Assessment of contributing factors to the reduction of diarrhea in rural communities of Para, Brazil

In developing communities the occurrence of diarrhea has been reported at elevated levels as compared to those communities in more developed regions. Diarrheal diseases were linked to over one million deaths in 2012 throughout the world. While multiple pathways are present for the transmission of diarrheal diseases, water has been the focus for many aid organizations. Point-of-use (POU) water treatment methods are a common tool used by aid organizations in efforts to provide potable water. The CAWST biosand filter is a POU tool that has shown removal effectiveness of pathogenic microorganisms ranging from 90-99%. However, minimal literature was found that reported on the effectiveness of the filter within the larger body of the complex system found in all communities. Therefore a hypothesis was derived to confirm that the intervention of a CAWST biosand filter is the most significant factor in the reduction of the diarrheal health burden within households in developing regions. Communities located along the Amazon River in Para, Brazil were selected for study. Structural Equation Modeling (SEM) was utilized to aid in representing the complex set of relationships within the communities. The Mahalanobis-Taguchi Strategy (MTS) was also used to confirm variable significance in the SEM model. Results show that while the biosand filter does aid in the reduction of diarrheal occurrences it is not the most significant factor. Results varied on which factor influenced diarrheal occurrences the greatest but consistently included education, economic status, and sanitation. Further, results from the MTS analysis reported education as the largest factor influencing household health. Continued work is needed for further understanding of these factors and their relationships to diarrhea reduction. --Abstract, page iv

Contributing factors to child stunting in Guatemala: A systems analysis focused on enteric disease transmission and mycotoxin exposure

Child stunting -- low height-for-age -- is a United Nation\u27s indicator for chronic malnutrition that has been linked to both acute and chronic health problems. Data from Guatemala suggests for children under five years of age, 49% are classified as stunted. This dissertation tests the following hypotheses, among children in Guatemala 1) environmental enteric dysfunction (EED) is correlated with height-for-age, 2) aflatoxin B (AFB) exposure is correlated with height-for-age, and 3) AFB exposure is correlated with EED. A network analysis was conducted on data from the US Agency for International Development (USAID) collected in 2012 to identify trends in a height-for-age model and an EED model. These results were then combined with a literature review, field observations, and informal interviews to hypothesize two structural equation models (SEM). Additionally, a third SEM was hypothesized for the AFB exposure model. The models were tested with data collected by the San Vicente Health Center in Totonicapán in October 2016 and February 2017. Finally, five geographic specific SEMs were built with the USAID 2012 data and tested with USAID 2013 data. Results of the hypotheses include 1) mixed findings on a correlation between EED and child height-for-age, 2) a confirmed correlation between AFB exposure and child height-for-age, and 3) no correlation between AFB exposure and EED. Furthermore, improved prenatal health and improved sanitary child play areas were correlated with child height-for-age. For the EED model improved water treatment was correlated with reduced EED. Finally, improved maize purchase habits, post-harvest practices, and maize storage were correlated with a decrease in AFB symptoms. Field practitioners and policy makers must account for local and regional suitability for interventions and policies on child health --Abstract, page vi

Measuring Multidimensional Poverty in a Complex Environment; Identifying the Sensitive Links

The central hypothesis of this study is that a holistic, systems-based approach employing multiple analytical tools is useful for identifying the most sensitive links within complex communities to down-scale global development priorities such as the United Nations Sustainable Development Goals. Results of latent factor regression, canonical correlation analysis, and structural equation modeling were compared for multiple, publically-available data sets for two rural regions in Brazil and Guatemala. The results of this study confirm previously reported findings, and collectively support the central hypothesis demonstrating a pathway for linking global priorities with the complex realities of \u27on-the-ground\u27 development conditions in specific communities

Utilizing Structural Equation Modeling in the Development of a Standardized Intervention Assessment Tool

There are numerous approaches to measuring multidimensional poverty; these include the Human Development Index and the Multidimensional Poverty Index among others [1]. However, a gap in the literature is found when intervention assessment tools are investigated. The idea of creating a standardized assessment tool would allow for a deeper understanding of poverty on a per community basis. Structural Equation Modeling (SEM) offers a robust platform in which to establish such a tool. An overview of SEM and several other general approaches to data aggregation are addressed. The notion of a standardized intervention assessment tool is discussed; this is focused on utilizing the SEM platform for this tool. Further, previous works by Divelbiss [2] and Voth-Gaeddert [3], [4] are discussed. To date SEM has shown to handle adaptability of differing environments positively. Divelbiss reported on the SEM multivariable poverty model within villages of Guatemala and Voth-Gaeddert reports on the applicability of this model used in a dissimilar environment in Brazil. These findings suggest feasibility in the utilization of a SEM platform for a standardized intervention assessment tool

Water, sanitation and hygiene (WASH) in sub-Saharan Africa and associations with undernutrition, and governance in children under five years of age: A systematic review

Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700)

Water, sanitation, and hygiene (WASH) factors associated with growth between birth and 1 year of age in children in Soweto, South Africa: Results from the Soweto Baby WASH study

Interventions to reduce undernutrition and improve child growth have incorporated improved water, sanitation, and hygiene (WASH) as part of disease transmission prevention strategies. Knowledge gaps still exist, namely, when and which WASH factors are determinants for growth faltering, and when WASH interventions are most effective at improving growth. This study drew cross-sectional data from a longitudinal cohort study and used hierarchical regression analyses to assess associations between WASH factors: water index, sanitation, hygiene index, and growth: height-forage (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) at 1, 6, and 12 months postpartum among infants a priori born healthy in Soweto, Johannesburg. Household access to sanitation facilities that were not safely managed was associated with a decrease in HAZ scores at 1 month (/? = -2.24) and 6 months (/?=-0.96); a decrease in WAZ at 1 month (8=-1.21), 6 months (/?= -1.57), and 12 months (/3= -1.92); and finally, with WHZ scores at 12 months (/?= -1.94). Counterintuitively, poorer scores on the hygiene index were associated with an increase at 1 month for both HAZ (/? = 0.53) and WAZ (0 = 0.44). Provision of safely managed sanitation at household and community levels may be required before improvements in growth-related outcomes are obtained

Growing the Crowd of Users for Microtask Platforms With the Goal of Alleviating Poverty

Microtasks are short simple tasks that almost any human being can perform but a computer program cannot. These types of tasks are available online through several different mediums. The objective of this research project is to grow the crowd of users engaged in microtasks in rural Missouri and in villages in developing countries. An initial step in this process has been the creation of MSTWorks.org, a website and marketing campaign designed to specifically grow the number of microtask workers in Phelps County region. Current microtask platforms provide opportunities to earn minimum wage, and linking unemployed and underemployed individuals with self-paced, work-from-anywhere jobs through the internet promises to improve access to income with the additional anticipated benefits of improved wellness and reduced criminal tendencies

Acute to Chronic Malnutrition: How Significant Water, Sanitation, and Hygiene Factors Change with Health Outcomes and Geographies in the Western Highlands of Guatemala

Adequate and appropriate water, sanitation, and hygiene (WaSH) infrastructure is important for reducing pathogen exposures in developing communities. To improve the ability of field practitioners in optimizing WaSH infrastructure within communities, models can provide insight into the complex interactions among WaSH infrastructure, health outcomes, and geographies. This study investigated the significant correlations between WaSH infrastructure variables and three different health outcomes (diarrhea, environmental enteric dysfunction, and stunting) over five geographic regions within Guatemala. Exploratory structural equation modeling was used to build WaSH models from U.S. Agency for International Development (USAID) 2012 Food for Peace Survey data (n = 2,103). The models were then tested using USAID 2013 Western Highlands Integrated Program survey data collected from the same regions (n = 4,633). Our results support that significant WaSH infrastructure variables vary widely over health outcome and geographic region. Improved sanitation had the highest prevalence of significance among all models. The floor transmission route for pathogens was identified as significant across all geographies for child stunting. Additionally, commonalities in potential pathogen transmission routes were identified among environmentally similar geographies. Practitioners and policy makers must account for the specific geography and health outcome to identify which set of WaSH infrastructure interventions are most appropriate at the correct scale

Limited Benefits and High Costs are Associated with Low Monetary Returns for Guatemalan Household Investment in Water, Sanitation, and Hygiene Technologies

The child stunting rate (low height-for-age) in Guatemala is the sixth worst in the world. Child stunting is correlated both with short and long-term economic costs. While technologies to improve water, sanitation and hygiene (WaSH) are effective at ameliorating child stunting, current household investment in WaSH technologies is constrained (i.e., self-supply). To understand this constraint, data on household spending priorities and barriers to investment in WaSH technologies must be assessed. We utilize primary data from our partner community in Totonicapán, Guatemala to populate a structural equation model and benefit-cost analysis assessing the association between household WaSH technologies and child height-for-age. To test regional variations, we scale-up our approach to examine four additional regions across western Guatemala. The results suggest there is limited monetary gain for households to invest in WaSH technologies. Among the communities and regions where higher returns on investment for households were identified, significant WaSH technologies were cumulatively low cost and simple to obtain and use. We encourage stakeholders supporting a self-supply model to evaluate that incremental improvements in WaSH technologies financed by the household do not impose large costs without sufficient benefits, facilitating healthy WaSH mobility (a household\u27s ability to improve their WaSH technology status)