Thesis (doctoral)--Philipps Universität Marburg/Lahn. / Includes bibliographical references (p. 307-314).

Magister Philosophiae (Land and Agrarian Studies) - MPhil(LAS) / Water supply and sanitation remain a huge problem in townships and rural areas of South Africa, in effect affecting the water supply, hygiene and health of marginalized communities. Following democracy in 1994, South Africa’s new government embarked on a program of eradicating backlogs in water supply and sanitation that had become endemic under apartheid in townships and rural areas. In addition, South Africa’s constitution categorically states that every citizen has a right to a minimum of basic water supply and sanitation. Internationally, access to basic water supply and sanitation are fundamental human rights. Thus the South African government aims is to ensure that all South Africans have access to basic water and sanitation services. This study investigated the quantity and quality of water and how these effect sanitation and hygiene of communities using Walmer Township in the Nelson Mandela Bay Municipality as a case study. The study used a multi-pronged methodological approach including structured interviews with a sample of households, key informant interviews, focus group discussions, observations and secondary information. Although the Walmer Community felt that they had access to sufficient quantity of water for their daily use and that the quality of the water was fine, the reality was that most households use less than the daily minimum amount of water per person as required in the constitution because of the distance where they have to fetch the water, which is too far to collect more water than they absolutely need. There is need for municipality to provide more stand pipes in order to reduce the distance that most households have to walk to fetch water. 80% of Walmer residents still use the bucket system, which is the issue that the community is more aggrieved about. One of the reasons the bucket system persists is the unplanned development of the Township and the type of dwellings (mostly shacks) that people still use. Also, the Township has grown and mushroomed organically as a result of the constant influx of people looking for better economic opportunities from rural areas or other urban areas. This makes it very difficult for the municipality to plan for and provide services and infrastructure as the Municipality is always playing catch-up. Worse still, the average number of people that use each bucket toilet (over 80) makes it extremely difficult to maintain the toilets clean and in functional and usable state at all times. Another problem is that the buckets, in particular those managed by the municipality, are not collected as scheduled resulting in spill-over of the toilets. Most of all, there are currently no clear arrangements around management and maintenance of the bucket toilets. Therefore the impact that the bucket system has on the residents’ health and hygiene, and the general Township environment is dire. The uncontrolled and continuing influx of people into Walmer Township has led to very high population density, with the average number of people per household up to ten. Most people of working age in these households are unemployed, which means that most households in the Township depend on social grants for survival. The high unemployment rate and dependency on social grants by most households in Walmer Township means that the community cannot afford to pay for services and therefore depend on amenities provided by the Municipality. The majority of the population of Walmer Township depends on basic services provided by the Municipality. These are provided as public amenities available to all Walmer residents, which makes them largely ‘open access’. This has resulted in poor management and poor maintenance of these amenities. The unhygienic state of most of the bucket toilets and the poor state of water stand taps is as a result of this current management arrangement. It would improve management of these public amenities if a system of locating stand taps and bucket toilets to specific households that could limit access and use to these defined groups of households was introduced. These households would then be responsible for maintaining and managing use of the specific and allocated amenities. The current management arrangements for these public amenities point to the fact that there is currently lack of participatory planning and management between the Municipality and the community. The Municipality takes top-down decisions resulting in disjuncture between the Municipality and the Community in terms of real community needs, provision of these needs, and how they should be serviced and managed.

No description available.

Educating girls is advantageous for future livelihood security and socio economic development. Menstruating schoolgirls especially need to experience improved menstrual hygiene management (MHM) within schools in order to obtain quality education towards securing future as well as present wellbeing. This paper explores how menstruating schoolgirls’ opportunities are affected by insufficient water, sanitation and hygiene (WASH) facilities in schools within Sub-Saharan Africa. The required information has been gathered through a qualitative research method using scientifically based material on the situation of MHM in Sub-Saharan African schools as well as semi-structured questionnaires alongside my personal recollection of MHM. Focus has been given to the capabilities of menstruating schoolgirls under existing WASH facilities in schools analysed through the Capability Approach. Effects of poor MHM in schools are known to cause discomfort and poor constructive participation during lessons as well as decreased school attendance. A gender-based approach has also been examined which presents most schools as non-conducive towards girl’s education promotion. / Utbildning är gynnsam för deras framtida försörjningsmöjligheter samt för socioekonomisk utveckling. Menstruerande skolflickor är mest utsatta under de otillräckliga sanitetsförhållanden som råder i flera skolor söder om Sahara. Den här rapporten utforskar skolflickors förmåga att sköta deras menshygien under skolvistelsen samt hur bristande sanitetsresurser påverkar flickornas framtida utsikter och akademiska kapacitet. Undersökningen är baserad på en kombination av kvalitativa metoder och material som vetenskapliga studier, en semistrukturerade enkätundersökning samt min egen erfarenhet av menshygien i skolor söder om Sahara. Fokus har tillägnats menstruerande skolflickors möjligheter att hantera deras mens i ohygieniska förhållanden genom att koppla detta till ”The Capability Approach”. Avsaknaden av fungerande sanitetsstrukturer försämrar skolflickors välmående vilket leder till nedsatt deltagande under lektioner samt minskad skolgång vid mens. En könsbaserad utgångspunkt har det också påvisat att skolorna är mindre anpassande för flickor.

Magister Public Health - MPH / Background and Rationale The World Health Organization (WHO) has shown that the provision of Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) of many low and middle-income countries is poor. This is compounded by the lack of national plans and consolidated data on WASH in HCFs. This study assessed the availability and adequacy of Water Sanitation and Hygiene (WASH) infrastructure in 13 mission hospitals spanning 13 districts in Zambia. The objectives of this study were to identify the different kinds of WASH infrastructure available, and their adequacy, and factors influencing the status of WASH infrastructure and services in the selected hospitals. Methodology This study had a mixed methods design with semi-quantitative, descriptive and qualitative components. Assessments were conducted of the WASH infrastructure on the hospital property, and specifically in the male medical wards and outpatient facilities as two tracer areas, using a WHO checklist adapted and administered by the researcher. Checklist items were assigned scores (0=absent/bad to 2=on target/good) and total WASH scores for each facility compiled. For the qualitative component, individual semi-structured interviews using an interview guide were conducted, also by the researcher, with the facility managers and the head staff of the male medical wards. Results Overall coverage with an improved water source was reasonably good with 11 of the 13 hospitals reporting availability of improved water sources within the facilities. Hand washing basin coverage was similarly good. In contrast, coverage by well-functioning toilets was not as high, with 5 hospitals reporting toilets that were either broken, blocked, or having no running water and no toilet paper. Facility WASH scores varied from 22 (38%) to 57 (97%) out of a possible total of 58 points. Most of the Facility Managers indicated that the hospital WASH infrastructure was old, and with frequent breakdowns. This was worsened by lack of readily available spares and materials for repairing once there was a fault. Conclusion This study reveals an uneven coverage of WASH across facilities and elements, with poor sanitation a challenge across facilities. This is compounded by ongoing challenges in WASH infrastructure maintenance. Moving forward, there is need for government to develop a clear policy on WASH in HCFs. A national plan with resources and a monitoring framework need to be in place for streamlined support and tracking of progress by all stakeholders.

Diarrheal diseases are a global public health burden, killing 1.8 million people annually. Diarrhea disproportionately affects children and those in poverty. Most diarrheal cases can be prevented through safe drinking water, basic hygiene and/or sanitation measures, with drinking water interventions having the most impact on reducing diarrheal disease. A meta-evaluation was completed of studies evaluating a specific household water treatment method, the biosand water filter. Results from the meta-evaluation illustrate that biosand water filters improve drinking water quality and reduce diarrheal disease. However, there is no generally agreed upon field method for determining biosand water filter effectiveness that is useable in low-resource communities. A pilot study was conducted of potential field use indicators, including the Colilert coliform Presence/ Absence test, hydrogen sulfide, alkalinity, hardness, pH, and fluorescently-labeled latex microspheres. The study included both laboratory and field testing. The Colilert Presence/ Absence test had the highest correlation to the United States Environmental Protection Agency standard method (IDEXX Quantitrays), but more data is needed before making a recommendation. This study adds to understanding about evaluation of biosand water filters and provides preliminary data to address the need for a field use indicator for biosand water filters.

Climate change and increased pressure on water resources through urban and peri-urban population growth present some major uncertainties to the sustainable provision of good quality water, sanitation and hygiene (WASH) services, particularly to small-scale decentralized systems which are considered more vulnerable compared to centralized systems. The concept of “resilience” could be useful when dealing with such uncertainties. It deals with planning for shocks and stressors which could help address long-term water security and sanitation challenges. The aim of this research is to explore the relevance of the concept of resilience in dealing with uncertainties for decentralized WASH systems. Through literature review, interviews (n=22) and group discussions (n=18), the relevance of the 7 resilience principles, developed by SRC, to WASH planning for decentralized systems was explored. WHO community water and sanitation planning guidelines were reviewed to determine how resilience could add useful aspects to management of decentralised WASH systems.  Results showed that the resilience concept is important in planning and management of decentralized WASH systems, since, with the resilience principles as a basis, there is potential to involve different stakeholders to share knowledge, skills and resources across multiple scales. The three resilience principles considered most important from the 7 SRC resilience principles for decentralized WASH were identified as: 1) Broadening participation, 2) Maintenance of diversity and redundancy, and 3) Management of slow changing variables and feedbacks. Other important WASH aspects missing from the resilience principles were: 1) Contextuality, 2) Accountability, 3) Equity and human rights, 4) Monitoring and maintenance, 5) Resource capacity. Two case studies served as examples of how decentralized WASH systems are managed in a high-income country (Värmdö, Sweden) and  a low/middle income country (MSETO, Kenya). In both cases, applied resilience principles were identified together with areas of improvement. With reference to resilience, Värmdö municipality showed strength in the flow of information (connectivity) between actors but lacked integrated WASH planning guidelines and diversity of water supplies. The MSETO project exhibited strength in overlapping responsibilities (polycentric governance) but lacked management of slow changing variables and feedbacks, linked to the lack of adequate re-sources. The analysis of WHO Water Safety Plans and sanitation safety planning guidelines through the resilience framework revealed that the WHO guidelines have a heavy focus on technical aspects and lack an integrated approach involving polycentric governance and complex adaptive system thinking. There is need for the revision of the guide-lines to incorporate community social aspects, strategies of improving water availability and consideration of complex adaptive systems thinking. Municipalities and practitioners are recommended to consider resilience principles as well as the identified missing aspects in WASH planning and interventions. Further research is needed investigating necessary conditions for the application of resilience principles and important trade-offs.

Les Objectifs de Développement Durable visent d'ici 2030 un « accès pour tous à des services d'assainissement et d'hygiène adéquats, en mettant fin à la défécation à l'air libre ». Un service d'assainissement peut-être défini par ses composantes techniques et sociales, et leurs interactions. Dans l'optique de proposer des pistes d'améliorations des services d'assainissement en zone tropicale, les travaux de cette thèse ont porté à la fois sur des infrastructures de traitement et sur l'implication de l'ensemble des acteurs dans la définition du service. L'analyse croisée des contextes des départements d'outre-mer (DOM) français et du Sénégal a permis d'identifier des contraintes qui pèsent sur le secteur de l'assainissement en zone tropicale. Du point de vue des infrastructures de traitement, ces contraintes nous ont amenées à proposer des procédés issus de la famille des Filtres Plantés de Végétaux (FPV) comme solutions à priori pertinentes. Cette thèse présente leurs adaptations à la zone tropicale, en détaillant les choix retenus pour le dimensionnement, la conception des filtres et le choix des végétaux. Une centaine de campagnes de suivi ont été réalisées sur 7 stations pilotes en tailles réelles, à travers les 5 DOM. Les résultats montrent que malgré une plus grande compacité, le dimensionnement proposé permet de conserver des niveaux de traitement au moins comparables à ceux observés en climat tempéré. Compte tenu des contraintes climatiques et organisationnelles en milieu tropical, une analyse de leur résilience à des perturbations et de leur fiabilité de traitement a été réalisée par une étude statistique sur les données produites par l'autosurveillance réglementaire. Elle montre que les FPV sont également plus fiables que les procédés de traitement conventionnel les plus répandus pour les petites collectivités. Ce qui s'explique à la fois par la barrière physique que représente ces procédés de cultures fixées sur support fin ainsi que par des besoins en entretien plus réduits. Le deuxième axe de recherche part du constat d'un manque de concertation entre acteurs au moment de la planification de l'assainissement, étape qui préside à la construction du système d'assainissement. En particulier, les utilisateurs, leurs besoins et leurs contraintes sont très peu et mal pris en compte. La modélisation d'accompagnement pourrait permettre de créer à la fois un support (le modèle) permettant de discuter des choix techniques et de leurs conséquences, ainsi que le cadre dans lequel les différents acteurs pourraient échanger leurs points de vue et trouver un consensus soutenable. Un processus de modélisation d'accompagnement a été conçu et mis en place sur la planification de l'assainissement dans 2 zones (urbaine et rurale) du Sénégal. Il nécessitait, pour proposer des scénarios viables, d'intégrer une part non négligeable de connaissances expertes. Centré sur les populations, ce processus a permis la création d'un premier modèle générique sur l'accès à l'assainissement qui prend la forme d'un jeu de rôle. La pertinence de tels outils dans la caractérisation des besoins des usagers a été évaluée. Par ailleurs, l'attention a été portée sur l'acceptation par les usagers du service proposé et sa traduction en volonté de contribution / Sustainable Develoment Goals aim by 2030, to « achieve access to adequate and equitable sanitation and hygiene for all and end open defecation », by « using safely managed sanitation services ». Sanitation service can be defined by its technical and social components, and their interactions. This thesis focuses on both treatment infrastructures and involvement of all the stakeholders into service definition. Cross analysis of French Overseas Territories (FOT) and Senegal contexts, has identified common constraints that weigh on sanitation sector in tropical areas. From treatment infrastructure point of view, these constraints lead to suggest treatment wetlands systems and particularly French vertical-flow treatment wetland (FS-VFTW) to easier sludge managment, as a relevant solution. Their adaptation for tropical climate is the subjet of the first axis of our work. It aimed at defining their adaptation in terms of design, plant choices and defining the treatment wetlands type to implement according to outlet requirements. A hundred of 24h sampling campains were performed on 7 full scale demonstration plants, accross the 5 FOTs. Results show that despite more compacity, the proposed design allows maintaining performances at least similar to those observed in temperate climate. Due to climatic and organizational constraints inn tropical climate, a statistical analysis has been done to point out the resilience and reliability of the systems based on regulatory selfmonitoring data. It highlights the fact that FS-VFTWs are more reliable than most of the conventional treatment processes when applied for small size communities. Their physical barrier (filter) and their lower maintenance requirement explain this observation. The second axis of our research is based on an observed lack of consultation between stakeholders during the sanitation planning phase, which is responsible for the construction of the sanitation system. In particular, the users, their needs and their constraints are poorly and badly taken into account. Companion modeling approach could create both a support (the model) for discussing technical choices, as well as the framework within which the stakeholders could exchange points of view and find a sustainable consensus. Such a process has been developed and implemented for sanitation planning in 2 areas (urban and rural) of Senegal. Focused on household population, this process has led to create a generic model for sanitation access, embodied as a role playing game, which include a significant part of expert knowledge. The relevance of such tools in the characterization of user needs has been evaluated. In addition, attention was paid to users' acceptance of the proposed service and its translation into a willingness to contribute

Philosophiae Doctor - PhD (School of Public Health) / Poor water, sanitation and hygiene (WASH) services and practices in communities are known to be responsible for most of the infections occurring among infants and young children in developing countries. A combined effect of disease, poor diet, care practices and other factors among infants/children are known to lead to undernutrition reported in most developing countries. Apart from the reduced growth and productivity potential that malnutrition exhibits on the affected population, it is also an underlying cause to 50% of child mortality in poor communities. In light of this, the primary objective of the study was to evaluate the effect of poor WASH practices on growth and infectious disease incidence in infants and young children aged 6-23 months in the rural district of Monze in Zambia.

Background: Antenatal care (ANC), facility delivery and postnatal care (PNC), are proven to reduce maternal and child mortality and morbidity in high burden settings. However, few rural pregnant women use these services sufficiently and it is essential to identify the barriers. Aim: The aim of this study was to examine barriers, with a focus on water, sanitation and hygiene (WASH), affecting women’s decision to seek care during pregnancy, childbirth and postnatal period in rural Kenya, and to examine if the Afya intervention helped overcome barriers. Methods: A qualitative study was conducted in the Siaya County, Kenya. 25 mothers were selected by using purposive sampling for in-depth interviews and focus group discussions. Assessment of WASH facilities was conducted at 5 healthcare facilities. Data were analysed by content analysis method. The “three delay model” informed the analytic process and discussion. Results: Women delayed seeking or did not attend ANC and PNC or gave birth at home, due to lack of knowledge of benefits of maternal health services and on complications; traditional and religious beliefs; embarrassed over pregnancy; busy with other life activities or of fear of HIV status and hospitals. Gender norms, distance and transport costs were the contributing factor for delaying in reaching the hospital. Unprofessional and inadequate number of staff, lack of equipment and supplies, and the water, sanitation and hygiene quality were factors delaying receiving quality care. The assessment showed on inadequate WASH facilities. Conclusion: Use of antenatal care, delivery and postnatal care in rural western Kenya is influenced by several barriers. The findings suggest a need to increase the knowledge about ANC and PNC, and to lower barriers preventing women from reaching the healthcare facility. There is also a need to improve the WASH facilities and the healthcare personnel’s treatment.