Equity of Coverage and Utilization of Water, Sanitaiton and Hygiene Infrastructure by Measures of Vulnerability: A study in rural Ethiopia Público

Abstract

Background: The health benefits of access to and behaviors associated with improved water, sanitation and hygiene (WASH) practices are well established [1-3]. The Millennium Development Goal (MDG) target for access to improved drinking water sources was met in 2010, but inequity remained a major concern [5]. The MDG target for access to improved sanitation was not met, and the most vulnerable populations did not experience the same equity to improvements as less vulnerable populations [6].

Methods: We analyzed the relationship between coverage and utilization of water, sanitation and hygiene infrastructure, as part of a countrywide WASH program, and how that relationship was altered by vulnerability factors. Households were assessed for coverage of water, sanitation, and hygiene technologies through key indicators, and those with coverage were further assessed for utilization of the infrastructure. To compare baseline and endline values in a cluster survey with categorical values, we used the population average model, which uses generalized estimating equations with a link identity, family binomial, and correlation exchangeable to determine if there was a significant change from baseline to endline. To find the difference in the change of given indicators between two unique groups, we included an interaction term between time and the group categorization to determine the difference-in-difference.

Results: We found improvements in coverage of our three outcomes of interest: improved water coverage, household latrine coverage, and household handwashing station coverage. The project succeeded at increasing utilization of two of the outcomes of interest: improved water source utilization and household latrine utilization by all family members and safe disposal of feces of children under 5. Vulnerable households differed from non-vulnerable households on two key indicators: household latrine coverage and improved water source utilization. Households in non-difficult and challenging (D&C) kebeles reported greater improvements on improved water coverage and utilization when compared to D&C kebeles, but D&C kebeles reported greater improvements on household handwashing station coverage.

Conclusion: Some vulnerability statuses may contribute to greater increases in coverage and utilization rates, while other vulnerability statuses hinder these increases. Differing vulnerability statuses should be considered when implementing WASH projects in similar contexts.

Table of Contents

Introduction................................................................................................1

Methods......................................................................................................3

Background.................................................................................................3

Eligibility criteria for inclusion.....................................................................4

Sampling design..........................................................................................4

Data collection............................................................................................5

Data analysis...............................................................................................7

Results........................................................................................................9

Demographic data........................................................................................9

Assessment of improvements in coverage and utilization from baseline to endline.......9

Assessment of coverage and utilization by vulnerability status.......................10

Assessment of coverage and utilization by difficult and challenging status......11

Discussion..................................................................................................11

Strengths and Limitations............................................................................15

Conclusions and Recommendations..............................................................16

References..................................................................................................18

Tables and Figures.......................................................................................20

Table 1: Demographic Characteristics at baseline and endline........................20

Table 2: Baseline and Endline Characteristics for Coverage and Utilization......21

Table 3: Coverage and Utilization by vulnerability status on a cluster level......22

Table 4: Coverage and Utilization by Difficult and Challenging (D&C) status....23

Supplemental Table 1: Coverage and Utilization by vulnerability status..........24

Supplemental Table 2: Coverage and Utilization by multiple vulnerability statuses... 25

Appendix I: Regions of program implementation...........................................26

Appendix II: Kebeles sampled at baseline and endline, by partner.................. 26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Health
Palabra Clave	Water, Sanitation, and Hygiene Ethiopia Vulnerability Program Evaluation WASH
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.) University, college or educational institution (other than Emory)

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