Cited by 187Child Nutrition and Water AccessWater Resource Management and QualityPublic Health and Environmental Issues

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

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Deshpande, Aniruddha, Miller-Petrie, Molly K, Lindstedt, Paulina A, Baumann, Mathew M, Johnson, Kimberly B, Blacker, Brigette F, Abbastabar, Hedayat, Abd-Allah, Foad +661 more·2020·The Lancet Global Health

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.

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  • In Ghana, availability and access to safe drinking water and proper sanitation depend on several factors, including geographical location.

    “in Ghana, availability and access to safe drinking water and proper sanitation depend on several factors, including geographical location.”

    From Demographic disparities in unimproved drinking water and sanitation in Ghana: a nationally representative cross-sectional study (2022) · cites this paper as [16]

    The Discussion (page unavailable) reports substantial within-country geographical inequalities in access to drinking water and sanitation and discusses infrastructure, urbanisation, and policy as possible influences. Our copy does not present a Ghana-specific finding or establish that these factors determine access in Ghana, so the claim is supported only at the broader level. (LLM, conf=0.79)

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  1. [57]Luby SP Rahman M Arnold BF Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial Lancet Glob Health 6 2018 e302 e315 29396217 PMC5809718

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Deshpande, A., Miller-Petrie, M. K., Lindstedt, P. A., Baumann, M. M., Johnson, K. B., Blacker, B. F., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahpour, I., Abegaz, K. H., Abejie, A. N., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Accrombessi, M. M. K., Adamu, A. A., Adebayo, O. M., Adedeji, I. A., Adedoyin, R. A., Adekanmbi, V., Adetokunboh, O. O., Adhikari, T. B., Afarideh, M., Agudelo-Botero, M., Ahmadi, M., Ahmadi, K., Ahmed, M. B., Ahmed, A. E., Akalu, T. Y., Akanda, A. S., Alahdab, F., Al-Aly, Z., Alam, S., Alam, N., Alamene, G. M., Alanzi, T. M., Albright, J., Albujeer, A., Alcalde-Rabanal, J. E., Alebel, A., Alemu, Z. A., Ali, M., Alijanzadeh, M., Alipour, V., Aljunid, S. M., Almasi, A., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Altirkawi, K. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amit, A. M. L., Amul, G. G. H., Andrei, C. L., Anjomshoa, M., Ansariadi, A., Antonio, C. A. T., Antony, B., Antriyandarti, E., Arabloo, J., Aref, H. M. A., Aremu, O., Armoon, B., Arora, A., Aryal, K. K., Arzani, A., Asadi-Aliabadi, M., Asmelash, D., Atalay, H. T., Athari, S. M., Athari, S. S., Atre, S. R., Ausloos, M., Awasthi, S., Awoke, N., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Aynalem, Y. A., Azari, S., Azman, A. S., Babaee, E., Badawi, A., Bagherzadeh, M., Bakkannavar, S. M., Balakrishnan, S., Banach, M., Banoub, J. A. M., Barac, A., Barboza, M. A., Bärnighausen, T. W., Basu, S., Bay, V. D., Bayati, M., Bedi, N., Beheshti, M., Behzadifar, M., Behzadifar, M., Bejarano Ramirez, D. F., Bell, M. L., Bennett, D. A., Benzian, H., Berbada, D. A., Bernstein, R. S., Bhat, A. G., Bhattacharyya, K., Bhaumik, S., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biswas, R. K., Bohlouli, S., Boufous, S., Brady, O. J., Briko, A. N., Briko, N. I., Britton, G. B., Brown, A., Burugina Nagaraja, S., Butt, Z. A., Cámera, L. A., Campos-Nonato, I. R., Campuzano Rincon, J. C., Cano, J., Car, J., Cárdenas, R., Carvalho, F., Castañeda-Orjuela, C. A., Castro, F., Cerin, E., Chalise, B., Chattu, V. K., Chin, K. L., Christopher, D. J., Chu, D.-T., Cormier, N. M., Costa, V. M., Cromwell, E. A., Dadi, A. F. F., Dahiru, T., Dahlawi, S. M. A., Dandona, R., Dandona, L., Dang, A. K., Daoud, F., Darwesh, A. M., Darwish, A. H., Daryani, A., Das, J. K., Das Gupta, R., Dash, A. P., Dávila-Cervantes, C. A., Davis Weaver, N., De la Hoz, F. P., De Neve, J.-W., Demissie, D. B., Demoz, G. T., Denova-Gutiérrez, E., Deribe, K., Desalew, A., Dharmaratne, S. D., Dhillon, P., Dhimal, M., Dhungana, G. P., Diaz, D., Dipeolu, I. O., Do, H. T., Dolecek, C., Doyle, K. E., Dubljanin, E., Duraes, A. R., Edinur, H. A., Effiong, A., Eftekhari, A., El Nahas, N., El Sayed Zaki, M., El Tantawi, M., Elhabashy, H. R., El-Jaafary, S. I., El-Khatib, Z., Elkout, H., Elsharkawy, A., Enany, S., Endalew, D. A., Eshrati, B., Eskandarieh, S., Etemadi, A., Ezekannagha, O., Faraon, E. J. A., Fareed, M., Faro, A., Farzadfar, F., Fasil, A. F., Fazlzadeh, M., Feigin, V. L., Fekadu, W., Fentahun, N., Fereshtehnejad, S.-M., Fernandes, E., Filip, I., Fischer, F., Flohr, C., Foigt, N. A., Folayan, M. O., Foroutan, M., Franklin, R. C., Frostad, J. J., Fukumoto, T., Gad, M. M., Garcia, G. M., Gatotoh, A. M., Gayesa, R. T., Gebremedhin, K. B., Geramo, Y. C. D., Gesesew, H. A., Gezae, K. E., Ghashghaee, A., Ghazi Sherbaf, F., Gill, T. K., Gill, P. S., Ginindza, T. G., Girmay, A., Gizaw, Z., Goodridge, A., Gopalani, S. V., Goulart, B. N. G., Goulart, A. C., Grada, A., Green, M. S., Gubari, M. I. M., Gugnani, H. C., Guido, D., Guimarães, R. A., Guo, Y., Gupta, R., Gupta, R., Ha, G. H., Haagsma, J. A., Hafezi-Nejad, N., Haile, D. H., Haile, M. T., Hall, B. J., Hamidi, S., Handiso, D. W., Haririan, H., Hariyani, N., Hasaballah, A. I., Hasan, M. M., Hasanzadeh, A., Hassen, H. Y., Hayelom, D. H., Hegazy, M. I., Heibati, B., Heidari, B., Hendrie, D., Henok, A., Herteliu, C., Heydarpour, F., Hidru, H. D. D., Hird, T. R., Hoang, C. L., Hollerich, G. I., Hoogar, P., Hossain, N., Hosseinzadeh, M., Househ, M., Hu, G., Humayun, A., Hussain, S. A., Hussen, M. A. A., Ibitoye, S. E., Ilesanmi, O. S., Ilic, M. D., Imani-Nasab, M. H., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Ivers, R. Q., Iwu, C. J., Jahanmehr, N., Jakovljevic, M., Jalali, A., Jayatilleke, A. U., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Jonas, J. B., Jozwiak, J. J., Kabir, A., Kabir, Z., Kanchan, T., Karch, A., Karki, S., Kasaeian, A., Kasahun, G. G., Kasaye, H. K., Kassa, G. G., Kassa, G. M., Kayode, G. A., Kebede, M. M., Keiyoro, P. N., Ketema, D. B., Khader, Y. S., Khafaie, M. A., Khalid, N., Khalilov, R., Khan, E. A., Khan, J., Khan, M. N., Khatab, K., Khater, M. M., Khater, A. M., Khayamzadeh, M., Khazaei, M., Khosravi, M. H., Khubchandani, J., Kiadaliri, A., Kim, Y. J., Kimokoti, R. W., Kisa, S., Kisa, A., Kochhar, S., Kolola, T., Komaki, H., Kosen, S., Koul, P. A., Koyanagi, A., Krishan, K., Kuate Defo, B., Kugbey, N., Kumar, P., Kumar, G. A., Kumar, M., Kusuma, D., La Vecchia, C., Lacey, B., Lal, A., Lal, D. K., Lam, H., Lami, F. H., Lansingh, V. C., Lasrado, S., Lebedev, G., Lee, P. H., LeGrand, K. E., Leili, M., Lenjebo, T. L., Leshargie, C. T., Levine, A. J., Lewycka, S., Li, S., Linn, S., Liu, S., Lopez, J. C. F., Lopukhov, P. D., Magdy Abd El Razek, M., Mahadeshwara Prasad, D. R., Mahasha, P. W., Mahotra, N. B., Majeed, A., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manafi, N., Mansournia, M. A., Mapoma, C. C., Martinez, G., Martini, S., Martins-Melo, F. R., Mathur, M. R., Mayala, B. K., Mazidi, M., McAlinden, C., Meharie, B. G., Mehndiratta, M. M., Mehrabi Nasab, E., Mehta, K. M., Mekonnen, T., Mekonnen, T. C., Meles, G. G., Meles, H. G., Memiah, P. T. N., Memish, Z. A., Mendoza, W., Menezes, R. G., Mereta, S. T., Meretoja, T. J., Mestrovic, T., Metekiya, W. M., Metekiya, W. M., Miazgowski, B., Miller, T. R., Mini, G., Mirrakhimov, E. M., Moazen, B., Mohajer, B., Mohammad, Y., Mohammad, D. K., Mohammad Gholi Mezerji, N., Mohammadibakhsh, R., Mohammed, S., Mohammed, J. A., Mohammed, H., Mohebi, F., Mokdad, A. H., Moodley, Y., Moradi, M., Moradi, G., Moradi-Joo, M., Moraga, P., Morales, L., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mozaffor, M., Munro, S. B., Muriithi, M. K., Murray, C. J. L., Musa, K. I., Mustafa, G., Muthupandian, S., Naderi, M., Nagarajan, A. J., Naghavi, M., Naik, G., Nangia, V., Nascimento, B. R., Nazari, J., Ndwandwe, D. E., Negoi, I., Netsere, H. B., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nguyen, Q. P., Nigatu, S. G., Ningrum, D. N. A., Nnaji, C. A., Nojomi, M., Norheim, O. F., Noubiap, J. J., Oancea, B., Ogbo, F. A., Oh, I.-H., Olagunju, A. T., Olusanya, J. O., Olusanya, B. O., Onwujekwe, O. E., Ortega-Altamirano, D. V., Osarenotor, O., Osei, F. B., Owolabi, M. O., P A, M., Padubidri, J. R., Pakhale, S., Pana, A., Park, E.-K., Patel, S. K., Pathak, A., Patle, A., Paulos, K., Pepito, V. C. F., Perico, N., Pervaiz, A., Pescarini, J. M., Pesudovs, K., Pham, H. Q., Pigott, D. M., Pilgrim, T., Pirsaheb, M., Poljak, M., Pollock, I., Postma, M. J., Pourmalek, F., Pourshams, A., Prada, S. I., Preotescu, L., Quintana, H., Rabiee, N., Rabiee, M., Radfar, A., Rafiei, A., Rahim, F., Rahimi, S., Rahimi-Movaghar, V., Rahman, M. A., Rahman, M. H. U., Rajati, F., Ranabhat, C. L., Rao, P. C., Rasella, D., Rath, G. K., Rawaf, S., Rawal, L., Rawasia, W. F., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Riahi, S. M., Ribeiro, A. I., Rickard, J., Roever, L., Ronfani, L., Rubagotti, E., Rubino, S., Saad, A. M., Sabour, S., Sadeghi, E., Saeedi Moghaddam, S., Safari, Y., Sagar, R., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salam, N., Saleem, A., Salem, H., Salem, M. R., Salimi, Y., Salimzadeh, H., Samy, A. M., Sanabria, J., Santos, I. S., Santric-Milicevic, M. M., Sao Jose, B. P., Saraswathy, S. Y. I., Sarrafzadegan, N., Sartorius, B., Sathian, B., Sathish, T., Satpathy, M., Sawhney, M., Sayyah, M., Sbarra, A. N., Schaeffer, L. E., Schwebel, D. C., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Serván-Mori, E., Shafieesabet, A., Shaheen, A. A., Shahid, I., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsi, M., Shamsizadeh, M., Shannawaz, M., Sharafi, K., Sharma, R., Sheikh, A., Shetty, B. S. K., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shiri, R., Shirkoohi, R., Shivakumar, K. M., Si, S., Siabani, S., Siddiqi, T. J., Silva, D. A. S., Singh, V., Singh, N. P., Singh, B. B. S., Singh, J. A., Singh, A., Sinha, D. N., Sisay, M. M., Skiadaresi, E., Smith, D. L., Soares Filho, A. M., Sobhiyeh, M. R., Sokhan, A., Soriano, J. B., Sorrie, M. B., Soyiri, I. N., Spurlock, E. E., Sreeramareddy, C. T., Sudaryanto, A., Sufiyan, M. B., Suleria, H. A. R., Sykes, B. L., Tabarés-Seisdedos, R., Tabuchi, T., Tadesse, D. B., Tarigan, I. U., Taye, B., Tefera, Y. M., Tehrani-Banihashemi, A., Tekelemedhin, S. W., Tekle, M. G., Temsah, M.-H., Tesfay, B. E., Tesfay, F. H., Tessema, Z. T., Thankappan, K. R., ThekkePurakkal, A. S., Thomas, N., Thompson, R. L., Thomson, A. J., Topor-Madry, R., Tovani-Palone, M. R., Traini, E., Tran, B. X., Tran, K. B., Ullah, I., Unnikrishnan, B., Usman, M. S., Uthman, O. A., Uzochukwu, B. S. C., Valdez, P. R., Varughese, S., Veisani, Y., Violante, F. S., Vollmer, S., W/hawariat, F. G., Waheed, Y., Wallin, M. T., Wang, Y.-P., Wang, Y., Wangdi, K., Weiss, D. J., Weldesamuel, G. T., Werkneh, A. A., Westerman, R., Wiangkham, T., Wiens, K. E., Wijeratne, T., Wiysonge, C. S., Wolde, H. F., Wondafrash, D. Z., Wonde, T. E., Worku, G. T., Yadollahpour, A., Yahyazadeh Jabbari, S. H., Yamada, T., Yaseri, M., Yatsuya, H., Yeshaneh, A., Yilma, M. T., Yip, P., Yisma, E., Yonemoto, N., Younis, M. Z., Yousof, H.-A. S. A., Yu, C., Yusefzadeh, H., Zadey, S., Zahirian Moghadam, T., Zaidi, Z., Zaman, S. B., Zamani, M., Zandian, H., Zar, H. J., Zerfu, T. A., Zhang, Y., Ziapour, A., Zodpey, S., Zuniga, Y. M. H., Hay, S. I., & Reiner, R. C.
Affiliations
University of Washington (US)
Corresponding author
Reiner, Robert C
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2020-09
Volume
8
Issue
9
Pages
e1162-e1185
ISSN
2214-109X (ISSN-L)
OpenAlex
W3071879207
Cited by
187
References
53
Citations by year
2026: 26 · 2025: 31 · 2024: 34 · 2023: 37 · 2022: 30 · 2021: 26 · 2020: 2
FWCI
14.95
Type
journal article
Language
en
Open access
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Funders
  • Aksum University
  • National Authority for Scientific Research and Innovation
  • Instituto de Salud Carlos III (PI17/00719)
  • Alexander von Humboldt-Stiftung
  • Wellcome Trust
  • Public Health Agency of Canada
  • Fundação de Amparo à Pesquisa do Estado de Minas Gerais
  • Ministério da Ciência, Tecnologia e Ensino Superior
  • Secretaría Nacional de Ciencia, Tecnología e Innovación
  • Secretaria Nacional de Ciencia y Tecnología (SFRH/BHD/110001/2015, UID/MULTI/04378/2019, UID/QUI/50006/2019)
  • Department of Health and Social Care
  • Council for the Development of Social Science Research in Africa
  • Manipal Academy of Higher Education
  • Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
  • Chandigarh University
  • National Institute for Health and Care Research
  • British Heart Foundation
  • Bundesministerium für Bildung und Forschung
  • Conselho Nacional de Desenvolvimento Científico e Tecnológico
  • Universiti Kebangsaan Malaysia
  • Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja (175087)
  • Department of Science and Technology, Ministry of Science and Technology, India
  • European Commission
  • National Heart Foundation of Australia
  • National Research Foundation
  • South African Medical Research Council
  • University Grants Commission
  • Deakin University (OI175014)
  • Fundação para a Ciência e a Tecnologia (201900/Z/16/Z, DL57/2016/CP1334/CT0006)
  • Fogarty International Center (D43-TW009775)
  • Bill and Melinda Gates Foundation (OPP1132415)
  • European Regional Development Fund (P_40_382)
  • National Institutes of Health (R01-HD084233)
  • National Institute on Aging (P01-AG041710)
  • National Institute of Allergy and Infectious Diseases (R01-AI112339, R01-AI124389)
  • NIHR Oxford Biomedical Research Centre
  • Sistema Nacional de Investigadores
  • Research Management Centre, International Islamic University Malaysia
  • Debre Markos University
  • Defence Science Institute
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Public Health and Environmental Issues
Keywords
drinking water access, sanitation facilities, regional disparities, low- and middle-income countries, piped water, open defecation, surface water, SDG 6, sub-Saharan Africa, urban-rural disparities
MeSH terms
Bayes Theorem, Developing Countries, Diarrhea, Humans, Sanitation, Socioeconomic Factors, Models, Statistical, Drinking Water, Geographic Mapping

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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