Water, sanitation, and hygiene insecurity and psychological distress in South Sudan

There is a growing body of research on the relationship between water, sanitation, and hygiene (WASH) insecurity and mental health. The goal of this research was to understand the relationship between WASH insecurity and psychological wellbeing in one community in Juba, South Sudan, using a participatory approach with community members. We aimed to: (1) explore the kind of WASH insecurity experienced in South Sudan; and (2) hear how community members understood the relationship between these insecurities and their psychological wellbeing. A total of 56 adults from the community of Rejah, South Sudan, participated in this study. We used concept mapping to develop a conceptual framework for how community members viewed the relationship between WASH insecurity and psychological wellbeing. Participants engaged in three rounds of data collection that included brainstorming ideas, sorting ideas into meaningful groups, and providing feedback. Men generated 33 statements related to WASH insecurity and psychological wellbeing, and women generated 34. Men’s ideas grouped into 5 clusters, with one focused on positive impacts; women’s ideas grouped into 6 clusters, with two focused on fears related to gender-based violence and other dangers. Together, men and women articulated a wide variety of negative impacts of WASH insecurity on psychological wellbeing, including sadness, shame, stress, worry, fear, being afraid, “thinking too much”, and low self-esteem. More focus is needed on the psychosocial impact of WASH insecurity among individuals in conflict and post-conflict settings. Addressing these daily stressors may have a positive impact on mental distress.