@article{a394c7868f9e4ec29a05825bd44ae7bd,
title = "When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana",
abstract = "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.",
keywords = "Diarrhea, Drinking water, Poverty, Sachets, Sub-Saharan Africa",
author = "Justin Stoler and G{\"u}nther Fink and Weeks, {John R.} and Otoo, {Richard Appiah} and Ampofo, {Joseph A.} and Hill, {Allan G.}",
note = "Funding Information: This research was funded in part by Grant number R01 HD054906 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (“Health, Poverty and Place in Accra, Ghana,” John R. Weeks, Project Director/Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. Additional funding was provided by Hewlett/PRB (“Reproductive and Overall Health Outcomes and Their Economic Consequences for Households in Accra, Ghana,” Allan G. Hill, Project Director/Principal Investigator). We also acknowledge the assistance from Matthias Schuendeln at Harvard University, as well as the generous support received during all phases of this study from the Institute for Statistical, Social and Economic Research (ISSER – Director – Ernest Aryeetey), the School of Public Health (Richard Adanu) and the Medical School (Rudolph Darko and Richard Biritwum), University of Ghana. We are grateful to Anthony Y. Karikari, William Arko, Mohammed Bello, and Lady Asantewa at CSIR-WRI for their field assistance; David Nunoo for additional GIS processing; Susan Murcott for sharing her experience with water quality testing in Tamale; and Livia Montana for supervision of the HAWS project and logistical assistance during the field work for this study. The authors thank two anonymous reviewers for comments that helped improve this paper.",
year = "2012",
month = mar,
doi = "10.1016/j.healthplace.2011.09.020",
language = "English (US)",
volume = "18",
pages = "250--262",
journal = "Health and Place",
issn = "1353-8292",
publisher = "Elsevier Limited",
number = "2",
}
