Abstract
Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards all-in-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.
Highlights
Sustainable Development Goal (SDG) 6 focuses on universal access to improved drinking water and sanitation by the year 2030
In the sub-Saharan nation of Zambia, WASH factors have been found to be responsible for 11.4% of all deaths [4]; only 67.7% and 40% of the population have access to improved drinking water and sanitation respectively [5]
In comparison to national statistics, peri-urban figures reveal that approximately 56% and as much as 90% of the peri-urban population lack access to safe water and sanitation facilities respectively [6]
Summary
Sustainable Development Goal (SDG) 6 focuses on universal access to improved drinking water and sanitation by the year 2030. Access to basic services such as water, sanitation and hygiene (WASH) is still low in high density peri-urban settlements. This primarily results from their being low income unplanned settlements having limited space and municipal provisions [1]. In the sub-Saharan nation of Zambia, WASH factors have been found to be responsible for 11.4% of all deaths [4]; only 67.7% and 40% of the population have access to improved drinking water and sanitation respectively [5]. In comparison to national statistics, peri-urban figures reveal that approximately 56% and as much as 90% of the peri-urban population lack access to safe water and sanitation facilities respectively [6]
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