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Mapping Geographical Inequalities in Access to Drinking Water and Sanitation Facilities in Low-Income and Middle-Income Countries, 2000-17 Publisher Pubmed



Deshpande A1 ; Millerpetrie MK1 ; Lindstedt PA1 ; Baumann MM1 ; Johnson KB1 ; Blacker BF1 ; Abbastabar H4 ; Abdallah F21 ; Abdelalim A21 ; Abdollahpour I27 ; Abegaz KH29, 30 ; Abejie AN35 ; Abreu LG36 ; Abrigo MRM41 Show All Authors
Authors
  1. Deshpande A1
  2. Millerpetrie MK1
  3. Lindstedt PA1
  4. Baumann MM1
  5. Johnson KB1
  6. Blacker BF1
  7. Abbastabar H4
  8. Abdallah F21
  9. Abdelalim A21
  10. Abdollahpour I27
  11. Abegaz KH29, 30
  12. Abejie AN35
  13. Abreu LG36
  14. Abrigo MRM41
  15. Abualhasan A21
  16. Accrombessi MMK42, 45
  17. Adamu AA46, 47
  18. Adebayo OM50
  19. Adedeji IA53
  20. Adedoyin RA54
  21. Adekanmbi V56
  22. Adetokunboh OO46, 57
  23. Adhikari TB58, 59
  24. Afarideh M5, 60
  25. Agudelobotero M61
  26. Ahmadi M64
  27. Ahmadi K63, 69
  28. Ahmed AE70
  29. Ahmed MB71, 74
  30. Akalu TY75
  31. Akanda AS79
  32. Alahdab F80
  33. Alaly Z81, 82
  34. Alam N83, 84
  35. Alam S85
  36. Alamene GM31
  37. Alanzi TM86
  38. Albright J1
  39. Albujeer A89
  40. Alcalderabanal JE90
  41. Alebel A32, 96
  42. Alemu ZA33
  43. Ali M98
  44. Alijanzadeh M99
  45. Alipour V100, 101
  46. Aljunid SM109, 110
  47. Almasi A111
  48. Almasihashiani A123
  49. Almekhlafi HM126, 128
  50. Altirkawi KA129
  51. Alvisguzman N131, 132
  52. Alviszakzuk NJ133, 134
  53. Amini S124
  54. Amit AML136, 139
  55. Amul GGH144
  56. Andrei CL145
  57. Anjomshoa M148
  58. Ansariadi A149
  59. Antonio CAT137, 150
  60. Antony B152
  61. Antriyandarti E153
  62. Arabloo J100
  63. Aref HMA154
  64. Aremu O156
  65. Armoon B157, 158
  66. Arora A159, 160
  67. Aryal KK161
  68. Arzani A162, 166
  69. Asadialiabadi M102
  70. Asmelash D76
  71. Atalay HT167
  72. Athari SS171
  73. Athari SM170
  74. Atre SR140, 174
  75. Ausloos M175, 176
  76. Awasthi S177
  77. Awoke N178
  78. Quintanilla BPA181
  79. Ayano G183
  80. Ayanore MA184
  81. Aynalem YA186
  82. Azari S100
  83. Azman AS141
  84. Babaee E102
  85. Badawi A187, 188
  86. Bagherzadeh M191
  87. Bakkannavar SM192, 586, 587
  88. Balakrishnan S195
  89. Banach M198, 199
  90. Banoub JAM200, 201
  91. Barac A203, 204
  92. Barboza MA207, 208
  93. Barnighausen TW209, 210
  94. Basu S211, 214
  95. Bay VD217
  96. Bayati M218
  97. Bedi N127, 220
  98. Beheshti M221
  99. Behzadifar M223
  100. Behzadifar M223
  101. Ramirez DFB226, 227
  102. Bell ML228
  103. Bennett DA229
  104. Benzian H222
  105. Berbada DA232
  106. Bernstein RS234
  107. Bhat AG235
  108. Bhattacharyya K236, 237
  109. Bhaumik S238, 240
  110. Bhutta ZA189, 244
  111. Bijani A163
  112. Bikbov B246
  113. Sayeed MSB247, 249
  114. Biswas RK241
  115. Bohlouli S250
  116. Boufous S241
  117. Brady OJ43
  118. Briko AN251
  119. Briko NI252
  120. Britton GB255, 256
  121. Brown A1
  122. Nagaraja SB257
  123. Butt ZA258, 259
  124. Camera LA260, 261
  125. Camposnonato IR91
  126. Rincon JCC95, 263
  127. Cano J42
  128. Car J215, 264
  129. Cardenas R265
  130. Carvalho F266
  131. Castanedaorjuela CA135, 269
  132. Castro F256
  133. Cerin E271, 272
  134. Chalise B275
  135. Chattu VK190
  136. Chin KL276, 279
  137. Christopher DJ280, 664
  138. Chu DT283
  139. Cormier NM1
  140. Costa VM266
  141. Cromwell EA1, 2
  142. Dadi AF77, 284
  143. Dahiru T287
  144. Dahlawi SMA87
  145. Dandona R1, 2, 291
  146. Dandona L1, 291, 292
  147. Dang AK293
  148. Daoud F1
  149. Darwesh AM294
  150. Darwish AH296
  151. Daryani A297
  152. Das JK245
  153. Das Gupta R301, 302
  154. Dash AP303
  155. Davilacervantes CA304
  156. Weaver ND1
  157. De La Hoz FP270
  158. De Neve JW209
  159. Demissie DB305, 308
  160. Demoz GT168
  161. Denovagutierrez E92
  162. Deribe K309, 310
  163. Desalew A196
  164. Dharmaratne SD1, 315
  165. Dhillon P316
  166. Dhimal M319
  167. Dhungana GP320
  168. Diaz D62, 321
  169. Dipeolu IO322
  170. Do HT325
  171. Dolecek C229, 327
  172. Doyle KE328, 330
  173. Dubljanin E205, 600
  174. Duraes AR331, 333
  175. Edinur HA334
  176. Effiong A335
  177. Eftekhari A172, 337
  178. El Nahas N154
  179. El Sayed Zaki M338
  180. El Tantawi M202, 569
  181. Elhabashy HR22
  182. Eljaafary SI21
  183. Elkhatib Z339
  184. Elkout H340, 341
  185. Elsharkawy A23
  186. Enany S342
  187. Endalew DA343
  188. Eshrati B102
  189. Eskandarieh S6
  190. Etemadi A344
  191. Ezekannagha O345, 346
  192. Faraon EJA137
  193. Fareed M347
  194. Faro A348
  195. Farzadfar F7
  196. Fasil A76
  197. Fazlzadeh M8, 349
  198. Feigin VL1, 352, 353
  199. Fekadu W311, 354
  200. Fentahun N355
  201. Fereshtehnejad SM356, 359
  202. Fernandes E267
  203. Filip I360, 361
  204. Fischer F362
  205. Flohr C363
  206. Foigt NA365
  207. Folayan MO55
  208. Foroutan M366
  209. Franklin RC367
  210. Frostad JJ1
  211. Fukumoto T368
  212. Gad MM369, 371
  213. Garcia GM1
  214. Gatotoh AM372, 373
  215. Gayesa RT376
  216. Gebremedhin KB312
  217. Geramo YCD232
  218. Gesesew HA285, 379
  219. Gezae KE380
  220. Ghashghaee A100, 103
  221. Sherbaf FG142
  222. Gill TK387
  223. Gill PS390
  224. Ginindza TG392
  225. Girmay A167
  226. Gizaw Z77
  227. Goodridge A393
  228. Gopalani SV394, 395, 396
  229. Goulart AC397, 398
  230. Goulart BNG400
  231. Grada A401
  232. Green MS402
  233. Gubari MIM403
  234. Gugnani HC404, 405
  235. Guido D406
  236. Guimaraes RA407
  237. Guo Y276, 408
  238. Gupta R409, 410
  239. Gupta R409, 410
  240. Ha GH293
  241. Haagsma JA413
  242. Hafezinejad N9, 143
  243. Haile DH32
  244. Haile MT306
  245. Hall BJ414
  246. Hamidi S415
  247. Handiso DW416
  248. Haririan H417
  249. Hariyani N388, 418
  250. Hasaballah AI420
  251. Hasan MM421, 422
  252. Hasanzadeh A10, 173
  253. Hassen HY423, 424
  254. Hayelom DH232
  255. Hegazy MI21
  256. Heibati B425
  257. Heidari B5
  258. Hendrie D183
  259. Henok A426
  260. Herteliu C176, 426
  261. Heydarpour F112
  262. De Hidru HD427
  263. Hird TR428
  264. Hoang CL326
  265. Hollerich GI1
  266. Hoogar P193
  267. Hossain N430
  268. Hosseinzadeh M295, 431
  269. Househ M432
  270. Hu G433
  271. Humayun A434
  272. Hussain SA435
  273. Hussen MAA72
  274. Ibitoye SE322
  275. Ilesanmi OS51, 323
  276. Ilic MD436
  277. Imaninasab MH225
  278. Iqbal U438
  279. Irvani SSN440
  280. Islam SMS446, 447
  281. Ivers RQ449
  282. Iwu CJ46, 49
  283. Jahanmehr N441, 442
  284. Jakovljevic M253, 437
  285. Jalali A113, 114
  286. Jayatilleke AU450, 451
  287. Jenabi E452
  288. Jha RP457, 458
  289. Jha V194, 239
  290. Ji JS459, 460
  291. Jonas JB462, 463
  292. Jozwiak JJ464
  293. Kabir A104
  294. Kabir Z465
  295. Kanchan T466
  296. Karch A467
  297. Karki S241
  298. Kasaeian A11, 105
  299. Kasahun GG168
  300. Kasaye HK377
  301. Kassa GM34
  302. Kassa GG169
  303. Kayode GA468, 469, 470
  304. Kebede MM471, 472
  305. Keiyoro PN372
  306. Ketema DB33
  307. Khader YS473
  308. Khafaie MA65
  309. Khalid N474
  310. Khalilov R475, 476
  311. Khan EA478
  312. Khan J317
  313. Khan MNN336, 477
  314. Khatab K479, 480
  315. Khater MM24
  316. Khater AM25
  317. Khayamzadeh M445, 481
  318. Khazaei M453
  319. Khosravi MH106
  320. Khubchandani J482
  321. Kiadaliri A483, 484
  322. Kim YJ485
  323. Kimokoti RW486
  324. Kisa S487
  325. Kisa A488, 489
  326. Kochhar S3, 490
  327. Kolola T307
  328. Komaki H454, 455, 491
  329. Kosen S492
  330. Koul PA493
  331. Koyanagi A494, 495
  332. Krishan K496
  333. Defo BK497, 498
  334. Kugbey N185
  335. Kumar P318
  336. Anil Kumar G291
  337. Kumar M374, 499
  338. Kusuma D216, 500
  339. La Vecchia C501
  340. Lacey B229, 502
  341. Lal A247
  342. Lal DK291
  343. Lam H503
  344. Lami FH504
  345. Lansingh VC505, 506
  346. Lasrado S507
  347. Lebedev G254, 508
  348. Lee PH151
  349. Legrand KE1
  350. Leili M453
  351. Lenjebo TL179
  352. Leshargie CT509
  353. Levine AJ1
  354. Lewycka S230, 510
  355. Li S279
  356. Linn S403
  357. Liu S511
  358. Lopez JCF138, 512
  359. Lopukhov PD251
  360. El Razek MMA513
  361. Mahadeshwara Prasad DR514, 515
  362. Mahasha PW48
  363. Mahotra NB516
  364. Majeed A215
  365. Malekzadeh R12, 219
  366. Malta DC37
  367. Mamun AA422
  368. Manafi N107, 517
  369. Mansournia MA13
  370. Mapoma CC518
  371. Martinez G519
  372. Martini S419, 520
  373. Martinsmelo FR521
  374. Mathur MR289, 522
  375. Mayala BK1, 523
  376. Mazidi M364
  377. Mcalinden C524
  378. Meharie BG525
  379. Mehndiratta MM526, 527
  380. Nasab EM14
  381. Mehta KM528
  382. Mekonnen T530
  383. Mekonnen TC526
  384. Meles GG381
  385. Meles HG386
  386. Memiah PTN531
  387. Memish ZA532, 533
  388. Mendoza W534
  389. Menezes RG88
  390. Mereta ST73
  391. Meretoja TJ535, 536
  392. Mestrovic T537, 538
  393. Metekiya WM382
  394. Miazgowski B539, 540, 541
  395. Miller TR183, 542
  396. Mini GK452, 543
  397. Mirrakhimov EM544, 545
  398. Moazen B210, 546
  399. Mohajer B7
  400. Mohammad Y130
  401. Mohammad DK357, 547
  402. Mezerji NMG456
  403. Mohammadibakhsh R457
  404. Mohammed S209
  405. Mohammed JA548
  406. Mohammed H389
  407. Mohebi F7, 15
  408. Mokdad AH1, 2
  409. Moodley Y549
  410. Moradi G550, 551
  411. Moradi M115
  412. Moradijoo M550, 551, 552
  413. Moraga P429
  414. Morales L93
  415. Mosapour A164, 553
  416. Mosser JF1
  417. Mouodi S163
  418. Mousavi SM16
  419. Mozaffor M554, 555
  420. Munro SB1
  421. Muriithi MK375
  422. Murray CJL1
  423. Musa KI556
  424. Mustafa G557, 558
  425. Muthupandian S383
  426. Naderi M116
  427. Nagarajan AJ559, 560, 561
  428. Naghavi M1, 2
  429. Naik G562
  430. Nangia V564
  431. Nascimento BR38, 39
  432. Nazari J125
  433. Ndwandwe DE47
  434. Negoi I146, 565
  435. Netsere HB78, 566
  436. Ngunjiri JW567
  437. Nguyen CT293
  438. Nguyen HLT293
  439. Nguyen QP1
  440. Nigatu SG77
  441. Ningrum DNA439, 568
  442. Nnaji CA49, 570
  443. Nojomi M102, 108
  444. Norheim OF212, 571
  445. Noubiap JJ572
  446. Oancea B573
  447. Ogbo FA329
  448. Oh IH574
  449. Olagunju AT575, 576, 578
  450. Olusanya BO579
  451. Olusanya JO579
  452. Onwujekwe OE580
  453. Ortegaaltamirano DV94
  454. Osarenotor O581
  455. Osei FB582, 583
  456. Owolabi MO52, 324
  457. Mahesh PA584
  458. Padubidri JR585
  459. Pakhale S588
  460. Pana A176, 589
  461. Park EK590
  462. Patel SK591
  463. Pathak A358, 592
  464. Patle A317, 593
  465. Paulos K180
  466. Pepito VCF594
  467. Perico N595
  468. Pervaiz A596
  469. Pescarini JM598
  470. Pesudovs K242
  471. Pham HQ293
  472. Pigott DM1, 2
  473. Pilgrim T599, 645
  474. Pirsaheb M115
  475. Poljak M601
  476. Pollock I1
  477. Postma MJ602, 603
  478. Pourmalek F604
  479. Pourshams A12
  480. Prada SI605, 606
  481. Preotescu L147, 607
  482. Quintana H256
  483. Rabiee N191
  484. Rabiee M608
  485. Radfar A609
  486. Rafiei A298, 299
  487. Rahim F17, 66
  488. Rahimi S300
  489. Rahimimovaghar V18
  490. Rahman MHU610, 611
  491. Rahman MA182
  492. Rajati F115
  493. Ranabhat CL612, 613
  494. Rao PC1
  495. Rasella D332
  496. Rath GK612
  497. Rawaf S615, 616
  498. Rawal L617
  499. Rawasia WF618
  500. Remuzzi G597
  501. Renjith V619
  502. Renzaho AMN620, 621
  503. Resnikoff S243, 622
  504. Riahi SM623
  505. Ribeiro AI268
  506. Rickard J622, 624
  507. Roever L625
  508. Ronfani L626
  509. Rubagotti E627, 628
  510. Rubino S629
  511. Saad AM370
  512. Sabour S443
  513. Sadeghi E115
  514. Moghaddam SS7
  515. Safari Y115
  516. Sagar R614
  517. Sahraian MA6
  518. Mohammad Sajadi S630, 631
  519. Salahshoor MR117
  520. Salam N632
  521. Saleem A633
  522. Salem MR634
  523. Salem H26
  524. Salimi Y118, 119
  525. Salimzadeh H12
  526. Samy AM155
  527. Sanabria J635, 636
  528. Santos IS398, 399
  529. Santricmilicevic MM204, 206
  530. Jose BPS40
  531. Saraswathy SYI637, 638
  532. Sarrafzadegan N28, 604
  533. Sartorius B2, 44
  534. Sathian B639, 640
  535. Sathish T577
  536. Satpathy M641, 642
  537. Sawhney M643
  538. Sayyah M67
  539. Sbarra AN1
  540. Schaeffer LE1
  541. Schwebel DC563
  542. Senbeta AM643
  543. Senthilkumaran S644
  544. Sepanlou SG12, 219
  545. Servanmori E91
  546. Shafieesabet A646, 647
  547. Shaheen AA648
  548. Shahid I649
  549. Shaikh MA648
  550. Shalash AS154
  551. Shamsbeyranvand M649
  552. Shamsi M120
  553. Shamsizadeh M650
  554. Shannawaz M288, 651
  555. Sharafi K115
  556. Sharma R652
  557. Sheikh A213, 653
  558. Shetty BSK588
  559. Shiferaw WS186
  560. Shigematsu M655
  561. Shin JI656
  562. Shiri R657
  563. Shirkoohi R19, 20
  564. Shivakumar KM658
  565. Si S277
  566. Siabani S97, 121
  567. Siddiqi TJ659
  568. Silva DAS661
  569. Singh BB448, 662
  570. Singh A153
  571. Singh V663
  572. Singh NP665
  573. Singh JA564, 666
  574. Sinha DN667, 668
  575. Sisay MM76
  576. Skiadaresi E669
  577. Smith DL1, 2
  578. Filho AMS670, 671
  579. Sobhiyeh MR122
  580. Sokhan A672
  581. Soriano JB673, 674
  582. Sorrie MB233
  583. Soyiri IN675
  584. Spurlock EE1
  585. Sreeramareddy CT676
  586. Sudaryanto A677
  587. Sufiyan MB288
  588. Suleria HAR678
  589. Sykes BL680
  590. Tabaresseisdedos R681, 682
  591. Tabuchi T683
  592. Tadesse DB168
  593. Tarigan IU684
  594. Taye B685
  595. Tefera YM389, 529
  596. Tehranibanihashemi A102, 108
  597. Tekelemedhin SW388
  598. Tekle MG197
  599. Temsah MH129
  600. Tesfay FH286, 382
  601. Tesfay BE430
  602. Tessema ZT77
  603. Thankappan KR686
  604. Thekkepurakkal AS290
  605. Thomas N281
  606. Thompson RL1
  607. Thomson AJ687
  608. Topormadry R688, 689
  609. Tovanipalone MR690, 691
  610. Traini E473
  611. Tran BX692
  612. Tran KB693, 694
  613. Ullah I695
  614. Unnikrishnan B589
  615. Usman MS660
  616. Uthman OA391
  617. Uzochukwu BSC582
  618. Valdez PR262, 696
  619. Varughese S282
  620. Veisani Y697
  621. Violante FS698, 699
  622. Vollmer S700
  623. Whawariat FG232
  624. Waheed Y701
  625. Wallin MT533, 702
  626. Wang YP703
  627. Wang Y402
  628. Wangdi K248
  629. Weiss DJ231
  630. Weldesamuel GT167
  631. Werkneh AA384
  632. Westerman R705
  633. Wiangkham T706
  634. Wiens KE1
  635. Wijeratne T679, 707
  636. Wiysonge CS50, 570
  637. Wolde HF76
  638. Wondafrash DZ313, 385
  639. Wonde TE33
  640. Worku GT233, 708
  641. Yadollahpour A68
  642. Jabbari SHY709
  643. Yamada T710
  644. Yaseri M13, 444
  645. Yatsuya H711, 712
  646. Yeshaneh A344
  647. Yilma MT378
  648. Yip P273, 274
  649. Yisma E314
  650. Yonemoto N713, 714
  651. Younis MZ715, 716
  652. Yousof HASA24
  653. Yu C703, 704
  654. Yusefzadeh H717
  655. Zadey S461
  656. Moghadam TZ350
  657. Zaidi Z718
  658. Zaman SB278, 719
  659. Zamani M165
  660. Zandian H350, 351
  661. Zar HJ571, 720
  662. Zerfu TA654, 721
  663. Zhang Y722, 723
  664. Ziapour A121
  665. Zodpey S291
  666. Zuniga YMH724, 725
  667. Hay SI1, 2

Source: The Lancet Global Health Published:2020


Abstract

Background: 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. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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