Learning practical data analysis for strong sanitation programs in India

Posted on by nayavill
Picture of Katie in a kayak on a lake.
Enjoying my summer kayaking whenever I got the chance.

I worked with Gram Vikas (GV), an Indian NGO, based in Bhubaneswar, Odisha, India for my practicum this summer. GV has been working in the Odisha state for the past 50 years. GV partners with rural communities to enable them to lead a dignified life by building their capabilities, strengthening community institutions, and mobilizing resources. Gram Vikas has been working to understand and expand access to piped water supply and sanitation in the communities it reaches, as well as to understand and strengthen the institutional systems for community ownership and management of water, sanitation, and hygiene (WaSH) systems since 1993.

Gram Vikas recently completed a sustainability assessment survey capturing data on water and sanitation access, functionality, and management status for over 40,000 households in areas of India where Gram Vikas has worked between 1993 – 2020. Household survey data were collected between August 2018 to January 2020 covering a total of 10 districts across the Odisha state. The sample frame for the survey was a census of communities served in these districts (n = 41,586), meaning that GV attempted to collect data from each household in each community across these districts in which GV had worked.

Working with this dataset from GV has been an incredible learning experience. I have been able to learn Stata in a way that I could not have been able to otherwise. Using data collected by GV across a diverse geographic region, in combination with additional publicly available secondary data, we undertook additional analyses to support GV’s efforts to better understand what variables and factors influence service delivery, service quality, access and use, and sustainability, to strengthen service delivery, enhance equity, and expand access to sanitation across the Odisha state

Some of the challenges that came up from working with this data included my learning curve using Stata in an applied way for the first time and determining how to clean up the variables to get an accurate read. My previous class experience taught me the basics of how to use Stata, but this dataset allowed me to learn in an applied way. Using some of the resources from those classes, the expertise of Cathy Zimmer from the UNC Odem Institute, and assistance from my team I was able to get the support I needed to tackle this dataset. Some of the variables in the dataset needed to be edited to provide the best possible outcome. For example, each household answered a question what type of phone they had, but the outcome of no phone was not included in this variable. It was important that I combine them to have the full picture of what type of phone outcome each household had. I will be grouping this variable with other variables in order to create a wealth quintile in the coming months to see how wealth impacts households ability to have a toilets and bathing rooms in their home and other sanitary dependent variables.

Gorgeous sunset during my vacation to Hilton Head Island
Gorgeous sunset during my vacation to Hilton Head Island.

I have been given the opportunity to continue working on this data in the fall semester and look forward to learning more about what impacts sanitation and how GV’s interventions are helping to close these gaps.

– Katie

“On my feet” Adaptation Skills

Posted on by nayavill
A Tableau map we constructed from geotagging ourselves once in each of the 35 surveyed villages.
A Tableau map we constructed from geotagging ourselves once in each of the 35 surveyed villages.

Hello again!

I hope everyone’s summer went well. Ours was … honestly… a bit chaotic, but it taught me a lot of patience and “on my feet” adaptation skills! While I was always safe and cautious, we did encounter some challenges with COVID-19 during our Sickle Cell Awareness Survey and Community Needs Assessment in Western Uganda. The national policies on travel were changed a few times, and usually with little notice – which made planning our daily work nothing short of challenging.

– However-

I’m really really proud of the work that we did and am very thankful for the help and support that I had along the way!

We [surprisingly] were able to interview ALL 35 villages in the sub-county. This ended up being a little over 200+ individual household interviews. It was not an easy feat but was extremely important, as we wanted to establish the baseline awareness of sickle cell in the area. So far, we are finding an unexpected spatial distribution of sickle cell awareness, which will be interesting to dig into later.

To estimate the current burden of disease, and service utilization in the nearby municipality we visited the records department of four different hospitals and mapped the five-year trend of in-patient, out-patient, and laboratory visits for sickle cell – a bit of grunt work, digging through a lot of loosely-organized dusty papers, and broken binders, but the recovered information is really going to give us some great insight into the current situation in the area.

Most importantly, we got a good look at the service availability and challenges for families with sickle cell from 19 family interviews, and visits with local and national stakeholders in sickle cell care. We looked more deeply into resource availability by surveying 23 area drug shops and traditional healers.  And identified some gaps in provider knowledge and awareness of sickle cell, areas for improvement, through 51 health provider surveys.

Overall, the last three months have been really busy – but really rewarding – because I know the efforts of that work won’t end here. We expect this Community Needs Assessment will lay the groundwork for a future monthly clinic day dedicated exclusively to sickle cell. A day where individuals in this sub-county can come to test for sickle cell and where those with Sickle Cell Disease or Sickle Cell Trait can receive regular health visits and support within their own community.

– Tiffany

With goal-motivated fun, time flies

Posted on by nayavill

I have been privileged to work on a hugely satisfying and rewarding practicum with the Gillings Zambia Hub. It is qualitative research to assess the acceptability and feasibility of engaging male partners and other family members to support HIV-positive mothers to practice the recommended Infant feeding practices and Anti-Retroviral Therapy (ART) adherence.

My drive and interest in HIV research and the prevention of mother-to-child transmission stem from seeing the hardship faced by people living with HIV. Hence, I was glad for the opportunity to work on a subject matter I find interesting and relevant, so I have had no problem finding my footing or staying motivated, especially with the practicum being a virtual one.

For the project, we use the Trials of Improved Practices (TIPs), a formative participatory research technique developed by the Manoff group to pretest and improve the recommended practices on a small scale before introducing them broadly. Trained interviewers discuss current feeding practices and ART adherence with study participants in individual interviews. In addition, study participants are encouraged to identify home supporters. Subsequently, there is counseling on the recommended practices, and with the interviewer’s help, each study participant decides on specific practices to be adopted over a trial period. In follow-up meetings, the interviewer asks questions to assess the uptake of the recommended practices. By taking this approach, we draw from the experience of the study participants, who are members of our target population, to pilot test our recommendations. This approach enables us to recognize and determine the practicability or limitations of recommended infant feeding practices in the context of the local communities. Furthermore, using TIPs makes it possible to identify possible challenges that might impact the uptake of our proposed recommendations, provide solutions to these challenges, eliminate or modify practices that are not feasible.

As an intern, I support the team by reviewing the transcripts of the focused interviews and providing feedback. I also use Ona to assess and summarize the data and ATLAS.ti for qualitative data analysis. In addition, I am working on a secondary analysis of already coded data to determine the role of social support systems and couples’ joint decision-making in preventing mother-to-child transmission of HIV. Through my interactions with the research team, I am learning to be perceptive of cultural differences, be humble and respectful while giving feedback, and be open to responses that challenge my worldview and perspective. The opportunity to work on a diverse team has also afforded me a better appreciation of the interaction between individual social identities and power dynamics in a research ecosystem.

Sometimes, things do not go according to plan. A little over a month ago, the project had a slight hiccup when the Zambian government had to suspend all hospital-based research because of another wave of the COVID-19 pandemic. Data collection had to stop temporarily, affecting our deadlines for specific points in the study. Thankfully, the COVID-19 cases are dwindling, the suspension was lifted a week ago, and data collection has commenced again. Overall, I would say that this summer has been productive and a lot of fun. Through meeting other students,  I expanded my Gillings community. I also explored more of North Carolina. Most of all, I am thankful for a fantastic opportunity to learn and grow my skills through the Gillings Zambia Hub. Now, my only grudge is the swift passage of time because it feels like I started the practicum a day ago, yet it’s been three months and more. Indeed, time flies.

While spending a summer day at Ft. Macon State Park, I couldn’t resist taking a picture of these lovely seagulls.

– Olu