Examining the Cross-Sectional Relationship Between Women’s Empowerment, Water Treatment, and Childhood Health Outcomes in Zambia 公开

Abstract

Poor water sanitation, and hygiene (WASH) is a major contributor of diarrheal disease,

which has resulted in the death of 12% children under the age of five in Zambia in 2019. Women’s

empowerment may be linked to childhood health outcomes. The purpose of this study is to

understand the relationship between women’s empowerment, safe water treatment methods and

children’s diarrhea.

We used Zambia 2018-2019 Demographic and health survey (DHS) datasets to examine

the relationship between women’s empowerment and use of safe water treatment methods and

diarrhea. The Survey-based Women’s EmPowERment index (SWPER) was used to measure

empowerment using three separate domains; attitudes towards violence, participation indecision

making, and social independence. Values of 0-2 were assigned based on responses to a given

variable, and final scores for each domain ranged between -1.5 and 1.5. The direct relationships

between empowerment, safe water treatment, and children’s diarrhea were then calculated using

logistic regression.

The final sample consisted of 3151 women. 72% of respondents were from urban areas,

28% were from rural areas, 31% used safe water treatment, and 12% of children reported having

diarrhea within 2 weeks of interview. The mean overall score was highest for participation in

decision making domain at 0.34 and lowest for attitude towards violence at -0.997. Social

independence was most positively associated with increased use of safe water treatment

(AOR=1.5), and with children’s diarrhea (AOR=1.3) Attitude towards violence and participation

in decision making were not found to be strongly associated with either outcome.

The results of this study are in agreement with existing literature and suggest that social

independence is associated with use of safe water treatment and diarrhea. More research using the

SWPER index to measure empowerment and other WASH related variables is needed to fully

understand the relationship between women’s empowerment and WASH in Zambia.

Table of Contents

1. INTRODUCTION ........................................................................................................................................... 1

1.1 BACKGROUND ..................................................................................................................................................... 1

1.2 WASH AND EMPOWERMENT .............................................................................................................................. 2

1.3 EMPOWERMENT AND CHILDREN’S HEALTH ........................................................................................................ 2

1.4 MEASURING EMPOWERMENT .............................................................................................................................. 3

1.5 STUDY PURPOSE ................................................................................................................................................. 4

2. METHODS ..................................................................................................................................................... 4

2.1 STUDY DESIGN, DATASET, AND PARTICIPANTS ................................................................................................... 4

2.2 SETTING .............................................................................................................................................................. 5

2.3 VARIABLES ......................................................................................................................................................... 6

2.4 ANALYSIS ........................................................................................................................................................... 8

3. RESULTS ....................................................................................................................................................... 9

3.1 DESCRIPTIVE ANALYSIS ...................................................................................................................................... 9

3.2 RELATIONSHIP BETWEEN EMPOWERMENT DOMAINS AND SAFE WATER TREATMENT ...................................... 10

3.3 RELATIONSHIP BETWEEN EMPOWERMENT DOMAINS AND CHILD DIARRHEA .................................................... 12

3.4 MEDIATION ANALYSIS ...................................................................................................................................... 13

4. DISCUSSION ................................................................................................................................................ 13

4.1 EMPOWERMENT AND SAFE WATER TREATMENT .............................................................................................. 13

4.2 EMPOWERMENT AND CHILDHOOD DIARRHEA ................................................................................................... 15

4.3 POPULATION CHARACTERISTICS ....................................................................................................................... 16

4.4 STRENGTHS AND LIMITATIONS .......................................................................................................................... 17

4.5 NEXT STEPS ...................................................................................................................................................... 18

5. CONCLUSION ............................................................................................................................................. 18

TABLES AND FIGURES ................................................................................................................................. 24

APPENDIX ....................................................................................................................................................... 28

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	Children Under Five Empowerment WASH
Committee Chair / Thesis Advisor	Bethany A. Caruso, Emory University

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