Context-specific approaches to the assessment of WASH exposures, interventions, and outcomes
Wolfe, Marlene.
2019
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Infectious diseases
are a leading cause of morbidity and mortality worldwide, and there has been a worldwide
increase in outbreaks and emerging infectious diseases (EIDs) since the middle of the
20th century. Water, sanitation, and hygiene (WASH) interventions have the potential to
interrupt transmission of infectious diseases spread by direct or indirect contact,
particularly via the fecal-oral ... read moreroute, and are widely used in community disease
prevention and for infection prevention and control. However, WASH interventions often
focus on access to services without accounting for the content of those services and the
ways in which the exposure to risks, appropriate interventions, and most important
health outcomes may differ in each context. The goal of this dissertation is to present
five case studies developing an argument that WASH-related infectious challenges can be
addressed more effectively when they are assessed with a context-specific perspective
along the causal chain of disease. This process includes: 1) assessing exposure to
identify sources of risk, 2) designing and implementing interventions that address key
pathogens and transmission pathways, and, 3) assessing the health outcomes of greatest
concern. The five projects within these three themes include one project investigating
exposure to zoonotic and antimicrobial resistant pathogens on hands in India, three
projects evaluating handwashing interventions used during the Ebola outbreak in
2014-2016, and one project investigating the relationship between intestinal parasitic
infection and child development. Each of these chapters investigates ways in which
context-specificity can be addressed and the usefulness of the information that can be
gained. Results confirmed that investigations of context-specificity can provide
valuable information to guide WASH activities in the field, and the projects in this
dissertation present approaches to exploring this context specificity and providing
richer, more contextualized information about exposures, interventions, and outcomes.
This body of work demonstrates that taking this perspective can prompt valuable
improvements in WASH approaches, and this research should be continued to provide more
concrete recommendations for best practices against the changing landscape of infectious
disease.
Thesis (Ph.D.)--Tufts University, 2019.
Submitted to the Dept. of Civil Engineering.
Advisor: Daniele Lantagne.
Committee: Amy Pickering, Kara Nelson, and Steve Luby.
Keyword: Environmental health.read less - ID:
- pz50h842w
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