Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys
Abstract
:1. Introduction
Theoretical Background and Study Aims
2. Materials and Methods
2.1. Study Design and Population
2.2. Water and Sanitation
2.3. MCH Services
2.4. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
- WHO; UNICEF. Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on Inequalities; United Nations Children’s Fund (UNICEF): New York, NY, USA; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
- UNESCO; World Water Assessment Programme. The United Nations World Water Development Report 2020: Water and Climate Change; United Nations Educational, Scientific and Cultural Organization: Paris, France, 2020. [Google Scholar]
- United Nations. Transforming out World: The 2030 Agenda for Sustainable Development; United Nations: New York, NY, USA, 2015. [Google Scholar]
- World Health Organization. World Health Statistics 2020: Monitoring Health for the SDGs, Sustainable Development Goals; World Health Organization: Geneva, Switzerland, 2020. [Google Scholar]
- GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 1736–1788. [Google Scholar] [CrossRef] [Green Version]
- GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 1684–1735. [Google Scholar] [CrossRef] [Green Version]
- GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted lif e-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 1859–1922. [Google Scholar] [CrossRef] [Green Version]
- GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 1923–1994. [Google Scholar]
- GBD 2017 SDG Collaborators. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 2091–2138. [Google Scholar] [CrossRef] [Green Version]
- UN Economic and Social Commission for Asia and the Pacific. Achieving the Sustainable Development Goals in South Asia: Key Policy Priorities and Implementation Challenges; Economic and Social Commission for Asia and the Pacific (ESCAP): Bangkok, Thailand, 2018; ISBN 978-92-1-120746-0. [Google Scholar]
- Geere, J.-A.L.; Hunter, P.R. The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries. Int. J. Hyg. Environ. Health 2020, 223, 238–247. [Google Scholar] [CrossRef]
- Patel, R.; Gupta, A.; Chauhan, S.; Bansod, D.W. Effects of sanitation practices on adverse pregnancy outcomes in India: A conducive finding from recent Indian demographic health survey. BMC Pregnancy Childbirth 2019, 19, 378. [Google Scholar] [CrossRef]
- Matanock, A.; Anderson, T.; Ayers, T.; Likicho, L.; Wamimbi, R.; Lu, X.; Emeetai, T.; Kakande, C.; Mutabazi, M.; Quick, R. Integrating Water Treatment into Antenatal Care: Impact on Use of Maternal Health Services and Household Water Treatment by Mothers-Rural Uganda, 2013. Am. J. Trop. Med. Hyg. 2016, 94, 1150–1156. [Google Scholar] [CrossRef] [Green Version]
- Routh, J.A.; Loharikar, A.; Chemey, E.; Msoma, A.; Ntambo, M.; Mvula, R.; Ayers, T.; Gunda, A.; Russo, E.T.; Barr, B.T.; et al. Safe Water and Hygiene Integration with Human Immunodeficiency Virus and Antenatal Services: Leveraging Opportunities for Public Health Interventions and Improved Service Uptake. Am. J. Trop. Med. Hyg. 2018, 98, 1234–1241. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fagerli, K.; Routh, J.; Hancock, W.T.; Hoots, B.; Gunda, A.; Deng, L.; Tippett Barr, B.; Kamb, M.; Quick, R. Impact of program transfer from a non-governmental organization to a district health office: Evaluation of a program integrating water treatment and hygiene kits into reproductive health and HIV services, Machinga District, Malawi, 2010–2012. PLoS ONE 2019, 14, e0219984. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Link, B.G.; Phelan, J. Social conditions as fundamental causes of disease. J. Health Soc. Behav. 1995, 80–94. [Google Scholar] [CrossRef] [Green Version]
- Rose, G. Sick individuals and sick populations. Int. J. Epidemiol. 1985, 14, 32–38. [Google Scholar] [CrossRef] [Green Version]
- Goldberg, D.S. The implications of fundamental cause theory for priority setting. Am. J. Public Health 2014, 104, 1839–1843. [Google Scholar] [CrossRef] [PubMed]
- Bronfenbrenner, U. Ecological systems theory. In Six Theories of Child Development: Revised Formulations and Current Issues; Jessica Kingsley Publishers: London, UK, 1992; pp. 187–249. [Google Scholar]
- Corsi, D.J.; Neuman, M.; Finlay, J.E.; Subramanian, S. Demographic and health surveys: A profile. Int. J. Epidemiol. 2012, 41, 1602–1613. [Google Scholar] [CrossRef]
- International, I. Demographic and Health Survey Sampling and Household Listing Manual; ICF International: Calverton, MD, USA, 2012. [Google Scholar]
- UN Department of Economic and Social Affairs Population Devision. World Population Prospects: The 2017 Revision. 2017. Available online: https://population.un.org/wpp/ (accessed on 13 June 2018).
- WHO. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines; World Health Organization (WHO): Geneva, Switzerland; United Nations Children’s Fund (UNICEF): New York, NY, USA, 2017. [Google Scholar]
- Yaya, S.; Bishwajit, G.; Ekholuenetale, M.; Shah, V.; Kadio, B.; Udenigwe, O. Timing and adequate attendance of antenatal care visits among women in Ethiopia. PLoS ONE 2017, 12, e0184934. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Heredia-Pi, I.; Serván-Mori, E.; Darney, B.; Reyes-Morales, H.; Lozano, R. Measuring the adequacy of antenatal health care: A national cross-sectional study in Mexico. Bull. World Health Organ. 2016, 94, 452–461. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience; World Health Organization: Geneva, Switzerland, 2016; ISBN 978-92-4-154991-2. [Google Scholar]
- Greenland, S.; Daniel, R.; Pearce, N. Outcome modelling strategies in epidemiology: Traditional methods and basic alternatives. Int. J. Epidemiol. 2016, 45, 565–575. [Google Scholar] [CrossRef] [Green Version]
- Rutstein, S.; Johnson, K. The DHS Wealth Index. DHS Comparative Reports No. 6; ORC Macro: Calverton, MD, USA, 2004. [Google Scholar]
- World Health Organization. Mortality and Burden of Disease from Water and Sanitation. Available online: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/2260 (accessed on 2 May 2020).
- GBD Diarrhoeal Diseases Collaborators. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect. Dis. 2017, 17, 909–948. [Google Scholar] [CrossRef] [Green Version]
- GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect. Dis. 2018, 18, 1211–1228. [Google Scholar] [CrossRef] [Green Version]
- GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020, 396, 1223–1249. [Google Scholar] [CrossRef]
- Delele, T.G.; Biks, G.A.; Abebe, S.M.; Kebede, Z.T. Determinants of Health Facility Delivery in Northwest Ethiopia: A Community-Based Case-Control Study. Int. J. Gen. Med. 2021, 14, 993–1001. [Google Scholar] [CrossRef] [PubMed]
- Halim, N.; Bohara, A.K.; Ruan, X. Healthy mothers, healthy children: Does maternal demand for antenatal care matter for child health in Nepal? Health Policy Plan 2011, 26, 242–256. [Google Scholar] [CrossRef] [Green Version]
- Heymann, S.J.; Vo, P.H.; Bergstrom, C.A. Child Care Providers’ Experiences Caring For Sick Children: Implications For Public Policy. Early Child Dev. Care 2002, 172, 1–8. [Google Scholar] [CrossRef]
- Shaheed, A.; Orgill, J.; Montgomery, M.A.; Jeuland, M.A.; Brown, J. Why “improved” water sources are not always safe. Bull. World Health Organ. 2014, 92, 283–289. [Google Scholar] [CrossRef]
- World Health Organization. Global Strategy for Women’s and Children’s Health. Available online: https://www.who.int/pmnch/topics/maternal/20100914_gswch_en.pdf?ua=12010 (accessed on 30 June 2020).
- Islam, S.M.D.; Mondal, P.K.; Ojong, N.; Bodrud-Doza, M.; Siddique, M.A.B.; Hossain, M.; Mamun, M.A. Water, sanitation, hygiene and waste disposal practices as COVID-19 response strategy: Insights from Bangladesh. Environ. Dev. Sustain. 2021, 23, 11953–11974. [Google Scholar] [CrossRef]
- McGriff, J.A.; Denny, L. What COVID-19 Reveals about the Neglect of WASH within Infection Prevention in Low-Resource Healthcare Facilities. Am. J. Trop. Med. Hyg. 2020, 103, 1762–1764. [Google Scholar] [CrossRef] [PubMed]
- Parikh, P.; Diep, L.; Gupte, J.; Lakhanpaul, M. COVID-19 challenges and WASH in informal settlements: Integrated action supported by the sustainable development goals. Cities 2020, 107, 102871. [Google Scholar] [CrossRef] [PubMed]
- Kumar, J. Effect of COVID-19 on maternal and neonatal services. Lancet. Glob. Health 2021, 9, e113. [Google Scholar] [CrossRef]
- World Health Organization; United Nations Children’s Fund. WASH in Health Care Facilities: Global Baseline Report 2019; WHO: Geneva, Switzerland; UNICEF: New York, NY, USA, 2019. [Google Scholar]
Variable | Category | Definition |
---|---|---|
Water a | Improved | Water that came from a pipe, borehole, protected dug well, protected spring, filtration plant, or rainwater |
Unimproved | Water that came from unprotected dug well, unprotected spring, surface water, vendor-provided water, bottled water, or tanker truck water | |
Sanitation b | Improved | Pour-flush latrine, simple pit latrine, ventilated improved pit latrine, pit latrine with slab, composting toilet, or if toilet flushed to a public sewer or septic system |
Unimproved | Pit latrine without slab, open-pit latrine, bush, field, no toilet facility, bucket toilet, traditional dry vault, dry toilet, or toilet that flushed to “somewhere else” | |
Birth Attendant c | Skilled | Doctor, nurse, midwife, auxiliary midwife, or other health care professional present |
Unskilled | Traditional attendants, friends and/or relatives | |
Up-to-date immunizations d | 0 to <4 months | BCG (1 dose) Polio (1 doses) DPT (1 dose) |
4 to <6 months | BCG (1 dose) Polio (2 doses) DPT (2 doses) | |
6 to ≤12 months | BCG (1 dose) Polio (3 doses) DPT (3 doses) | |
13 to ≤36 months | BCG (1 dose) Polio (3 doses) DPT (3 doses) Measles (1 dose) |
Demographic Characteristics | Bangladesh | India | Nepal | Pakistan | All |
---|---|---|---|---|---|
Survey Year | 2014 | 2015–2016 | 2016 | 2012–2013 | 2012–2016 |
N = 4470 (%) | N = 132,667 (%) | N = 2687 (%) | N = 5438 (%) | N = 145,262 (%) | |
Mean age (SD) | 24.6 (0.09) | 26.4 (0.01) | 25.3 (0.10) | 28.5 (0.08) | 26.4 (0.01) |
Educational Attainment | |||||
No education | 600 (13.4) | 37,232 (28.1) | 767 (28.5) | 2944 (54.1) | 41,543 (28.6) |
Incomplete primary | 695 (15.6) | 8069 (6.1) | 333 (12.4) | 303 (5.6) | 9400 (6.5) |
Complete primary | 520 (11.6) | 10,276 (7.8) | 184 (6.9) | 500 (9.2) | 11,480 (7.9) |
Incomplete secondary | 1803 (40.3) | 50,583 (38.1) | 741 (27.6) | 474 (8.7) | 53,601 (36.9) |
Complete secondary | 328 (7.3) | 12,232 (9.2) | 233 (8.7) | 552 (10.2) | 13,345 (9.2) |
Higher than secondary | 524 (11.7) | 14,275 (10.8) | 429 (16.0) | 665 (12.2) | 15,893 (10.9) |
Marital Status | |||||
Not married | 51 (1.1) | 1774 (1.3) | 12 (0.5) | 38 (0.7) | 1875 (1.29) |
Married or living with partner | 4419 (98.9) | 130,893 (98.7) | 2675 (99.6) | 5400 (99.3) | 143,387 (98.7) |
Residency status | |||||
Urban | 1435 (32.1) | 31,958 (24.1) | 1535 (57.1) | 2343 (43.1) | 37,271 (25.7) |
Rural | 3035 (67.9) | 100,709 (75.9) | 1152 (42.9) | 3095 (56.9) | 107,991 (74.3) |
Household Wealth Index a | |||||
Poorest | 933 (20.9) | 33,095 (25.0) | 698 (26.0) | 1186 (21.8) | 35,912 (24.7) |
Poorer | 842 (18.8) | 30,815 (23.2) | 582 (21.7) | 1083 (19.9) | 33,322 (22.9) |
Middle | 865 (19.4) | 26,749 (20.2) | 554 (20.6) | 1042 (19.2) | 29,210 (20.1) |
Richer | 943 (21.1) | 22,784 (17.2) | 511 (19.0) | 1038 (19.1) | 25,276 (17.4) |
Richest | 887 (19.8) | 19,224 (14.5) | 342 (12.7) | 1089 (20.0) | 21,542 (14.8) |
Bangladesh | India | Nepal | Pakistan | All | ||||||
---|---|---|---|---|---|---|---|---|---|---|
N = 4470 (%) | N = 132,667 (%) | N = 2687 (%) | N = 5438 (%) | N = 145,262 (%) | ||||||
Low a (%) | High b (%) | Low a (%) | High b (%) | Low a (%) | High b (%) | Low a (%) | High b (%) | Low a (%) | High b (%) | |
N = 1295 | N = 3175 | N = 45,301 | N = 87,366 | N = 1100 | N = 1587 | N = 3247 | N = 2191 | N = 50,943 | N = 94,319 | |
Up-to-date immunizations | 913 (70.5) | 2649 (83.4) | 22,145 (48.9) | 54,947 (62.9) | 750 (68.2) | 1262 (79.5) | 1107 (34.1) | 1411 (64.5) | 24,915 (48.1) | 60,269 (63.9) |
ANC visits (4 or more) | 222 (17.1) | 1165 (36.7) | 13,337 (29.4) | 49,064 (56.2) | 621 (56.5) | 1305 (82.2) | 712 (21.9) | 1392 (63.5) | 14,892 (29.23) | 52,926 (56.1) |
ANC visits (8 or more) | 31 (2.4) | 246 (7.8) | 3180 (7.0) | 17,694 (20.3) | 40 (3.6) | 147 (9.3) | 152 (4.7) | 517 (23.6) | 3403 (6.7) | 18,604 (19.7) |
Presence of skilled attendant at delivery | 288 (22.2) | 1625 (51.2) | 30,231 (66.7) | 75,987 (87.0) | 551 (50.1) | 1239 (78.1) | 1413 (43.5) | 1717 (78.4) | 32,483 (63.8) | 80,568 (85.4) |
Improved water sources | 1176 (90.8) | 2735 (86.1) | 37,491 (82.8) | 71,264 (81.6) | 941 (85.6) | 1343 (84.6) | 2647 (81.5) | 1891 (86.3) | 42,255 (83.0) | 77,233 (81.9) |
Improved sanitation facilities | 622 (48.0) | 2145 (67.8) | 12,400 (27.4) | 51,556 (59.0) | 706 (64.2) | 1332 (83.9) | 1975 (60.8) | 1901 (86.8) | 15,703 (30.8) | 56,943 (60.4) |
MCH Service Indicators | All N a | Unimproved Water (%) | Improved Water (%) | Crude OR (95% CI) | Adjusted OR (95% CI) b |
---|---|---|---|---|---|
Lower education (none or incomplete primary) | |||||
Up-to-date immunizations | 50,943 | 45.0 | 51.9 | 1.31 (1.19, 1.45) | 1.29 (1.17, 1.42) |
ANC visits (4 or more) | 50,943 | 32.6 | 30.2 | 0.89 (0.80, 1.00) | 0.90 (0.81, 1.00) |
ANC visits (8 or more) | 50,943 | 7.6 | 7.5 | 0.99 (0.83, 1.17) | 0.99 (0.83, 1.18) |
Skilled attendant at delivery | 50,943 | 62.7 | 66.2 | 1.16 (1.04, 1.29) | 1.26 (1.13, 1.37) |
Higher education (complete primary or higher) | |||||
Up-to-date immunizations | 94,319 | 64.5 | 66.7 | 1.10 (1.02, 1.19) | 1.06 (0.99, 1.15) |
ANC visits (4 or more) | 94,913 | 62.0 | 60.0 | 0.92 (0.85, 1.00) | 0.92 (0.85, 1.00) |
ANC visits (8 or more) | 94,913 | 25.4 | 24.7 | 0.97 (0.88, 1.06) | 0.97 (0.88, 1.07) |
Skilled attendant at delivery | 94,913 | 88.4 | 87.9 | 0.94 (0.84, 1.06) | 1.07 (0.94, 1.21) |
MCH Service Indicators | All N a | Unimproved Sanitation (%) | Improved Sanitation (%) | Crude OR (95% CI) | Adjusted OR(95% CI) b |
---|---|---|---|---|---|
Lower education (none or incomplete primary) | |||||
Up-to-date immunizations | 50,943 | 49.3 | 55.6 | 1.29 (1.21, 1.37) | 1.27 (1.19, 1.36) |
ANC visits (4 or more) | 50,943 | 26.0 | 40.6 | 1.95 (1.83, 2.09) | 1.75 (1.62, 1.88) |
ANC visits (8 or more) | 50,943 | 6.1 | 10.9 | 1.89 (1.68, 2.13) | 1.67 (1.46, 1.92) |
Skilled attendant at delivery | 50,943 | 64.6 | 68.8 | 1.21 (1.13, 1.30) | 1.37 (1.27, 1.47) |
Higher education (complete primary or higher) | |||||
Up-to-date immunizations | 94,319 | 61.5 | 69.1 | 1.40 (1.33, 1.47) | 1.31 (1.24, 1.38) |
ANC visits (4 or more) | 94,319 | 48.5 | 66.5 | 2.14 (2.05, 2.24) | 1.71 (1.62, 1.80) |
ANC visits (8 or more) | 94,319 | 16.8 | 29.1 | 2.04 (1.91,2.17) | 1.64 (1.52, 1.76) |
Skilled attendant at delivery | 94,319 | 83.7 | 90.3 | 1.85 (1.73, 1.97) | 1.67 (1.55, 1.79) |
Up-to-Date Immunizations | ANC Visits (4 or More) | Skilled Attendant at Birth | |||||
---|---|---|---|---|---|---|---|
Time to water source | N = 9836 (%) | Crude OR | Adjusted OR (95% CI) b | Crude OR | Adjusted OR (95% CI) b | Crude OR | Adjusted OR (95% CI) b |
Water on premises (0 min) | 27.5 | ref | ref | ref | ref | ref | ref |
Water not on premises (>0 min) | 72.4 | 0.88 (0.77, 1.01) | 0.96 (0.84, 1.10) | 0.96 (0.82, 1.13) | 1.12 (0.95, 1.31) | 0.73 (0.62, 0.85) | 0.83 (0.71, 0.97) |
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Omidakhsh, N.; von Ehrenstein, O.S. Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys. Int. J. Environ. Res. Public Health 2021, 18, 7667. https://doi.org/10.3390/ijerph18147667
Omidakhsh N, von Ehrenstein OS. Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys. International Journal of Environmental Research and Public Health. 2021; 18(14):7667. https://doi.org/10.3390/ijerph18147667
Chicago/Turabian StyleOmidakhsh, Negar, and Ondine S. von Ehrenstein. 2021. "Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys" International Journal of Environmental Research and Public Health 18, no. 14: 7667. https://doi.org/10.3390/ijerph18147667