Water supply and sanitation affecting

health

Presentation overview

• Objectives

• Last decade WSS coverage

• Vietnam National Health Survey

• Diarrheal illness and poverty

• Analysis of WSS and health

• Conclusions and recommendations

BackgroundBackground• Objectives:

– Assess health risks of drinking water supply and sanitation

– Identify population at risk of illness

– Assist in identifying water and sanitation sector priorities

• Large sample (36,000 households, 61 provinces)

• Information on; – sources of household drinking water supply,

– sanitation facilities,

– household behavior, e.g boiling and treating of drinking water,

– identified pollution sources near dug wells,

– prevalence and indicators of severity of diarrheal illness

– socio-economic status, e.g. living standard, education level etc

Water and sanitation in the last decade

Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam. 2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the Vietnam National Health Survey 2001/02

Drinking water source

0%

10%

20%

30%

40%

50%

60%

Tap water Drilled well Rainwater Dug well Surfacewater

Othersource

1992-93

1997-98

2001-02

Sources of drinking water

Rain water

Tap water

Drilled well water

Dug well (no pollution source)

Bought water

Surface water

Dug well (with pollution source)

Piped mountain spring waterOther water

Toilet facilities in the last decade

Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam. 2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the Vietnam National Health Survey 2001/02

0%

5%

10%

15%

20%

25%

30%

35%

40%

Flush toiletwith septic

tank

Doublecompost/pour flush

Simpletoilet

Other toilet Joint toilet No toilet

1992-93

1997-98

2001-02

Types of toilets

Other

Suilabh, pour flush toilet

Double vault compose latrine

Toilet draining to pond/animal

shelter

Flush toilet

Simple toilet, single vault.

No toilet

Findings from VNHS Findings from VNHS datadata

Source : Calculated from the Vietnam National Health Survey 2002.Ministry of Health. Vietnam

WATER, SANITATION AND WATER, SANITATION AND HEALTHHEALTH

ADI prevalence by Age Group and Quintile

8.2%

7.1%6.6%

5.4%

4.2%

2.2% 2.3% 2.1% 2.2% 1.9%

0%

2%

4%

6%

8%

10%

Poor Near poor Average Better-off Rich

Under 5 5 and older

Means of days of ADI by Age Group

3.10

2.50

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

Under 5 Over 5

Number of days of ADI by Age and Quintile

3.02.6 2.4 2.5

2.0

3.3 3.1 2.93.3

2.8

0.00

1.00

2.00

3.00

4.00

5.00

Poor Nearpoor

Average Better-off Rich

5 and older

under 5

Index of Disease Burden (Acute Diarrheal Illness)

All age groups

Factors influencing ADI

(under 5)

51%

34%27%

-14%-20%

-10%

0%

10%

20%

30%

40%

50%

60%

Usingsurface water

No toilet Mother notfinishedprimary

Quintile

33%

23% 24%

44%

0%

10%

20%

30%

40%

50%

Usingsurface water

No toilet Unfinisedprimary

Ethinicminority

Factors influencing ADI

(5 or older)

Factors influencing ADI (all population)

15%

36%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Pollution source close todug well*

No toilet

* Only for people using dug well

Factors influencing # of disease days of ADI (all ages)

0.330.35

-0.12

-0.20

-0.10

0.00

0.10

0.20

0.30

0.40

No toilet Ethnic minority Quintile

27.1% 26.1%23.2%

20.3%

13.1%

0%

5%

10%

15%

20%

25%

30%

Poor Near poor Average Better-off Rich

Population by quintile have

using dug well close to pollution

source

Population using surface water by quintile

17.2%

10.4%9.0%

6.7%

3.1%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Poor Near poor Average Better-off Rich

Population by quintile using dug well with nearby pollution source

27.1% 26.1%

23.2%

20.3%

13.1%

0%

5%

10%

15%

20%

25%

30%

Poor Near poor Average Better-off Rich

Population with no toilet by quintile

36.0%

15.9%

10.3%

5.3%

1.4%0%

5%

10%

15%

20%

25%

30%

35%

40%

Poor Near poor Average Better-off Rich

% population using river, lake, spring,

pond as water supply

% population with pollution

source near drinking water source (i.e. dug well)

% population with no toilet

Proportion of population using dug well water

Proportion of population

with pollutionsource near water source

(% of population with dug

well)

Proportion of population using rain water for drinking by quintile

0%2%4%6%8%

10%12%14%16%18%20%22%

Poor NearPoor

Average Better-off

Rich

WholepopulationRural

Urban

Proportion of population that always boil their drinking water

Treatment of Drinking Water

Proportion of population that rarely or never

boil their drinking

water

Population always boiling drinking water (quintile)

62.9%

75.1%79.1%

83.3%87.3%

0%

20%

40%

60%

80%

100%

Poor Near poor Average Better-off Rich

Population using treated water by quintile*

13.2%

22.6%

26.0%28.1%

26.9%

0%

5%

10%

15%

20%

25%

30%

Poor Near poor Average Better-off Rich

Conclusions

• Impressive gains in WSS coverage rates• Poverty associated with significantly higher ADI in children but not in adults• Surface water, polluted dug wells and lack of toilet facilities are causing higher

ADI rates• Lack of toilet is also associated with longer duration of ADI• We do not find any difference in ADI for tap water, clean dug wells, drilled wells,

rain water, or piped spring water• We do not find any higher ADI for simple toilet compared to other types of toilets• Education is associated with lower ADI, suggesting the importance of hygiene

promotion in reducing ADI• The poor have much lower coverage rates of safe water supply and toilet facilities• Lack of safe water is partiularly prevalent in some of the northern, central

highlands, and MRD areas• Lack of toilet facilities is prevalent in northern mountainous and central parts of

Vietnam• It should be noted that the study only assessed infectious disease (ADI) in relation

to water supply, and not other types of water pollution health risks.

Recommendations

• Priority should be given to providing WSS to those without any services.

• Second priority must be to address dug well pollution. This requires further understanding of cost-effective sollutions

• It seems less important to focus on upgrading of services for those already with basic coverage (other than polluted dug wells).

• Additional health benefits could be gained by targeting poor households because of their higher ADI rates

• Hygiene promotion should be an integral part of WSS provision

• The study has identified provinces of particular priority for WSS programs

END