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Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17

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Local Burden of Disease WaSH Collaborators (Including: Gill, Paramjit and Uthman, Olalekan A.). (2020) Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17. The Lancet Global Health, 8 (9). e1162-e1185. doi:10.1016/S2214-109X(20)30278-3

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Official URL: https://doi.org/10.1016/S2214-109X(20)30278-3

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Abstract

Background:
Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities.

Methods:
We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs.

Findings:
Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017.

Interpretation:
Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.

Funding:
Bill & Melinda Gates Foundation.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Drinking water, Sanitation, Developing countries -- Sanitation, Poor -- Health and hygiene
Journal or Publication Title: The Lancet Global Health
Publisher: The Lancet Publishing Group
ISSN: 2214-109X
Official Date: 1 September 2020
Dates:
DateEvent
1 September 2020Published
1 June 2020Accepted
Date of first compliant deposit: 24 September 2020
Volume: 8
Number: 9
Page Range: e1162-e1185
DOI: 10.1016/S2214-109X(20)30278-3
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
OPP1132415Bill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
UNSPECIFIEDCoordenação de Aperfeiçoamento de Pessoal de Nível Superiorhttp://dx.doi.org/10.13039/501100002322
UNSPECIFIEDConselho Nacional de Desenvolvimento Científico e Tecnológicohttp://dx.doi.org/10.13039/501100003593
UNSPECIFIEDFundação de Amparo a Pesquisa do Estado de Minas GeraisUNSPECIFIED
UNSPECIFIEDNational Research Foundationhttp://dx.doi.org/10.13039/501100001321
UNSPECIFIEDKuwait Universityhttp://dx.doi.org/10.13039/501100004482
UNSPECIFIEDUniversiti Kebangsaan Malaysiahttp://dx.doi.org/10.13039/501100004515
UNSPECIFIEDAksum UniversityUNSPECIFIED
PN-III-P4-ID-PCCF-2016-0084CNDS-UEFISCDIUNSPECIFIED
OPP1171700Bill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
UNSPECIFIEDPublic Health Agency of Canadahttp://dx.doi.org/10.13039/100011094
UNSPECIFIEDAlexander von Humboldt-Stiftunghttp://dx.doi.org/10.13039/100005156
UNSPECIFIEDHorizon 2020 Framework Programmehttp://dx.doi.org/10.13039/100010661
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100010269
R01-HD084233National Institute of Child Health and Human Developmenthttp://dx.doi.org/10.13039/100000071
P01- AG041710National Institute on Aginghttp://dx.doi.org/10.13039/100000049
R01-AI124389National Institute of Allergy and Infectious Diseaseshttp://dx.doi.org/10.13039/100000060
R01-AI112339National Institute of Allergy and Infectious Diseaseshttp://dx.doi.org/10.13039/100000060
D43-TW009775Fogarty International Centerhttp://dx.doi.org/10.13039/100000061
UNSPECIFIEDNIHR Oxford Biomedical Research Centrehttp://dx.doi.org/10.13039/501100013373
UID/QUI/50006/2019Fundação para a Ciência e a TecnologiaUNSPECIFIED
UID/MULTI/04378/2019Fundação para a Ciência e a TecnologiaUNSPECIFIED
SFRH/BHD/110001/2015Fundação para a Ciência e a TecnologiaUNSPECIFIED
UNSPECIFIEDBill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
201900/Z/16/ZWellcome Trusthttp://dx.doi.org/10.13039/100010269
UNSPECIFIEDSistema Nacional de Investigadoreshttp://dx.doi.org/10.13039/501100013395
P_40_382[ERDF] European Regional Development Fundhttp://dx.doi.org/10.13039/501100008530
FellowshipNational Heart Foundation of Australiahttp://dx.doi.org/10.13039/501100001030
UNSPECIFIEDDeakin Universityhttp://dx.doi.org/10.13039/501100001778
175014Ministarstvo Prosvete, Nauke i Tehnološkog RazvojaUNSPECIFIED
2020 Benjamin V Cohen Peace FellowshipBall State Universityhttp://dx.doi.org/10.13039/100008326
XMUMRF/2018-C2/ITCM/0001Xiamen Universityhttp://dx.doi.org/10.13039/501100008865
DST PURSEUGC-DAE Consortium for Scientific Research, University Grants Commissionhttp://dx.doi.org/10.13039/501100010426
UNSPECIFIEDNIHR Oxford Biomedical Research Centrehttp://dx.doi.org/10.13039/501100013373
UNSPECIFIEDBritish Heart Foundationhttp://dx.doi.org/10.13039/501100000274
UNSPECIFIEDCouncil for the Development of Social Science Research in Africahttp://dx.doi.org/10.13039/501100001902
UNSPECIFIEDFulbright Associationhttp://dx.doi.org/10.13039/100010629
175087Ministarstvo Prosvete, Nauke i Tehnološkog RazvojaUNSPECIFIED
UNSPECIFIEDHealth Data Research UKUNSPECIFIED
PI17/00719Instituto de Salud Carlos IIIhttp://dx.doi.org/10.13039/501100004587
UNSPECIFIEDSouth African Medical Research Councilhttp://dx.doi.org/10.13039/501100001322
Scholarship Department of Education, Skills and Employment, Australian GovernmentUNSPECIFIED
Contributors:
ContributionNameContributor ID
Research GroupLocal Burden of Disease WaSH Collaborators, UNSPECIFIED

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