Mapping Geographical Inequalities in Access to Drinking Water and Sanitation Facilities in Low-income and Middle-income Countries, 2000–17

aut.relation.journalThe Lancet Global Healthen_NZ
aut.researcherFeigin, Valery
dc.contributor.authorDeshpande, Aen_NZ
dc.contributor.authorMiller-Petrie, MKen_NZ
dc.contributor.authorLindstedt, PAen_NZ
dc.contributor.authorBaumann, MMen_NZ
dc.contributor.authorJohnson, KBen_NZ
dc.contributor.authorBlacker, BFen_NZ
dc.contributor.authorAbbastabar, Hen_NZ
dc.contributor.authorAbd-Allah, Fen_NZ
dc.contributor.authorAbdelalim, Aen_NZ
dc.contributor.authorAbdollahpour, Ien_NZ
dc.contributor.authorAbegaz, KHen_NZ
dc.contributor.authorAbejie, ANen_NZ
dc.contributor.authorAbreu, LGen_NZ
dc.contributor.authorAbrigo, MRMen_NZ
dc.contributor.authorAbualhasan, Aen_NZ
dc.contributor.authorAccrombessi, MMKen_NZ
dc.contributor.authorAdamu, AAen_NZ
dc.contributor.authorAdebayo, OMen_NZ
dc.contributor.authorAdedeji, IAen_NZ
dc.contributor.authorAdedoyin, RAen_NZ
dc.contributor.authorAdekanmbi, Ven_NZ
dc.contributor.authorAdetokunboh, OOen_NZ
dc.contributor.authorAdhikari, TBen_NZ
dc.contributor.authorAfarideh, Men_NZ
dc.contributor.authorAgudelo-Botero, Men_NZ
dc.contributor.authorAhmadi, Men_NZ
dc.contributor.authorAhmadi, Ken_NZ
dc.contributor.authorAhmed, MBen_NZ
dc.contributor.authorAhmed, AEen_NZ
dc.contributor.authorAkalu, TYen_NZ
dc.contributor.authorAkanda, ASen_NZ
dc.contributor.authorAlahdab, Fen_NZ
dc.contributor.authorAl-Aly, Zen_NZ
dc.contributor.authorAlam, Sen_NZ
dc.contributor.authorAlam, Nen_NZ
dc.contributor.authorAlamene, GMen_NZ
dc.contributor.authorAlanzi, TMen_NZ
dc.contributor.authorAlbright, Jen_NZ
dc.contributor.authorAlbujeer, Aen_NZ
dc.contributor.authorAlcalde-Rabanal, JEen_NZ
dc.contributor.authorAlebel, Aen_NZ
dc.contributor.authorAlemu, ZAen_NZ
dc.contributor.authorAli, Men_NZ
dc.contributor.authorAlijanzadeh, Men_NZ
dc.contributor.authorAlipour, Ven_NZ
dc.contributor.authorAljunid, SMen_NZ
dc.contributor.authorAlmasi, Aen_NZ
dc.contributor.authorAlmasi-Hashiani, Aen_NZ
dc.contributor.authorAl-Mekhlafi, HMen_NZ
dc.contributor.authorAltirkawi, KAen_NZ
dc.contributor.authorAlvis-Guzman, Nen_NZ
dc.contributor.authorAlvis-Zakzuk, NJen_NZ
dc.contributor.authorAmini, Sen_NZ
dc.contributor.authorAmit, AMLen_NZ
dc.contributor.authorAmul, GGHen_NZ
dc.contributor.authorAndrei, CLen_NZ
dc.contributor.authorAnjomshoa, Men_NZ
dc.contributor.authorAnsariadi, Aen_NZ
dc.contributor.authorAntonio, CATen_NZ
dc.contributor.authorAntony, Ben_NZ
dc.contributor.authorAntriyandarti, Een_NZ
dc.contributor.authorArabloo, Jen_NZ
dc.contributor.authorAref, HMAen_NZ
dc.contributor.authorAremu, Oen_NZ
dc.contributor.authorArmoon, Ben_NZ
dc.contributor.authorArora, Aen_NZ
dc.contributor.authorAryal, KKen_NZ
dc.contributor.authorArzani, Aen_NZ
dc.contributor.authorAsadi-Aliabadi, Men_NZ
dc.contributor.authorAsmelash, Den_NZ
dc.contributor.authorAtalay, HTen_NZ
dc.contributor.authorAthari, SMen_NZ
dc.contributor.authorAthari, SSen_NZ
dc.contributor.authorAtre, SRen_NZ
dc.contributor.authorAusloos, Men_NZ
dc.contributor.authorAwasthi, Sen_NZ
dc.contributor.authorAwoke, Nen_NZ
dc.contributor.authorAyala Quintanilla, BPen_NZ
dc.contributor.authorAyano, Gen_NZ
dc.contributor.authorAyanore, MAen_NZ
dc.contributor.authorAynalem, YAen_NZ
dc.contributor.authorAzari, Sen_NZ
dc.contributor.authorAzman, ASen_NZ
dc.contributor.authorBabaee, Een_NZ
dc.contributor.authorBadawi, Aen_NZ
dc.contributor.authorBagherzadeh, Men_NZ
dc.contributor.authorBakkannavar, SMen_NZ
dc.contributor.authorBalakrishnan, Sen_NZ
dc.contributor.authorBanach, Men_NZ
dc.contributor.authorBanoub, JAMen_NZ
dc.contributor.authorBarac, Aen_NZ
dc.contributor.authorBarboza, MAen_NZ
dc.contributor.authorBärnighausen, TWen_NZ
dc.contributor.authorBasu, Sen_NZ
dc.contributor.authorBay, VDen_NZ
dc.contributor.authorBayati, Men_NZ
dc.contributor.authorBedi, Nen_NZ
dc.contributor.authorBeheshti, Men_NZ
dc.contributor.authorBehzadifar, Men_NZ
dc.contributor.authorBehzadifar, Men_NZ
dc.description.abstractBackground: 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.en_NZ
dc.identifier.citationLancet Global Health, 2020-09-01, Volume 8, Issue 9, Pages e1162-e1185.
dc.rightsCopyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
dc.titleMapping Geographical Inequalities in Access to Drinking Water and Sanitation Facilities in Low-income and Middle-income Countries, 2000–17en_NZ
dc.typeJournal Article
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Public Health & Psych Studies
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HY Public Health & Psychosocial Studies 2018 PBRF
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