Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys

Abstract

Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined whether household availability of improved drinking water and sanitation, respectively, is associated with utilization of maternal and child health (MCH) services in South Asia. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0–36 months (n = 145,262). Types of households’ water source and sanitation facilities were categorized based on the World Health Organization and UNICEF’s definitions of “improved” and “unimproved”. We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, in relation to reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. MCH services and water/sanitation should be addressed across sectors aiming at improvement of MCH.

Malnourished children? Child health disparities and its causes in Eastern India

“…This suggests that an improvement in sanitation facilities can reduce morbidity and mortality among children, particularly for postneonatal and 12-59-month-olds. Similar results highlighting the risk of poor sanitation on childhood diseases and malnutrition, impacting the overall development of children in Bangladesh, Nepal, and Pakistan, were observed by Omidakhsh and von Ehrenstein (2021).…”

“…significant for girls, who may otherwise experience disparities in nutrition, healthcare access, breastfeeding duration, and vaccination rates (Omidakhsh & von Ehrenstein, 2021).…”

Incidence and characteristics of maternal mortality: a retrospective study in Dhaka medical college

“…5 The transition from global to regional statistics reveals a concerning trend in South Asia, including Bangladesh, which bears a substantial proportion of the global maternal mortality burden. 6 In Bangladesh, the maternal mortality ratio (MMR) has shown fluctuations over the years. Despite progress, the country still faces challenges in reducing maternal deaths to meet the Sustainable Development Goals.…”

“…8 In Bangladesh, these factors are compounded by specific challenges such as high adolescent pregnancy rates and low utilization of maternal newborn and child health (MNCH) services. 6 Socioeconomic determinants, such as a woman's educational level, income, and access to media, significantly influence the utilization of antenatal care services in Bangladesh. 9 Additionally, the COVID-19 pandemic has further exacerbated these challenges, leading to a reduction in essential MNCH services and an increase in maternal mortality.…”

Barriers and facilitators to Water, Sanitation and Hygiene (WaSH) practices in Southern Africa: A scoping review

“…Inadequate water, access to improved sanitation, and hygiene (WaSH) are global health challenges affecting about one-third of the world’s population [ 1 , 2 ]. Improved sanitation and hygiene are essential because they reduce environmental health risks [ 3 ].…”