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Research Article

Public Opinions from Malawian and Malawi Refugee Camp Residents of Wastewater and Environmental Surveillance

Dammy Jeboda Department of Psychological and Brain Sciences, College of Arts and Sciences, University of Louisville, Louisville, Kentucky;

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Brandie Banner Shackelford The United Nations High Commissioner for Refugees, Lilongwe, Malawi;
The Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;

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Petros Chigwechokha Department of Biological Sciences, Malawi University of Science and Technology, Limbe, Malawi;

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Brighton A. Chunga Department of Water and Sanitation, Mzuzu University, Mzuzu, Malawi;

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Ayse Ercumen Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina;

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Cassandra Workman Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina;

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Joy L. Hart Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, Kentucky;
Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;

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Ted Smith Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;
Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky

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Rochelle H. Holm Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;
Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky

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DOI:
https://doi.org/10.4269/ajtmh.24-0759
Volume/Issue:
Ahead of Print
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Across low- and middle-income countries, there have been calls to expand wastewater and environmental surveillance to include non-sewered sanitation systems. Considering public opinion, understanding, and acceptance, as well as any related privacy and personal health information concerns, is important in this context. This study used an in-person survey to learn more about the perceptions of Malawian and Malawi refugee camp residents regarding wastewater and environmental surveillance as public health tools, as well as their views on privacy and personal health information. A 15-question survey was conducted from May to July 2024 at three locations in northern, central, and southern Malawi, including a refugee camp (N = 536). Some respondents (n = 30) also completed a board game and a post-game survey. The results indicated high public support for surveilling communicable diseases, deadly diseases, environmental toxicants, healthy eating, illegal drugs, mental illnesses, and prescription drugs. Respondents were less supportive of surveillance that might expose their lifestyle behaviors and alcohol use. Regarding sampling locations, the surveillance of an entire city or of camps and schools had the highest acceptance. Some opposition to surveillance in business and religious organizations was noted. If surveilled, respondents wanted the results of the data analysis to be communicated back to them. Our findings suggested that Malawian and Malawi camp residents supported, with little concern, ongoing wastewater and environmental surveillance for public health. Considering privacy thresholds and participant autonomy regarding public health surveillance tools, along with cultural relevance, is important for future policy development and investment.

    • Supplemental Materials (PDF 272.69 KB)

Author Notes

Data availability: All data generated or analyzed during this study are included in this published article and its Supplemental Information files.

Financial support: This work was supported by grants from the National Science Foundation (2236372 and 195006), Etscorn Summer Development Award, and the Ellis Foundation.

Disclosures: This study was reviewed and approved by the Malawi University of Science and Technology Research Ethics Committee (P.01/2024/117) and the University of Louisville Institutional Review Board (24.0245). Written informed consent was obtained from all participants.

Authors’ contributions: Conceptualization: D. Jeboda and R. H. Holm; methodology: D. Jeboda and R. H. Holm; formal analysis: D. Jeboda, C. Workman, and R. H. Holm; writing—original draft preparation: D. Jeboda and R. H. Holm; writing—review and editing: D. Jeboda, B. B. Shackelford, P. Chigwechokha, B. A. Chunga, A. Ercumen, C. Workman, J. L. Hart, T. Smith, and R. H. Holm; supervision: R. H. Holm. All authors have read and agreed to the published version of the manuscript.

Current contact information: Dammy Jeboda, Department of Psychological and Brain Sciences, College of Arts and Sciences, University of Louisville, Louisville, KY, E-mail: oluwadamilola.jeboda@louisville.edu. Brandie Banner Shackelford, The United Nations High Commissioner for Refugees, Lilongwe, Malawi, and The Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mail: brandie.shackelford@emory.edu. Petros Chigwechokha, Department of Biological Sciences, Malawi University of Science and Technology, Malawi, E-mail: pchigwechokha@must.ac.mw. Brighton A. Chunga, Department of Water and Sanitation, Mzuzu University, Mzuzu, Malawi, E-mail: chunga.b@mzuni.ac.mw. Ayse Ercumen, Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, E-mail: aercume@ncsu.edu. Cassandra Workman, Department of Anthropology, University of North Carolina Greensboro, Greensboro, NC, E-mail: clworkma@uncg.edu. Joy Hart, Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, and Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, E-mail: joy.hart@louisville.edu. Ted Smith, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, and Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, E-mail: ted.smith@louisville.edu. Rochelle H. Holm, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, and Center for Healthy Air Water and Soil, School of Medicine, University of Louisville, Louisville, KY, E-mail: rochelle.holm@louisville.edu.

Address correspondence to Rochelle H. Holm, Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202. E-mail: rochelle.holm@louisville.edu
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
12 Nov 2024
|
Accepted:
02 Mar 2025
|
Published Online:
13 May 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645

Leprosy

By Sir Leonard Rogers and Ernest Muir. Pp. i–xii, 1–260. Second Edition, Williams & Wilkins Co., Baltimore, Md., 1940

Goldberger on Pellagra

ed. by Milton Terris, Professor of Preventive Medicine, New York Medical College. xii + 395 pages. Louisiana State University Press, Baton Rouge, Louisiana. 1964. $12.50

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