ObjectivesTo assess access to adequate water, sanitation and hygiene (WASH) among people with disabilities at the household and individual level.DesignCross-sectional surveys.SettingData were included from five district-level or regional-level surveys: two in Bangladesh (Bangladesh-1, Bangladesh-2), and one each in Cameroon, Malawi and India.Participants99 252 participants were sampled across the datasets (range: 3567–75 767), including 2494 with disabilities (93–1374).OutcomePrevalence of access to WASH at household and individual level.Data analysisAge/sex disaggregated disability prevalence estimates were calculated accounting for survey design. The Unicef/WHO Joint Monitoring Programme definitions were used to classify facilities as improved/unimproved. Multivariable logistic regression was undertaken to compare between households with/without a person with a disability, and to identify predictors of access among people with disabilities.ResultsThere were no differences in access to improved sanitation or water sources between households with/without members with disabilities across the datasets. In Bangladesh-2, households including a person with a disability were more likely to share facilities with other households (OR 1.3, 95% CI 1.1 to 1.5). Households with people with disabilities were more likely to spend >30 min (round-trip) collecting drinking water than households without in both Cameroon (OR 1.8, 95% CI 1.0 to 3.4) and India (OR 2.3, 95% CI 1.2 to 4.7). Within households, people with disabilities reported difficulties collecting water themselves (23%–80% unable to) and accessing the same sanitation facilities as other household members, particularly without coming into contact with faeces (up to 47% in Bangladesh-2). These difficulties were most marked for people with more severe impairments.ConclusionsPeople with disabilities may not have poorer access to WASH at the household level, but may have poorer quality of access within their households. Further programmatic work is needed to ensure WASH facilities are inclusive of people with disabilities.

Community-led total sanitation (CLTS) is a common method for promoting sanitation in low-income settings. This cluster-randomized trial evaluated an intervention to improve inclusion of people with disability in CLTS through training facilitators. A qualitative study examined intervention acceptability. The trial included 171 people with disabilities (78 control and 93 intervention) living in 15 intervention and 15 control communities. In the intervention arm, respondents were more likely to participate in a community meeting about sanitation (+18.7%, 95% confidence interval [CI]: 3.2, 34.2) and to have been visited to discuss sanitation (+19.7, 95% CI: 0.6, 37.8). More intervention households improved latrine access for the disabled member (+9%, CI: -3.1, 21.0). Inclusive CLTS could improve sanitation access for people with disability but requires support to households beyond that provided in this trial.

The new coronavirus disease (COVID-19) has paralysed many sectors of human life, including economic, social-cultural and political processes. In the political arena, several countries have postponed elections due to the COVID-19 pandemic. Other countries, including Malawi, went ahead with their planned elections. Malawi held a presidential election at a time when the number of COVID-19 cases was increasing rapidly. In this paper, we assess the effect of the perceived risk of catching COVID-19 on willingness to vote in the Malawi presidential election that was held on 23 June 2020. Turn out in this election was ten percentage points lower than in the general elections that were held a year earlier. The paper draws on a nationally representative survey of adult Malawians (n = 1155). In our main analysis, we use instrumental variables to account for potential endogeneity. We find that nearly two thirds of Malawians thought that they were likely to catch COVID-19 at some point. Notwithstanding the COVID-19 risk, 86% of the country’s citizens were willing to vote. Our analysis shows that an individual’s perceived risk of catching COVID-19 is associated with a lower likelihood of voting (β = − 0.096; p < 0.05). This suggests that voter turnout in Malawi’s fresh presidential election may have been highly affected by the perceived risk of catching COVID-19. The policy implication is that instituting and enforcing primary preventive measures may help reduce the perceived risk of catching COVID-19 and mitigate voter apathy.

Access to water in Sub Saharan Africa (SSA) continues to be a challenge to the extent that there are more people without access to water in 2015 than in 1990. This inidcates that current approaches to water provision has been ineffective. Governments have failed to provide a structure, mechanisms or aproaches that guarantees water for ALL. Resulting in a vacuum which has been 'filled' by a number of social actors (NGOs, Faith Based Organisations, Donors). This paper examines the social actors involved in water access and provision in Malawi andZambia analysing the existing methods and approaches used by them in the sector. It seeks increase understanding of the contributions and the nature of influence of each social actor group. This was achieved by collecting data on social actors through a combination of methods; focus group discussions, semi-structured interviews and workshops. Social actor analyses of the data shaped the findings.The findings indicate that water provision is multifaceted requiring improved coordination and cooperation among social actors to streamline and focus on the provsion of for ALL. It draws attention to the need for Governments to take a leading role by facilitating long term investment in the sector and promoting initiatives which incorporate the right to water access.It concludes that in order to achieve universal access to water, a new perception of rights and responsibilities is vital in communities, donors, NGOs and the public sector as one step towards reducing the number of people without water in the future.

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