Contextualizing linkages between water security and global health in Africa, Asia and Europe:Geography matters in research, policy and practice

The linkages between water security and global health vary in space and time. Just like water connects every aspect of life, geography relates everything to everything else. Therefore, in order to address challenges at the interface of water security and global health, the use and application of medical geography, a sub-discipline of geography, is helpful in research, policy and practice. Using different water security pathway classifications (diminished water supply or quality, increased water demand, and extreme flood events) and the United Nations Sustainable Development Goals and targets as a frame, this paper looks at water and health challenges from different angles and from a holistic perspective, while contextualizing them. Drawing on five practical examples, including water-related infectious disease exposure in watersheds in semi-arid Kenya, health system response in floodplains in Namibia, public health implications in a protracted emergency setting in arid Northeast Nigeria, water, sanitation and hygiene (WASH) monitoring in households, schools and healthcare facilities in Small Island Developing States in the South Pacific, and WASH-related challenges and disease exposures among marginalized ethnic minority populations in Europe, the applicability and usefulness of geography contextualizations in research, policy-makers and practitioners is presented. Moreover, cross-cutting topics and contextualizations, beyond water security and global health, including climate- and weather-related extreme events, inequality, health- and water-related education, risk perceptions and behaviour, and the cultural context, are highlighted to showcase the value of applying medical geography in understanding the key drivers, barriers and bottlenecks in complex situations; recommending actionable and contextualized measures to address these challenges; directing programming and interventions; and informing policy-making to tackle and solve these challenges

Health Risk Perceptions Are Associated with Domestic Use of Basic Water and Sanitation Services—Evidence from Rural Ethiopia

We examine factors associated with the use of basic water supply and sanitation services as part of an integrated community-based nutrition programme which included a drinking water, sanitation and hygiene (WaSH) intervention and emphasise findings related to health risk perceptions. Data were collected from 2658 households in four regions in Ethiopia with a cross-sectional survey in WaSH intervention areas, as well as in control areas, where the intervention was not implemented. The data were analysed using bivariate and multivariable regression analysis. Awareness of health risk factors related to inadequate WaSH was high in the programme area. The use of basic water and sanitation services was associated with several health risk perceptions: Perceiving water quality as good increased the odds of using basic water services as opposed to believing the water quality was poor (OR 3.94; CI 3.06–5.08; p ≤ 0.001). Believing that drinking unsafe water was the main cause for diarrhoea increased the odds of using basic water services (OR 1.48; CI 1.20–1.81; p ≤ 0.001). In the WaSH intervention group, the use of basic sanitation was more likely than in the control group. The use of basic sanitation was associated with households who had previously received sanitation training, as opposed to such who had not (OR 1.55; CI 1.22–1.97; p ≤ 0.001). Perceiving dirty space as the main cause of diarrhoea (OR 1.81; CI 1.50–2.19; p ≤ 0.001), and privacy when using a latrine (OR 2.00; CI 1.67–2.40; p ≤ 0.001), were associated with higher odds of using basic sanitation. Households that indicated a disadvantage of owning a latrine was maintenance costs were less likely to use basic sanitation (OR 0.49; CI 0.38–0.63; p ≤ 0.001). Risk perceptions were important determinants of use of basic services. The findings point to risk perceptions motivating the application of positive WaSH-related and health-protective behaviours. This suggests that well-designed health risk communication strategies may be effective for engaging households in healthy WaSH behaviour

Indicators for evaluating shared sanitation quality: a systematic review and recommendations for sanitation monitoring

Shared sanitation facilities have replaced open defecation in many areas, improving sanitation access. Although a broad body of literature has been published regarding the importance of shared sanitation services, it is still unclear how to assess their quality. The objective of this review was to synthesize evidence on the use of shared sanitation facilities in informal settlements and identify indicators for assessing their quality. We conducted a systematic review of relevant studies and a total of 248 studies were included in the final analysis. Findings include a proposed list of indicators for evaluating the quality of shared sanitation such as the number of people sharing facilities, cleanliness, privacy, facility location, accessibility, and safety, and a tool for distinguishing between sanitation facilities that are improved shared, basic shared and unimproved shared. We recommend incorporating the proposed indicators in primary data collection, and routine national and global sanitation monitoring

Geographical inequalities in drinking water in the Solomon Islands

Sustainable Development Goal 6.1 seeks to “by 2030, achieve universal and equitable access to safe and affordable drinking water”, which is challenging particularly in Small Island Developing States (SIDS) and Pacific Island Countries (PIC). We report drinking water sources and services in the Solomon Islands and examine geographical inequalities. Based on two quantitative baseline datasets of n = 1,598 rural and n = 1,068 urban households, we analyzed different drinking water variables (source type, collection time, amount, use, perceived quality, storage, treatment) and a composite index, drinking water service level. We stratified data by urban and rural areas and by province, mapped, and contextualized them. There are substantive rural–urban drinking water inequalities in the Solomon Islands. Overall, urban households are more likely to: use improved drinking water sources, need less time to collect water, collect more water, store their water more safely, treat water prior to consumption, perceive their water quality as better and have an at least basic drinking water service than rural households. There are also provincial and center-periphery inequalities in drinking water access, with more centrally located provinces using piped water supplies and more distant and remote provinces using rainwater and surface water as their primary source. There are also inter-national inequalities. Out of all PICs, the Solomon Islands have among the lowest access to basic drinking water services: 92% of urban and 55% of rural households. Of all SIDS, PICs are least serviced. This study shows that drinking water inequality is a critical issue, and highlights that all identified dimensions of inequality - rural–urban, provincial, center-periphery and inter-national - need to be explicitly recognized and addressed and included in pro-equity monitoring, policy and programming efforts by the Solomon Islands Government and stakeholders to reduce inequalities as per the Agenda 2030