Mapping and situation analysis of basic WASH facilities at households in Bangladesh: Evidence from a nationally representative survey

Demographic, socioeconomic and regional disparities in the coverage of water, sanitation and hygiene facilities in four South Asian Countries

BACKGROUND

Ensuring an adequate water, sanitation, and hygiene (WASH) is crucial for upholding public health and achieving Sustainable Development Goals (SDG-6). The main goal of this study was to review the existing WASH facilities, mapping for regional comparisons, and identify the significant socioeconomic and demographic factors associated with WASH facilities in Afghanistan, Bangladesh, Nepal, and Pakistan.

METHODS

This study employed a quantitative research design using the most recent Multiple Indicator Cluster Survey (MICS) data from Afghanistan (2022-23, n =  23,213), Bangladesh (2019, n =  61,242), Nepal (2019, n =  12,655), and Pakistan (2017-19, n =  96,105). Data analysis was done using descriptive statistics and multivariate logistic regression model. Besides, spatial mapping was used for regional comparison, the Generalized Variance Inflation Factor (GVIF) was applied for checking multicollinearity, and the Receiver Operating Characteristic (ROC) curve was used to evaluate model performance.

RESULTS

This study revealed substantial disparities in the coverage of WASH facilities across four countries. Nepal had the highest coverage (75.33%), followed by Pakistan (59.47%), Bangladesh (50.28%) and Afghanistan (33.54%). Wealthier households were associated with higher odds of WASH facilities compared to the poor: Afghanistan (aOR = 7.83; 95% CI: 6.58-9.32; p <  0.001), Bangladesh (aOR = 5.75; 95% CI: 5.34-6.20; p <  0.001), Nepal (aOR = 5.80; 95% CI: 4.52-7.44; p <  0.001), and Pakistan (aOR = 9.64; 95% CI: 8.79-10.58; p <  0.001). In addition, place of residence, education of household head, access to the media, age of household head, and family size emerged as significant determinants of WASH facilities across all four countries.

CONCLUSION

The findings suggest that wealthier households, those with educated heads, and those in urban areas have higher coverage of WASH facilities. To ensure adequate WASH facilities, policymakers should focus on rural areas, lower-income groups, less educated household heads, and should conduct awareness campaigns.

The Enterics for Global Health (EFGH) Shigella Surveillance Study in Bangladesh

Background

Shigella is an important cause of diarrhea in Bangladeshi children <5 years of age, with an incidence rate of 4.6 per 100 person-years. However, the report was more than a decade old, and data on Shigella consequences are similarly outdated and heterogeneously collected.

Methods

Facility-based disease surveillance is planned to be carried out under the Enterics for Global Health (EFGH) Shigella Surveillance Study consortium for 2 years with aims to optimize and standardize laboratory techniques and healthcare utilization and coverage survey, clinical and anthropometric data collection, safety monitoring and responsiveness, and other related activities. The EFGH is a cohesive network of multidisciplinary experts, capable of operating in concert to conduct the study to generate data that will pave the way for potential Shigella vaccine trials in settings with high disease burden. The study will be conducted within 7 country sites in Asia, Africa, and Latin America.

Conclusions

We outline the features of the Bangladesh site as part of this multisite surveillance network to determine an updated incidence rate and document the consequences of Shigella diarrhea in children aged 6-35 months, which will help inform policymakers and to implement the future vaccine trials.

Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys

OBJECTIVE

To examine the association between household access to water, sanitation and handwashing (WaSH) facilities and child undernutrition in Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study of children less than 5 years using data collected from the 2019 Multiple Indicator Cluster Survey (MICS) and the 2017-2018 Bangladesh Demographic and Health Survey (BDHS).

OUTCOME MEASURES

Stunting, wasting and underweight, defined as a Z-score <-2 SD for height-for-age, weight-for-height and weight-for-age, respectively. We applied hierarchical multiple binary logistic regression models.

RESULTS

Among 30 514 children 0-59 months, there was a high prevalence of child undernutrition (MICS: 28.0% stunted, 9.8% wasted, 22.6% underweight; BDHS: 30.8% stunted, 8.4% wasted, 21.7% underweight). Most children came from households lacking basic sanitation (MICS: 39.1%, BDHS: 55.3%) or handwashing facilities (MICS: 43.8%, BDHS: 62.6%). Children from households without access to WaSH facilities experienced the highest rates of undernutrition. Exposure-specific adjusted logistic regression models showed that a lack of access to improved water sources was associated with greater odds of wasting (MICS: adjusted OR (AOR) 1.36, 95% CI 1.00 to 1.85, p<0.05); basic sanitation facility with higher rates of stunting (MICS: 1.13, 1.04 to 1.23, p<0.01) and underweight (BDHS: 1.18, 1.02 to 1.37, p<0.05); and a lack of handwashing facilities with stunting (BDHS: 1.27, 1.10 to 1.48, p<0.01) and underweight (MICS: 1.10, 1.01 to 1.19, p<0.05). In fully adjusted models, no basic sanitation facility was associated with higher odds of stunting (MICS: AOR 1.12, 1.03 to 1.22, p<0.01) and a lack of handwashing facilities with higher odds of underweight (BDHS: AOR 1.30, 1.10 to 1.54, p<0.01;MICS: AOR 1.09, 1.01 to 1.19, p<0.05).

CONCLUSION

These findings demonstrate a significant association between poor household WaSH facilities and high prevalence of child undernutrition. Improving WaSH may help reduce child undernutrition in Bangladesh.

Household access to basic drinking water, sanitation and hygiene facilities: secondary analysis of data from the demographic and health survey V, 2017-2018

BACKGROUND

In Benin, access to water, sanitation and hygiene (WASH) remains an issue. This study aims to provide an overview of household access to basic WASH services based on nationally representative data.

METHOD

Secondary analyses were run using the 'HOUSEHOLD' dataset of the fifth Demographic and Health Survey 2017-2018. The dependent variables were household access to individual and combined basic WASH services. The characteristics of the household head and those related to the composition, wealth and environment of the household were independent variables. After a descriptive analysis of all study variables, multivariate logistic regression was performed to identify predictors of outcome variables.

RESULTS

The study included 14,156 households. Of these, 63.98% (95% CI = 61.63-66.26), 13.28% (95% CI = 12.10-14.57) and 10.11% (95% CI = 9.19-11.11) had access to individual basic water, sanitation and hygiene facilities, respectively. Also, 3% (95% CI = 2.53-3.56) of households had access to combined basic WASH services. Overall, the richest households and few, and those headed by people aged 30 and over, female and with higher levels of education, were the most likely to have access to individual and combined basic WASH services. In addition, disparities based on the department of residence were observed.

CONCLUSION

The authors suggest a multifactorial approach that addresses the identified determinants.