Where There Is No Toilet: Water and Sanitation Environments of Domestic and Facility Births in Tanzania

Abstract

BackgroundInadequate water and sanitation during childbirth are likely to lead to poor maternal and newborn outcomes. This paper uses existing data sources to assess the water and sanitation (WATSAN) environment surrounding births in Tanzania in order to interrogate whether such estimates could be useful for guiding research, policy and monitoring initiatives.MethodsWe used the most recent Tanzania Demographic and Health Survey (DHS) to characterise the delivery location of births occurring between 2005 and 2010. Births occurring in domestic environments were characterised as WATSAN-safe if the home fulfilled international definitions of improved water and improved sanitation access. We used the 2006 Service Provision Assessment survey to characterise the WATSAN environment of facilities that conduct deliveries. We combined estimates from both surveys to describe the proportion of all births occurring in WATSAN-safe environments and conducted an equity analysis based on DHS wealth quintiles and eight geographic zones.Results42.9% (95% confidence interval: 41.6%–44.2%) of all births occurred in the woman's home. Among these, only 1.5% (95% confidence interval: 1.2%–2.0%) were estimated to have taken place in WATSAN-safe conditions. 74% of all health facilities conducted deliveries. Among these, only 44% of facilities overall and 24% of facility delivery rooms were WATSAN-safe. Combining the estimates, we showed that 30.5% of all births in Tanzania took place in a WATSAN-safe environment (range of uncertainty 25%–42%). Large wealth-based inequalities existed in the proportion of births occurring in domestic environments based on wealth quintile and geographical zone.ConclusionExisting data sources can be useful in national monitoring and prioritisation of interventions to improve poor WATSAN environments during childbirth. However, a better conceptual understanding of potentially harmful exposures and better data are needed in order to devise and apply more empirical definitions of WATSAN-safe environments, both at home and in facilities.

Water, Sanitation, and Hygiene in Rural Health-Care Facilities: A Cross-Sectional Study in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia

“…25,26 Inadequate quality sanitation in HCF can also lead to embarrassment and discomfort in patients seeking medical assistance. In addition to the previously mentioned study which found that 44% of Tanzanian HCF performing deliveries were WATSAN-safe, 14 a 2014 assessment of Service Provision Assessment survey data from Ethiopia found that more than 26% of HCF across the country did not have a functioning latrine for patient use. 27 The previously mentioned Steinmann and others study of 12 HCF in India found that women consider sanitation and hand hygiene installations a vital part of HCFs; a lack of these amenities can detract from a facility's appeal and reputation, and can affect the consistency and timeliness of care seeking.…”

“…12 A 2014 qualitative study of 10 HCFs in a rural province in Cambodia documented suboptimal hand hygiene, unsafe water storage practices, and a lack of sanitation facilities in health centers where women give birth. 13 A 2011 study in Tanzania analyzed the Service Provision Assessment survey, documenting that 44% of health facilities that conduct deliveries have delivery rooms that are WATSAN-safe 14 ; a similar analysis of the Service Provision Assessment survey in Malawi revealed that 59.3% of HCF conducting deliveries had "safe, reliable, and accessible" water sources. 15 These studies are limited in scope and have focused on HCF in one country or a few HCF in one district or province.…”

Maternal Mortality in India: An Overview of social causes

“…A systematic review on association between poor sanitation and maternal mortality found that women of households with poor sanitation have 3.14 times higher odds of dying than women with better sanitation conditions. Further, women with poor water supply had 1.75 times odds of maternal mortality as compared to those with adequate water supply (Benova, 2014).…”

Water, Sanitation, and Hygiene Practices Associated with Nutritional Status of Under-Five Children in Semi-Pastoral Communities Tanzania

“…20,21 For the case of Tanzania, 42.7% of its people rely on unsafe water sources for their domestic uses, only 36.8% have access to piped/tap water, 14% still practice open defecation, and 76.4% use traditional pit latrines. 22,23 Likewise, some people have to walk long distances to fetch water that may limit the amount of water available in the household for practicing good hygiene. The task of fetching water is the responsibility of women and children and may also affect time for mothers to feed and take care of the youngest children.…”