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      Comparison of respondent-reported and sensor-recorded latrine utilization measures in rural Bangladesh: a cross-sectional study

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          Abstract

          Background

          Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data.

          Methods

          We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach to assess agreement between respondent-reported latrine utilization and sensor-recorded measurement.

          Results

          Four-day household-level respondent-reported defecation averaged 28 events (inter-quartile range [IQR] 20–40), while sensor-recorded defecation averaged 17 events (IQR 11–29). Comparative analyses suggest moderately high accuracy (bias correction factor=0.84), but imprecision in the data (broad scatter of data, Pearson’s r=0.35) and thus only weak concordance between measures ( ρ c =0.29 [95% BCa CI 0.15 to 0.43]).

          Conclusions

          Respondent-reported latrine utilization data should be interpreted with caution, as evidence suggests use is exaggerated. Coupling reported utilization data with objective measures of use may aid in the estimation of latrine use.

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          Most cited references11

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          A concordance correlation coefficient to evaluate reproducibility.

          L Lin (1989)
          A new reproducibility index is developed and studied. This index is the correlation between the two readings that fall on the 45 degree line through the origin. It is simple to use and possesses desirable properties. The statistical properties of this estimate can be satisfactorily evaluated using an inverse hyperbolic tangent transformation. A Monte Carlo experiment with 5,000 runs was performed to confirm the estimate's validity. An application using actual data is given.
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            Measurement in Medicine: The Analysis of Method Comparison Studies

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              Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

              International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation.
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                Author and article information

                Journal
                Trans R Soc Trop Med Hyg
                Trans. R. Soc. Trop. Med. Hyg
                trstmh
                Transactions of the Royal Society of Tropical Medicine and Hygiene
                Oxford University Press
                0035-9203
                1878-3503
                July 2017
                20 November 2017
                20 November 2017
                : 111
                : 7
                : 308-315
                Affiliations
                [1 ] Department of Environmental Health, Rollins School of Public Health, Emory University , Atlanta, Georgia, USA
                [2 ] School of Public Health, Oregon Health and Science University , Portland State University, Portland, OR, USA
                [3 ] Environmental Intervention Unit, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
                Author notes
                Corresponding author: Tel: +1-404-727-5384; E-mail: mdelea@ 123456emory.edu
                Article
                trx058
                10.1093/trstmh/trx058
                5914303
                29126213
                7d1eeee5-fee5-4b98-b84b-758dbc2646da
                © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 April 2017
                : 21 September 2017
                : 11 October 2017
                Page count
                Pages: 8
                Funding
                Funded by: Bill & Melinda Gates Foundation 10.13039/100000865
                Award ID: OPP1102989
                Categories
                Original Articles

                Medicine
                bangladesh,public health,sanitation,wash
                Medicine
                bangladesh, public health, sanitation, wash

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