and drinking-water (GLAAS) - face difficulties in understanding how, and to what extent, vulnerable and marginalized groups access WASH services. In this context, this work examines the UNECE/WHO-Europe 'Equitable Access Score-card' for assessing the access to WASH services by vulnerable and marginalized groups. In particular, we: (i) analyse its strengths and limitations as a tool for revealing the needs of these groups in accessing WASH services; and (ii) propose an extended variant of the score-card that addresses these limitations. We test this version in two local-level case studies: Lima (Peru) and Castelló de la Plana (Spain). The score-card diagnosis is found to be particularly useful for collecting information on the level of access of the different vulnerable and marginalized groups, as well as the specific public policies and funding mechanisms in place that address and support their needs. However, the score-card should be complemented with specific assessments of all five normative dimensions of the human rights to water and sanitation (access, availability, quality, acceptability and affordability) in order to have a better understanding of the concerns for service delivery for the different vulnerable and marginalized groups.

Compositional data for global monitoring: The case of drinking water and sanitation.

INTRODUCTION: At a global level, access to safe drinking water and sanitation has been monitored by the Joint Monitoring Programme (JMP) of WHO and UNICEF. The methods employed are based on analysis of data from household surveys and linear regression modelling of these results over time. However, there is evidence of non-linearity in the JMP data. In addition, the compositional nature of these data is not taken into consideration. This article seeks to address these two previous shortcomings in order to produce more accurate estimates. METHODS: We employed an isometric log-ratio transformation designed for compositional data. We applied linear and non-linear time regressions to both the original and the transformed data. Specifically, different modelling alternatives for non-linear trajectories were analysed, all of which are based on a generalized additive model (GAM). RESULTS AND DISCUSSION: Non-linear methods, such as GAM, may be used for modelling non-linear trajectories in the JMP data. This projection method is particularly suited for data-rich countries. Moreover, the ilr transformation of compositional data is conceptually sound and fairly simple to implement. It helps improve the performance of both linear and non-linear regression models, specifically in the occurrence of extreme data points, i.e. when coverage rates are near either 0% or 100%.

Tiempo de pinzamiento del cordón umbilical y complicaciones neonatales, un estudio prospectivo / Time of cord clamping and neonatal complications, a prospective study

OBJETIVO: Evaluar los efectos del pinzamiento precoz o tardío del cordón umbilical en recién nacidos a término y su correlación con los niveles de hemoglobina, hematocrito, ferritina y ciertas complicaciones neonatales. PACIENTES Y MÉTODOS: Estudio prospectivo en recién nacidos sanos, a término, nacidos por parto eutócico o distócico en nuestro hospital, entre mayo del 2009 y mayo del 2010. Se asignó a los pacientes según el tiempo de pinzamiento: grupo 1 (< 60 s), grupo 2 (1 a <2 min) y grupo 3 (2 a 3 min). Se realizaron análisis al momento del nacimiento y a las 48 h de vida, valorando los niveles de hemoglobina, hematocrito, ferritina y bilirrubina. Se evalúo el riesgo de aparición de policitemia, síndrome distrés respiratorio, fototerapia o ingreso en la Unidad de Cuidados Intensivos neonatal y el tiempo de estancia hospitalaria. RESULTADOS: Se incluyó a 242 pacientes: grupo 1 (g1=80), grupo 2 (g2=31) y grupo 3 (g3=131). Los antecedentes maternos y las características neonatales fueron similares en todas las categorías. El primer análisis demostró diferencias significativas en los niveles de ferritina de aquellos recién nacidos con pinzamiento más tardío (g1: 111 mg/dl, g2: 125 mg/dl, g3: 173 mg/dl; p < 0,01). En el segundo análisis los valores de hemoglobina (g1: 17,3 g/dl, g2: 18,9 g/dl, g3: 19,2 g/dl; p < 0,01), hematocrito (g1: 53,4%, g2: 58%, g3: 59%; p < 0,01) y ferritina (g1: 254 mg/dl, g2: 254,7 mg/dl, g3: 313 mg/dl; p = 0,008), fueron estadísticamente mayores en este mismo grupo. Al evaluar las complicaciones, observamos un aumento significativo en el número de casos de policitemia asintomática en el grupo 3. CONCLUSIONES: El pinzamiento tardío del cordón umbilical se asocia a un aumento en los niveles de hemoglobina, hematocrito y ferritina a las 48 h de vida y en el número de casos de policitemia asintomática

OBJECTIVE: To assess the effects of early or late clamping of the umbilical cord in term newborns, assessing the levels of hemoglobin, hematocrit, and ferritin, and their correlation with some of the complications. PATIENTS AND METHODS: A prospective study of healthy newborns at term or born by dystotic or eutocic delivery in our hospital between May 2009 until May 2010. Patients were assigned according to the time of clamping, group 1 (< 60 seconds), group 2 (1 to < 2 minutes), and group 3 (2 to 3 minutes). Laboratory tests were performed at birth and at 48hours of life, assessing the levels of hemoglobin, hematocrit, ferritin, and bilirubin. The risk of polycythemia, respiratory distress syndrome, neonatal phototherapy or admission to the Intensive Care Unit and the hospital stay, were evaluated. RESULTS: A total of 242 patients were included: group 1 (g1 = 80), group 2 (g2 = 31) y group 3 (g3=131). The background maternal and neonatal characteristics were similar in all sets. The first test showed significant differences in ferritin levels in those infants with delayed clamping (g1: 111 mg/dl, g2: 125 mg/dl, g3: 173 mg/dl; p < 0.01). In the second analysis the values of hemoglobin (g1: 17.3 g/dl, g2: 18.9 g/dl, g3: 19.2 g/dl; p < 0.01), hematocrit (g1: 53.4%, g2: 58%, g3: 59%; p < 0.01) and ferritin (g1: 254 mg/dl, g2: 254.7 mg/dl, g3: 313 mg/dl; p = 0.008) were statistically higher in this group. As regards complications, a significant increase was observed in the number of cases of polycythemia symptoms in group 3. CONCLUSIONS: The late cord clamping is associated with an increase in hematocrit, hemoglobin and ferritin at 48hours of life, as well as an increased risk of polycythemia present with symptoms

[Time of cord clamping and neonatal complications, a prospective study]. / Tiempo de pinzamiento del cordón umbilical y complicaciones neonatales, un estudio prospectivo.

OBJECTIVE: To assess the effects of early or late clamping of the umbilical cord in term newborns, assessing the levels of hemoglobin, hematocrit, and ferritin, and their correlation with some of the complications. PATIENTS AND METHODS: A prospective study of healthy newborns at term or born by dystotic or eutocic delivery in our hospital between May 2009 until May 2010. Patients were assigned according to the time of clamping, group 1 (<60 seconds), group 2 (1 to<2 minutes), and group 3 (2 to 3 minutes). Laboratory tests were performed at birth and at 48 hours of life, assessing the levels of hemoglobin, hematocrit, ferritin, and bilirubin. The risk of polycythemia, respiratory distress syndrome, neonatal phototherapy or admission to the Intensive Care Unit and the hospital stay, were evaluated. RESULTS: A total of 242 patients were included: group 1 (g1=80), group 2 (g2=31) y group 3 (g3=131). The background maternal and neonatal characteristics were similar in all sets. The first test showed significant differences in ferritin levels in those infants with delayed clamping (g1: 111 mg/dl, g2: 125 mg/dl, g3: 173 mg/dl; p<0.01). In the second analysis the values of hemoglobin (g1: 17.3 g/dl, g2: 18.9 g/dl, g3: 19.2 g/dl; p<0.01), hematocrit (g1: 53.4%, g2: 58%, g3: 59%; p<0.01) and ferritin (g1: 254 mg/dl, g2: 254.7 mg/dl, g3: 313 mg/dl; p = 0.008) were statistically higher in this group. As regards complications, a significant increase was observed in the number of cases of polycythemia symptoms in group 3. CONCLUSIONS: The late cord clamping is associated with an increase in hematocrit, hemoglobin and ferritin at 48 hours of life, as well as an increased risk of polycythemia present with symptoms.

Spatial and temporal trace metal distribution of a Peruvian basin: recognizing trace metal sources and assessing the potential risk.

Recent efforts have been made to determine the environmental impact of mining over the past 11 years in the Jequetepeque River basin, in northern Peru. We have now analyzed data from two studies to elucidate the spatial and temporal trace metal distributions and to assess the sources of contamination. These two studies were carried out from 2003 to 2008 by a Peruvian government administration and from 2008 to 2010 by us. We analyzed 249 samples by principal component analysis, measuring: pH, electrical conductivity, total dissolved solids, total suspended solids, chloride, weak-acid-dissociable cyanide, total cyanide, nitrite and nitrate, ammonium, sulfate, and trace metals and metalloids (Al, As, Ca, Cd, Cu, Cr, Fe, Mg, Mn, Ni, Pb, and Zn). Within the spatial distribution of the basin, the highest Al, As, Cu, Fe, Ni, and Pb concentrations were found at the closest point to the mine sites for both periods of time, with the higher peaks measured during the first years of the sampling data. Temporal trends showed higher concentrations of Cu and Fe in samples taken before 2005, at which point the two mines were closed. Risk assessment was quantified by the hazard quotient as related to water ingestion. The risk for human health posed by the concentrations of several trace metals and metalloids was found to be highly adverse (As and Cr), significant (Al, Cd, Cu, Fe, and Pb), or minimal (Ni and Zn).

Application of a revised Water Poverty Index to target the water poor.

The Water Poverty Index (WPI) has been recognized as a useful tool in policy analysis. The index integrates various physical, social and environmental aspects to enable more holistic assessment of water resources. However, soundness of this tool relies on two complementary aspects: (i) inadequate techniques employed in index construction would produce unreliable results, and (ii) poor dissemination of final outcome would reduce applicability of the index to influence policy-making. From a methodological point of view, a revised alternative to calculate the index was developed in a previous study. This paper is therefore concerned not with the method employed in index construction, but with how the composite can be applied to support decision-making processes. In particular, the paper examines different approaches to exploit the index as a policy tool. A number of alternatives to disseminate achieved results are presented. The implications of applying the composite at different spatial scales are highlighted. Turkana District, in Kenya has been selected as initial case study to test the applicability and validity of the index. The paper concludes that the WPI approach provides a relevant tool for guiding appropriate action and policy-making towards more equitable allocation of water resources.

The relationship between technology and functionality of rural water points: evidence from Tanzania.

This paper presents an analysis of the relationships between technology of water point, management related practices and functionality over time through an extensive water point mapping study made in 15 rural districts of Tanzania, which covered 15% of the total rural population of the country. Results show irregular functionality rates at district level by technology, but reveal statistical dependence between functionality and technology at regional level. Management-related questions show that reported expenditure is the indicator most related to functionality. All categories of water points show very low performance over time. In the first five years of operation, about 30% of water points become non-functional. Only between 35% and 47% of water points are working 15 years after installation, depending on the technology. By categories, hand pumps are the less durable of the technologies studied. We suggest that more emphasis has to be placed on the creation of community capacities to manage the services during and after the installation of water points. At the same time, the role of decentralised government has to be strengthened to provide support to community services in the long term.