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Context matters: a multicountry analysis of individual‐ and neighbourhood‐level factors associated with women's sanitation use in sub‐Saharan Africa
Author(s) -
Winter Samantha,
Dreibelbis Robert,
Barchi Francis
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13016
Subject(s) - sanitation , context (archaeology) , urbanization , poverty , neighbourhood (mathematics) , improved sanitation , geography , public health , environmental health , socioeconomics , developing country , economic growth , open defecation , business , medicine , economics , mathematical analysis , mathematics , archaeology , pathology , nursing
Objectives To identify cross‐national trends in factors associated with women's sanitation use in sub‐Saharan Africa. Methods Using data from Demographic and Health Surveys conducted in 14 SSA countries between 2008 and 2014, we modelled women's sanitation use in relation to various individual‐ and neighbourhood‐level factors. Results Substantial variation exists between countries in the strength and direction of factors associated with sanitation use. Particularly significant associations across the region included access to different water sources, years of education, family size, age, living in a female‐headed household, being married and wealth. Neighbourhood‐level poverty, ethnic diversity and urbanisation were important factors in a majority of countries. Conclusions International development goals for sanitation are frequently framed in terms of availability, implicitly suggesting that if facilities are accessible, they will be used. A more nuanced view that takes into account not only the existence of facilities but also the factors influencing their use is needed to understand the dynamics of women's sanitation use in the region. Policies focused on availability may not yield the desired public health benefits from improved sanitation in sub‐Saharan Africa. Context‐relevant factors must be addressed concurrently to achieve sanitation development goals.