Demographic, socioeconomic and regional disparities in the coverage of water, sanitation and hygiene facilities in four South Asian Countries.

Abstract

Ensuring an adequate water, sanitation, and hygiene (WASH) is crucial for upholding public health and achieving Sustainable Development Goals (SDG-6). The main goal of this study was to review the existing WASH facilities, mapping for regional comparisons, and identify the significant socioeconomic and demographic factors associated with WASH facilities in Afghanistan, Bangladesh, Nepal, and Pakistan. This study employed a quantitative research design using the most recent Multiple Indicator Cluster Survey (MICS) data from Afghanistan (2022-23, n =  23,213), Bangladesh (2019, n =  61,242), Nepal (2019, n =  12,655), and Pakistan (2017-19, n =  96,105). Data analysis was done using descriptive statistics and multivariate logistic regression model. Besides, spatial mapping was used for regional comparison, the Generalized Variance Inflation Factor (GVIF) was applied for checking multicollinearity, and the Receiver Operating Characteristic (ROC) curve was used to evaluate model performance. This study revealed substantial disparities in the coverage of WASH facilities across four countries. Nepal had the highest coverage (75.33%), followed by Pakistan (59.47%), Bangladesh (50.28%) and Afghanistan (33.54%). Wealthier households were associated with higher odds of WASH facilities compared to the poor: Afghanistan (aOR = 7.83; 95% CI: 6.58-9.32; p <  0.001), Bangladesh (aOR = 5.75; 95% CI: 5.34-6.20; p <  0.001), Nepal (aOR = 5.80; 95% CI: 4.52-7.44; p <  0.001), and Pakistan (aOR = 9.64; 95% CI: 8.79-10.58; p <  0.001). In addition, place of residence, education of household head, access to the media, age of household head, and family size emerged as significant determinants of WASH facilities across all four countries. The findings suggest that wealthier households, those with educated heads, and those in urban areas have higher coverage of WASH facilities. To ensure adequate WASH facilities, policymakers should focus on rural areas, lower-income groups, less educated household heads, and should conduct awareness campaigns.