Browsing by Author "Sule, May N."

Now showing 1 - 4 of 4
  • Thumbnail Image
    ItemOpen Access
    Evaluation of failings in urban water supply and sanitation systems in Sub-Saharan Africa: a systematic review to inform future planning
    (IWA Publishing, 2025-02-01) Agbo, Chukwuemeka; Jeffrey, Paul; Sule, May N.
    The high failure rate of water supply and sanitation (WSS) systems is a major concern, especially for developing countries. Using the Collaboration for Environmental Evidence guidelines, this study carried out a systematic review of literature on failings in WSS in the urban areas of Sub-Saharan Africa to identify the factors hindering sustainability as lasting coverage. There were 101 full-text articles examined and 21 articles included in the final review. The findings are discussed through the lens of the financial, institutional, environmental, technological and social (FIETS) framework and depicted in a causal loop diagram to visualize the system structure. In total, 37 factors that contribute to the failings of urban WSS systems across 14 Sub-Saharan African countries were identified. The root causes of failed or failing systems included a lack of stakeholder engagement in the planning and implementation; limited human resources capacity; limitations imposed by settlement type (informal settlements); insufficient funds, corruption and mismanagement of funds; and insufficient operation and maintenance of facilities. The study concludes that sustainability in the sector will involve the use of legal instruments, adequate planning techniques, anti-corruption and cost recovery mechanisms to ensure long-term financing.
  • Thumbnail Image
    ItemOpen Access
    A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures
    (BMC (Part of Springer Nature), 2022-08-25) Sule, May N.; Mosha, Justina; Soboka, Teshome Emana; Kinung’hi, Safari M.; Sfynia, Chrysoula; Rafiq, Kamran; Dower, Alex; Comparet, Marianne; Bewley, Emma; Angelo, Teckla; Beshah, Feleke Zewge; Templeton, Michael R.
    Background: Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology: Our study was carried out in Mwanza, Tanzania and Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability, and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement an11 qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data was collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. Post-intervention (PI) survey was carried out after six months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results: The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (Male: BL:56%; PI:73%, Female: BL:43%; PI:50%). There was a significant increase in the selection of sanitation (Tanzania: BL:13%; PI:21%, Ethiopia: BL:63%; PI:90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions: This study showed substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures.
  • Thumbnail Image
    ItemOpen Access
    The persistence of failure in water, sanitation and hygiene programming: a qualitative study
    (BMJ Publishing Group, 2025-01) Barrington, Dani J.; Sindall, Rebecca C.; Chinyama, Annatoria; Morse, Tracy; Sule, May N.; Beale, Joanne; Kativhu, Tendai; Krishnan, Sneha; Luwe, Kondwani; Daudi Malolo, Rossanie; Mcharo, Onike; Odili, Anthony C.; Ravndal, Kristin T.; Rose, Jo; Shaylor, Esther; Wozei, Eleanor; Chikwezga, Faida; Evans, Barbara E.
    Introduction Unsafe water, sanitation and hygiene (WASH) causes millions of deaths and disability-adjusted life-years annually. Despite global progress towards universal WASH, much of WASH programming continues to fail to improve health outcomes or be sustainable in the longer term, consistently falling short of internal performance indicators and sometimes negatively impacting the well-being of local stakeholders. Although sector experts in high-income countries have often provided explanations for such failures, the opinions of those implementing WASH programming at the ground level are rarely published. Methods In 2020, we purposively recruited 108 front-line WASH professionals in Malawi, South Africa, Tanzania and Zimbabwe to participate in 96 in-depth interviews, explaining why they believe WASH failure persists. Through participatory analysis, including framework analysis with additional axial coding and member-checking of our findings, we determined the core reasons for WASH failure as perceived by participants. Results Interviewees reported poor engagement and commitment of intended users, unrealistic and idealistic expectations held by funders and implementers, and a general lack of workforce and financial capacity as significant contributors to WASH failure. Our analysis shows that these issues stem from WASH programming being implemented as time and budget-constrained projects. This projectisation has led to reduced accountability of funders and implementers to intended users and a focus on measuring inputs and outputs rather than outcomes and impacts. It has also placed high expectations on intended users to sustain WASH services and behaviour change after projects officially end. Conclusions Our findings imply that WASH programming needs to move away from projectisation towards long-term investments with associated accountability to local governments and longitudinal measurements of WASH access, as well as realistic considerations of the needs, abilities and priorities of intended users. Funders need to reconsider the status quo and how adjusting their systems could support sustainable WASH services.
  • Thumbnail Image
    ItemOpen Access
    Water chemistry poses health risks as reliance on groundwater increases: a systematic review of hydrogeochemistry research from Ethiopia and Kenya
    (Elsevier, 2023-09-12) Nowicki, Saskia; Birhanu, Behailu; Tanui, Florence; Sule, May N.; Charles, Katrina; Olago, Daniel; Kebede, Seifu
    Reliance on groundwater is increasing in Sub-Saharan Africa as development programmes work towards improving water access and strengthening resilience to climate change. In lower-income areas, groundwater supplies are typically installed without water quality treatment infrastructure or services. This practice is underpinned by an assumption that untreated groundwater is typically suitable for drinking due to the relative microbiological safety of groundwater compared to surface water; however, chemistry risks are largely disregarded. This article systematically reviews groundwater chemistry results from 160 studies to evaluate potential health risk in two case countries: Ethiopia and Kenya. Most studies evaluated drinking water suitability, focusing on priority parameters (fluoride, arsenic, nitrate, or salinity; 18 %), pollution impacts (10 %), or overall suitability (45 %). The remainder characterised general hydrogeochemistry (13 %), flow dynamics (10 %), or water quality suitability for irrigation (3 %). Only six studies (4 %) reported no exceedance of drinking water quality thresholds. Thus, chemical contaminants occur widely in groundwaters that are used for drinking but are not regularly monitored: 78 % of studies reported exceedance of contaminants that have direct health consequences ranging from hypertension to disrupted cognitive development and degenerative disease, and 81 % reported exceedance of aesthetic parameters that have indirect health impacts by influencing perception and use of groundwater versus surface water. Nevertheless, the spatiotemporal coverage of sampling has substantial gaps and data availability bias is driven by a) the tendency for research to concentrate in areas with known water quality problems, and b) analytical capacity limitations. Improved in-country analytical capacity could bolster more efficient assessment and prioritisation of water chemistry risks. Overall, this review demonstrates that universal and equitable access to safe drinking water (Sustainable Development Goal target 6.1) will not be achieved without wider implementation of groundwater treatment, thus a shift is required in how water systems are designed and managed.