Exploring the links between water, sanitation and hygiene and disability; Results from a case-control study in Guatemala

Abstract

ObjectiveTo assess the Water, Sanitation and Hygiene (WASH) access and appropriateness of people with disabilities compared to those without, in Guatemala.MethodsA case-control study was conducted, nested within a national survey. The study included 707 people with disabilities, and 465 age- and sex-matched controls without disabilities. Participants reported on WASH access at the household and individual level. A sub-set of 121 cases and 104 controls completed a newly designed, in-depth WASH questionnaire.ResultsHouseholds including people with disabilities were more likely to use an improved sanitation facility compared to control households (age-sex-adjusted OR: 1.7, 95% CI 1.3–2.5), but otherwise there were no differences in WASH access at the household level. At the individual level, people with disabilities reported greater difficulties in relation to sanitation (mean score 26.2, SD 26.5) and hygiene access and quality (mean 30.7, SD 24.2) compared to those without disabilities (15.5, 21.7, p<0.001; 22.4, 19.1, p<0.01). There were no differences in different aspects of water collection between people with and without disabilities in this context where over 85% of participants had water piped into their dwelling. Among people with disabilities, older adults were more likely to experience difficulties in hygiene and sanitation than younger people with disabilities.ConclusionsPeople with disabilities in Guatemala experience greater difficulties in accessing sanitation facilities and practicing hygienic behaviours than their peers without disabilities. More data collection is needed using detailed tools to detect these differences, highlight which interventions are needed, and to allow assessment of their effectiveness.

Can we achieve universal health coverage without a focus on disability? Results from a national case-control study in Guatemala

“…The participants included were representative of the national population in terms of age and sex distribution. [16] The survey identified 707 people with disabilities, and 465 age- and sex matched controls without disabilities; It was not possible to identify an eligible control for each case due to the high prevalence of disability among older adults. Cases with disabilities were on average older than controls, but well-matched in terms of sex, regional distribution and SES (Table 1).…”

“…A population-based case-control study was conducted in 2016 nested within a national survey of disability in Guatemala. [14] [16]…”

Association of anxiety and depression with physical and sensory functional difficulties in adults in five population-based surveys in low and middle-income countries

“…This study uses data from five cross-sectional surveys undertaken between 2011 and 2017 in five LMICs: Cameroon, Guatemala, Maldives, India and Nepal (Table 1) [24][25][26]. Three were regional/district level surveys, while two (Guatemala, Maldives) were national surveys.…”

“…Each survey received separate approval from the London School of Hygiene & Tropical Medicine and from local ethics committees [24][25][26]. Written (signed or fingerprint) informed consent was obtained from all subjects.…”

No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

“…However, children with disabilities face an increased risk of poor quality schooling, as education systems often do not have resources in place to support their learning (e.g., instruction in Braille, sign language) [44,45]. Similarly, indicators on household access to improved WASH can mask difficulties people with disabilities face in using these services independently, hygienically, consistently and with dignity [46][47][48]. Disability-specific indicators, such as stigma and access to assistive technology and rehabilitation are also be needed to track important deprivations for people with disabilities.…”