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Effect of Women’s Perceptions and Household Practices on Children’s Waterborne Illness in a Low Income Community

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Abstract

An ecosystem approach to human health was adopted in a community-based study carried out in Bebnine, an underserved town in Lebanon. The objective of the study is to examine the association between women’s household practices and diarrhea among children in a setting where contaminated drinking water and intestinal diseases are common. A total of 280 women were randomly selected and interviewed using a structured questionnaire. Data were collected on 712 children between the ages of 6 and 14. The study instrument included determinants of diarrhea such as sociodemographic characteristics, water, sanitation, hygiene practices, gender variables, and behavioral risk factors. Multivariate regression analysis was employed to examine the association between water handling practices and diarrhea. The prevalence of diarrhea is 5%. Female children are more likely to suffer from diarrhea than male children (OR = 2.58; 95% CI: 1.19–5.62). Treatment of drinking water at the household level and the use of drinking water for cooking and the preparation of hot beverages are protective against diarrhea (OR = 0.15; 95% CI: 0.03–0.65). Female caretakers’ behaviors such as daily bathing and seeking medical care at times of illness are protective against diarrhea in children. The findings suggest that diarrhea is a gendered health problem. Female children, who are generally more involved in household activities than male children, are at higher risk of suffering from diarrhea. Female caretakers’ personal hygiene, household practices, and perceptions of diarrhea are additional risk factors. Intervention activities would be more effective if based on a better understanding of gender roles and household power relations.

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References

  • Abou Mourad TA (2004) Palestinian refugee conditions associated with intestinal parasites and diarrhoea: Nuseirat refugee camp as a case study. Public Health 118:131–142

    Article  Google Scholar 

  • Agtini MD, Soeharno R, Lesmana M, Punjabi NH, Simanjuntak C, Wangsasaputra F, et al. (2005) The burden of diarrhea, shigellosis, and cholera in North Jakarta, Indonesia: findings from 24 months surveillance. BMC Infectious Diseases 5:1–11

    Article  Google Scholar 

  • Ahmed SA, Hoque BA, Mahmud A (1998) Water management practices in rural and urban homes: a case study from Bangladesh on ingestion of polluted water. Public Health 112:317–321

    Article  CAS  Google Scholar 

  • Alberts J, Sanderman R., Gerstenbluth I, van den Heuval W (1998) Sociocultural variations in help-seeking behavior for everyday symptoms and chronic disorders. Health Policy 44:57–72

    Article  CAS  Google Scholar 

  • Al-Ghazawi ZD (2004) Ecosystem approach to human health in two villages of the North Jordan Valley: scoping the problems. EcoHealth 1(Suppl 2):97–108

    Google Scholar 

  • Al-Medhawi E, Briggs C, Keane S (2005) Household Hygiene Improvement Survey in Yemen: Knowledge, Practices, and Coverage of Water Supply, Sanitation and Hygiene, Washington, DC: US Agency for International Development (USAID), pp 1–63

    Google Scholar 

  • Andersen R, Newman J (2005) Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly 83:1–8

    Article  Google Scholar 

  • Barbour EK, Al Sharif M, Sagherian VK, Habre AN, Talhouk RS, Talhouk SN (2004) Screening of selected indigenous plants of Lebanon for antimicrobial activity. Journal of Ethnopharmacology 93:1–7

    Article  Google Scholar 

  • Batal M, Hunter E (2007) Traditional Lebanese recipes based on wild plants: an answer to diet simplification? Food and Nutrition Bulletin 28:S303–S311

    Google Scholar 

  • Billig P, Bendahmane D, Swindale A (1999) Water and Sanitation Indicators Measurement Guide, Washington, DC: Food and Nutrition Technical Assistance Project (FANTA)—US Agency for International Development (USAID)

  • Bucardo F, Nordgren J, Carlsson B, Paniagua M, Lindgren P, Espinoza F (2008) Pediatric norovirus diarrhea in Nicaragua. Journal of Clinical Microbiology 46:2573–2580

    Article  Google Scholar 

  • Caulfield LE, de Onis M, Blössner M, Black R (2004) Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. American Journal of Clinical Nutrition 80:193–198

    CAS  Google Scholar 

  • Chiller TM, Mendoza CE, Lopez MB, Alvarez M, Hoekstra RM, Keswick BH, et al. (2006) Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking water. Bulletin of the World Health Organization 84:28–35

    Google Scholar 

  • Cifuentes E, Rodriguez S (2005) Urban sprawl, water insecurity, and enteric diseases in children in Mexico City. EcoHealth 2:70–75

    Article  Google Scholar 

  • Cifuentes E, Mazari-Hiriart M, Carneiro F, Bianchi F, Gonzalez D (2002) The risk of enteric diseases in young children and environmental indicators in sentinel areas of Mexico City. International Journal of Environmental Health Research 12:53–62

    Article  Google Scholar 

  • Clasen TF, Bastable A (2003) Faecal contamination of drinking water during collection and household storage: the need to extend protection to the point of use. Journal of Water and Health 1:109–115

    Google Scholar 

  • Clasen TF, Mintz ED (2004) International network to promote household water treatment and safe storage. Conference summary. Emerging Infectious Diseases 10. Available: http://www.cdc.gov/ncidod/EID/vol10no6/pdfs/04-0243.htm [accessed May 10, 2006]

  • Curtis V, Cairncross S (2003) Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases 3:275–281

    Article  Google Scholar 

  • Curtis V, Cairncross S, Yonli R (2000) Review: domestic hygiene and diarrhoea—pinpointing the problem. Tropical Medicine and International Health 5:22–32

    Article  CAS  Google Scholar 

  • De Melo MC, Taddei JA, Diniz-Santos DR, Vieira C, Carneiro NB, Melo RF, et al. (2008) Incidence of diarrhea in children living in urban slums in Salvador, Brazil. The Brazilian Journal of Infectious Diseases 12:89–93

    Google Scholar 

  • Demo DH, Acock AC (1993) Family diversity and the division of domestic labor. How much have things really changed? Family Relations 42:323–331

    Article  Google Scholar 

  • El Laithy H, Abu-Ismail K, Hamdan K (2008) Poverty, growth and income distribution in Lebanon. Country study n.13. The International Poverty Center (IPC), United National Development Program (UNDP). Available: http://www.undp-povertycentre.org/pub/IPCCountryStudy13.pdf [accessed April 25, 2008]

  • Esrey S (1996) Water, waste and well being: a multi-country study. American Journal of Epidemiology 143:608–623

    CAS  Google Scholar 

  • Esrey S, Potash J, Roberts L, Schiff C (1991) Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bulletin of the World Health Organization 69:609–621

    CAS  Google Scholar 

  • Feachem RG (1984) Interventions for the control of diarrheal diseases among young children: promotion of personal and domestic hygiene. Bulletin of the World Health Organization 62:467–476

    CAS  Google Scholar 

  • Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller N, Colford JM (2005) Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. The Lancet Infectious Diseases 5:42–52

    Article  Google Scholar 

  • Forget G, Lebel J (2001) An ecosystem approach to human health. International Journal of Occupational and Environmental Health 7:S3–S35

    CAS  Google Scholar 

  • Gorter AC, Sandiford P, Smith GD, Pauw JP (1991) Water supply, sanitation and diarrhoeal disease in Nicaragua: results from a case-control study. International Journal of Epidemiology 20:527–533

    Article  CAS  Google Scholar 

  • Gorter AC, Sandiford P, Pauw J, Morales P, Perez RM, Alberts H (1998) Hygiene behaviour in rural Nicaragua in relation to diarrhoea. International Journal of Epidemiology 27:1090–1100

    Article  CAS  Google Scholar 

  • Guerrant RL, Oria RB, Moore SR, Oria M, Lima A (2008) Malnutrition as an enteric infectious disease with long term effects of child development. Nutrition Reviews 66:487–505

    Article  Google Scholar 

  • Habib RR, El-Masri A, Heath HL (2006a) Women’s strategies for handling household detergents. Environmental Research 101:84–194

    Article  Google Scholar 

  • Habib RR, Nuwayhid I, Yeretzian JS (2006b) Paid work and domestic labor in disadvantaged communities on the outskirts of Beirut, Lebanon. Sex Roles: A Journal of Research 55:321–329

    Article  Google Scholar 

  • Habib RR, Myntti C, Nuwayhid I, Merhi M (2008) Children and adults in the division of domestic labour in disadvantaged communities in the outskirts of Beirut. Section I: gender mainstreaming at home and at work. In: Selected Readings—IV International Congress on Women, Work and Health, Sahaya A (editor), New Delhi: WWHI Publications, pp 25–46

    Google Scholar 

  • Han AM, Oo KN, Midorikawa Y, Shwe S (1989) Contamination of drinking water during collection and storage. Tropical and Geographical Medicine 41:138–140

    CAS  Google Scholar 

  • Hojeij S (2006) Determinants and health implications of drinking water from the public spring of Bebnine. Thesis, Beirut, Lebanon: American University of Beirut

  • Hosmer D, Lemeshow S (2000) Applied Logistic Regression, New York: John Wiley & Sons

    Book  Google Scholar 

  • Howard G, Bartram J (2003) Domestic Water Quantity, Service Level and Health, Geneva: World Health Organization

    Google Scholar 

  • Hutin Y, Luby S, Paquet C (2003) A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. Journal of Water and Health 1:45–52

    Google Scholar 

  • Huttly SR, Morris S, Pisani V (1997) Prevention of diarrhoea in young children in developing countries. Bulletin of the World Health Organization 75:163–174

    CAS  Google Scholar 

  • Jensen P, Ensink JH, Jayasinghe G, van der Hoek W, Cairncross S, Dalsgaard A (2002) Domestic transmission routes of pathogens: the problem of in-house contamination of drinking water during storage in developing countries. Tropical Medicine and International Health 7:604–609

    Article  Google Scholar 

  • Jensen PK, Jayasinghe G, van der Hoek W, Cairncross S, Dalsgaards A (2004) Is there an association between bacteriological drinking water quality and childhood diarrhea in developing countries? Tropical Medicine and International Health 9:1210–1215

    Article  CAS  Google Scholar 

  • Kosek M, Bern C, Guerrant RL (2003) The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bulletin of the World Health Organization 81:197–204

    Google Scholar 

  • Lanata CF (2003) Studies of food hygiene and diarrhoeal disease. International Journal of Environmental Health Research 13:175–183

    Article  Google Scholar 

  • Larson E, Duarte CG (2001) Home hygiene practices and infectious disease symptoms among household members. Public Health Nursing 18:116–127

    Article  CAS  Google Scholar 

  • Luby S, Syed AH, Atiullah N, Faizan MK, Fisher-Hoch S (2000) Limited effectiveness of home drinking water purification efforts in Karachi, Pakistan. International Journal of Infectious Diseases 4:3–7

    Article  CAS  Google Scholar 

  • Mara DD (2003) Water, sanitation and hygiene for the health of developing nations. Public Health 117:452–456

    Article  CAS  Google Scholar 

  • Mintz ED, Reiff F, Tauxe R (1995) Safe water treatment and storage in the home: a practical new strategy to prevent waterborne disease. Journal of the American Medical Association 273:948–953

    Article  CAS  Google Scholar 

  • Morris S, Cousens S, Kirkwood B, Arthur P, Ross D (1996) Is prevalence of diarrhea a better predictor of subsequent mortality and weight gain than diarrhea incidence? American Journal of Epidemiology 144:582–588

    CAS  Google Scholar 

  • Motarjemi Y, Kaferstein F, Moy G, Quevedo F (1993) Contaminated weaning food: a major risk for diarrhoea and associated malnutrition. Bulletin of the World Health Organization 71:79–92

    CAS  Google Scholar 

  • Nath KJ (2003) Home hygiene and environmental sanitation: a country situation analysis for India. International Journal of Environmental Health Research 13:S19–S28

    Article  Google Scholar 

  • Nielsen M, Hoogvorst A, Konradsen F, Mudasser M, van der Hoek W (2001) Childhood Diarrhea and Hygiene: Mothers’ Perceptions and Practices in the Punjab, Pakistan, Working Paper 25, Battaramulla, Sri Lanka: International Water Management Institute (IWMI)

  • Nuwayhid I, Habib RR, Harakeh S (2004) Understanding water, understanding health: the case of Bebnine in Akkar. In: A Participatory Approach towards Integrated Coastal Zone Management in Lebanon: Opportunities for Socio-Economic Growth and Environmental Protection, El-Fadel M (editor), Beirut, Lebanon: Water Resources Center, Environmental and Water Resources Engineering Program, IGESP, AUB

    Google Scholar 

  • Nyong AO, Kanaroglou PS (1999) Domestic water use in rural semiarid Africa: a case study of Katarko village in northeastern Nigeria. Human Ecology: An Interdisciplinary Journal 27:537

    Google Scholar 

  • Pruss A, Kay D, Fewtrell L, Bartram J (2002) Estimating the burden of disease from water, sanitation and hygiene at a global level. Environmental Health Perspectives 110:537–542

    Google Scholar 

  • Quick RE, Venczel L, Mintz ED, Soleto L, Aparicio J, Gironaz M, et al. (1999) Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy. Epidemiology and Infection 122:83–90

    Article  CAS  Google Scholar 

  • Schorling JB, McAuliffe JF, de Souza MA, Guerrant RL (1990) Malnutrition is associated with increased diarrhoea incidence and duration among children in an urban Brazilian slum. International Journal of Epidemiology 19:728–735

    Article  CAS  Google Scholar 

  • Semenza J, Roberts L, Henderson A, Bogan J, Rubin C (1998) Water distribution system and diarrheal disease transmission: a case study in Uzbekistan. American Journal of Tropical Medicine and Hygiene 59:941–946

    CAS  Google Scholar 

  • Sobsey MD (2002) Managing water in the home: accelerated health gains from improved water supply, Geneva: World Health Organization. Available: http://www.who.int/water_sanitation_health/dwq/wsh0207/en/ [accessed February 10, 2006]

  • Sobsey MD, Handzel T, Venczel L (2003) Chlorination and safe storage of household drinking water in developing countries to reduce waterborne disease. Water Science and Technology 47:221–228

    CAS  Google Scholar 

  • The National Commission for Lebanese Women (NCLW) (2000) First official report on the Convention on the Elimination of all Forms of Discrimination against Women, Beirut, Lebanon. Available: http://www.nclw.org.lb/textfile/CEDAW_report.pdf [accessed June 26, 2007]

  • Tokajian S, Hashwa F (2003) Water quality problems associated with intermittent water supply. Water Science and Technology 47:229–234

    CAS  Google Scholar 

  • Tumwine JK, Thompson J, Katua-Katua M, Mujwajuzi M, Johnstone N, Wood E, et al. (2002) Diarrhoea and effects of different water sources, sanitation and hygiene behaviour in East Africa. Tropical Medicine and International Health 7:750–756

    Article  Google Scholar 

  • United Nations Development Program (UNDP) (2008) Lebanon. Poverty and social development. Available: http://www.undp.org.lb/WhatWeDo/poverty.cfm [accessed October 23, 2008]

  • van der Hoek W, Feenstra SG, Konradsen F (2002) Availability of irrigation water for domestic use in Pakistan: its impact on prevalence of diarrhea and nutritional status of children. Journal of Health, Population and Nutrition 20:77–84

    Google Scholar 

  • World Bank (2008) Middle East and North Africa region (MENA)—Lebanon. Country brief. The World Bank 2008. Available: http://siteresources.worldbank.org/INTLEBANON/Resources/LEBANON-ENG2008AM.pdf [accessed October 23, 2008]

  • World Health Organization (WHO) (2002) Burden of disease in DALYs by cause, sex and mortality stratum in WHO Regions, estimates for 2001 as reported in World Health Report. Geneva: WHO. Available: http://www3.who.int/whosis/menu.cfm?path=evidence,burden,burden_estimates,burden_estimates_2001,burden_estimates_2001_region&language=english [accessed October 16, 2008]

  • World Health Organization (WHO) (2004) Guidelines for Drinking-water Quality, Geneva: WHO

    Google Scholar 

  • World Health Organization and United Nations Children’s Fund (WHO/UNICEF) (2000) Global water supply and sanitation assessment 2000 report. Geneva: WHO/UNICEF. Available: http://www.who.int/water_sanitation_health/monitoring/globalassess/en/ [accessed January 23, 2006]

  • World Health Organization and United Nations Children’s Fund (WHO/UNICEF) (2005) WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Water for Life: Making It Happen, Geneva: WHO/UNICEF

    Google Scholar 

  • Wright J, Gundry S, Conroy RM (2004) Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Tropical Medicine and International Health 9:106–117

    Article  Google Scholar 

  • Yassi A, Mas P, Bonet M, Tate RB, Fernandez N, Spiegel J, et al. (1999) Applying an ecosystem approach to the determinants of health in Centro Habana. Ecosystem Health 5:3–19

    Article  Google Scholar 

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Acknowledgments

The authors thank the community of Bebnine and the participants in this study. Special thanks to Ms. Hind Farah, the community coordinator. The research project was funded by a grant from IDRC, Canada.

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  1. Faculty of Health Sciences, American University of Beirut, 3 Dag Hammarskjöld Plaza, 8th Floor, New York, NY, 10017-2303, USA

    Grace E. El Azar, Rima R. Habib, Ziyad Mahfoud, Mutassem El-Fadel, Rami Zurayk, Mey Jurdi & Iman Nuwayhid

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  1. Grace E. El Azar
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  2. Rima R. Habib
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  3. Ziyad Mahfoud
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  4. Mutassem El-Fadel
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  7. Iman Nuwayhid
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Correspondence to Rima R. Habib.

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El Azar, G.E., Habib, R.R., Mahfoud, Z. et al. Effect of Women’s Perceptions and Household Practices on Children’s Waterborne Illness in a Low Income Community. EcoHealth 6, 169–179 (2009). https://doi.org/10.1007/s10393-009-0239-8

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