Framework for mitigating the risk of waterborne diarrheal diseases in peri-urban areas of Lusaka district Zambia

Abstract

Waterborne diarrheal diseases are a public health problem in developing countries including Zambia. Despite implementing various interventions, the diseases have persisted in Zambia. This study aimed to develop a framework for identifying appropriate interventions for mitigating the risk of waterborne diarrheal diseases in peri-urban areas of Lusaka district Zambia. The study employed a sequential mixed methods design. The first step of the study involved a systematic review to determine interventions for mitigating risk of waterborne diarrheal diseases. This was followed by a longitudinal study to investigate trends of diarrheal diseases over a 10 year period (2010 to 2019) using secondary data from the Health Management Information System in 15 health care facilities of Lusaka district. A scoping review was then conducted to identify frameworks for mitigating risk of waterborne diarrheal diseases. These frameworks were analyzed using Strength, Weakness, Opportunity, and Threat analysis to identify gaps and used as a basis for drafting the framework. Finally, the draft framework was validated by health workers and other WASH experts for correctness of information and acceptability, after which the refined framework was developed. Under the systematic review, the study found 56 studies that met the inclusion criteria reporting several interventions including: vaccines for rotavirus disease (Monovalent, Pentavalent and Lanzhou lamb vaccine); enhanced water filtration for preventing Cryptosporidiosis, Vi polysaccharide for typhoid; cholera 2 dose vaccines, water supply, water treatment and safe storage, household disinfection and hygiene promotion for cholera outbreaks. The longitudinal study revealed a decrease in trends of diarrheal diseases with non-bloody and bloody diarrhea being the main cause of morbidity and mortality, respectively. The highest number of cases were recorded in 2016 and lowest 2019 with more cases in children under five years. Notably, most cases were recorded during the rainy season. First level hospitals recorded the highest number of cases and deaths compared to other health facilities. The scoping review found five frameworks for mitigating risk of diarrheal diseases including hygiene improvement framework, community led total sanitation, global action plan for pneumonia and diarrhea, participatory hygiene and sanitation transformation, and sanitation and family education. None of these frameworks was specific for waterborne diarrheal diseases. These frameworks were used to propose a draft framework. Validation of the draft framework helped to improve the tool as the health workers and experts suggested several issues included in the final framework. The final framework consisted of the following elements: problem identification; identification and quantifying of risks; identification of evidence-based intervention(s); assessment of intervention(s) in target community; selection and adoption of intervention(s); implementing selected intervention(s); monitoring and evaluation; sustainability and system support factors. The developed framework is envisaged to help mitigate risk of waterborne diarrheal diseases in peri-urban areas of Lusaka Zambia if implemented and ultimately improving public health in Zambia and related settings.