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Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis

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  • Sclar, G.D.
  • Penakalapati, G.
  • Caruso, B.A.
  • Rehfuess, E.A.
  • Garn, J.V.
  • Alexander, K.T.
  • Freeman, M.C.
  • Boisson, S.
  • Medlicott, K.
  • Clasen, T.

Abstract

The WHO defines health not as the absence of disease but as a “state of complete physical, mental, and social well-being.” To date, public health research on sanitation has focused mainly on the impact of sanitation on infectious diseases and related sequelae, such as diarrhea and malnutrition. This review focuses on the mental and social well-being implications of sanitation. We systematically searched leading databases to identify eligible studies. Qualitative studies were assessed using a 17-point checklist adapted from existing tools, while quantitative studies were assessed using the Liverpool Quality Appraisal Tool. We followed a best-fit framework synthesis approach using six a priori well-being dimensions (privacy, shame, anxiety, fear, assault, and safety), which were examined using line-by-line coding. Two additional dimensions (dignity and embarrassment) inductively emerged during coding for a total of eight well-being outcomes. We then synthesized coded text for each dimension into descriptive themes using thematic analysis. For quantitative studies, we extracted any measures of association between sanitation and well-being. We identified 50 eligible studies covering a variety of populations and sanitation contexts but many studies were conducted in India (N = 14) and many examined the sanitation experience for women and girls (N = 19). Our synthesis results in a preliminary conceptual model in which privacy and safety, including assault, are root well-being dimensions. When people perceive or experience a lack of privacy or safety during open defecation or when using sanitation infrastructure, this can negatively influence their mental and social well-being. We found that perceptions and experiences of privacy and safety are influenced by contextual and individual factors, such as location of sanitation facilities and user's gender identity, respectively. Privacy and safety require thorough examination when developing sanitation interventions and policy to ensure a positive influence on the user's mental and social well-being.

Suggested Citation

  • Sclar, G.D. & Penakalapati, G. & Caruso, B.A. & Rehfuess, E.A. & Garn, J.V. & Alexander, K.T. & Freeman, M.C. & Boisson, S. & Medlicott, K. & Clasen, T., 2018. "Exploring the relationship between sanitation and mental and social well-being: A systematic review and qualitative synthesis," Social Science & Medicine, Elsevier, vol. 217(C), pages 121-134.
    • Handle: RePEc:eee:socmed:v:217:y:2018:i:c:p:121-134
    DOI: 10.1016/j.socscimed.2018.09.016
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    2. Brewis, Alexandra & Choudhary, Neetu & Wutich, Amber, 2019. "Household water insecurity may influence common mental disorders directly and indirectly through multiple pathways: Evidence from Haiti," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    3. Sania Ashraf & Cristina Bicchieri & Upasak Das & Tanu Gupta & Alex Shpenev, 2024. "Learning from diversity: ``jati" fractionalization, social expectations and improved sanitation practices in India," Discussion Papers 24-01, Indian Statistical Institute, Delhi.
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    5. Débora Cynamon Kligerman & Telma Abdalla de Oliveira Cardoso & Simone Cynamon Cohen & Déborah Chein Bueno de Azevedo & Graziella de Araújo Toledo & Ana Paula Chein Bueno de Azevedo & Susanne M. Charle, 2022. "Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil," IJERPH, MDPI, vol. 19(19), pages 1-26, October.
    6. Renee De Shay & Dawn L. Comeau & Gloria D. Sclar & Parimita Routray & Bethany A. Caruso, 2020. "Community Perceptions of a Multilevel Sanitation Behavior Change Intervention in Rural Odisha, India," IJERPH, MDPI, vol. 17(12), pages 1-16, June.
    7. Robinson, Jude & Chiumento, Anna & Kasujja, Rosco & Rutayisire, Theoneste & White, Ross, 2022. "The ‘good life’, personal appearance, and mental health of Congolese refugees in Rwanda and Uganda," Social Science & Medicine, Elsevier, vol. 293(C).
    8. Michela Accerenzi & Pablo Brañas-Garza & Diego Jorrat, 2022. "Parents’ knowledge and predictions about the age of menarche: Experimental evidence from Honduras," Working Papers 132, Red Nacional de Investigadores en Economía (RedNIE).
    9. Sri Irianti & Puguh Prasetyoputra, 2021. "Rural–Urban Disparities in Access to Improved Sanitation in Indonesia: A Decomposition Approach," SAGE Open, , vol. 11(3), pages 21582440211, July.
    10. Ross, Ian & Cumming, Oliver & Dreibelbis, Robert & Adriano, Zaida & Nala, Rassul & Greco, Giulia, 2021. "How does sanitation influence people's quality of life? Qualitative research in low-income areas of Maputo, Mozambique," Social Science & Medicine, Elsevier, vol. 272(C).
    11. Sania Ashraf & Cristina Bicchieri & Upasak Das & Tanu Gupta & Alex Shpenev, 2023. "Learning from diversity: jati fractionalization, social expectations and improved sanitation practices in India," Papers 2312.15221, arXiv.org.

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