Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ying Chen

Second Advisor

Windy Tanner

Abstract

Water, Sanitation, and Hygiene (WASH) is crucially important to public health in low- and middle-income countries, with implications in a variety of health outcomes, including bacterial and viral infection, transmission of diarrheal diseases such as cholera and dysentery, and malnutrition. Important drivers of WASH status include practices of open defecation, handwashing, water disinfection methods, and perceived water quality. These indicators vary based on geographic location, culture, and urban-rural differences in lifestyle. This study specifically focuses on WASH indicators in rural villages surrounding Ranomafana National Park, Madagascar, and their relationships to enteric infections, skin infections, and diarrheal disease.

In partnership with the Centre Valbio Health Team, which provides health services to individuals residing in these communities, surveys were administered to assess the presence of protective, preventative, and harmful WASH indicators as well as self-reported symptoms of enteric infections, skin infections, and diarrheal disease. Additionally, samples were collected from the primary water sources within each village and analyzed for the presence and concentrations of coliform bacteria. Due to the low-resource setting, portable 3M Petrifilm Plates and body heat were used to promote and assess coliform concentration and facilitate bacterial colony growth, respectively.

Coliform counts were assessed for each water source in every village to identify those with the highest and lowest contamination levels. Most associations between WASH indicators and self-reported symptoms of infection were non-significant. The Consolidated Framework for Implementation Research (CFIR) was then applied to guide the development and implementation of a WASH intervention tailored toward the villages participating in this study.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2027

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