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The Africa Infrastructure Country Diagnostic (AICD) has produced continent-wide analysis of many aspects of Africa's infrastructure challenge. The main findings were synthesized in a flagship report titled Africa's Infrastructure: a time for transformation, published in November 2009. Meant for policy makers, that report necessarily focused on the high-level conclusions. It attracted widespread media coverage feeding directly into discussions at the 2009 African Union Commission Heads of State Summit on Infrastructure. Although the flagship report served a valuable role in highlighting the main findings of the project, it could not do full justice to the richness of the data collected and technical analysis undertaken. There was clearly a need to make this more detailed material available to a wider audience of infrastructure practitioners. Hence the idea of producing four technical monographs, such as this one, to provide detailed results on each of the major infrastructure sectors, information and communication technologies (ICT), power, transport, and water, as companions to the flagship report. These technical volumes are intended as reference books on each of the infrastructure sectors. They cover all aspects of the AICD project relevant to each sector, including sector performance, gaps in financing and efficiency, and estimates of the need for additional spending on investment, operations, and maintenance. Each volume also comes with a detailed data appendix, providing easy access to all the relevant infrastructure indicators at the country level, which is a resource in and of itself.

Shared sanitation facilities are critical for universal access to sanitation. This exploratory study examines the role that free shared sanitation facilities play in equalizing sanitation access in peri-urban India, where, despite extensive state-led efforts towards universal access, household toilets remain infeasible for the country’s poorest citizens. We conducted one-on-one semi-structured interviews with 39 shared sanitation facility users in two peri-urban communities in Jharkhand, India. Participants were recruited after they used the sanitation facility. Data were analyzed using both deductive and inductive coding and thematic analysis. We found that clean and safe community sanitation facilities were used by people when at home, and were used both by those with and without a home toilet. We also found (consistent with previous work) that when people were outside of the home for work, school, and errands, they often needed but did not have access to usable toilets. These findings suggest why, and under what conditions, shared sanitation facilities are essential to realizing the human right to sanitation. Shared facilities are complements to, and not substitutes for, household facilities. Global sanitation targets, therefore, should be modified to reflect the role of well-maintained shared sanitation in meeting the goal of universal access.

Background Malaria remains a major public health challenge in sub-Saharan Africa, and its burden may be influenced by access to clean water, sanitation, and childhood vitamin A supplementation. Understanding how these indicators relate to malaria incidence can help inform targeted prevention strategies. Methods Country-level data from global health databases were analyzed using nonparametric statistical tests and machine learning models. The Kruskal–Wallis test and Dunn’s post hoc comparisons were used to assess differences in malaria incidence across categories of water and sanitation access. Cliff’s delta was used to measure effect sizes. Tree-based machine learning models and logistic regression were trained to evaluate the predictive strength of the three indicators. Results Significant differences in malaria incidence were found across water and sanitation access groups, with the lowest access groups consistently exhibiting the highest incidence. Cliff’s delta indicated large effect sizes, particularly between low and high access categories. Vitamin A supplementation showed statistically significant group differences, though effect sizes were generally small. Tree-based machine learning models showed moderate predictive performance and outperformed logistic regression in classification accuracy and recall. Conclusions Access to clean water and adequate sanitation are strongly associated with lower malaria incidence, underscoring their importance in malaria control efforts. While vitamin A supplementation shows weaker associations, it may still interact with broader health conditions. These findings highlight the essential role of basic infrastructure in reducing malaria burden and demonstrate the potential of predictive modeling to support future global health research.

Water and sanitation affordability has drawn researchers’ attention over the past years due to the recent economic crisis and the growing role of tariffs on funding services. This paper conducted a systematic review of previous research on water and/or sanitation affordability and a critical qualitative discussion on the methodologies adopted. The research framework relied on a hybrid approach that combines systematic quantitative and narrative analyses. The literature review protocol applied returned 79 relevant studies published by journals and recognized international organizations and four key topics, namely affordability indicators, threshold, data source, and practical use of the analysis were identified and critically discussed. This paper contributes to the literature by presenting and discussing the most important water affordability issues and enlightening the potential role of the analysis in public financial policies.

IntroductionExtensive research on human and economic development in the Least Developed Countries (LDC) signaled concerns about the critical barriers that impede sustainable growth in these nations. This study examines the dynamic relationship between the two indices of human development (Human Development Index and Human Assets Index) and the capacity of 22 LDCs, between 2003 and 2019, to attract FDI, the degree of urbanization, water and sanitation access, as well as fertility rate.MethodsThe methodological construct is based on panel VAR and Granger causality methods. By considering all variables endogenous and interdependent, a cross-sectional dimension is introduced. The lag length was found using the Akaike Information Criterion (AIC), the Bayesian Information Criterion (BIC), and the Hannan-Quinn Information Criterion (HQIC). To analyse the changing relationship between variables, we used the 7-variable panel VAR for impulse response function analysis.Results and discussionThe results show a strong cause-and-effect link between urbanization, access to sanitation, and human development. Subsidiary, human development, and water access affect the level of foreign investments. The findings have practical implications for LDC governments by revealing a possible pathway for the sustainable development of the region. The provision of water access and sanitation infrastructure are investments that positively affect economic growth and human development. The paper emphasized the importance of equal and non-discriminatory access to water and sanitation services, an objective otherwise configured in SDG 6 “Clean water and sanitation”. Countries’ higher levels of human development are linked to more people living in cities, as they lead to more social and economic progress. Research examining how investments, access to water and sanitation, and birth rates affect human development supports this. The mechanisms of such interaction reside in higher income levels in urban areas, employment opportunities, and increased access to educational and health services.

Evidence on the performance of market-based sanitation (MBS) interventions is needed to support renewed focus on using them to deliver sanitation services at scale. We conducted a comprehensive review of WASH grantfunding since 1980 to identify household sanitation supply projects using an MBS approach, assessed project characteristics and outcomes (population impacted), and reviewed project strategies against three key factors for scaling MBS (customer and business finance; availability and viability of local entrepreneurs; appropriate toilet product and business models). For a subset with higher outcomes, we assessed project strategies more fully against nine MBS strategies considered good practice, and the programme’s ability to leverage household investment. Of 103 sanitation supply projects in eight global databases, 49 qualified as MBS and occurred in 22 countries across sub-Saharan Africa, South/Southeast Asia, and Latin America. Cumulatively, 27.6 million people, nearly all rural, gained access to basic sanitation via markets across these projects. ‘Large-scale’ MBS projects exceeding 50,000 people gaining basic sanitation (n = 27) compared with those that did not (n = 22) were longer and significantly more likely to address all three key factors (74 per cent vs. 41 per cent; p = 0.019), but on average applied only six of nine good practice strategies. Outcomes and programme leverage were higher in South/Southeast Asia than in sub-Saharan Africa. However, African projects tended to have shorter duration, fewer reached ‘large-scale’, and rarely employed a sales and marketing strategy. We discuss implications for improving the design and performance of MBS interventions globally and particularly in sub-Saharan Africa.

Access to sanitation is a fundamental human right essential for health and dignity, yet inadequate access remains a significant challenge globally. This has a significant negative impact on vulnerable populations, especially older adults. This study assesses the spatial distribution and socioeconomic determinants of access to sanitation among older adults in Ghana. We used data from the 2021 Population and Housing Census and employed the Moran’s I, Hotspot, and Cluster and Outlier analytic tools to assess the spatial distribution of access to sanitation. Logistic regression models were used to determine the factors influencing access to sanitation. Findings indicated regional and district-level disparities in sanitation access among older adults in Ghana. Individual-level factors such as sex, age, marital status, education, rural residence, religion, ownership of household assets, and disabilities significantly influence sanitation access. Specifically, the adjusted logistic regression results indicated that females had higher odds of sanitation access than males (AOR: 1.054, CI 1.023, 1.087, p-value < 0.001). while those in the ‘‘80 + ’’ age group had higher odds of sanitation access compared to those in the ‘‘60–69’’ age group (AOR: 1.171, CI 1.129, 1.214, p-value < 0.001). In addition, separated/divorced (AOR: 1.374, CI 1.263, 1.494], p-value < 0.001), widowed (AOR: 1.143, CI 1.059, 1.234, p-value < 0.001) and never-married (AOR: 1.208, CI 1.077, 1.354, p-value < 0.001) individuals were more likely to have sanitation access compared to those living informally/living together. Also, those attending or attended school in the past (AOR: 2.749, CI 2.662, 2.838, p-value < 0.001) had significantly higher odds of sanitation access than those who never attended. These data highlight the need for integrated approaches considering spatial variations and individual-level determinants to effectively address disparities in sanitation access.

Background Lack of access to adequate sanitation contributes to environmental pollution and diarrheal diseases. This study assessed household access to, and regular use of, improved latrines in Somaliland using Somaliland health and demographic survey (SLHDS) 2020 data. Methods The study analyzed secondary data from 2806 households selected through multi-stage sampling, covering urban, rural, and nomadic areas across six regions. Logistic regression models assessed factors influencing latrine utilization, such as gender of the household head, region, and wealth. Results Male-headed households had higher latrine utilization (AOR = 1.45, 95% CI [1.30, 1.60], p < 0.001). Households in Sanaag had greater odds of using latrines compared to Awdal (AOR = 1.72, 95% CI [1.50, 1.94], p < 0.001). Urban households had better access than rural (AOR = 2.34, 95% CI [2.10, 2.58], p < 0.001) and nomadic households (AOR = 3.56, 95% CI [3.10, 4.02], p < 0.001). Wealthier households were more likely to use improved sanitation facilities (AOR = 2.89, 95% CI [2.50, 3.28], p < 0.001). Conclusion The study identifies significant disparities in access to sanitation facilities, influenced by socioeconomic status and regional factors. These findings underscore the need for targeted interventions to improve sanitation access in underserved communities.

As of the year 2014, about 2.5 billion people globally lacked access to improved sanitation. The situation is even worse in the sub-Saharan African countries including Kenya. The practice of open defecation (OD) peaks beyond 72% of the population in Turkana County, Kenya, despite various interventions to end it. This article reports on both qualitative and quantitative aspects of a cross-sectional study. A partially mixed sequential dominant (quantitative) status was used to understand various socioeconomic factors associated with OD practice in Lodwar’s human settlements, Turkana County. Simple random sampling technique was chosen to select participants for this study with the sample drawn from various administrative units of Lodwar. Standardized questionnaires, focus group discussions, and key informant interviews were used to collect data. The quantitative findings revealed that culture was the leading factor as to why people practiced OD with a frequency of 44%. The findings further revealed that poverty was the major influencing factor for latrine ownership among the households (frequency 27%). Pearson χ2 tests revealed that there was a significant association between latrine presence and education level of the household head (χ2 = 107.317; P < .05), latrine sharing (χ2 = 403; P < .05), and occupation of the household head (χ2 = 74.51; P < .05). The quantitative findings showed that culture was by far the most common factor that contributed to the OD practice with a theme intensity of 31.1%. Further analyses identified 5 major cultural aspects that were associated with OD practice. This included sexual immorality, OD as a common habit, nomadic pastoralism, bride’s dignity and mixing of feces. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (theme intensity 31.3%) followed closely by nomadic pastoralism kind of life among the residents that limit latrine construction (theme intensity 28.1%). In addition to cultural aspects, high poverty levels influence latrine adoption and consequently OD practices. Future sanitation interventions addressing OD should assess and factor in these cultural aspects in such communities to come up with appropriate eradication measures which have otherwise been difficult to solve through poverty eradication and sanitation campaigns that have been in existence.

Poor latrine conditions, structure, and design may deter latrine use and provoke reversion to open defecation (OD). Statistics show that only 18% of the households in Turkana County, Kenya, have access to a latrine facility with most of these facilities in poor structural designs and poor hygienic conditions, which encourages rampant OD practices. This article reports on quantitative aspects of a larger cross-sectional survey to assess latrine structure, design, and conditions, and the practice of OD in Lodwar. An observational study was carried out to examine latrine conditions, structure, and design in Lodwar, Kenya. A standardized questionnaire was also used to collect quantitative data. Stratified random sampling technique was employed to select respondents for this study with the sample drawn from 4 administrative units of Lodwar town covering the low-, medium-, and high-income households. Data were managed using Statistical Packages for Social Science (SPSS) software. Nineteen percent of the sampled households did not possess a latrine facility at their homesteads with 73% of the latrines constructed using poor materials (mud, mats, polythene bags, and grass). Twenty percent of the respondents were scared of using a latrine with the main reason being loose soils that do not support strong constructions. Eighty-seven percent of the respondents agreed that the presence of feces on the latrine floor encouraged the practice of OD and 321 (80%) respondents stated that the latrine construction materials influenced latrine ownership and its subsequent use. Respondents attributed rampant OD practices to poor latrine structure, design, and conditions. In addition, rampant cases of latrine sharing result in latrine filthiness, which eventually encourages OD practice. Inequality in sanitation, among counties, should be addressed in Kenya. The government should take charge of provision of good-quality communal latrines to the less-privileged societies like Turkana. Community empowerment and introduction of a small fee for cleaning and maintenance of these facilities will also improve their conditions. Ending the practice of OD will lead to increased positive public health and environmental outcomes in the study area