Abstract
ABSTRACTIn Zambia limited access to adequate water and sanitation is a key developmental challenge, particularly for rapidly expanding peri-urban areas. During 2016–2017, a cross-sectional household survey was conducted among 12,500 households representing ~60,000 individuals to assess the burden of household diarrheal and respiratory disease and to measure water, sanitation, and hygiene (WASH) characteristics in Lusaka, Zambia. We found that socio-economic factors, including having an additional household member, having children <5 years old in the household, living in a rental home, and higher annual household expenditure were associated with diarrhea and respiratory illness. We also found an increased risk for diarrhea associated with a number of WASH-related factors–such as not covering all water storage containers, not using soap for handwashing, having an unimproved sanitation facility, and utilizing a heavily shared toilet (≥18 people). Detectable free chlorine residual in household stored water and more hours of water availability per day were associated with reduced odds of waterborne illness. In all, 75% of household stored water was contaminated with E. coli and households consuming less water (<20 L/day per person) for all purposes had lower odds of diarrhea than households consuming more water—these findings highlight the need for enhanced WASH services within densely populated peri-urban areas and the importance of achieving universal access to safely managed water and sanitation services.
Highlights
55% of the world’s population lives in urban areas, a figure which will approach 70% in 20501
The findings from this cross-sectional study in peri-urban Lusaka, Zambia suggest that waterborne illness, diarrheal illness, and respiratory illness were positively associated with socioeconomicrelated factors such as larger household size, renting homes, and higher household expenditures
For waterborne illness and diarrheal illness, WASH-related indicators including not using soap when handwashing, not covering all household water storage containers, using an unimproved sanitation facility, heavy toilet sharing, and higher water consumption for all purposes were identified as risk factors
Summary
55% of the world’s population lives in urban areas, a figure which will approach 70% in 20501. Global population size is projected to reach nearly 10 billion persons by 2050, with the majority of population growth occurring in urban and peri-urban areas (PUAs) in low-income countries in Asia and Africa[1]. Many of these cities lack the basic water and sanitation infrastructure to support rapidly expanding populations[2]. Limited access to water and sanitation services results in diarrheal illness, which causes 500,000 deaths among children
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