The conditions/hygiene of most outdoor toilets in Haiti can be seen as a health concern that cannot be ignored. In Haiti, most people do not have access to basic sanitation facilities, including toilets. As a result, open defecation is a common practice, and outdoor toilets are often poorly constructed, maintained, and unhygienic. These conditions create an ideal breeding ground for transmitting diseases, including waterborne diseases, fecal-oral diseases, and vector-borne diseases. Moreover, these conditions also contribute to the spread of bacterial and viral infections, including COVID-19, as outdoor toilets do not provide adequate ventilation and promote close contact with other individuals.
Overview of the chosen country, region, or state
Haiti is a small island nation located in the Caribbean Sea. It shares the island of Hispaniola with the Dominican Republic. The country is divided into ten departments and is home to approximately 11.4 million people, with a population growth rate of 1.2%. The life expectancy at birth in Haiti is 64.7 years, and the infant mortality rate is 46.8 deaths per 1,000 live births (Paul et al., 2022). Haiti is a low-income country with a gross national income per capita of $1,300.
Haiti faces many health challenges, including a high burden of infectious diseases, inadequate access to healthcare services, poor sanitation, and inadequate nutrition. The country also experiences political instability, natural disasters, and socioeconomic inequalities, exacerbating health disparities and hindering access to essential health services. These determinants of health must be addressed to improve the population’s overall health.
One major prevalent disease in Haiti is cholera, a waterborne disease caused by Vibrio cholerae. According to the World Health Organization (WHO), there were 822,101 reported cases of cholera and 9,792 deaths in Haiti from 2010 to 2019. Cholera is a significant public health concern in Haiti, as poor sanitation and inadequate access to clean water contribute to its transmission. The country is also experiencing an increase in cases of malaria, a vector-borne disease transmitted by infected mosquitoes. In 2019, there were 335,501 confirmed malaria cases in Haiti, resulting in 368 deaths (Paul et al., 2022). The incidence and prevalence rates of these diseases highlight the urgent need to address Haiti’s health determinants, including poor sanitation and inadequate access to clean water.
Upstream Causes
Two upstream factors that may have resulted in poorly constructed, maintained, and unhygienic outdoor toilets in Haiti are poverty and limited access to resources. Poverty is a significant upstream factor that can lead to inadequate sanitation infrastructure. Many Haitians live below the poverty line, so they may not have the necessary resources to build or maintain outdoor toilets adequately. They may also lack the knowledge and education needed to understand the importance of proper sanitation practices, leading to poor hygiene conditions.
Limited access to resources is another upstream factor contributing to poor sanitation conditions. In rural areas, for example, access to clean water may be limited, making it difficult to maintain proper hygiene. Additionally, there may be limited access to building materials, making constructing sturdy and reliable outdoor toilets challenging.
One causal link between poverty and limited access to resources is that poverty can lead to limited access to education and healthcare, resulting in poor health outcomes. Poor health outcomes, in turn, can lead to further poverty as people cannot work and support themselves and their families (Yu et al., 2019). This cycle of poverty and poor health can perpetuate poor sanitation conditions, as people may not have the resources or knowledge to improve their living conditions.
Downstream effects
Two potential downstream effects of the issue photographed here include increased incidence of waterborne diseases and poor maternal and child health outcomes.
Increased incidence of waterborne diseases: Poor conditions/hygiene of most outdoor toilets in Haiti can lead to contamination of nearby water sources such as rivers and streams with fecal matter, which increases the risk of waterborne diseases such as cholera, typhoid fever and hepatitis A. The downstream effect of this is an increased incidence of these diseases, which can lead to a higher burden of morbidity and mortality in the population.
Poor maternal and child health outcomes: Poor sanitation and hygiene in outdoor toilets can also lead to poor maternal and child health outcomes. Inadequate sanitation can increase the risk of infections during pregnancy and childbirth, leading to complications such as sepsis, which can be fatal for both the mother and the child (Lucien et al., 2019). Poor hygiene can also increase the risk of diarrheal diseases in children, leading to malnutrition and poor growth.
These downstream effects can hinder population health by increasing the burden of disease and morbidity, leading to reduced productivity and increased healthcare costs. They can also lead to significant social and economic consequences, such as increased poverty and decreased educational attainment. Addressing the issue of poor conditions/hygiene of most outdoor toilets in Haiti is therefore essential to improve population health and reduce the country’s disease burden.
DNP-Prepared Nurse Role
As a highly trained and educated healthcare professional, a DNP-prepared nurse can play a crucial role in decreasing the prevalence and incidence of the health concern presented in the paper, which is the poor conditions and hygiene of outdoor toilets in Haiti that can lead to various diseases.
The DNP-prepared nurse can address this issue by developing and implementing evidence-based practices and policies for improving sanitation and hygiene practices in outdoor toilets. They can collaborate with local communities, government agencies, and other healthcare professionals to promote health education, raise awareness, and provide resources for safe and effective sanitation practices (Yu et al., 2019). They can also conduct research and evaluate the effectiveness of interventions to ensure that the best practices are being implemented.
The resources available to a DNP-prepared nurse for addressing this issue may include funding for health education and awareness campaigns, partnerships with community organizations and healthcare providers, and access to current research and evidence-based practices (Guillaume et al., 2019). However, additional resources may be needed, such as improved infrastructure, supplies, and facilities for better sanitation practices, which the nurse may need to advocate for.
When addressing this issue, a DNP-prepared nurse must also acknowledge ethical considerations. These may include respecting cultural beliefs and practices related to sanitation, ensuring that interventions do not infringe on human rights or dignity, and promoting equitable access to resources and interventions for all individuals and communities affected by this issue. The nurse must also consider ethical data privacy and confidentiality issues when conducting research and evaluating interventions.
References
Lucien, M. A. B., Adrien, P., Hadid, H., Hsia, T., Canarie, M. F., Kaljee, L. M., … & Boncy, J. (2019). Cholera outbreak in Haiti: Epidemiology, control, and prevention. Infectious Diseases in Clinical Practice, 27(1), 3-11.
Paul, B., Jean Simon, D., Kiragu, A., Généus, W., & Emmanuel, E. (2022). Socioeconomic and demographic factors influencing open defecation in Haiti: a cross-sectional study. BMC Public Health, 22(1), 1-16.
Yu, X., Pendse, A., Slifko, S., Inman, A. G., Kong, P., & Knettel, B. A. (2019). Healthy people, healthy community: evaluation of a train-the-trainers program for community health workers on water, sanitation, and hygiene in rural Haiti. Health Education Journal, 78(8), 931-945.
Guillaume, Y., Raymond, M., Jerome, G. J., Ternier, R., & Ivers, L. C. (2019). ‘It was a ravage!’: lived experiences of epidemic cholera in rural Haiti. BMJ Global Health, 4(6), e001834.
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