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Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress

BACKGROUND: Approximately 18% of Sub-Saharan Africa’s urban population relies on shared sanitation facilities, which are shared by one or more households. While there is growing recognition of sanitation’s relationship with stress and well-being – particularly among women – most research has focused...

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Autores principales: Shiras, Tess, Cumming, Oliver, Brown, Joe, Muneme, Bacelar, Nala, Rassul, Dreibelbis, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060455/
https://www.ncbi.nlm.nih.gov/pubmed/30045729
http://dx.doi.org/10.1186/s12914-018-0169-z
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author Shiras, Tess
Cumming, Oliver
Brown, Joe
Muneme, Bacelar
Nala, Rassul
Dreibelbis, Robert
author_facet Shiras, Tess
Cumming, Oliver
Brown, Joe
Muneme, Bacelar
Nala, Rassul
Dreibelbis, Robert
author_sort Shiras, Tess
collection PubMed
description BACKGROUND: Approximately 18% of Sub-Saharan Africa’s urban population relies on shared sanitation facilities, which are shared by one or more households. While there is growing recognition of sanitation’s relationship with stress and well-being – particularly among women – most research has focused on rural populations and the transition from open defecation and/or unimproved latrines to private shared sanitation. This study explores sanitation-related stressors among users of both improved and unimproved shared sanitation facilities. METHODS: This study was nested within the larger MapSan health impact trial (Trial Registration: NCT02362932). Participants were recruited from the control arm of the trial (Traditional Latrine (TL) users) and intervention arm, which received one of two improved shared sanitation facilities – Shared Latrines (SL) shared by up to 20 individuals and Community Sanitation Blocks (CSBs) shared by more than 20 individuals. Sampling was informed by a life stage perspective to reflect diversity in sanitation needs and experiences within the population. Data included 96 in-depth interviews, 7 focus group discussions, and 25 unstructured observations. Data collection and analysis followed a Grounded Theory approach, which was used to identify the key domains of sanitation-related stress among participants. A semi-structured tool was applied to all female interview transcripts to assess the frequency and severity of key stressors. RESULTS: Participants reported stress due to: lack of safety; lack of privacy; disgust about the latrine condition; and collective action failure in terms of managing the latrine, often causing neighborhood conflict or unhygienic sanitation conditions. Fewer SL and CSB users reported specific stress domains and – with the exception of perceived safety – reported fewer severe stressors. The leading cause of stress reduction due to the intervention was decreased disgust followed by increased privacy and safety. CONCLUSIONS: Our data suggest that “improved”, shared facilities can reduce stress when proper maintenance and management systems are in place. Private, shared sanitation only had limited impact on users’ perceptions of safety, particularly at night, suggesting that safety concerns extend beyond the physical latrine structure. Our research demonstrates that factors including latrine location and neighborhood violence are important determinants of safety perceptions and corresponding psychosocial stress.
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spelling pubmed-60604552018-07-31 Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress Shiras, Tess Cumming, Oliver Brown, Joe Muneme, Bacelar Nala, Rassul Dreibelbis, Robert BMC Int Health Hum Rights Research Article BACKGROUND: Approximately 18% of Sub-Saharan Africa’s urban population relies on shared sanitation facilities, which are shared by one or more households. While there is growing recognition of sanitation’s relationship with stress and well-being – particularly among women – most research has focused on rural populations and the transition from open defecation and/or unimproved latrines to private shared sanitation. This study explores sanitation-related stressors among users of both improved and unimproved shared sanitation facilities. METHODS: This study was nested within the larger MapSan health impact trial (Trial Registration: NCT02362932). Participants were recruited from the control arm of the trial (Traditional Latrine (TL) users) and intervention arm, which received one of two improved shared sanitation facilities – Shared Latrines (SL) shared by up to 20 individuals and Community Sanitation Blocks (CSBs) shared by more than 20 individuals. Sampling was informed by a life stage perspective to reflect diversity in sanitation needs and experiences within the population. Data included 96 in-depth interviews, 7 focus group discussions, and 25 unstructured observations. Data collection and analysis followed a Grounded Theory approach, which was used to identify the key domains of sanitation-related stress among participants. A semi-structured tool was applied to all female interview transcripts to assess the frequency and severity of key stressors. RESULTS: Participants reported stress due to: lack of safety; lack of privacy; disgust about the latrine condition; and collective action failure in terms of managing the latrine, often causing neighborhood conflict or unhygienic sanitation conditions. Fewer SL and CSB users reported specific stress domains and – with the exception of perceived safety – reported fewer severe stressors. The leading cause of stress reduction due to the intervention was decreased disgust followed by increased privacy and safety. CONCLUSIONS: Our data suggest that “improved”, shared facilities can reduce stress when proper maintenance and management systems are in place. Private, shared sanitation only had limited impact on users’ perceptions of safety, particularly at night, suggesting that safety concerns extend beyond the physical latrine structure. Our research demonstrates that factors including latrine location and neighborhood violence are important determinants of safety perceptions and corresponding psychosocial stress. BioMed Central 2018-07-25 /pmc/articles/PMC6060455/ /pubmed/30045729 http://dx.doi.org/10.1186/s12914-018-0169-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Shiras, Tess
Cumming, Oliver
Brown, Joe
Muneme, Bacelar
Nala, Rassul
Dreibelbis, Robert
Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title_full Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title_fullStr Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title_full_unstemmed Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title_short Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress
title_sort shared latrines in maputo, mozambique: exploring emotional well-being and psychosocial stress
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060455/
https://www.ncbi.nlm.nih.gov/pubmed/30045729
http://dx.doi.org/10.1186/s12914-018-0169-z
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