Elasticity of demand for water in Khartoum, Sudan

Divided infrastructure: legal exclusion and water inequality in an urban slum in Mumbai, India

Inadequate water access is central to the experience of urban inequality across low- and middle-income countries and leads to adverse health and social outcomes. Previous literature on water inequality in Mumbai, India's second largest city, offers diverse explanations for water disparities between and within slums.⁽¹⁾ This study provides new insights on water disparities in Mumbai's slums by evaluating the influence of legal status on water access. We analyzed data from 593 households in Mandala, a slum with legally recognized (notified) and unrecognized (non-notified) neighborhoods. Relative to households in a notified neighborhood, households in a non-notified neighborhood suffered disadvantages in water infrastructure, accessibility, reliability, and spending. Non-notified households used significantly fewer liters per capita per day of water, even after controlling for religion and socioeconomic status. Our findings suggest that legal exclusion may be a central driver of water inequality. Extending legal recognition to excluded slum settlements, neighborhoods, and households could be a powerful intervention for reducing urban water inequality.

PROTOCOL: Water, sanitation and hygiene for reducing childhood mortality in low- and middle-income countries

Respiratory tract infections and diarrhoea are the two biggest killers of children in low income contexts. They are closely related to access to, and use of improved water, sanitation and hygiene (WASH). However, there is no high quality systematic review that quantifies the effect of WASH improvements on childhood mortality. Existing systematic reviews of WASH improvements measure effects on morbidity, under the (often implicit) assumption that morbidity is closely correlated with mortality. This is at least partly because the impact evaluations on which they are based are only designed to detect changes in morbidity with statistical precision, whereas mortality is a relatively rare outcome. The proposed review will address this evidence synthesis gap, using the greater statistical power of meta-analysis to pool findings across studies.

The role of piped water supplies in advancing health, economic development, and gender equality in rural communities

In rural areas of sub-Saharan Africa, one in eight households obtain drinking water from a piped system; the rest fetch water from improved and unimproved sources located at some distance from their homes. This task falls primarily to women and girls, creating time poverty and risks to safety and health. In this paper, we present a conceptual model that elaborates the mechanisms linking access to piped water with food security and long-term economic impacts. These hypotheses were tested in a quasi-experimental study of four villages in rural Zambia using a combination of household surveys, Global Positioning System transponders, and water meters to measure time spent fetching water, water consumption, and how water was being utilized for domestic and productive activities. Households receiving the piped water intervention spent a median of 3.8 h per week less fetching water, savings that accrued primarily to women and girls. Household water consumption increased 32%, which was used for both domestic and productive uses. Increases in the frequency of gardening and the size of garden plots in treatment households were observed. Households receiving piped water reported being happier, healthier, and having more time to participate in work inside or outside the home. We find that piped water supplies can promote the economic development and well-being of rural households, with particular benefits to women and girls, conditional upon pricing and management models that ensure sustainable service.

A SEM Approach to the Direct and Indirect Links between WaSH Services and Access to Food in Countries in Protracted Crises: The Case of Western Bahr-el-Ghazal State, South Sudan

As highlighted by the 2030 Agenda, access to food is a crucially important aspect of sustainable development. In this context, the association between WaSH services and access to food still needs to be clearly understood. This study investigates the direct and indirect impact of the WaSH environment of households on access to food, and the role of mediation variables and insecurity due to war and conflicts in South Sudan. We considered a statistically representative sample of 1382 households and used two structural equation models based on primary data. A basic model estimates association between household WaSH environment and food security directly and indirectly through the household livelihood-based coping capacity and poverty perception. Its extended version includes the indirect effect of insecurity due to war and conflicts. Results are theoretically coherent and demonstrate the relevance of the household WaSH environment for food security. The indirect effect of the absence of insecurity due to conflicts and war on food security adds to the basic model a statistically significant total indirect effect. From a policy perspective, the study suggests reinforcement of the capacity of the public sector for delivering WaSH services and the need for multi-sectoral solutions linking humanitarian, development, and peace approaches.

Can water, sanitation and hygiene help eliminate stunting? Current evidence and policy implications

Stunting is a complex and enduring challenge with far‐reaching consequences for those affected and society as a whole. To accelerate progress in eliminating stunting, broader efforts are needed that reach beyond the nutrition sector to tackle the underlying determinants of undernutrition. There is growing interest in how water, sanitation and hygiene (WASH) interventions might support strategies to reduce stunting in high‐burden settings, such as South Asia and sub‐Saharan Africa. This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.

Measuring domestic water use: a systematic review of methodologies that measure unmetered water use in low-income settings

OBJECTIVE

To present a systematic review of methods for measuring domestic water use in settings where water meters cannot be used.

METHODS

We systematically searched EMBASE, PubMed, Water Intelligence Online, Water Engineering and Development Center, IEEExplore, Scielo, and Science Direct databases for articles that reported methodologies for measuring water use at the household level where water metering infrastructure was absent or incomplete. A narrative review explored similarities and differences between the included studies and provide recommendations for future research in water use.

RESULTS

A total of 21 studies were included in the review. Methods ranged from single-day to 14-consecutive-day visits, and water use recall ranged from 12 h to 7 days. Data were collected using questionnaires, observations or both. Many studies only collected information on water that was carried into the household, and some failed to mention whether water was used outside the home. Water use in the selected studies was found to range from two to 113 l per capita per day.

CONCLUSION

No standardised methods for measuring unmetered water use were found, which brings into question the validity and comparability of studies that have measured unmetered water use. In future studies, it will be essential to define all components that make up water use and determine how they will be measured. A pre-study that involves observations and direct measurements during water collection periods (these will have to be determined through questioning) should be used to determine optimal methods for obtaining water use information in a survey. Day-to-day and seasonal variation should be included. A study that investigates water use recall is warranted to further develop standardised methods to measure water use; in the meantime, water use recall should be limited to 24 h or fewer.

Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework

OBJECTIVE

To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.

METHODS

We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically.

RESULTS

The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. 'In-water' associations: (a) Inorganic contaminants, and (b) 'water-system' related infections, (c) 'water-based' infections, and (d) 'water borne' infections. 2. 'Behaviour' associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes.

CONCLUSION

WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies.

Hygiene, sanitation, and water: what needs to be done?

In the final article in a four-part PLoS Medicine series on water and sanitation, Sandy Cairncross and colleagues outline what needs to be done to make significant progress in providing more and better hygiene, sanitation, and water for all.

Impact of improvement of water supply on household economy in a squatter area of Manila

To estimate the impact of the improvement of water supply. a comparative study on water collection and household expenditure on water was conducted between a former squatter community with an improved water supply (Leveriza: LE) and a typical squatter community with public water faucets (Maestranza: MA) in Manila, the Philippines. Data were collected from 201 structured household interviews and a focus group discussion among housewives in each community. To measure the time spent collecting water, observations of private and public water faucets were conducted. The residents in LE enjoyed significantly larger quantities of water from private water connections than in MA, where only three public water faucets were available as a water source. Conversely, the unit price of water in LE was much lower than in MA. In LE, 72.1% of the households started working for more income using time saved through the improvement of water supply and the proportion of the households under the poverty threshold was reduced from 55.6% to 29.9%. In MA, 68.6% of the households expressed their willingness to work for more income when time spent collecting water was saved. It would be possible for MA to reduce the proportion of the households under the poverty threshold through the improvement of the water supply. The results of the study indicated that the improvement of water supply would possibly encourage urban slum residents to increase their household incomes through reallocating time saved to income-generating activities. The underserved residents spent more money for less water compared to those with access to private water connections. In MA, it took 3-4 h, on average, to complete one water collecting task, even though the nearest public water faucet was within 100 m of any housing unit. This suggests that the definition of accessibility to safe water be reconsidered when discussing the urban poor.

Water usage patterns in low-income urban communities in Uganda: implications for water supply surveillance

The selection of water sources by poor households in three urban areas in Uganda is shown to be complex, with a range of communal water sources used. In all towns, significant numbers of households used multiple sources. An aggregated estimate of the level of use in the largest town, Kampala, showed little difference in the number of households collecting water from piped and non-piped sources. In the other towns, households in Soroti were more likely to use point sources than piped water and in Masaka most households used piped water, with unprotected sources the most common subsidiary source. Differentiation in use by source type was evaluated. In two of the towns no differentiation in use is seen. In Soroti, some differentiation in use is seen as the water from boreholes is widely used for drinking and that from other sources less frequently consumed. Supplemental water purchased from vendors was relatively uncommon in the towns, but two towns showed that many households collect rainwater for domestic use. The implications of these findings for the drinking water surveillance programme are discussed.

Improving human welfare through appropriate technology: government responsibility, citizen duty or customer choice

This paper explores recent attempts to improve the effectiveness of environmental health programmes and projects by reference to the International Drinking Water Supply and Sanitation Decade (1980-1990) and beyond. Reference is made to how water and sanitation as technical interventions have drawn upon the natural sciences, notably concepts of race and sex, and the social sciences including culture and gender, for their authority and legitimacy. A new and apparently progressive movement, the Water Decade sought to challenge the powerful and enduring high tech image of development on which much western environmental and social transformations have been based. Beginning as a critique of modernism with a commitment to basic needs as human rights, it was driven by a recognition that sophisticated technology could not satisfy human health needs. Alternative technologies would, by contrast, cater for a more extensive and varied market and would promote participatory approaches to service delivery. The paper demonstrates how, during the course of the Decade, sections of the aid community began to redefine basic needs as commodities involving the efficient marketing and delivery of a product with minimal state intervention. Within a shifting international political and economic context, it examines the changing role of the expert and the links being forged between large donors, non-governmental organisations and the private sector. The significance of this reformulated progressivism for the development debate is then considered, notably in relation to concepts of citizenship, consumer choice and the role of the state.

Variations in poverty and health between slum settlements: contradictory findings from Visakhapatnam, India

Whilst much work has been done to highlight the plight of the urban poor in less developed countries, little information exists about differences in health between poor urban areas. This paper describes environmental and other health hazards in five slum settlements in Visakhapatnam, India. Despite considerable differences in infrastructural and socio-economic development, morbidity rates were not found to vary between the study settlements. Methodological and epidemiological explanations for this lack of variation are discussed.