Exploring changes in open defecation prevalence in sub-Saharan Africa based on national level indices.

Deise I Galan,Jay P Graham,Seung-Sup Kim

doi:10.1186/1471-2458-13-527

Deise I Galan, Jay P Graham + Show 1 more

Open Access

https://doi.org/10.1186/1471-2458-13-527

Copy DOI

Abstract

BackgroundIn sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation. This practice facilitates the transmission of diarrheal diseases – one of the leading causes of mortality in children under 5 in sub-Saharan Africa. The main purpose of this study is to: estimate changes in open defecation prevalence between 2005 and 2010 across countries in sub-Saharan Africa; examine the association between national level indices and changes in open defecation prevalence; and assess how many countries can achieve ‘open defecation free status’ by 2015.MethodsAfter applying selection criteria, this study analyzed country-level data for 34 sub-Saharan African countries. Seven country-level indices were collected: 1) presence of a national sanitation policy; 2) budget line for sanitation; 3) budget allocated to sanitation; 4) annual per capita GDP; 5) GDP growth; 6) implementation of total sanitation approaches; and 7) per capita aid disbursement for water supply and sanitation. The relationships between these country-level indices and the change in open defecation from 2005 to 2010 were investigated using Wilcoxon Signed-Rank test and Spearman's rank correlation test.ResultsOnly 3 countries (i.e. Ethiopia, Angola and Sao Tome and Principe) decreased open defecation by 10% or more between 2005 and 2010. No significant associations were observed between the change in open defecation prevalence and all of national level indices except per capita aid disbursement. Per capita aid disbursement for water and sanitation was positively associated with a reduction in open defecation (p-value = 0.02) for a subset of 29 low-income countries from 2005 to 2010. Only one country in our analysis, Angola, is on track to end open defecation by 2015 based on their performance between 2000 and 2010.ConclusionsMost of the national level indices, including a country’s economic status, were not associated with the change in the open defecation prevalence. Based on current trends, the goal of ending open defecation in the majority of sub-Saharan African countries by 2015 will not be achieved. Our findings may be limited by the exploratory nature of this analysis, and future research is required to identify and characterize national level factors specific to reducing open defecation in sub-Saharan Africa.

Highlights

In sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation
National level indices Based on recent reports [15,16], we identified three important domains that could influence Open defecation (OD) prevalence in sub-Saharan Africa: Government policy and practice: (1) implementation of a national sanitation policy; (2) public sector budget line for sanitation, (3) government budget allocation to sanitation; Economic factors: (4) per capita gross domestic product (GDP), (5) economic growth, (6) amount of external development assistance for water and sanitation; and Sanitation approach: (7) adoption of total sanitation approaches at the national level
Statistical analysis We applied the Mann–Whitney U test to assess relationships between changes in OD prevalence of sub-Saharan countries between 2005 and 2010 and the following national level factors: 1) national sanitation policy, 2) budget line to sanitation, 3) budget allocated to sanitation, and 4) total sanitation approaches

Summary

Introduction

In sub-Saharan Africa, it is estimated that 215 million people continue to engage in open defecation. This practice facilitates the transmission of diarrheal diseases – one of the leading causes of mortality in children under 5 in sub-Saharan Africa. The practice of open defecation (hereafter, OD) facilitates the transmission of pathogens that cause diarrheal diseases – the second leading contributor to the global burden of disease, as measured in disability-adjusted life years (DALYs) [1,2,3,4]. It is estimated that 1.1 billion people – 15% of the global population – still engage in OD [7]. In 2010, OD was practiced by 8% of the urban population and 35% of the rural population in sub-Saharan Africa [7]

Objectives

Methods

Results

Discussion

Conclusion