Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa.

BACKGROUND: Diarrhoea remains the major cause of morbidity and mortality of children under five years in Africa. Several studies have shown that inadequate and unsafe water, lack of sanitation, and poor hygiene practices are complex issues for different pathogens and accountable for the occurrence of diarrhoea diseases. We assessed the combined effect of household's source of drinking water and type of toilet facility and residential wellbeing on the incidence of childhood diarrhoea in 33 Sub-Saharan Africa countries while accounting for relevant compositional and contextual factors. METHODS: The 2010-2019 datasets from the Demographic and Health Surveys were drawn for analyses. The outcome variable used in this study was the incidence of childhood diarrhoea. Three negative log-log generalized linear regression models were then sequentially fitted to the data to examine the joint effect of household water and sanitation practices on child diarrhoea. The results were presented using crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence intervals (CIs). Using ArcGIS software, maps were design to unveil the spatial distribution of key variables. FINDINGS: Approximately 16% of the 307,741 mothers interviewed reported an incidence of diarrhoea disease among children under-five years in their households. The results showed that a household depending on an unimproved source of drinking water and with an unimproved type of toilet facility was not significantly associated with childhood diarrhoea. However, those with improved drinking water but an unimproved type of toilet facility had higher odds of reporting childhood diarrhoea (AOR = 1.020, 95% CI = 1.003-1-036) compared to those in households with both improved source of drinking water and type of toilet facility. Across the geographical regions, Eastern (aOR = 1.102, 95% CI = 1.084-1.120) and Central Africa (aOR = 1.102, 95% CI = 1.083-1.121) were more likely to experience child diarrhoea. CONCLUSION: Water and sanitation practices such as the source of drinking water and toilet facility, and geographic region had significant effects on childhood diarrhoea in sub-Saharan Africax. The findings suggest the need for multi-sectoral actions that recognise the geo-spatial and temporal characteristics identified in the study through regional to national policies. Water and sanitation community-based interventions that seek to improve equitable access to safe water and sanitation in the sub-region should be intensified.

Partner alcohol consumption and intimate partner violence against women in sexual unions in sub-Saharan Africa.

INTRODUCTION: Intimate partner violence is increasingly gaining attention as the leading form of violence against women globally, particularly sub-Saharan Africa. Given that substance abuse, especially alcohol consumption has long been associated with aggressive behaviour, emotional abuse, and sexual misconduct, it is surprising that studies on the potential association between partner's alcohol consumption and intimate partner violence are scarce. The current study seeks to fill this gap in the literature by examining the association between partner's alcohol consumption and intimate partner violence among women in sub-Saharan Africa. METHODS: Cross-sectional survey data of 89,229 women aged 15 to 49 in sexual unions from 21 sub-Saharan African countries were pooled from the Demographic and Health Surveys. Percentages with their corresponding confidence intervals (CIs) were used to present the results of the prevalence of partner's alcohol consumption and intimate partner violence. Multivariable binary logistic regression analysis was used to examine the association between partner's alcohol consumption and intimate partner violence. The regression analysis results were presented using adjusted odds ratio (aOR) with 95% CI. Statistical significance was set at p<0.05. RESULTS: The pooled prevalence of partner alcohol consumption was 36.3% [36.0-36.6]. The highest prevalence of partner alcohol consumption was found in Burundi (67.1%) with Mali (3.9%) recording the lowest prevalence. Similarly, the overall prevalence of physical violence, emotional violence, and sexual violence among the women were 19.7% [19.2-20.2], 25.0% [24.5-25.5], and 9.7% [9.3-10.1], respectively. In the pooled data, women whose partners consumed alcohol were more likely to experience physical violence [aOR = 2.37, 95% CI = 2.24-2.50], emotional violence [aOR = 1.96, 95% CI = 1.86-2.07], and sexual violence [aOR = 2.03, 95% CI = 1.89-2.18] compared to those whose partners did not consume alcohol. In all the 21 countries, women whose partners consumed alcohol had higher odds for physical and emotional violence. The odds of sexual violence was higher among women whose partners consumed alcohol compared to their counterparts whose partners did not in 20 countries, except Namibia. CONCLUSIONS: We found that partner's alcohol consumption increases women's likelihood of experiencing physical, emotional, and sexual violence in sub-Saharan Africa. There is the need to implement behavioural change interventions targeted at male partners to reduce alcohol consumption. The findings call for the need to effectively create and organize support networks in addressing intimate partner violence among married and cohabiting women.