Public Health Institute, Oakland, California, United States of America.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2018 Nov 16;13(11):e0207339. doi: 10.1371/journal.pone.0207339. eCollection 2018.
Low levels of household access to basic environmental health assets (EHAs)-including technologies such as clean cookstoves and bed nets or infrastructure such as piped water and electricity-in low- and middle-income countries (LMICs) are known to contribute significantly to the global burden of disease. This low access persists despite decades of promotion of many low-cost, life-saving technologies, and is particularly pronounced among poor households. This study aims to characterize variation in access to EHAs among LMIC households as a function of wealth, as defined by ownership of various assets.
Demographic and Health Survey (DHS) data from 41 low- and middle-income countries were used to assess household-level access to the following EHAs: 1) improved water supply; 2) piped water supply; 3) improved sanitation; 4) modern cooking fuels; 5) electricity; and 6) bed nets. For comparison, we included access to mobile phones, which is considered a highly successful technology in terms of its penetration into poor households within LMICs. Ownership levels were compared across country-specific wealth quintiles constructed from household assets using bivariate analysis and multivariable linear regression models.
Access to EHAs was low among the households in the bottom three quintiles of wealth. Access to piped water, modern cooking fuels, electricity and improved sanitation, for example, were all below 50% for households in the bottom three wealth quintiles. Access to certain EHAs such as improved water supply and bed nets increased only slowly with concomitant increases in wealth, while gaps in access to other EHAs varied to a greater degree by wealth quintile. For example, disparities in access between the richest and poorest quintiles were greatest for electricity and improved sanitation. Rural households in all wealth quintiles had much lower levels of access to EHAs, except for bed nets, relative to urban households.
The findings of this study provide a basis for understanding how EHAs are distributed among poor households in LMICs, elucidate where inequalities in access are particularly pronounced, and point to a need for strategies that better reach the poor, if the global environmental burden of disease is to be reduced.
在低收入和中等收入国家（LMICs），家庭获得基本环境卫生资产（EHAs）的水平较低，包括清洁炉灶和蚊帐等技术，以及管道水和电等基础设施，这被认为是导致全球疾病负担的重要因素。尽管几十年来一直在推广许多低成本、救生技术，但这种低水平的获得情况仍然存在，特别是在贫困家庭中更为明显。本研究旨在根据拥有各种资产的情况（定义为财富），描述 LMIC 家庭获得 EHAs 的情况。
使用来自 41 个低收入和中等收入国家的人口与健康调查（DHS）数据，评估家庭获得以下 EHAs 的情况：1）改善供水；2）管道供水；3）改善卫生；4）现代烹饪燃料；5）电；6）蚊帐。为了比较，我们还包括了移动电话的普及情况，因为移动电话在 LMIC 贫困家庭中的普及程度被认为是一项非常成功的技术。使用二元分析和多变量线性回归模型，比较了各国根据家庭资产构建的特定财富五分位数的所有权水平。
处于财富五分位中后三位的家庭获得 EHAs 的机会较低。例如，在财富五分位中后三位的家庭中，获得管道水、现代烹饪燃料、电和改善卫生设施的比例均低于 50%。获得某些 EHAs（如改善供水和蚊帐）的比例随着财富的增加而缓慢增加，而获得其他 EHAs 的比例则因财富五分位的不同而有较大差异。例如，在最富有和最贫穷的五分位之间，在获得电和改善卫生设施方面的差距最大。除了蚊帐之外，所有财富五分位的农村家庭获得 EHAs 的水平都明显低于城市家庭。
本研究的结果为了解 LMIC 中贫困家庭获得 EHAs 的情况提供了基础，阐明了在获得方面不平等现象特别明显的地方，并指出需要采取更好地惠及贫困人口的战略，如果要减少全球环境疾病负担的话。
