{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:13:52Z","timestamp":1789132432377,"version":"build-2803163510"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    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                    <jats:italic>N<\/jats:italic>\n                    = 536). Some respondents (\n                    <jats:italic>n<\/jats:italic>\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.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.24-0759","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T10:47:26Z","timestamp":1747133246000},"page":"200-213","source":"Crossref","is-referenced-by-count":3,"title":["Public Opinions from Malawian and Malawi Refugee Camp Residents of Wastewater and Environmental Surveillance"],"prefix":"10.4269","volume":"113","author":[{"given":"Dammy","family":"Jeboda","sequence":"first","affiliation":[{"name":"Department of Psychological and Brain Sciences, College of Arts and Sciences, University of Louisville, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandie Banner","family":"Shackelford","sequence":"additional","affiliation":[{"name":"The United Nations High Commissioner for Refugees, Lilongwe, Malawi;"},{"name":"The Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Chigwechokha","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, Malawi University of Science and Technology, Limbe, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brighton A.","family":"Chunga","sequence":"additional","affiliation":[{"name":"Department of Water and Sanitation, Mzuzu University, Mzuzu, Malawi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Ercumen","sequence":"additional","affiliation":[{"name":"Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Workman","sequence":"additional","affiliation":[{"name":"Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy L.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, Kentucky;"},{"name":"Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Smith","sequence":"additional","affiliation":[{"name":"Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;"},{"name":"Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rochelle H.","family":"Holm","sequence":"additional","affiliation":[{"name":"Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky;"},{"name":"Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"FEMS Microbes","first-page":"xtab011","article-title":"Wastewater monitoring, surveillance and epidemiology: A review of terminology for a common understanding","volume":"2","author":"Larsen","year":"2021"},{"key":"b2","series-title":"J Expo Sci Environ Epidemiol","first-page":"432","article-title":"Vibrio cholerae and Salmonella typhi culture-based wastewater or non-sewered sanitation surveillance in a resource-limited region","volume":"34","author":"Chigwechokha","year":"2024"},{"key":"b3","series-title":"Am J Epidemiol","first-page":"305","article-title":"Wastewater surveillance for infectious disease: A systematic review","volume":"192","author":"Kilaru","year":"2023"},{"key":"b4","series-title":"Environmental Surveillance for SARS-CoV-2 to Complement Other Public Health Surveillance","year":"2023"},{"key":"b5","series-title":"Sci Total Environ","first-page":"159351","article-title":"Occurrence of Z-drugs, benzodiazepines, and ketamine in wastewater in the United States and Mexico during the Covid-19 pandemic","volume":"857","author":"Adhikari","year":"2023"},{"key":"b6","series-title":"Proc Natl Acad Sci USA","first-page":"21864","article-title":"Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology","volume":"116","author":"Choi","year":"2019"},{"key":"b7","series-title":"Progress on Household Drinking Water, Sanitation and Hygiene 2000-2022: Special Focus on Gender","year":"2023"},{"key":"b8","series-title":"Sci Total Environ","first-page":"138234","article-title":"Environmental health conditions in protracted displacement: A systematic scoping review","volume":"726","author":"Behnke","year":"2020"},{"key":"b9","series-title":"Sci Total Environ","first-page":"143136","article-title":"Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review","volume":"762","author":"Cooper","year":"2021"},{"key":"b10","series-title":"Sci Total Environ","first-page":"136553","article-title":"Environmental health in forced displacement: A systematic scoping review of the emergency phase","volume":"714","author":"Shackelford","year":"2020"},{"key":"b11","series-title":"WASH Annual Report 2023","year":"2023"},{"key":"b12","series-title":"Environ Health (Wash)","first-page":"684","article-title":"Moving beyond wastewater: Perspectives on environmental surveillance of infectious diseases for public health action in low-resource settings","volume":"2","author":"Delgado Vela","year":"2024"},{"key":"b13","series-title":"Science","first-page":"509","article-title":"Privacy and human behavior in the age of information","volume":"347","author":"Acquisti","year":"2015"},{"key":"b14","series-title":"J Water Health","first-page":"1409","article-title":"Towards the outbreak tail, what is the public opinion about wastewater surveillance in the United States?","volume":"22","author":"Holm","year":"2024"},{"key":"b15","series-title":"PLoS One","first-page":"e0275075","article-title":"Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States","volume":"17","author":"LaJoie","year":"2022"},{"key":"b16","series-title":"Environ Health Insights","first-page":"1178630220984147","article-title":"A qualitative study of NIMBYism for waste in smaller urban areas of a low-income country, Mzuzu, Malawi","volume":"15","author":"Holm","year":"2021"},{"key":"b17","series-title":"JAMA","first-page":"2147","article-title":"Patient and study participant rights to privacy in journal publication","volume":"323","author":"Flanagin","year":"2020"},{"key":"b18","series-title":"S Afr J Bl","first-page":"93","article-title":"Core aspects of ubuntu: A systematic review","volume":"12","author":"Ewuoso","year":"2019"},{"key":"b19","series-title":"Public Health Ethics","first-page":"256","article-title":"Realizing Ubuntu in global health: An African approach to global health justice","volume":"15","author":"Jecker","year":"2022"},{"key":"b20","series-title":"J Med Ethics","first-page":"3","article-title":"Patients\u2019 and public views and attitudes towards the sharing of health data for research: A narrative review of the empirical evidence","volume":"48","author":"Kalkman","year":"2022"},{"key":"b21","series-title":"PLoS One","first-page":"e0278554","article-title":"When Peppa Pig and Confucius meet, joining forces on the battlefield of health literacy\u2013A qualitative analysis of COVID-19 educational materials for children and adolescents from China, the USA, and Europe","volume":"17","author":"\u015awi\u0105tkiewicz-Mo\u015bny","year":"2022"},{"key":"b22","series-title":"Front Public Health","first-page":"1213615","article-title":"Measuring the willingness to share personal health information: A systematic review","volume":"11","author":"Benevento","year":"2023"},{"key":"b23","series-title":"Clin Infect Dis","first-page":"v","article-title":"An end to the era of the US HIV entry ban","volume":"53","author":"Taylor","year":"2011"},{"key":"b24","series-title":"J Law Biosci","first-page":"lsaa039","article-title":"Legal and ethical implications of wastewater monitoring of SARS-CoV-2 for COVID-19 surveillance","volume":"7","author":"Gable","year":"2020"},{"key":"b25","series-title":"Sci Total Environ","first-page":"155664","article-title":"Wastewater treatment plant operators report high capacity to support wastewater surveillance for COVID-19 across New York State, USA","volume":"837","author":"Hill","year":"2022"},{"key":"b26","series-title":"ACS ES T Water","first-page":"1891","article-title":"Public awareness of and support for the use of wastewater for SARS-CoV-2 Monitoring: A community survey in Louisville, Kentucky","volume":"2","author":"Holm","year":"2022"},{"key":"b27","article-title":"2018 Malawi population and housing","year":"2019"},{"key":"b28","series-title":"J Res Pers","first-page":"609","article-title":"At what sample size do correlations stabilize?","volume":"47","author":"Sch\u00f6nbrodt","year":"2013"},{"key":"b29","series-title":"Environ Sci Technol","first-page":"1413","article-title":"Contingent valuation: A user\u2019s guide","volume":"34","author":"Carson","year":"2000"},{"key":"b30","series-title":"Natural Resource Economics: The Essentials","author":"Tietenberg","year":"2016"},{"key":"b31","article-title":"R: A language and environment for statistical computing","year":"2021"},{"key":"b32","series-title":"Analyzing Qualitative Data: Systematic Approaches","author":"Bernard","year":"2017"},{"key":"b33","series-title":"PLoS Negl Trop Dis","first-page":"e0009176","article-title":"Impact of sampling depth on pathogen detection in pit latrines","volume":"15","author":"Capone","year":"2021"},{"key":"b34","series-title":"Summary of Results Afrobarometer Round 8 Survey in Malawi, 2020","year":"2020"},{"key":"b35","series-title":"JAMA Intern Med","first-page":"1798","article-title":"Public preferences about secondary uses of electronic health information","volume":"173","author":"Grande","year":"2013"},{"key":"b36","series-title":"BMC Med Ethics","first-page":"19","article-title":"Trust and digital privacy in healthcare: A cross-sectional descriptive study of trust and attitudes towards uses of electronic health data among the general public in Sweden","volume":"23","author":"Belfrage","year":"2022"},{"key":"b37","series-title":"Can J Public Health","first-page":"159","article-title":"Public opinions about participating in health research","volume":"101","author":"Teschke","year":"2010"},{"key":"b38","series-title":"Health Aff (Millwood)","first-page":"328","article-title":"Trust in us federal, state, and local public health agencies during COVID-19: Responses and policy implications","volume":"42","author":"SteelFisher","year":"2023"},{"key":"b39","series-title":"Glob Public Health","first-page":"2617","article-title":"Ethical tensions surrounding \u2018third-party disclosure\u2019 by participants: Lessons from participatory health research in Eswatini","volume":"17","author":"Brear","year":"2022"},{"key":"b40","series-title":"Lancet Glob Health","first-page":"e59","article-title":"Affordability of the EAT\u2013Lancet reference diet: A global analysis","volume":"8","author":"Hirvonen","year":"2020"},{"key":"b41","article-title":"The global health observatory","year":"2024"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/1\/article-p200.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/1\/article-p200.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/1\/article-p200.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T09:51:54Z","timestamp":1751449914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/1\/article-p200.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,2]]},"references-count":41,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0759","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.11.12.24317144","asserted-by":"object"}]},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,2]]}}}