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  <front>    <journal-meta>
      <journal-title>African Journal of Environmental Science and Technology </journal-title>
      <issn pub-type="epub">1996-0786</issn>      <publisher>
        <publisher-name>Academic Journals</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.5897/AJEST2019.2802</article-id>
      <title-group>
        <article-title><![CDATA[Assessment of the health impacts of WASH interventions in disaster-prone communities in three regions of Northern Ghana]]></article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author" xlink:type="simple">
        		        	<name name-style="western">
	            <surname>Eugene</surname>
            <given-names>Appiah-Effah</given-names>
	          </name>	
        		        	<name name-style="western">
	            <surname>Gideon</surname>
            <given-names>Sagoe</given-names>
	          </name>	
        		        	<name name-style="western">
	            <surname>Kobina</surname>
            <given-names>Mensah Afful</given-names>
	          </name>	
        		        	<name name-style="western">
	            <surname>Dwuodwo</surname>
            <given-names>Yamoah-Antwi</given-names>
	          </name>	
        	        </contrib>
      </contrib-group>
      <author-notes>
		<corresp id="cor1">* E-mail: <email xlink:type="simple">appiaheffah@gmail.com</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2020</year>
      </pub-date>
      <pub-date pub-type="epub">
      	<day>30</day>
        <month>09</month>
        <year>2020</year>
      </pub-date>
      <history>
      			<date date-type="received">
			<day>03</day>
			<month>12</month>
			<year>2019</year>
		</date>
						<date date-type="accepted">
			<day>07</day>
			<month>07</month>
			<year>2020</year>
		</date>
			  </history>
      <volume>14</volume>
      <issue>9</issue>
	  	  <fpage>269</fpage>
	  <lpage>280</lpage>
      <permissions>
		<license xlink:type="simple">
			<license-p>
			This is an open-access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
			</license-p>
		</license>
	  </permissions>
	  <self-uri xlink:href="http://politicalwaffle.uk/journal/AJEST/article-abstract/49534D464801">
		This article is available from http://politicalwaffle.uk/journal/AJEST/article-abstract/49534D464801	  </self-uri>
	  <self-uri xlink:href="http://politicalwaffle.uk/journal/AJEST/article-full-text-pdf/49534D464801">
		The full text article is available as a PDF file from http://politicalwaffle.uk/journal/AJEST/article-full-text-pdf/49534D464801	  </self-uri>
	  
      <abstract><![CDATA[This study evaluated the health impacts of WASH interventions in 9 intervention communities against 9 control communities in disaster-prone areas in northern Ghana. We extracted community-specific data on patient-reported cases of WASH-related diseases from health facilities in the study areas. Also, we used key informant interviews and household questionnaires to seek information for validation. The impact was measured using the before-after study with concurrent control (BAC) method of Health Impact Evaluation in WASH interventions. The findings indicate a substantial increase in the number of WASH facilities across the intervention communities. However, some respondents complained of access to inadequate quantities and increase downtime of water systems when there is a breakdown. Access to improved sanitation facilities was still a challenge, although a steady increase in the number of household access to latrines was observed. We extracted about 2,315 reported cases of WASH-related diseases, comprising diarrhoea (83%), dysentery (8%), typhoid fever (7%) and intestinal worms (2%). Impacts on diarrhoea prevalence were generally lower than reported figures, and varied across the intervention communities, ranging from 0 to 7% reduction. We recommend that greater attention be given to the sustainability of the intervention to ensure service delivery, rather than as a one-time investment, to achieve more significant impacts.

	 

	Key words: Disaster-prone communities, WASH, sanitation, public health.]]></abstract>
    </article-meta>
  </front>
      <body/>
    <back>
		<ref-list>
			<title>References</title>
						<ref id="ref1">
				<label>1</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Appiah-Effah E, Duku GA, Azangbego NY, Aggrey RK, Gyapong-Korsah B, Nyarko KB (2019). Ghanas post-MDGs sanitation situation: An overview. Journal of Water, Sanitation and Hygiene for Development 9(3):397-415.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref2">
				<label>2</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Bartram J, Cairncross S (2010). Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med 7(11): e1000367.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref3">
				<label>3</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Burger SE, Esrey SA (1995). Water and sanitation: Health and nutrition benefits to children. In: Child growth and nutrition in developing countries: Priorities for action. pp. 153-174.]]>
				</mixed-citation>
			</ref>
						<ref id="ref4">
				<label>4</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Care Nederland (2012). Techniques to improve the resilience of community WASH systems in flood-prone areas.]]>
				</mixed-citation>
			</ref>
						<ref id="ref5">
				<label>5</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Dangour A, Watson L, Cumming O, Boisson S, Che Y, Velleman Y, Cavill S, Allen E, Uauy R (2013). Interventions to Improve Water Quality and Supply, sanitation and Hygiene Practices and Their Effects on the Nutritional Status of Children. In Child Growth and Nutrition in Developing Countries: Priorities for Action, edited by P Pinstrup-Andersen, A Pelletier, A Alderman 8:153-75. Cornell University Press.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref6">
				<label>6</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Esrey SA, Potash JB, Roberts L, Shiff C (1991). Effects of improved water supply and sanitation on ascariasis, diarrhea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull WHO, 69:609-621.]]>
				</mixed-citation>
			</ref>
						<ref id="ref7">
				<label>7</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford Jr JM (2005). Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. The Lancet Infectious Diseases 5(1):42-52.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref8">
				<label>8</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014a). 2010 population and housing census: District analytical report, Binduri district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref9">
				<label>9</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014b). 2010 population and housing census: District analytical report, Builsa North district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref10">
				<label>10</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014c). 2010 population and housing census: District analytical report, Chereponi district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref11">
				<label>11</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014d). 2010 population and housing census: District analytical report, Kassena Nankana West district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref12">
				<label>12</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014e). 2010 population and housing census: District analytical report, Nadowli-Kaleo district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref13">
				<label>13</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014f). 2010 population and housing census: District analytical report, Saboba district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref14">
				<label>14</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014g). 2010 population and housing census: District analytical report, Sagnarigu district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref15">
				<label>15</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014h). 2010 population and housing census: District analytical report, Sissala East district.]]>
				</mixed-citation>
			</ref>
						<ref id="ref16">
				<label>16</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ghana Statistical Service (GSS) (2014i). 2010 population and housing census: District analytical report, Wa East district. Accra, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref17">
				<label>17</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[GSS, GHS, ICF International (2015). Ghana Laxminarayan demographic and health survey 2014. Rockville, Maryland, USA.]]>
				</mixed-citation>
			</ref>
						<ref id="ref18">
				<label>18</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Laxminarayan R, Mills AJ, Breman JG, Measham AR., Alleyne G, Claeson M, Jha P, Musgrove P, Chow J, Shahid-Salles S, Jamison DT (2006). Advancement of global health: Key messages from the Disease Control Priorities Project. Lancet 367(9517):1193-1208.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref19">
				<label>19</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn J, Rudan I, Campbell H, Cibulskis R, Li M, Mathers Black RE (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet, May.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref20">
				<label>20</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Mahajan A (2015). Limitations of CBA study: Controlled before after study. Lung India 32(6):670-671.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref21">
				<label>21</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[McKeown T, Record RG (1962). Reasons for the decline of mortality in England and Wales during the nineteenth century. Population Studies 16(2):94-122.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref22">
				<label>22</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Mills JE, Cumming O (2016). The impact of water, sanitation and hygiene on key health and social outcomes: Review of evidence. Retrieved fromView]]>
				</mixed-citation>
			</ref>
						<ref id="ref23">
				<label>23</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[OpenWASH. (2016). Ethiopias One WASH National Programme. Retrieved from
				
					View]]>
				</mixed-citation>
			</ref>
						<ref id="ref24">
				<label>24</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Prss A, Kay D, Fewtrell L, Bartram J (2002). Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environmental Health Perspectives 110(5):537-542
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref25">
				<label>25</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Ramesh A, Blanchet K, Ensink JH, Roberts B (2015). Evidence on the effectiveness of water, sanitation, and hygiene (WASH) interventions on health outcomes in humanitarian crises: A systematic review. PLoS ONE 10(9):e0124688.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref26">
				<label>26</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Robson LS, Shannon HS, Goldenhar LM, Hale AR (2001). Guide to Evaluating the Effectiveness of Strategies for Preventing Work Injuries. NIOSH.]]>
				</mixed-citation>
			</ref>
						<ref id="ref27">
				<label>27</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Schmidt WP, Norman G, Cumming O (2011). Evaluating the health impact of urban WASH programmes: An affordable approach for enhancing effectiveness (No. DP#001). Retrieved from
				
					View]]>
				</mixed-citation>
			</ref>
						<ref id="ref28">
				<label>28</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Shadish WR, Cook TD, Campbell DT (2002). Experimental and Quasi-Experimental Designs for Generalized Causal Inference (2nd ed.). Boston: Houghton Mifflin Company.
					]]>
				</mixed-citation>
			</ref>
						<ref id="ref29">
				<label>29</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[UNDP (2019). Water, sanitation and hygiene in disaster prone communities in Northern Ghana: Consolidated final narrative report.]]>
				</mixed-citation>
			</ref>
						<ref id="ref30">
				<label>30</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Waddington H, Snilstveit B, White H, Fewtrell L (2009). Water, sanitation and hygiene interventions to combat childhood diarrhoea in developing countries. New Delhi: International Initiative for Impact Evaluation.]]>
				</mixed-citation>
			</ref>
						<ref id="ref31">
				<label>31</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[World Health Organization (WHO) (2004). Comparative quantification of health risks. Geneva.]]>
				</mixed-citation>
			</ref>
						<ref id="ref32">
				<label>32</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[World Health Organization (WHO) (2017). Terms of reference - End of project evaluation: for the assessment of health impact of WASH intervention in WASH in DPC Communities, Northern Ghana, Ghana.]]>
				</mixed-citation>
			</ref>
						<ref id="ref33">
				<label>33</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[WHO UNICEF (2014). Progress on Drinking Water and Sanitation - 2014 Update. Switzerland.]]>
				</mixed-citation>
			</ref>
						<ref id="ref34">
				<label>34</label>
				<mixed-citation publication-type="other" xlink:type="simple">
				<![CDATA[Wolf J, Prss-Ustn A, Cumming O, Bartram J, Bonjour S, Cairncross S, Clasen T, Colford JM, Curtis Jr V, De France J, Fewtrell L, Freeman MC, Gordon B, Hunter PR, Jeandron A, Johnston RB, Musezahl D, Mathers C, Neira M, Higgins JP (2014). Assessing the impact of drinking water and sanitation on diarrhoeal disease in low-and middle-income settings: A systematic review and metaregression. Tropical Medicine and International Health 19(8):928-942.
					]]>
				</mixed-citation>
			</ref>
					</ref-list>
	</back>
    </article>