ABSTRACT
AbstractReducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.
Subject(s)
Health Knowledge, Attitudes, Practice , Hygiene/education , Maternal Health Services/statistics & numerical data , Prenatal Care/statistics & numerical data , Water Purification/ethics , Adolescent , Adult , Female , Health Services Accessibility/statistics & numerical data , Humans , Kenya , Nutritional Status , Odds Ratio , Pregnancy , Rural Population , Surveys and QuestionnairesABSTRACT
The aim of this study is to examine unequal access to drinking water as a public health problem in terms of normative and analytical tools in the bioethics of protection. Therefore, we analyze both the moral implications of unequal treatment of primary needs, such as situations of vulnerability and threat to population groups, and the public sector's responsibility in supplying safe water. In addition, solutions are proposed for the protection of public health and the promotion of legitimate personal development projects. The bioethics of protection reaffirms the state's role in maintaining the drinking water supply and recommends avoiding a policy of privatization of this public good, meanwhile justifying public policies to correct situations of social injustice.
Subject(s)
Bioethical Issues , Morals , Social Justice/ethics , State Government , Water Supply/ethics , Humans , Public Health , Public Policy , Water Purification/ethicsABSTRACT
A formerly classified US document, 'Iraq Water Treatment Vulnerabilities,' provides evidence that ill health was knowingly induced in the population of Iraq through the ruination of that country's water purification system. We believe that the uncovering of this document should stimulate the public health community to clarify principles of public health ethics and to formulate statements giving voice to these principles. We propose here two statements, one dealing with the broad issue of public health ethics and international relations, and one dealing specifically with public health ethics and water purification.
