Unequal geographic distribution of water and sanitation at the household and school level in Sudan

Abstract

The Sudanese Government launched the National SDG-6 Plan and commences its implementation to achieve and sustain universal and equitable access to basic WASH services by 2030. It is critical to understand the geographical heterogeneity of Sudan and patterns in the inequality of access to safe drinking water and sanitation. Through such research, the disease control strategy can be optimized, and resource allocation can be prioritized. We explored spatial heterogeneity and inequality in access to improved water and sanitation across Sudan by mapping the coverage at both the state and district levels. We decomposed the inequality across Sudan into within-state, between-state, within-district, and between-state inequalities using the Theil L and Theil T indices. We calculated the Gini coefficient to assess the inequality of access to improved water and sanitation, based on the deviation of the Lorenz curve from the line of perfect equality. The study population was 105,167 students aged 8–13 at 1,776 primary schools across the country. Geographical heterogeneity was prominent in the Central Darfur, South Darfur, East Darfur, Kassala, West Kordofan, and Blue Nile States, all of which showed severe inequality in access to an improved latrine at the household level in terms of the Theil T or Theil L index. The overall inequality in the coverage of improved sanitation went beyond the warning limit of 0.4 for the Gini coefficient. The inequality in terms of the Theil L and Theil T indices, as well as the Gini coefficient, was always higher for improved sanitation than for improved water at the household level. Within-state inequality accounted for 66% or more of national inequalities in the distribution of improved sanitation and drinking water for both the Theil L and Theil T indices. This is the first study to measure geographical heterogeneity and inequalities in improved water and sanitation coverage across Sudan. The study may help to prioritize resource allocation to areas with the greatest water and sanitation needs.

Spatial heterogeneity in drinking water sources in the Greater Accra Metropolitan Area (GAMA), Ghana

“…The past decade has witnessed significant progress in access to drinking water sources globally (Mosello, 2017). Despite these improvements, there are considerable disparities in access to and use of improved water 1 within cities of the developing world (Alba et al, 2020;Cha et al, 2021;Deshpande et al, 2020;Mutono et al, 2022). Since access to improved drinking water is a central concern for population health and well-being, several international organizations including the United Nations, the World Health Organization (WHO), and United Nations Children's Fund (UNICEF) have been very proactive in setting targets and providing support for universal access to safe drinking water.…”

“…Previous studies on variations in drinking water sources in SSA have largely focused on between-country analyses (Adams & Smiley, 2018;Armah et al, 2018;Deshpande et al, 2020;Hopewell & Graham, 2014;Pullan et al, 2014). A few studies have also examined disparities in drinking water within countries and major SSA cities (Cha et al, 2021;Cole et al, 2018;Grace et al, 2017;Osei et al, 2015;Songsore & McGranahan, 1998;Thompson et al, 2000). However, only a handful of studies have examined water drinking patterns at localized settings 2 for fast growing metropolitan cities in SSA (see Alba et al, 2019;Cha et al, 2021;Cole et al, 2018;Thompson et al, 2000), which is needed to better understand inequality in the provision of local infrastructure and essential services.…”

Programmatic Implications for Schistosomiasis Elimination Based on Community-Based Survey in the Blue Nile, North Kordofan, and Sennar States, Sudan

“…Primary education from age six for 8 years has been compulsory in Sudan since 1998 [17]. According to a nationwide survey conducted in 2017, the percentages of Sudanese households with improved water and sanitation were 86% and 16%, respectively [18]. It has been reported that about 10% of Sudanese live a nomadic life and that more than 30% depend on farming and animal husbandry.…”

Implications for selecting persistent hot spots of schistosomiasis from community- and school-based surveys in Blue Nile, North Kordofan, and Sennar States, Sudan

“…From January to February 2017, a nationwide schistosomiasis survey was conducted in Sudan in 1,711 randomly selected primary schools to estimate the statewide prevalence of Schistosoma haematobium and Schistosoma mansoni in the 18 states [6,7]. Random selection was chosen to obtain precise estimates of schistosomiasis prevalence and the number of infected individuals.…”