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dc.contributor.authorDeshpande, Aniruddha
dc.contributor.authorMiller-Petrie, Molly K
dc.contributor.authorLindstedt, Paulina A
dc.contributor.authorBaumann, Mathew M
dc.contributor.authorJohnson, Kimberly B
dc.contributor.authorBlacker, Brigette F
dc.contributor.authorAbbastabar, Hedayat
dc.contributor.authorAbd-Allah, Foad
dc.contributor.authorAbdelalim, Ahmed
dc.contributor.authorAbdollahpour, Ibrahim
dc.contributor.authorAbegaz, Kedir Hussein
dc.contributor.authorAbejie, Ayenew Negesse
dc.contributor.authorAbreu, Lucas Guimarães
dc.contributor.authorAbrigo, Michael RM
dc.contributor.authorAbualhasan, Ahmed
dc.contributor.authorKokou Accrombessi, Manfred Mario
dc.contributor.authorAdamu, Abdu A
dc.contributor.authorAdebayo, Oladimeji M
dc.contributor.authorAdedeji, saac Akinkunmi
dc.contributor.authorAdedoyin, Rufus Adesoji
dc.contributor.authorAdekanmbi, Victor
dc.contributor.authorAdetokunboh, Olatunji O
dc.contributor.authorAdhikari, Tara Ballav
dc.contributor.authorAfarideh, Mohsen
dc.contributor.authorAgudelo-Botero, Marcela
dc.contributor.authorAhmadi, Mehdi
dc.contributor.authorAhmadi, Keivan
dc.contributor.authorAhmed, Muktar Beshir
dc.contributor.authorAhmed, Anwar E
dc.contributor.authorAkalu, Temesgen Yihunie
dc.contributor.authorAkanda, Ali S
dc.contributor.authorAlahdab, Fares
dc.contributor.authorAl-Aly, Ziyad
dc.contributor.authorAlam, Samiah
dc.contributor.authorAlam, Noore
dc.contributor.authorAlamene, Genet Melak
dc.contributor.authorAlanzi, Turki M
dc.contributor.authorAlbright, James
dc.contributor.authorAlbujeer, Ammar
dc.contributor.authorAlcalde-Rabanal, Jacqueline Elizabeth
dc.contributor.authorAlebel, Animut
dc.contributor.authorAlemu, Zewdie Aderaw
dc.contributor.authorAli, Muhammad
dc.contributor.authorAlijanzadeh, Mehran
dc.contributor.authorAlipourv, Vahid
dc.contributor.authorAljunid, Syed Mohamed
dc.contributor.authorAlmasi, Ali
dc.contributor.authorAlmasi-Hashiani, Amir
dc.contributor.authorAl-Mekhlafi, Hesham M
dc.contributor.authorAltirkawi, Khalid A
dc.contributor.authorAlvis-Guzman, Nelson
dc.contributor.authorAlvis-Zakzuk, Nelson J
dc.contributor.authorAmini, Saeed
dc.contributor.authorMaever Amit, Arianna L
dc.contributor.authorHerrera Amul, Gianna Gayle
dc.contributor.authorAndrei, Catalina Liliana
dc.contributor.authorAnjomshoa, Mina
dc.contributor.authorAnsariadi, Ansariadi
dc.contributor.authorAbelardo Antonio, Carl T
dc.contributor.authorAntony, Benny
dc.contributor.authorAntriyandarti, Ernoiz
dc.contributor.authorArabloo, Jalal
dc.contributor.authorAmin Aref, Hany Mohamed
dc.contributor.authorAremu, Olatunde
dc.contributor.authorArmoon, Bahram
dc.contributor.authorArora, Amit
dc.contributor.authorAryal, Krishna K
dc.contributor.authorArzani, Afsaneh
dc.contributor.authorAsadi-Aliabadi, Mehran
dc.contributor.authorAsmelash, Daniel
dc.contributor.authorTasew Atalay, Hagos
dc.contributor.authorMasoume Athari, Seyyede
dc.contributor.authorShamsadin Athari, Seyyed
dc.contributor.authorAtre, Sachin R
dc.contributor.authorAusloos, Marcel
dc.contributor.authorAwasthi, Shally
dc.contributor.authorAwoke, Nefsu
dc.contributor.authorAyala Quintanilla, Beatriz Paulina
dc.contributor.authorAyano, Getinet
dc.contributor.authorAmogre Ayanore, Martin
dc.contributor.authorAsmare Aynalem, Yared
dc.contributor.authorAzari, Samad
dc.contributor.authorAzman, Andrew S
dc.contributor.authorBabaee, Ebrahim
dc.contributor.authorBadawi, Alaa
dc.contributor.authorBagherzadeh, Mojtaba
dc.contributor.authorBakkannavar, Shankar M
dc.contributor.authorBalakrishnan, Senthilkumar
dc.contributor.authorBanach, Maciej
dc.contributor.authorMattar Banoub, Joseph Adel
dc.contributor.authorBarac, Aleksandra
dc.contributor.authorBarboza, Miguel A
dc.contributor.authorWinfried Bärnighausen, Till
dc.contributor.authorBasu, Sanjay
dc.contributor.authorBay, Vo Dinh
dc.contributor.authorBayati, Mohsen
dc.contributor.authorBedi, Neeraj
dc.contributor.authorBeheshti, Mahya
dc.contributor.authorBehzadifar, Meysam
dc.contributor.authorBehzadifar, Masoud
dc.contributor.authorFernanda, Diana
dc.contributor.authorRamirez, Bejarano
dc.contributor.authorBell, Michelle L
dc.contributor.authorBennett, Derrick A
dc.contributor.authorBenzian, Habib
dc.contributor.authorAjema Berbada, Dessalegn
dc.contributor.authorBernstein, Robert S
dc.contributor.authorGanapati Bhat, Anusha
dc.contributor.authorBhattacharyya, Krittika
dc.contributor.authorBhaumik, Soumyadeep
dc.contributor.authorBhutta, Zulfiqar A
dc.contributor.authorBijani, Ali
dc.contributor.authorBikbov, Boris
dc.contributor.authorBin Sayeed, Muhammad Shahdaat
dc.contributor.authorKishore Biswas, Raaj
dc.contributor.authorBohlouli, Somayeh
dc.contributor.authorBoufous, Soufiane
dc.contributor.authorBrady, Oliver J
dc.contributor.authorNikolaevich Briko, Andrey
dc.contributor.authorIvanovich Briko, Nikolay
dc.contributor.authorBritton, Gabrielle B
dc.contributor.authorBrown, Alexandria
dc.contributor.authorBurugina Nagaraja, Sharath
dc.contributor.authorButt, Zahid A
dc.contributor.authorCámera, Luis Alberto
dc.contributor.authorCampos-Nonato, Ismael R
dc.contributor.authorCampuzano Rincon, Julio Cesar
dc.contributor.authorCano, Jorge
dc.contributor.authorCar, Josip
dc.contributor.authorCárdenas, Rosario
dc.contributor.authorCarvalho, Felix
dc.contributor.authorCastañeda-Orjuela, Carlos A
dc.contributor.authorCastro, Franz
dc.contributor.authorCerin, Ester
dc.contributor.authorChalise, Binaya
dc.contributor.authorKumar Chattu, Vijay
dc.contributor.authorLee Chin, Ken
dc.contributor.authorChristopher, Devasahayam J
dc.contributor.authorChu, Dinh-Toi
dc.contributor.authorCormier, Natalie Maria
dc.contributor.authorCosta, Vera Marisa
dc.contributor.authorCromwell, Elizabeth A
dc.contributor.authorFekadu Dadi, Abel Fekadu
dc.contributor.authorDahiru, Tukur
dc.contributor.authorDahlawi, Saad MA
dc.contributor.authorDandona, Rakhi
dc.contributor.authorDandona, Lalit
dc.contributor.authorDang, Anh Kim
dc.contributor.authorDaoud, Farah
dc.contributor.authorDarwesh, Aso Mohammad
dc.contributor.authorHamed Darwish, Amira
dc.date.accessioned2020-09-01T05:38:30Z
dc.date.available2020-09-01T05:38:30Z
dc.date.issued2020-09
dc.identifier.otherhttps://doi.org/10.1016/S2214-109X(20)30278-3
dc.identifier.urihttp://repositorio-indicasat.org.pa/handle/123456789/246
dc.descriptionBackground Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.en_US
dc.description.abstractBackground Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.en_US
dc.language.isoengen_US
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rightshttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.subjectMapping geographicalen_US
dc.subjectinequalitiesen_US
dc.subjectaccess to drinking wateren_US
dc.subjectanitation facilitiesen_US
dc.subjectlow-incomeen_US
dc.subjectmiddle-income countriesen_US
dc.titleMapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17en_US
dc.typeinfo:eu-repo/semantics/articleen_US
dc.typeinfo:eu-repo/semantics/publishedVersion


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