When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana

Department of Geography, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
Health & Place (Impact Factor: 2.81). 03/2012; 18(2):250-62. DOI: 10.1016/j.healthplace.2011.09.020
Source: PubMed


Intraurban differentials in safe drinking water in developing cities have been exacerbated by rapid population growth that exceeds expansion of local water infrastructure. In Accra, Ghana, municipal water is rationed to meet demand, and the gap in water services is increasingly being filled by private water vendors selling packaged "sachet" water. Sachets extend drinking water coverage deeper into low-income areas and alleviate the need for safe water storage, potentially introducing a health benefit over stored tap water. We explore correlates of using sachets as the primary drinking water source for 2093 women in 37 census areas classified as slums by UN-Habitat, and links between sachet water and reported diarrhea episodes in a subset of 810 children under five. We find that neighborhood rationing exerts a strong effect on a household's likelihood of buying sachet water, and that sachet customers tend to be the poorest of the poor. Sachet use is also associated with higher levels of self-reported overall health in women, and lower likelihood of diarrhea in children. We conclude with implications for sachet regulation in Accra and other sub-Saharan cities facing drinking water shortages.

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Available from: Allan G Hill, Oct 07, 2015
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    • "A consequence of urban complexity is that traditional individual-level risk factors for child mortality can become complicated by overwhelming environmental burdens of living conditions such as lack of sanitation and poor air quality (Boadi and Kuitunen 2006; Cameron and Williams 2009). This can also work in the positive direction with environmental characteristics, such as improved access to nutrition, medical care, or pure drinking water in the form of sachets that shield children from higher-than-expected mortality (Stoler et al. 2012b). The impact of these urban interactions may create a dissonance between the risk profile of an individual and observed health outcomes among local residents. "
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    ABSTRACT: Recent studies indicate that the traditional rural-urban dichotomy pointing to cities as places of better health in the developing world can be complicated by poverty differentials. Knowledge of spatial patterns is essential to understanding the processes that link individual demographic outcomes to characteristics of a place. A significant limitation, however, is the lack of spatial data and methods that offer flexibility in data inputs. This paper tackles some of the issues in calculating intra-urban child mortality by combining multiple data sets in Accra, Ghana and applying a new method developed by Rajaratnam et al. (2010) that efficiently uses summary birth histories for creating local-level measures of under-five child mortality (5q0). Intra-urban 5q0 rates are then compared with characteristics of the environment that may be linked to child mortality. Rates of child mortality are calculated for 16 urban zones within Accra for birth cohorts from 1987 to 2006. Estimates are compared to calculated 5q0 rates from full birth histories. 5q0 estimates are then related to zone measures of slum characteristics, housing quality, health facilities, and vegetation using a simple trendline R(2) analysis. Results suggest the potential value of the Rajaratnam et al. method at the micro-spatial scale. Estimated rates indicate that there is variability in child mortality between zones, with a spread of up to 50 deaths per 1,000 births. Furthermore, there is evidence that child mortality is connected to environmental factors such as housing quality, slum-like conditions, and neighborhood levels of vegetation.
    Demographic Research 01/2013; 28:33-62. DOI:10.4054/DemRes.2013.28.2 · 1.20 Impact Factor
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    • "The plastic waste menace, dubious sachet quality control, and social justice concerns over water as a human right spur talks of a ban on the plastic sleeves – or on plastic bags altogether – which has precedent in sub-Saharan Africa (Simpson 2007). At the same time the urban poor may reap an unintended health advantage as sachets replace the consumption stored water that is often cross-contaminated in the home (Stoler et al. 2012), while in Ghana's rural north, the Upper West Regional Iodated Salt Committee recently appealed to sachet producers to add iodine to sachet water to combat low iodated salt consumption. As the future of sachet water continues to be tugged in multiple directions, the appeal of sachet water continues to spread throughout West Africa. "
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    ABSTRACT: Population growth in West Africa has outpaced local efforts to expand potable water services, and private sector sale of packaged drinking water has filled an important gap in household water security. Consumption of drinking water packaged in plastic sachets has soared in West Africa over the last decade, but the long-term implications of these changing consumption patterns remain unclear and unstudied. This paper reviews recent shifts in drinking water, drawing upon data from the 2003 and 2008 Demographic and Health Surveys, and provides an overview of the history, economics, quality, and regulation of sachet water in Ghana's Accra-Tema Metropolitan Area. Given the pros and cons of sachet water, we suggest that a more holistic understanding of the drinking water landscape is necessary for municipal planning and sustainable drinking water provision.
    Journal of Water, Sanitation and Hygiene for Development 12/2012; 2(4). DOI:10.2166/washdev.2012.104 · 0.44 Impact Factor
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    • "The sachet water quality literature is generally littered with poor study designs and tiny sample sizes, and a recent review of this literature reveals occasional bacteriological quality concerns (Stoler et al. 2012b), as previously observed in bottled water (Ehlers et al. 2004; Kassenga 2007). In urban regions with public water infrastructure such as Accra, municipally treated water is often re-treated during the sachet filling process, and the resulting product quality is often quite high and may even be good for your health if consumed in lieu of poorly stored water (Stoler et al. 2012a). In rural areas, sachets of dubious quality may be filled from unprotected boreholes or even river water. "
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    ABSTRACT: The advent and rapid spread of sachet drinking water in West Africa presents a new challenge for providing sustainable access to global safe water. Sachet water has expanded drinking water access and is often of sufficient quality to serve as an improved water source for Millennium Development Goals (MDG) monitoring purposes, yet sachets are an unsustainable water delivery vehicle due to their overwhelming plastic waste burden. Monitoring of primary drinking water sources in West Africa generally ignores sachet water, despite its growing ubiquity. Sub-Saharan Africa as a region is unlikely to meet the MDG Target for drinking water provision, and post-2015 monitoring activities may depend upon rapid adaptability to local drinking water trends. La survenue et la propagation rapide de l’eau potable en sachet en Afrique de l’Ouest constituent un nouveau défi pour l’accès durable à l’eau potable mondialement. L’eau en sachet a augmenté l’accès à l’eau potable et est souvent d’une qualité suffisante pour servir de source d’eau améliorée pour les objectifs de surveillance des Objectifs du Millénaire pour le Développement (OMD). Mais les sachets sont un véhicule de livraison d’eau non durable en raison de leur charge écrasante en déchets plastiques. La surveillance des principales sources d’eau potable en Afrique de l’Ouest ignore généralement l’eau en sachet malgré son omniprésence croissante. L’Afrique subsaharienne en tant que région est peu probable d’atteindre les cibles des OMD pour l’approvisionnement en eau potable et les activités de suivi après 2015 pourraient dépendre de la capacité d’adaptation rapide aux tendances locales pour l’eau potable. La aparición y rápida expansión del agua potable envasada en bolsas en África Occidental presenta un nuevo reto en la provisión de un acceso sostenible y global a agua segura. El agua en bolsa ha expandido el acceso a agua potable y es a menudo de suficiente calidad para servir como una fuente mejorada de agua para los propósitos de monitorización de los Objetivos de Desarrollo del Milenio (ODM). Y sin embargo las bolsas son un vehículo insostenible de agua potable debido a la inmensa carga de desechos de plástico que representan. La monitorización de fuentes primarias de agua potable en África Occidental generalmente ignoran el agua en bolsas, a pesar su creciente ubicuidad. Es improbable que la región del África subsahariana cumpla los ODM de abastecimiento de agua potable, y las actividades de monitorización posteriores al 2015 podrían depender de una adaptación rápida a las tendencias locales en agua potable.
    Tropical Medicine & International Health 10/2012; 17(12). DOI:10.1111/j.1365-3156.2012.03099.x · 2.33 Impact Factor
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