A framework for targeting water, sanitation and hygiene interventions in pastoralist populations in the Afar region of Ethiopia

Globally, many populations face structural and environmental barriers to access safe water, sanitation and hygiene (WASH) services. Among these populations are many of the 200 million pastoralists whose livelihood patterns and extreme environmental settings challenge conventional WASH programming approaches. In this paper, we studied the Afar pastoralists in Ethiopia to identify WASH interventions that can mostly alleviate public health risks, within the population's structural and environmental living constraints. Surveys were carried out with 148 individuals and observational assessments made in 12 households as part of a Pastoralist Community WASH Risk Assessment. The results show that low levels of access to infrastructure are further compounded by risky behaviours related to water containment, storage and transportation. Additional behavioural risk factors were identified related to sanitation, hygiene and animal husbandry. The Pastoralist Community WASH Risk Assessment visually interprets the seriousness of the risks against the difficulty of addressing the problem. The assessment recommends interventions on household behaviours, environmental cleanliness, water storage, treatment and hand hygiene via small-scale educational interventions. The framework provides an approach for assessing risks in other marginal populations that are poorly understood and served through conventional approaches

Emotional wellbeing as a proxy indicator for water security among pastoralists in Afar, Ethiopia

Recent thinking proposes a more holistic approach to measuring household water security. In addition to conventional service-level based indicators, assessments should account for broader social, political and cultural structures which shape how households interact with water. Contributing to this agenda, the paper introduces new research that aims to evaluate the relationship between emotional wellbeing and water security among pastoralists in the Afar region of Ethiopia. It is hypothesised that the measurement of emotion could have potential value as an indicator of water security among vulnerable populations who have particularly complex water use patterns that are poorly captured by conventional indicators. Within the pastoralist context, preliminary data collection has indicated an emotional response to seasonality in resource availability and distance travelled to infrastructure points. Further research is underway to explore the complexity of emotion and its interrelation with water security to better understanding the needs of pastoralists in Afar

Water and emotion: testing a new approach for monitoring water security among Afar pastoralists in Ethiopia

Ethiopia has over 12 million pastoralists that raise livestock and move their herds in search of fresh pasture and water. This way of life is especially vulnerable to climate change as drought and shifts in seasonal rainfall patterns are changing the distribution and availability of these resources in pastoralist regions. The dynamic use of water within these settings is also not well-understood or captured by conventional water sector monitoring systems, which prevents appropriate supportive interventions and policies to be delivered. This paper presents results from a study into a new approach to measuring water security that focuses on assessing the emotional response of pastoralist populations to their water security situation. Formative research involving focus groups and interviews was followed by a survey of 148 pastoralists to assess their emotional response to different water security dimensions. The results indicate that emotional response can be used to elicit valuable insights into water security and provide a powerful complement to conventional water security monitoring techniques. Using the approach, we show a strong relationship between variation in seasonal water access and reported emotional response. Negative emotions also strongly associate with the most laborious methods of collecting water such as scoop holes and hand dug wells, whereas positive emotions were associated with access to higher quantities of water. Access to equines for carrying water was associated with more positive emotional well-being indicating a route to water security improvement in this context could be through the provision of donkeys and mules for water carrying. The paper discusses the value of using an emotion-based approach to capture experiences of water security alongside more conventional objective measures, especially among populations with water use patterns that continue to be poorly understood.Economic and Social Research Council (ESRC): ES/ R001049/1 and ES/T015977/

Environmental Associated Emotional Distress and the Dangers of Climate Change for Pastoralist Mental Health

Pastoralists in the Horn of Africa are among the most vulnerable populations to climate change yet little is known about how environmental change shapes their wellbeing and mental health. This paper presents a formative study into the relations between emotion, wellbeing and water security among pastoralist communities in Afar, Ethiopia. It uses focus group and interview data to demonstrate the close relationship between environmental conditions and emotional wellbeing, and shows how current water insecurity leads to extreme worry and fatigue among the studied population, especially in the dry season. In the context of difficulties of translating mental health clinical classifications and diagnostic tools in cross-cultural settings, the paper argues the inductive study of emotion may be a useful approach for studying environmental determined wellbeing outcomes among marginal populations in the light of understanding climate change impacts

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% 47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% 32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% 27.9-42.8] and 33.3% 25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license