The disgust box: a novel approach to illustrate water contamination with feces

Below are links to 5 Aug 2015 studies on digust, handwashing and maternal mortality, handwashing and NTDs, water quality awareness and breastfeeding and household characteristics and diarrhea.

The disgust box: a novel approach to illustrate water contamination with feces. Health & Science Bulletin, June 2015.


Inadequate drinking water, sanitation and hand hygiene are responsible for approximately 800,000 deaths per year in low and middle-income countries. We evaluated the benefits of a behaviour change communication method to motivate water treatment practices in urban low income communities in Dhaka. We used a device called the ‘Disgust Box’ to provide a vivid demonstration of how piped water is contaminated with faeces to motivate people to chlorinate water. Most of the respondents were able to recall the demonstration at both four-month and one year qualitative assessments. At four months, the majority of participants stated that they still felt disgusted by the demonstration and mentioned it as a motivator for water chlorination. However, after one year, despite being able to recall the demonstration, disgust was no longer mentioned as a motivator to chlorinate water. The Disgust Box has the potential to be an effective communication method to motivate water treatment but additional research is necessary to establish a more sustainable approach to reinforce behaviour change.

Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal. PLoS One, Aug 2015. Authors: Nadine Seward, et al.


Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

Assessment of water, sanitation, and hygiene practices and associated factors in a Buruli ulcer endemic district in Benin (West Africa). BMC Public Health, Aug 2015.


BU is an important conditions in the district of Lalo with 917 new cases detected from 2006 to 2012. More than 49 % of the household surveyed used unimproved water sources for their daily needs. Only 8.7 % of the investigated household had improved sanitation facilities at home and 9.7 % had improved hygiene behavior. The type of housing as an indicator of the socioeconomic status, the permanent availability of soap and improved hygiene practices were identified as the main factors positively associated with improved sanitation status.

Country characteristics and acute diarrhea in children from developing nations: a multilevel study. BMC Public Health, Aug 2015. Authors: Ángela María Pinzón-Rondón, et al.


The household characteristics associated with diarrhea in this study were as follows. (1) Number of household members: This was associated with diarrhea on bivariate correlation but not on the multivariable model, probably due to other household conditions included in the present study that may be associated with overcrowding. (2) Type of residence: Bivariate correlation showed that children from rural areas were more likely to present with diarrhea, as described previously in the literature [36]. This association disappeared on multivariable models, probably due to the introduction of household wealth in the multivariable models. (3) Nuclear families: Children from nuclear families had 5 % smaller odds of developing diarrhea than did children from non-nuclear families. This outcome is probably secondary to the described effect of social stability that a nuclear family structure has on child health [37]. (4) Sanitation: Adequate sanitation conditions helped prevent diarrhea. It has been estimated that approximately 88 % of diarrhea-induced deaths in the world are attributable to inadequate water supplies, poor hygiene and unsanitary conditions [38].

Water Quality Awareness and Breastfeeding: Evidence of Health Behavior Change in Bangladesh, June 2015. Author: Pinar Keskin, et al.


Decades of nation-wide campaigns regarding water safety in Bangladesh have cautioned households about the dangers of water-borne diseases from surface water and, more recently, arsenic contamination from certain tubewells. In addition to switching to uncontaminated well water, mothers can also protect their young children by breastfeeding longer. We study whether mothers modify their behavior in response. We exploit geographic variation in exposure to arsenic and time variation in whether children were born before or after the most recent campaign. In addition, we exploit geographic variation in the cost of switching to an arsenic-free well, namely the distance to nearby uncontaminated wells. We find that mothers breastfeed their children longer in contaminated areas and that this change is driven by households that have less access to clean wells. We also find that very young children in contaminated areas are more likely to be exclusively breastfed. This behavior change is consistent with the separate spheres model of intra-household bargaining where men have authority over certain decisions (which well to use), but women are able to influence other decisions (how to feed their children). Consistent with this breastfeeding response, we find suggestive evidence of relatively lower mortality rates and incidence of diarrhea for infants in more contaminated areas.

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