Measuring disparities in sanitation access: does the measure matter?

Area of Science:

• Global Health
• Environmental Health
• Socioeconomic Determinants of Health

Background:

• Monitoring progress in health interventions like sanitation is crucial.
• Focus on disparities in access across socio-economic and demographic factors is increasing.
• Methodological challenges exist in accurately measuring sanitation coverage changes.

Purpose of the Study:

• To explore methodological challenges in monitoring sanitation coverage disparities.
• To assess the impact of wealth indices, setting-specific versus national indices, and child-level versus household-level analyses.
• To provide insights for robust monitoring of sanitation access.

Main Methods:

• Utilized Demographic and Health Surveys from six low-income countries.
• Estimated sanitation coverage by wealth for children and households.
• Assessed concordance using wealth indices with and without water/sanitation assets, and across different settings.

Main Results:

• Wealth indices including water and sanitation assets can overstate sanitation access disparities.
• Setting-specific wealth indices correlate well with national index estimates.
• Household-level analyses consistently showed lower sanitation coverage and disparities compared to child-level analyses.

Conclusions:

• Standard asset indices are reasonably robust for measuring sanitation disparities but may overestimate them.
• Separate setting wealth quintiles highlight urban disparities; national index analysis is sufficient.
• Household-level sanitation coverage estimates may underestimate access for children under five.