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      Having a toilet is not enough: the limitations in fulfilling the human rights to water and sanitation in a municipal school in Bahia, Brazil

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          Abstract

          Background

          This article addresses the enjoyment of the human rights to water and sanitation (HRTWS), in particular access to toilets, in a public school in Bahia, Brazil.

          Methods

          Participant observation of the school’s routine, focus groups with students in grades 8 and 9 of primary school (13 to 17 years old) and individual, semi-structured, interviews with members of school staff were applied, exploring access to water and sanitation by adolescent girls and boys.

          Results

          Students and school staff reported that the amount of toilets was insufficient and that their conditions were often inadequate because they were plugged or dirty. The impact on girls is greater as toilets do not offer a clean and healthy environment for menstrual hygiene management. Several elements of the normative content of the HRTWS, especially accessibility, acceptability, quality, safety and dignity, were largely not fulfilled. The study identified that, to comply with the HRTWS, it is necessary to go beyond infrastructure, as the lack of maintenance; cultural elements and student participation hinder the usage of sanitary facilities. Since schools can be privileged spaces to train critical and reflective citizens and to foster autonomy and emancipation, education oriented by human rights and citizenship is an opportunity for a more equitable society. By increasing access to social, economic and cultural rights in all phases and aspects of life, including when children and adolescents are in a school environment, people are able to enjoy better living conditions and a higher standard of health.

          Conclusions

          The study raised the importance of considering each community’s sociocultural aspects in analyzing access to sanitary facilities in schools, which are spaces where citizens’ rights should be exercised and fulfilled.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-019-6469-y) contains supplementary material, which is available to authorized users.

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          Most cited references25

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          Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

          Annette Prüss-Ustün, Jamie Bartram, Thomas Clasen … (2014)
          Objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.
          Article 0 comments Cited 331 times – based on 0 reviews     Review now
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            Water, sanitation and hygiene for the prevention of diarrhoea

            Sandy Cairncross, Caroline Hunt, Sophie Boisson … (2010)
            Background Ever since John Snow’s intervention on the Broad St pump, the effect of water quality, hygiene and sanitation in preventing diarrhoea deaths has always been debated. The evidence identified in previous reviews is of variable quality, and mostly relates to morbidity rather than mortality. Methods We drew on three systematic reviews, two of them for the Cochrane Collaboration, focussed on the effect of handwashing with soap on diarrhoea, of water quality improvement and of excreta disposal, respectively. The estimated effect on diarrhoea mortality was determined by applying the rules adopted for this supplement, where appropriate. Results The striking effect of handwashing with soap is consistent across various study designs and pathogens, though it depends on access to water. The effect of water treatment appears similarly large, but is not found in few blinded studies, suggesting that it may be partly due to the placebo effect. There is very little rigorous evidence for the health benefit of sanitation; four intervention studies were eventually identified, though they were all quasi-randomized, had morbidity as the outcome, and were in Chinese. Conclusion We propose diarrhoea risk reductions of 48, 17 and 36%, associated respectively, with handwashing with soap, improved water quality and excreta disposal as the estimates of effect for the LiST model. Most of the evidence is of poor quality. More trials are needed, but the evidence is nonetheless strong enough to support the provision of water supply, sanitation and hygiene for all.
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              Menstrual hygiene management among adolescent girls in India: a systematic review and meta-analysis

              Anna van Eijk, M Sivakami, Mamita Bora Thakkar … (2016)
              Objectives To assess the status of menstrual hygiene management (MHM) among adolescent girls in India to determine unmet needs. Design Systematic review and meta-analysis. We searched PubMed, The Global Health Database, Google Scholar and references for studies published from 2000 to September 2015 on girls’ MHM. Setting India. Participants Adolescent girls. Outcome measures Information on menarche awareness, type of absorbent used, disposal, hygiene, restrictions and school absenteeism was extracted from eligible materials; a quality score was applied. Meta-analysis was used to estimate pooled prevalence (PP), and meta-regression to examine the effect of setting, region and time. Results Data from 138 studies involving 193 subpopulations and 97 070 girls were extracted. In 88 studies, half of the girls reported being informed prior to menarche (PP 48%, 95% CI 43% to 53%, I2 98.6%). Commercial pad use was more common among urban (PP 67%, 57% to 76%, I2 99.3%, n=38) than rural girls (PP 32%, 25% to 38%, I2 98.6%, n=56, p<0.0001), with use increasing over time (p<0.0001). Inappropriate disposal was common (PP 23%, 16% to 31%, I2 99.0%, n=34). Menstruating girls experienced many restrictions, especially for religious activities (PP 0.77, 0.71 to 0.83, I2 99.1%, n=67). A quarter (PP 24%, 19% to 30%, I2 98.5%, n=64) reported missing school during periods. A lower prevalence of absenteeism was associated with higher commercial pad use in univariate (p=0.023) but not in multivariate analysis when adjusted for region (p=0.232, n=53). Approximately a third of girls changed their absorbents in school facilities (PP 37%, 29% to 46%, I2 97.8%, n=17). Half of the girls’ homes had a toilet (PP 51%, 36% to 67%, I2 99.4%, n=21). The quality of studies imposed limitations on analyses and the interpretation of results (mean score 3 on a scale of 0–7). Conclusions Strengthening of MHM programmes in India is needed. Education on awareness, access to hygienic absorbents and disposal of MHM items need to be addressed. Trial registration number CRD42015019197.
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                Author and article information

                Contributors
                Édila Dalmaso Coswosk: +55 31 3349 7882 , edila.coswosk@cpqrr.fiocruz.br
                Priscila Neves-Silva: +55 31 3349 7882 , priscila.neves@cpqrr.fiocruz.br
                Celina Maria Modena: +55 31 3349 7882 , celina@cpqrr.fiocruz.br
                Léo Heller: +55 31 3349 7882 , heller@cpqrr.fiocruz.br
                Journal
                Journal ID (nlm-ta): BMC Public Health
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2458
                Publication date (Electronic): 31 January 2019
                Publication date PMC-release: 31 January 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 137
                Affiliations
                René Rachou Research Institute, FIOCRUZ-Minas, Av. Augusto de Lima 1715, Barro Preto, Belo Horizonte, MG 30190-002 Brazil
                Article
                Publisher ID: 6469
                DOI: 10.1186/s12889-019-6469-y
                PMC ID: 6357509
                PubMed ID: 30704435
                SO-VID: e559b570-d62d-4463-81e8-0d8501779020
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 29 May 2018
                Date accepted : 23 January 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Public health
                Keywords: human rights,water,toilet,school,hygiene
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: human rights, water, toilet, school, hygiene

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