Water and sanitation accessibility and the health of rural Ugandans

The lack of access to sufficient water and sanitation facilities is one of the largest hindrances towards the sustainable development of the poorest 2.2 billion people in the world. Rural Uganda is one of the areas where such inaccessibility is seriously hampering their efforts at development. Many rural Ugandans must travel several kilometers to fetch adequate water and many still do not have adequate sanitation facilities. Such poor access to clean water forces Ugandans to spend an inordinate amount of time and energy collecting water - time and energy that could be used for more useful endeavors. Furthermore, the difficulty in getting water means that people use less water than they need to for optimal health and well-being. Access to other sanitation facilities can also have a large impact, particularly on the health of young children and the elderly whose immune systems are less than optimal. Hand-washing, presence of a sanitary latrine, general household cleanliness, maintenance of the safe water chain and the households’ knowledge about and adherence to sound sanitation practices may be as important as access to clean water sources. This report investigates these problems using the results from two different studies. It first looks into how access to water affects peoples’ use of it. In particular it investigates how much water households use as a function of perceived effort to fetch it. Operationally, this was accomplished by surveying nearly 1,500 residents in three different districts around Uganda about their water usage and the time and distance they must travel to fetch it. The study found that there is no statistically significant correlation between a family’s water usage and the perceived effort they must put forth to have to fetch it. On average, people use around 15 liters per person per day. Rural Ugandan residents apparently require a certain amount of water and will travel as far or as long as necessary to collect it. Secondly, a study entitled “What Works Best in Diarrheal Disease Prevention?” was carried out to study the effectiveness of five different water and sanitation facilities in reducing diarrheal disease incidences amongst children under five. It did this by surveying five different communities before and after the implementation of improvements to find changes in diarrheal disease incidences amongst children under five years of age. It found that household water treatment devices provide the best means of preventing diarrheal diseases. This is likely because water often becomes contaminated before it is consumed even if it was collected from a protected source.

Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

Moving Beyond Hastiness and Superficiality: Being an Ethical Technical Communicator via Digital Communication Technologies in Health Care

This thesis examines digital technologies used by technical communicators in healthcare settings. I show that technical communicators, who function as users, advocators and evaluators, need a useable framework for ethical engagement with digital technologies, which integrally affect the physician-patient relationship. Therefore, I apply rhetorical methodology by producing useable knowledge and phenomenological methodology by examining lived experiences of technical communicators. Substantiation comes from theories spanning technical communication, philosophy, and composition studies. Evidence also emerges from qualitative interviews with communication professionals working in healthcare; my concerns arise from personal experiences with electronic recordkeeping in the exam room. This thesis anticipates challenging the presumed theory-practice divide while encouraging greater disciplinary reciprocity. Because technical communication infuses theory into productive capacity, this thesis presents the tripartite summons of the ethical technical communicator: to exercise critically-reflective action that safeguards the physician-patient relationship by ways of using digital technologies, advocating for audiences, and evaluating digital technologies.

THE EFFECT OF EASTERN KENTUCKY COAL FIRES ON LOCAL AIR QUALITY AND PERSONAL HEALTH

The purpose of this project was to investigate student learning in the areas of earth science and environmental responsibility using the subject of coal fires. Eastern Kentucky, where this study was performed, has several coal fires burning that affect the local air quality and may also affect the health of people living near them. This study was conducted during the regular education of 9th grade Earth Science classroom in Russell Independent Schools, located in Russell, Kentucky. Students conducted internet research, read current articles on the subject of coal fire emissions and effect on local ecology, and demonstrated what they learned through summative assessments. There were several aspects of coalmines and coal fires that students studied. Students were able to take this knowledge and information and use it as a learning tool to gain a better understanding of their own environment. Using the local history and geology of coalmines, along with the long tradition of mine production, was a very beneficial starting point, allowing students to learn about environmental impact, stewardship of their local environment, and methods of preserving and protecting the ecosystem.

TEACHING MENSTRUAL HEALTH AND HYGIENE TO YOUNG WOMEN IN EASTERN UGANDA WITH REUSABLE MENSTRUAL PADS

In order to identify the impact of teaching menstrual health and hygiene with reusable menstrual pads on knowledge retention and school attendance, qualitative and quantitative data was collected from three rural schools in three districts of eastern Uganda: Amuria, Bukedea, and Ngora. Research techniques employed were preliminary and post surveys of 85 young women; average age 16.9 years. Findings include positive and negative results. Participants’ feelings of normalcy and comfort increased and participants had improved understanding of sexual climax and appropriate menstrual management strategies. There was no statistically significant impact of teaching on topics of sexual intercourse or pregnancy. The impact of reusable menstrual pad sanitary technology on school attendance was negative as more young women reported missing up to a full day of school during their menstrual period (χ2 (3, 73) = 7.81, p = 0.05). Study limitations are discussed and future work is suggested.

WATER RESOURCES, HEALTH, AND THE SUSTAINABILITY OF INTERVENTIONS TO ACHIEVE WATER AND SANITATION TARGETS OF THE MILLENNIUM DEVELOPMENT GOALS IN A CHANGING WORLD

This dissertation addresses sustainability of rapid provision of safe water and sanitation required to meet the Millennium Development Goals. Review of health-related literature and global statistics demonstrates engineers' role in achieving the MDGs. This review is followed by analyses relating to social, environmental, and health aspects of meeting MDG targets. Analysis of national indicators showed that inadequate investment, poor or nonexistent policies and governance are challenges to global sanitation coverage in addition to lack of financial resources and gender disparity. Although water availability was not found to be a challenge globally, geospatial analysis demonstrated that water availability is a potentially significant barrier for up to 46 million people living in urban areas and relying on already degraded water resources for environmental income. A daily water balance model incorporating the National Resources Conservation Services curve number method in Bolivian watersheds showed that local water stress is linked to climate change because of reduced recharge. Agricultural expansion in the region slightly exacerbates recharge reductions. Although runoff changes will range from -17% to 14%, recharge rates will decrease under all climate scenarios evaluated (-14% to -27%). Increasing sewer coverage may place stress on the readily accessible natural springs, but increased demand can be sustained if other sources of water supply are developed. This analysis provides a method for hydrological analysis in data scarce regions. Data required for the model were either obtained from publicly available data products or by conducting field work using low-cost methods feasible for local participants. Lastly, a methodology was developed to evaluate public health impacts of increased household water access resulting from domestic rainwater harvesting, incorporating knowledge of water requirements of sanitation and hygiene technologies. In 37 West African cities, domestic rainwater harvesting has the potential to reduce diarrheal disease burden by 9%, if implemented alone with 400 L storage. If implemented in conjunction with point of use treatment, this reduction could increase to 16%. The methodology will contribute to cost-effectiveness evaluations of interventions as well as evaluations of potential disease burden resulting from reduced water supply, such as reductions observed in the Bolivian communities.