The paradox of water accessibility: understanding the temporal and spatial dimensions of access to improved water sources in Rwanda

2015 ◽  
Vol 5 (4) ◽  
pp. 553-564 ◽  
Author(s):  
Lydia Osei ◽  
Jonathan Amoyaw ◽  
Godfred Odei Boateng ◽  
Sheila Boamah ◽  
Isaac Luginaah
Keyword(s):  
Drinking Water ◽  
Water Sources ◽  
Regional Disparities ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Logistic Regression Models ◽  
The People ◽  
Spatial Dimensions ◽  
Sub Saharan ◽  
Over Time

According to the United Nations, the world has met the Millennium Development Goal target of halving the proportion of people without access to safe drinking water. However, global figures mask massive disparities between regions and countries, and within countries. For instance, only 64% of the people in sub-Saharan Africa have access to improved water sources. Over 40% of all people globally who lack access to drinking water live in sub-Saharan Africa. Rwanda is used as a case in point in this study. Despite the abundance of water resources in the country, access to improved water sources is limited. Using the Rwandan Demographic and Health Surveys (2000–2010), we examined regional disparities in access to improved water sources. Results from logistic regression models show that overall, access to improved water has declined between 2000 and 2010; except in the western region, where access to water marginally improved. Educated individuals, wealthier and urban dwellers were more likely to have access to improved water sources over time compared to their uneducated, poor and rural counterparts. The persistence of regional disparities in access to improved water over time suggests the need for policy to address insufficient investments in water infrastructure in Rwanda.

scholarly journals Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

2021 ◽  
Vol 18 (S1) ◽  
Author(s):  
Martin K. Mutua ◽  
Yohannes D. Wado ◽  
Monica Malata ◽  
Caroline W. Kabiru ◽  
Elsie Akwara ◽  
...  
Keyword(s):  
Family Planning ◽  
West Africa ◽  
Adolescent Girls ◽  
Young Women ◽  
Rate Of Change ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Sexually Active ◽  
Sub Saharan ◽  
Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

Access to drinking water in sub-Saharan Africa: does the developmental state doctrine matter?

2020 ◽  
pp. 002085232093006
Author(s):  
Bacha Kebede Debela ◽  
Geert Bouckaert ◽  
Steve Troupin
Keyword(s):  
Drinking Water ◽  
Developmental State ◽  
Water Sources ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Drinking Water Sources ◽  
Developmental States ◽  
Urban Rural ◽  
Sub Saharan ◽  
Using Data

Using data from 14 sub-Saharan African countries, this study investigates the relevance of the developmental state doctrine to enhancing access to improved drinking water sources and to reducing urban–rural inequalities in access to improved sources and piped-on premises. Although access to improved water sources and urban–rural inequality seems better in developmental states than in non-developmental states, we have not found sufficient support for the claim that the developmental state approach is the best alternative. The influence of corruption is, unexpectedly, higher in developmental states than in non-developmental states. Moreover, both developmental states and non-developmental states were not significantly investing in access to drinking water supply programs. We find that the total population growth rate is the strongest predictor, rather than regime type. Other factors that explain the variation between all samples of developmental states and non-developmental states are identified and discussed, and implications are outlined. Points for practitioners There is significant variation in access to improved drinking water sources and urban–rural inequalities in access to improved sources and piped-on premises between developmental states and non-developmental states. The relevance of the developmental state doctrine to improving access to drinking water, reducing socio-economic inequalities in access to drinking water, and realizing Sustainable Development Goal targets in sub-Saharan Africa is ambiguous. We advise strengthening a functional Weberian bureaucracy and promoting political decentralization.

scholarly journals Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Fanuel Meckson Bickton ◽  
Latif Ndeketa ◽  
Grace Thandekire Sibande ◽  
Juvenal Nkeramahame ◽  
Chipiliro Payesa ◽  
...  
Keyword(s):  
Air Pollution ◽  
Sub Saharan Africa ◽  
Household Air Pollution ◽  
Demographic And Health Surveys ◽  
Logistic Regression Models ◽  
Under Five ◽  
Awareness Campaigns ◽  
Increased Risk ◽  
Sub Saharan ◽  
Ssa Countries

Abstract Background Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries. Methods We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models. Results Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03–1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73–0.98)] or outside [0.75 (0.64–0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children. Conclusions HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.

scholarly journals Levels and socioeconomic correlates of nonmarital fertility in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247189
Author(s):  
Samuel H. Nyarko ◽  
Lloyd Potter
Keyword(s):  
Formal Education ◽  
Sexual Debut ◽  
Unmet Need ◽  
Well Being ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Nonmarital Fertility ◽  
Logistic Regression Models ◽  
Poor Households ◽  
Sub Saharan

Childbirth outside marriage has several negative implications for the well-being of children, women, and families globally. In sub-Saharan Africa, however, the phenomenon appears to be under-studied. In this study, we examine the levels and socioeconomic correlates of nonmarital fertility in Ghana. Using pooled data from the 2003, 2008, and the 2014 Ghana Demographic and Health Surveys, logistic regression models were used in determining significantly predictive factors of nonmarital fertility. The results show that nonmarital fertility levels have been on the rise over time without any sign of reduction (24.0%, 33.0%, and 40.0% for 2003, 2008, and 2014, respectively). Some socioeconomic characteristics are linked to nonmarital fertility levels with women without formal education, women from poor households, and self-employed women having significantly higher nonmarital fertility risks. Also, older unmarried women, women who have an early sexual debut, cohabiters, women with unmet need for family planning are all associated with considerably higher risks of nonmarital childbearing. A few significant regional disparities also exist, with the Central Region having higher whereas the Upper West Region has lower risks of nonmarital fertility compared to the Greater Accra Region. Childbirth outside marriage is a social concern among women in Ghana. The findings have possible implications for bridging socioeconomic disparities among unmarried women.

scholarly journals Exposure to Armed Conflict and Fertility in Sub-Saharan Africa

2019 ◽  
Author(s):  
Brian C. Thiede ◽  
Matthew Hancock ◽  
Ahmed Kodouda ◽  
James Piazza
Keyword(s):  
Family Size ◽  
Armed Conflict ◽  
Second Order ◽  
Sub Saharan Africa ◽  
Order Effects ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Logistic Regression Models ◽  
Sub Saharan ◽  
The Many

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Dataset with data on fertility goals and outcomes from the Demographic and Health Surveys (n=368,765 women aged 15-49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents’ preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women’s vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the many second-order effects of organized violence on vulnerable populations.

scholarly journals Household Cooking Fuel Type and Child Anaemia in Sub-saharan Africa: Insights From Demographic and Health Surveys

2020 ◽  
Author(s):  
Iddrisu Amadu ◽  
Abdul-Aziz Seidu ◽  
Abdul-Rahaman Afitiri ◽  
Bright Opoku Ahinkorah
Keyword(s):  
Drinking Water ◽  
Maternal Education ◽  
Household Head ◽  
Childhood Mortality ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Fuel Type ◽  
Cooking Fuel ◽  
Cooking Fuels ◽  
Sub Saharan

Abstract Background Childhood anaemia is one of the major public health concerns in low and middle-income countries, contributing substantially to childhood mortality and morbidity. This study, therefore, sought to investigate the association between household cooking fuel type, and the joint impact of household cooking fuel type and urbanicity on anaemia among children under the age of 5 in sub-Saharan Africa. Methods We analysed cross-sectional data of 95,056 children under the age of 5 from 29 sub-Saharan African countries. Bivariate and multivariate analyses were performed using chi-square test of independence and negative log-log regression respectively at p < 0.05. Results were presented as Adjusted Odds Ratios for the negative log-log regression analysis. Results The percentage of children who had anaemia was 57%. Children from rural households that depend on unclean cooking fuels were more likely to be anaemic [AOR = 1.042; 95% CI = 1.010–1.074] compared to children from urban households using unclean cooking fuel. We also found that children in female headed households [AOR = 1.047; CI = 1.019–1.076], children in large households [AOR = 1.066; CI = 1.021–1.113]; those in households with improved source of drinking water [AOR = 1.035; CI = 1.006–1.065] had higher odds of suffering from anaemia. However, children with normal weight [AOR = 0.946;CI = 0.916–0.976], children aged 4 [AOR = 0.900; CI = 0.868–0.934], children whose mothers are aged 45–49 [AOR = 0.866; CI = 0.778–0.963] and those aged 30–34 [AOR = 0.868; CI = 0.815–0.925], children whose mothers had tertiary level of education [AOR = 0.865; CI = 0.809–0.925], children in rich households [AOR = 0.935; CI = 0.904–0.968] and those in households with improved type of toilet facility [AOR = 0.955; CI = 0.929–0.981] had lower odds of being anaemic. Conclusion Our study established an association between the joint effect of type of household cooking fuel and urbanicity and anaemia among children under the age of 5 in SSA. Childs’ birthweight, current age, maternal age, sex of household head, age of household head, maternal education, wealth status, size of household, type of source of drinking water and country of residence are associated with childhood anaemia. It is therefore critical to promote the usage of clean cooking fuels among households and women in rural areas. This could be done by governments in various countries subsidising the cost of liquefied petroleum gases and cylinders. Stakeholders that seek to improve maternal and child health should also take these associated factors into consideration.

Human Development Paradigm for South Asia

2018 ◽  
Keyword(s):  
South Asia ◽  
Human Development ◽  
Sub Saharan Africa ◽  
Health And Nutrition ◽  
The People ◽  
Sub Saharan ◽  
Development Paradigm

In the chapter, Haq gives a snapshot of the human progress of South Asia, comparing it with other regions. He was worried about the region beginning to lag behind all other regions, including Sub-Saharan Africa. He highlights the role of the two largest economies in the region, India and Pakistan, in financing the major investment in education, health and nutrition for the people. Haq advocates some fiscal and monetary reforms are suggested to invest in human development.

scholarly journals Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

2021 ◽  
Vol 6 (1) ◽  
pp. e003773
Author(s):  
Edward Kwabena Ameyaw ◽  
Yusuf Olushola Kareem ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Sanni Yaya
Keyword(s):  
Decomposition Analysis ◽  
Household Wealth ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Childhood Immunisation ◽  
Urban Settings ◽  
Factors Associated ◽  
Rural And Urban ◽  
Full Immunisation ◽  
Sub Saharan

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

scholarly journals Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016

2021 ◽  
Vol 6 (4) ◽  
pp. e004230
Author(s):  
Teesta Dey ◽  
Sam Ononge ◽  
Andrew Weeks ◽  
Lenka Benova
Keyword(s):  
Postnatal Care ◽  
Health Surveys ◽  
Post Partum ◽  
Quality Care ◽  
Critical Time ◽  
Healthcare Facility ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Changes Over Time ◽  
Over Time

IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.MethodsWe analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.ResultsData from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).ConclusionIn Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.

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