Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa

Abstract

IntroductionSub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa.MethodsWe carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child’s status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression.ResultsThe analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24–6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51–58.78), 28.18% (95% CI = 27.74–28.63), and 17.06% (95% CI = 16.71–17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04–1.16) or surface water (aOR = 1.11; 95% CI = 1.03–1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04–1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality.ConclusionInterventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.

Impact of Water, Sanitation, and Hygiene Components on Under-5 Children's Mortality in Ethiopia: A Comparative Analysis of Count Regression Models

“…According to this study's findings, the mortality rate of under-five children in Ethiopia is significantly impacted by water, sanitation, and hygiene (WASH) components. Poor WASH conditions are linked to poor health outcomes in children, which are consistent with those of other studies (Amadu et al, 2023;Gaffan et al, 2023;Parker et al, n.d.-b;Sahiledengle et al, 2022;Tamene et al, 2023b). Children under five die at a higher rate due to a variety of factors, including inadequate sanitation facilities, outdated water sources, and inadequate hygiene habits.…”

“…Under-five mortality is decreased by having access to water and sanitary facilities. There was an increased risk of under-five mortality for children residing in households with inadequate sanitation facilities (Gaffan et al, 2023). According to a different study, Ethiopia's improvements in water and sanitation have somewhat decreased stunting and diarrhea, which helps to explain the drop in under-5 mortality and emphasizes the need for more WASH improvements (Girma et al, 2021).…”

Wastewater Management Strategy for Resilient Cities—Case Study: Challenges and Opportunities for Planning a Sustainable Timor-Leste

“…According to the report, many do not have a decent toilet of their own [30] and the high infant, under-five, and maternal mortality rates in Timor-Leste are associated with the poor access to and utilization of health care [31]. On the other hand, children living in households using unimproved water facilities or surface water are more likely to die before five than those with basic water facilities [32].…”

Understanding Households’ Willingness to Pay for Improved Sanitation Services in Benin: A Study Protocol

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