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Towards Effective and Socio-Culturally Appropriate Sanitation and Hygiene Interventions in the Philippines: A Mixed Method Approach

Institute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2015, 12(2), 1902-1927; https://doi.org/10.3390/ijerph120201902
Received: 9 September 2014 / Revised: 4 January 2015 / Accepted: 2 February 2015 / Published: 5 February 2015
Inadequate water, sanitation and hygiene (WASH) represent an important health burden in the Philippines. The non-governmental organisation Fit for School intends to complement its handwashing programme in schools with sanitation interventions. The objectives of this mixed-method study therefore were to describe WASH practices and their impact on childhood diarrhoea in the Philippines, and to examine socio-cultural and environmental factors underlying defecation and anal cleansing practices in Northern Mindanao. We quantified the effect of WASH practices on diarrhoea through logistic regression models, using the Philippine Demographic and Health Survey 2008. When adjusting for non-modifiable factors, susceptibility and socioeconomic factors, WASH factors failed to show a statistically significant effect. Focus group discussions were held with women in urban and rural Northern Mindanao, and findings analysed using thematic analysis. Defecation and anal cleansing behaviours were constrained by the physical environment, particularly the lack of clean, safe, comfortable and private facilities. Individual determinants of behaviour were influenced by habit and motivations such as disgust, with some evidence of planned behaviour. Where available, water was the preferred material for anal cleansing. This study combines nationally-representative quantitative data with local in-depth qualitative insights, constituting critical formative research in the development of effective and appropriate interventions. View Full-Text
Keywords: water; sanitation and hygiene (WASH); anal cleansing behaviour; demographic and health survey (DHS); mixed methods; focus group discussion; thematic analysis; Philippines; developing countries; complex interventions water; sanitation and hygiene (WASH); anal cleansing behaviour; demographic and health survey (DHS); mixed methods; focus group discussion; thematic analysis; Philippines; developing countries; complex interventions
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Pfadenhauer, L.M.; Rehfuess, E. Towards Effective and Socio-Culturally Appropriate Sanitation and Hygiene Interventions in the Philippines: A Mixed Method Approach. Int. J. Environ. Res. Public Health 2015, 12, 1902-1927.

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