Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India
Abstract Background Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall expos...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-021-11353-z |
| _version_ | 1818864720344514560 |
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| author | Julia Vila-Guilera Priti Parikh Hemant Chaturvedi Lena Ciric Monica Lakhanpaul |
| author_facet | Julia Vila-Guilera Priti Parikh Hemant Chaturvedi Lena Ciric Monica Lakhanpaul |
| author_sort | Julia Vila-Guilera |
| collection | DOAJ |
| description | Abstract Background Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India. Methods This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors). Results Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants’ exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers’ motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors. Conclusions Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant’s enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels. |
| first_indexed | 2024-12-19T10:36:08Z |
| format | Article |
| id | doaj.art-57ea76db2ace40c18168686d99246b33 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-19T10:36:08Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-57ea76db2ace40c18168686d99246b332022-12-21T20:25:36ZengBMCBMC Public Health1471-24582021-07-0121111510.1186/s12889-021-11353-zTowards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal IndiaJulia Vila-Guilera0Priti Parikh1Hemant Chaturvedi2Lena Ciric3Monica Lakhanpaul4Population, Policy and Practice, UCL Great Ormond Street Institute of Child HealthEngineering for International Development Centre, The Bartlett, UCL Faculty of the Built EnvironmentAceso Global Health Consultants Ltd.Healthy Infrastructure Research Group, UCL Department of Civil, Environmental and Geomatic EngineeringPopulation, Policy and Practice, UCL Great Ormond Street Institute of Child HealthAbstract Background Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India. Methods This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors). Results Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants’ exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers’ motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors. Conclusions Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant’s enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels.https://doi.org/10.1186/s12889-021-11353-zEnteric infections - Faecal exposure - infants and young children- sanitation and hygieneSocio-ecological determinantsRural India |
| spellingShingle | Julia Vila-Guilera Priti Parikh Hemant Chaturvedi Lena Ciric Monica Lakhanpaul Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India BMC Public Health Enteric infections - Faecal exposure - infants and young children- sanitation and hygiene Socio-ecological determinants Rural India |
| title | Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India |
| title_full | Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India |
| title_fullStr | Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India |
| title_full_unstemmed | Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India |
| title_short | Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India |
| title_sort | towards transformative wash an integrated case study exploring environmental sociocultural economic and institutional risk factors contributing to infant enteric infections in rural tribal india |
| topic | Enteric infections - Faecal exposure - infants and young children- sanitation and hygiene Socio-ecological determinants Rural India |
| url | https://doi.org/10.1186/s12889-021-11353-z |
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