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      What If Your Husband Doesn’t Feel the Pressure? An Exploration of Women’s Involvement in WaSH Decision Making in Nyanchwa, Kenya

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          Abstract

          Access to water, sanitation and hygiene (WaSH) is a major challenge in sub-Saharan Africa (SSA). Women and girls suffer the main burden of a lack of access to WaSH because they are primarily responsible for collecting water for their homes. However, they are often excluded from WaSH decision-making and implementation processes. This research sought to explore women’s experiences in participating in WaSH decision-making through a case study in Nyanchwa, Kenya. Twelve (12) key informant interviews were conducted with community leaders and members regarding challenges and possible measures for enhancing women and girls’ participation in WaSH decision-making. From this research, it is evident that economic challenges and cultural factors such as male dominance, greatly inhibit women and girls’ participation in WaSH decision-making and implementation processes. Other factors such as time constraints and low literacy rates also emerged. The paper concludes with a call for collaboration among women’s groups to enhance collective action for improved access to WaSH. This will undoubtedly lead to enhanced community health and wellbeing (Sustainable Development Goal 3, SDG3) through the empowerment of women (Sustainable Development Goal 5, SDG5).

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          Menstrual health and school absenteeism among adolescent girls in Uganda (MENISCUS): a feasibility study

          Background Management of menstruation can present substantial challenges to girls in low-income settings. In preparation for a menstrual hygiene intervention to reduce school absenteeism in Uganda, this study aimed to investigate menstruation management practices, barriers and facilitators, and the influence of menstruation on school absenteeism among secondary school students in a peri-urban district of Uganda. Methods Qualitative and quantitative studies were conducted among consenting girls and boys aged 14–17 years in four secondary schools in Entebbe sub-District, Uganda. Methods included group and in-depth interviews with students, a quantitative cross-sectional questionnaire, a prospectively self-completed menstrual diary, key informant interviews with policy makers, and observations of school water, sanitation and hygiene facilities. Multiple logistic regression was used to assess factors associated with school absenteeism during the most recent menstrual period. Results Girls reported substantial embarrassment and fear of teasing related to menstruation in the qualitative interviews, and said that this, together with menstrual pain and lack of effective materials for menstrual hygiene management, led to school absenteeism. All policy makers interviewed reported poverty and menstruation as the key factors associated with school attendance. The 352 girls with questionnaire data had a median age of 16 (inter-quartile range (IQR) = 15,16) years, with median age at menarche of 13 (IQR = 13,14) years. Of these, 64 girls (18.7%) reported having stained their clothes and 69 (19.7%) reported missing at least 1 day of school, during their most recent period. Missing school during the most recent period was associated with physical symptoms (headache (odds ratio (OR) = 2.15, 95%CI:1.20, 3.86), stomach pain (OR = 1.89, 95%CI:0.89, 4.04), back pain (OR = 1.75, 95%CI:0.97, 3.14), and with changing protection 4 or more times per 24 h period (OR = 2.08, 95%CI:1.06, 4.10). In the diary sub-study among 40 girls, school absence was reported on 28% of period-days, compared with 7% of non-period days (adjusted odds ratio = 5.99, 95%CI:4.4, 8.2; p < 0.001). Conclusion In this peri-urban Ugandan population, menstruation was strongly associated with school attendance. Evaluation of a menstrual management intervention that address both psychosocial (e.g. self-confidence, attitudes) and physical (e.g. management of pain, use of adequate menstrual hygiene materials, improved water and sanitation facilities) aspects of menstruation are needed.
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            Challenges to changing health behaviours in developing countries: a critical overview.

            This overview of recent research on health behaviour change in developing countries shows progress as well as pitfalls. In order to provide guidance to health and social scientists seeking to change common practices that contribute to illness and death, there needs to be a common approach to developing interventions and evaluating their outcomes. Strategies forming the basis of interventions and programs to change behaviour need to focus on three sources: theories of behaviour change, evidence for the success and failure of past attempts, and an in-depth understanding of one's audience. Common pitfalls are a lack of attention to the wisdom of theories that address strategies of change at the individual, interpersonal, and community levels. Instead, programs are often developed solely from a logic model, formative qualitative research, or a case-control study of determinants. These are relevant, but limited in scope. Also limited is the focus solely on one's specific behaviour; regardless of whether the practice concerns feeding children or seeking skilled birth attendants or using a latrine, commonalities among behaviours allow generalizability. What we aim for is a set of guidelines for best practices in interventions and programs, as well as a metric to assess whether the program includes these practices. Some fields have approached closer to this goal than others. This special issue of behaviour change interventions in developing countries adds to our understanding of where we are now and what we need to do to realize more gains in the future. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Violence, gender and WASH: spurring action on a complex, under-documented and sensitive topic

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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                18 May 2019
                May 2019
                : 16
                : 10
                : 1763
                Affiliations
                [1 ]Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3GI, Canada; susan.elliott@ 123456uwaterloo.ca
                [2 ]School of Kinesiology and Health Studies, Queen’s University, 28 Division St, Kingston, ON K7L 3N6, Canada; eb120@ 123456queensu.ca
                Author notes
                [* ]Correspondence: tzabu@ 123456uwaterloo.ca
                Article
                ijerph-16-01763
                10.3390/ijerph16101763
                6572541
                31109038
                2d4624d2-b355-4704-a312-222720903b99
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 March 2019
                : 14 May 2019
                Categories
                Article

                Public health
                women and girls,wash,participation,finance,kenya
                Public health
                women and girls, wash, participation, finance, kenya

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