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" The Impact of Sanitation on Child Health in Vulnerable Populations: "
Contreras, Jesse Doyle
Eisenberg, Joseph Neil
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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1106594
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| Doc. No
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TLpq2405488373
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| Main Entry
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Contreras, Jesse Doyle
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Eisenberg, Joseph Neil
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| Title & Author
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The Impact of Sanitation on Child Health in Vulnerable Populations:\ Contreras, Jesse DoyleEisenberg, Joseph Neil
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| College
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University of Michigan
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| Date
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2020
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| student score
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2020
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| Degree
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Ph.D.
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| Page No
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24
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| Abstract
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The separation of humans from fecal waste through sanitation is a crucial element of public health that has prevented countless deaths throughout history. However, health improvements from sanitation are not shared equally across populations. Almost 500,000 children under five die from diarrhea each year, mostly in low-income countries that depend on low-cost sanitation technologies that may not effectively prevent disease. Those diseases have been virtually eliminated in high-income countries through widespread coverage with sewerage and wastewater treatment, but many populations within wealthy countries, including rural communities, racial/ethnic minorities, and other marginalized groups, do not share equitable access to sanitation and experience poor health as a result. Furthermore, sewerage requires copious amounts of water and is not sustainable in an increasingly water-stressed world. One existing solution is the reuse of wastewater for irrigation, but without adequate treatment the practice poses health risks to exposed communities. Achieving global access to sanitation that protects health requires understanding the true health benefits of different sanitation solutions, improved safety and sustainability of waste management practices, and efforts to reach vulnerable populations. In this dissertation, I present three research aims on these topics with the goal of improving our understanding of sanitation and health across national income levels. In Aim 1, we conducted a literature review and meta-analysis of studies on sanitation and diarrhea. Three of four recent major trials on low-cost sanitation interventions found no effect on diarrhea, while historical average estimates have found strong effects. We evaluated literature reviews on sanitation and diarrhea to understand this discordance and found that consensus estimates included numerous flawed studies and inappropriately averaged across widely heterogeneous interventions and contexts. Our meta-analysis highlighted that average effects are largely driven by sewerage and interventions that improved more than sanitation alone. We found that there is no true overall effect of sanitation because variability between interventions and contexts is too complex to average and that the null effects of recent low-cost interventions are not surprising. In Aim 2, we conducted a spatial analysis on households in Central Mexico to understand routes of exposure between wastewater reuse and diarrhea. To test if these exposures have a spatial dependency, we estimated the association between diarrheal disease in children living where wastewater is reused and household proximity to wastewater canals. We constructed a multilevel logistic regression model accounting for spatial autocorrelation and found that children living closer to wastewater canals had substantially higher odds of diarrhea compared to children living farther away. This finding suggests that spatially dependent exposure routes, such as spread by domestic animals or through aerosolization, affect communities that reuse wastewater. In Aim 3, we characterized water and sanitation access among a marginalized population within a high-income country: the Bedouin of the Negev region in Israel. The Bedouin in Israel are formerly nomadic and have faced relocation, demolition, and forced sedentarization since the founding of Israel. Land disputes have resulted in some Bedouin living in historical villages that are not recognized as legal by the government. We conducted a household survey among planned, recognized, and unrecognized Bedouin communities. We found that Bedouin people, especially in unrecognized villages, face limited access to safely managed water and sanitation and have high rates of diarrhea in children. Our study emphasizes shortfalls in global sanitation access and the importance of reaching marginalized communities.
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Environmental health
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Epidemiology
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Public health
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