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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    • "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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    • "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.
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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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