ABSTRACT
Many sanitation interventions suffer from poor sustainability. Failure to maintain or replace toilet facilities risks exposing communities to environmental pathogens, yet little is known about the factors that drive sustained access beyond project life spans. Using data from a cohort of 1666 households in Kwale County, Kenya, we investigated the factors associated with changes in sanitation access between 2015 and 2017. Sanitation access is defined as access to an improved or unimproved facility within the household compound that is functional and in use. A range of contextual, psychosocial, and technological covariates were included in logistic regression models to estimate their associations with (1) the odds of sustaining sanitation access and (2) the odds of gaining sanitation access. Over two years, 28.3% households sustained sanitation access, 4.7% lost access, 17.7% gained access, and 49.2% remained without access. Factors associated with increased odds of households sustaining sanitation access included not sharing the facility and presence of a solid washable slab. Factors associated with increased odds of households gaining sanitation access included a head with at least secondary school education, level of coarse soil fragments, and higher local sanitation coverage. Results from this study can be used by sanitation programs to improve the rates of initial and sustained adoption of sanitation.
Subject(s)
Sanitation , Toilet Facilities , Family Characteristics , Humans , Kenya , SoilABSTRACT
TRIAL REGISTRATION: ClinicalTrials.gov NCT02397772.
Subject(s)
Helminthiasis/epidemiology , Helminthiasis/transmission , Schools , Soil/parasitology , Adolescent , Adult , Aged , Ancylostoma , Animals , Ascaris lumbricoides , Child , Child, Preschool , Environmental Monitoring , Family Characteristics , Female , Health Surveys , Helminthiasis/drug therapy , Helminths , Humans , Kenya/epidemiology , Male , Middle Aged , Necator americanus , Prevalence , Randomized Controlled Trials as Topic , Risk Factors , Socioeconomic Factors , Trichuris , World Health Organization , Young AdultABSTRACT
BACKGROUND: Indoor air pollution remains an important health problem in some countries. Although research data on this issue is available, routine monitoring in affected areas is limited. The aims of this study were to quantify exposure to biomass-related indoor air pollution; assess the respiratory health of subjects; and explore the feasibility of routine monitoring in Kwale district, Kenya. METHODS: We sampled 125 rural houses using short-term monitoring for levels of CO, CO2 and TSP. Additional exposure information was obtained using a checklist. Respiratory health was also assessed using a questionnaire, and electronic spirometer in 172 inhabitants. RESULTS: The overall median levels of CO in the sampled houses on all study sites ranged from 5.9 (IQR 3-14.5) to 10 (5.5-21.2) mg/m3, levels of CO2 ranged from 774 (IQR 724-846) to 839 (IQR 749-961) mg/m3) and the levels of TSP ranged from 295 (IQR 79-853 to 1384 (IQR 557-3110) µg/m(3) which indicates that safe levels recommended by WHO and USEPA could be exceeded. Relatively high incidences of respiratory illness or symptoms were reported and the spirometry readings suggested impaired lung function in over 80% of respondents. CONCLUSION: Our results quantify that the use of biomass fuel can give rise to high levels of indoor air pollution. Given that poor lung function contributes to public health problems in rural regions of East Africa, such as Kwale in Kenya, our findings create grounds for more detailed investigations of the problem and may provide motivation for community based interventions.
