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Mobile Health Technologies Are Essential for Reimagining the Future of Water, Sanitation, and Hygiene
Christine E. Stauber
Christine E. Stauber
Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia;
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Joe Brown
Joe Brown
Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina;
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Anu G. Bourgeois
Anu G. Bourgeois
Department of Computer Science, College of Arts and Sciences, Georgia State University, Atlanta, Georgia;
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Fabiana Palma
Fabiana Palma
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil;
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Claire A. Spears
Claire A. Spears
Department of Health Policy and Behavioral Sciences, School of Public Healh, Georgia State University, Atlanta, Georgia;
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Cassandra White
Cassandra White
Department of Anthropology, College of Arts and Sciences, Georgia State University, Atlanta, Georgia;
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Federico Costa
Federico Costa
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil;
Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
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Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
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ABSTRACT.
The new Lancet Commission on water, sanitation, and hygiene (WASH) hopes to reimagine and guide global WASH efforts. This comes at a time when unequal living conditions and global disparities in response and recovery have been highlighted by the COVID-19 pandemic and recent large impact trials have delivered mostly disappointing results suggesting the need for radically more effective interventions to improve global public health. We find ourselves at an inflection point in global WASH with an opportunity to build new approaches with potentially more equitable, cost-effective, and scalable solutions. Mobile health (mHealth) technology is an important and innovative tool for WASH advances. Yet, the use of mHealth has not been equally distributed in terms of its benefits nor is its impact guaranteed. In resource-constrained settings, where technology can increase inequalities, special attention should be paid to structural and systemic hierarchies during the development of mHealth programs along with the acknowledgment and understanding of how these systems can reinforce the systematic exclusion of those most vulnerable. The WASH sector needs to adapt to a future that is innovative and inclusive with a commitment to rethinking the resources needed to enhance scope and impact. We highlight urban sanitation in Brazil as a case study to demonstrate that mHealth can support and enhance publicly funded infrastructure and to help reimagine WASH for postpandemic and beyond.
Author Notes
Financial support: This manuscript was supported in part by a Georgia State University Faculty International Partnership Engagement grant.
Authors’ addresses: Christine E. Stauber, School of Public Health, Georgia State University, Atlanta, GA, E-mail: cstauber@gsu.edu. Joe Brown, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, E-mail: joebrown@unc.edu. Anu Bourgeois, College of Arts and Sciences, Georgia State University, Atlanta, GA, E-mail: abourgeois@gsu.edu. Fabiana Palma, Institute of Collective Health, Federal University of Bahia, Salvador, Brazil, E-mail: fabiana.palma@yahoo.com.br. Claire A. Spears, School of Public Health, Georgia State University, Atlanta, GA, E-mail: cspears@gsu.edu. Cassandra White, College of Arts and Sciences, Georgia State University, Atlanta, GA, E-mail: cwhite@gsu.edu. Federico Costa, Institute of Collective Health, Federal University of Bahia, Salvador, Brazil, and School of Public Health, Yale University, New Haven, CT, E-mail: fcosta2001@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
 Amebelu A. et al., 2021. The Lancet Commission on water, sanitation and hygiene, and health. The Lancet. Available at: https://doi.org/10.1016/S0140-6736(21)02005-5.
-
2.
 Lancet WASH Commission. Available at: https://wash-commission.com/. Accessed September 21, 2021.
-
3.
  Jensen N , Kelly AH , Avendano M , 2021. The COVID-19 pandemic underscores the need for an equity-focused global health agenda. Humanities and Social Sciences Communications 8: 15.
-
4.
  Corburn J et al.2020. Slum health: arresting COVID-19 and improving well-being in urban informal settlements. J Urban Health 97: 348–357.
-
5.
 2019 Sustainable Development Goals Statistics. Available at: https://unstats.un.org/sdgs/report/2019/goal-11/. Accessed August 8, 2020.
-
6.
 Deshpande A et al., 2020 Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000– 17. Lancet Glob Health 8: e1162–e1185.
-
7.
  Ahmad K , Erqou S , Shah N , Nazir U , Morrison AR , Choudhary G , Wu W-C , 2020. Association of poor housing conditions with COVID-19 incidence and mortality across US counties. PLoS One 15: e0241327.
-
8.
  Donde OO , Atoni E , Muia AW , Yillia PT , 2021. COVID-19 pandemic: water, sanitation and hygiene (WASH) as a critical control measure remains a major challenge in low-income countries. Water Res 191: 116793.
-
9.
 UNICEF/WHO, 2019. Progress on Household Drinking Water, Sanitation and Hygiene 2000--2017. Special focus on inequalities. New York, NY: United Nations Children’s Fund (UNICEF) and World Health Organization.
-
10.
 Tanana H, Combs J, Hoss A, 2021. Water is life: law, systemic racism, and water security in Indian country. Health Security. Available at: http://doi.org/10.1089/hs.2021.0034.
-
11.
Van de Lande L , 2013. Eliminating Discrimination and Inqualities in Access to Water and Sanitation. Geneva, Switzerland: UN Water.
-
12.
  Berendes D et al.2017. The influence of household- and community-level sanitation and fecal sludge management on urban fecal contamination in households and drains and enteric infection in children. Am J Trop Med Hyg 96: 1404–1414.
-
13.
  Berendes DM , Sumner TA , Brown JM , 2017. Safely managed sanitation for all means fecal sludge management for at least 1.8 billion people in low and middle income countries. Environ Sci Technol 51: 3074–3083.
-
14.
  Jones ER , van Vliet MTH , Qadir M , Bierkens MFP , 2021. Country-level and gridded estimates of wastewater production, collection, treatment and reuse. Earth Syst Sci Data 13: 237–254.
-
15.
  Kresch EP , Lipscomb M , Schechter L , 2020. Externalities and spillovers from sanitation and waste management in urban and rural neighborhoods. Applied Economic Perspectives and Policy 42: 395–420.
-
16.
  Thoradeniya T , Jayasinghe S , 2021. COVID-19 and future pandemics: a global systems approach and relevance to SDGs. Global Health 17: 59.
-
17.
  Cumming O et al.2019. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement. BMC Med 17: 173.
-
18.
  Workman CL , Cairns MR , de Los Reyes FL 3rd , Verbyla ME , 2021. Global water, sanitation, and hygiene approaches: anthropological contributions and future directions for engineering. Environ Eng Sci 38: 402–417.
-
19.
  McGranahan G , 2015. Realizing the right to sanitation in deprived urban communities: meeting the challenges of collective action, coproduction, affordability, and housing tenure. World Dev 68: 242–253.
-
20.
  Shiras T , Cumming O , Brown J , Muneme B , Nala R , Dreibelbis R , 2018. Shared sanitation management and the role of social capital: findings from an urban sanitation intervention in Maputo, Mozambique. Int J Environ Res Public Health 15: 2222.
-
21.
 McGranahan G, Mitlin D, Diana , 2016. Learning from sustained success: how community-driven initiatives to improve urban sanitation can meet the challenges. World Dev 87: 307–317.
-
22.
  Ramos da Silva S , Heller L , de Campos Valadares J , Cairncross S , 2010. Relationship (or its lack) between population and a water and sanitation service: a study of users’ perception in Vitoria (ES) Brazil. J Water Health 8: 764–778.
-
23.
  Adans-Dester CP et al.2020. Can mHealth technology help mitigate the effects of the COVID-19 pandemic? IEEE Open Journal of Engineering in Medicine and Biology 1: 243–248.
-
24.
  Choudhury A , Asan O , Choudhury MM , 2021. Mobile health technology to improve maternal health awareness in tribal populations: mobile for mothers. J Am Med Inform Assoc 28: 2467–2474.
-
25.
  Loh P-S , 2020. Flipping the perspective in contract tracing. arXiv:2010.03806v2 [cs.CY].
-
26.
  Thomas E , Brown J , 2021. Using feedback to improve accountability in global environmental health and engineering. Environ Sci Technol 55: 90–99.
-
27.
 2019 Smartphone Ownership Is Growing Rapidly Around the World, but Not Always Equally. Available at: https://www.pewresearch.org/global/2019/02/05/smartphone-ownership-is-growing-rapidly-around-the-world-but-not-always-equally/. Accessed April 19, 2020.
-
28.
  Hutchings M , Dev A , Palaniappan M , Srinivasan V , Ramanathan N , Taylor J , Ross N , Luu P Oakland, CA: Pacific Institute, 115.
-
29.
  Phillips D , 2019. Sewage, Zika virus – and the team in Brazil mapping disease hotspots. The Guardian.
-
30.
  Marcolino MS , Oliveira JAQ , D’Agostino M , Ribeiro AL , Alkmim MBM , Novillo-Ortiz D , 2018. The Impact of mHealth interventions: systematic review of systematic reviews. JMIR Mhealth Uhealth 6: e23–e23.
-
31.
  Alghamdi M , Gashgari H , Househ M , 2015. A systematic review of mobile health technology use in developing countries. Stud Health Technol Inform 213: 223–226.
-
32.
  Carstensen LS , Tamason CC , Sultana R , Tulsiani SM , Phelps MD , Gurley ES , Jensen PKM , 2019. The cholera phone: diarrheal disease surveillance by mobile phone in Bangladesh. Am J Trop Med Hyg 100: 510–516.
-
33.
  Biswas SK et al.2021. Formative research for the design of a baby water, sanitation, and hygiene mobile health program in Bangladesh (CHoBI7 mobile health program). Am J Trop Med Hyg 104: 357–371.
-
34.
  Nachega JB , Leisegang R , Kallay O , Mills EJ , Zumla A , Lester RT , 2020. Mobile health technology for enhancing the COVID-19 response in Africa: a potential game changer? Am J Trop Med Hyg 103: 3–5.
-
35.
  Logie CH et al.2021. Kukaa Salama (Staying Safe): study protocol for a pre/post-trial of an interactive mHealth intervention for increasing COVID-19 prevention practices with urban refugee youth in Kampala, Uganda. BMJ Open 11: e055530.
-
36.
  Jennings L , Gagliardi L , 2013. Influence of mhealth interventions on gender relations in developing countries: a systematic literature review. Int J Equity Health 12: 85.
-
37.
  Jelks NO , Smith-Perry DJ , Fuller CH , Stauber C , 2020. Participatory research in Northwest Atlanta’s Proctor Creek Watershed: using photovoice to explore environmental health risks at the water’s edge. Health Place 66: 102444.
-
38.
 Jelks NO, Hawthorne TL, Dai D, Fuller CH, Stauber C, 2018. Mapping the hidden hazards: community-led spatial data collection of street-level environmental stressors in a degraded, urban watershed. Int J Environ Res Public Health 15: 825. https://doi.org/10.3390/ijerph15040825.
-
39.
  Loo A et al.2019. Development and field testing of low-cost, quantal microbial assays with volunteer reporting as scalable means of drinking water safety estimation. J Appl Microbiol 126: 1944–1954.
-
40.
George CM et al., 2020. Effects of a water, sanitation and hygiene mobile health program on diarrhea and child growth in Bangladesh: a cluster-randomized controlled trial of the CHoBI7 mobile health program. Clin Infect Dis 73.
-
41.
  Markle L , Maganani A , Katooka O , Tiwari A , Osbert N , Larsen DA , Winters B , 2017. A mobile platform enables unprecedented sanitation uptake in Zambia. PLoS Negl Trop Dis 11: e0005131.
-
42.
  Zohura F et al.2020. Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster-randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 25: 1008–1015.
-
43.
  Dugas M , Gao GG , Agarwal R , 2020. Unpacking mHealth interventions: a systematic review of behavior change techniques used in randomized controlled trials assessing mHealth effectiveness. Digit Health 6. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036494/pdf/10.1177_2055207620905411.pdf.
-
44.
 Agarwal A, Chaudhuri U, Chaudhuri S, Seetharaman G, 2014. Detection of potential mosquito breeding sites based on community sourced geotagged images. Proc. SPIE 9089, Geospatial InfoFusion and Video Analytics IV, and Motion Imagery for ISR and Situational Awareness II, 90890M, July 3, 2014. Available at: https://doi.org/10.1117/12.2058121.
-
45.
  Donaire-Gonzalez D , ValentÃn A , de Nazelle A , Ambros A , Carrasco-Turigas G , Seto E , Jerrett M , Nieuwenhuijsen MJ , 2016. Benefits of mobile phone technology for personal environmental monitoring. JMIR Mhealth Uhealth 4: e126.
-
46.
WHO Global Observatory for eHealth,2011. mHealth: New Horizons for Health through Mobile Technologies: Second Global Survey on eHealth. Geneva, Switzerland: World Health Organization. Available at: https://apps.who.int/iris/handle/10665/44607.
-
47.
  Iribarren SJ , Cato K , Falzon L , Stone PW , 2017. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions. PLoS One 12: e0170581.
-
48.
  Ray I , Smith KR , 2021. Towards safe drinking water and clean cooking for all. Lancet Glob Health 9: e361–e365.
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