AFGANİSTAN’DA SU VE SANİTASYONUN BEŞ YAŞ ALTINDAKİ ÇOCUK ÖLÜMLERİ ÜZERİNDEKİ NEDENSEL ETKİSİ

Abstract

Afgan çocukları, hanelerin sağlığa uygun içme suyuna ve güvenli sanitasyona erişimi olmaması nedeniyle erken çocukluk döneminde ölmektedir. Bu çalışma, güvenli olmayan içme suyunun ve yetersiz sanitasyonun Afganistan'daki 5 yaş altı ölümler üzerindeki etkisini incelemek için deneysel kanıtlar sunmaktadır. Beş yaş altı çocuklarda hanenin sanitasyon ortamı ve içme suyu kaynakları arasındaki ilişkiyi test etmek için beş yaşın altındaki çocuklar “yenidoğan”, “bebek” ve “beş yaş altı” olarak sınıflandırıldı. Afganistan'da beş yaş altı çocuk ölüm hızı ile su ve sanitasyon etkisini ortaya çıkarabilmek için binary lojistik regresyon ve marjinal etki kullanıldı. Bulgularda, güvenli olmayan içme suyu ve yetersiz sanitasyon gibi iyileştirilmemiş ortamlarda doğan çocukların ölme olasılığının bebeklik döneminde daha yüksek olduğu ortaya koyulmuştur. Beş yaş altı çocuk ölüm hızı için Afganistan'daki yetersiz sanitasyon tesislerinin riski, güvenli olmayan su tedariğinden daha anlamlıdır. Sonuçta, kirli bir çevre Afganistan'da beş yaş altı çocuk ölüm hızını istatistiksel olarak artırmaktadır. Bulgulara göre suyun ve yetersiz sanitasyonun beş yaş altındaki çocuklar üzerindeki etkisini azaltmak için hükümetin güvenli bir su temini sağlaması, hanehalkı bireylerin sanitasyon hakkında farkındalığının artırılması, kırsal alanlarda kamu sağlık hizmetlerinin kalitesini artırması önerilmelidir.

Keywords

• Yenidoğan
• bebek
• 5 yaş altı çocuk ölümü
• sanitasyon
• su

THE CAUSAL EFFECT OF WATER AND SANITATION ON CHILDREN UNDER FIVE-YEAR MORTALITY IN AFGHANISTAN

Abstract

Due to the inaccessibility of households to improved drinking water and safe sanitation, Afghan children die at the early age of childhood. This study provides empirical evidence to examine the causal effect of unsafe drinking water and poor sanitation on children under 5-year mortality in Afghanistan. To testify the relationship between household’s sanitation environment and drinking water sources on children under five-year mortality, the children under five-year categorized into the neonatal, infant, and under five-year ages. The binary logistic regression and marginal effect model have been used to discover the impact of water and sanitation on children under-five year mortality. The result revealed that children born in unimproved environments such as unclean drinking water sources and poor sanitation facilities are more likely to die in infancy age. The risk of poor sanitation facilities is significantly higher than unsafe water supply on child mortality at the age of less than 5. In conclusion, an unprotected environment is statistically more likely to increase the risk of children under five-year mortality in Afghanistan. The result recommended to the government to provide a safe water supply, increase the awareness of household members about sanitation, and improve the quality of public healthcare services to decrease the casual effect of water and poor sanitation on children under five-year mortalities.

Keywords

• Neonatal mortality
• infant mortality
• children under 5-year mortality
• sanitation
• water

References

1. 1- UNICEF, WHO, World Bank, UN. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2019[cited 2019 Aug 25]. Available from: https://www.unicef.org/media/60561/file/UN-IGME-child-mortality-report-2019.pdf.
2. 2- UN. World Mortality[Internet]. New York: United Nations;2017[cited 2019 Aug 30]. Available from: https://www.un.org/en/development/desa/population/publications/pdf/mortality/World-Mortality-2017-Data-Booklet.pdf.
3. 3- UN. Sustainable Development Goals[internet]. New York : United Nations;2015 [cited 2019 Sep 15]. Available from: https://www.un.org/sustainabledevelopment/health/.
4. 4- World Bank. Mortality rate, infant, male [per 1,000 live births] –Afghanistan[internet]. Washington: world bank;2018[cited 2019 Sep 15]. Available from: https://data.worldbank.org/indicator/SP.DYN.IMRT.MA.IN?locations=AF.
5. 5- Ministry of Public Health.National Health Strategy of Afghanistan 2016‒2020[internet]. Kabul: Ministry of Public Health of Afghanistan; 2016[cited 2019 Sep 29]. Available from: http://www.nationalplanningcycles.org/sites/default/files/planning_cycle_repository/afghanistan/afghanistan_mophstrategy2016-2020_final09september2016111201614508950553325325.pdf.
6. 6- CIA.The World Factbook Afghanistan[internet]. Washington DC: Central Intelligence Agency; 2019 [cited Dec 14 2019]. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/af.html#field-anchor-people-and-society-current-healthexpenditure.
7. 7- Curtis V, Cairncross S.Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003; 3[5]:275-81. Available from: https://doi.org/10.1016/S1473 3099[03]00606-6.
8. 8- WHO. Country Cooperation Strategy at a galance- Afghanistan[internet]. Geneva: World Health Organization;2018[cited 2019 Oct 10]. Available from: https://apps.who.int/iris/bitstream/handle/10665/136852/ccsbrief_afg_en.pdf?sequence=1.

9. 9- UNICEF, WHO. Progress on Drinking Water, Sanitation and Hygiene Update and SDG Baselines[internet]. New York: United Nations International Children's Emergency Fund;2017[cited 2019 Oct 20]. Available from: https://www.unicef.org/publications/index_96611.html.
10. 10- UNICEF. WASH: Water, sanitation and hygiene[internet]. New York: United Nations International Children's Emergency Fund; 2018[cited 2019 Oct 25]. Available from: https://www.unicef.org/afghanistan/washwater-sanitation-and-hygiene.
11. 11- WHO,UNICEF.Progress on Drinking Water, Sanitation and Hygiene: Special Focus on Equality[internet]. Geneva: world health organization;2017[cited 2019 Oct 10]. Available from:https://www.unicef.org/media/55276/file/Progress%20on%20drinking%20water,%20sanitation%20and%20hygiene%202019%20.pdf.
12. 12- WHO, UNICEF, Progress on Sanitation and Drinking Water: Update and MDG Assessment[internet]. Geneva: world Health Organization;2015[cited 2019 Oct 26]. Available from: https://www.unicef.org/publications/index_82419.html.
13. 13-UN. Water, sanitation, hygiene and health:A PRIMER FOR HEALTH PROFESSIONALS[internet]. New York: United Nation;2019[cited 2019 Dec 10]. Available from: https://apps.who.int/iris/bitstream/handle /10665/330100/WHO-CED-PHE-WSH-19.149-eng.pdf?ua=1.
14. 14- Ezeh O,Agho K,Dibley M,Hall J,Page A.The Impact of Water and Sanitation on Childhood Mortality in Nigeria: Evidence from Demographic and Health Surveys, 2003–2013. Int J Environ Res Public Health. 2014;11[9]:9256-72. Available from:https://doi.org/10.3390/ijerph110909256
15. 15- Sanusi Y. Water, sanitation and human development in urban fringe settlements in Nigeria. Theor Empir Res Urban Manag. 2010 [cited 2019 Nov 15];8[17]:14-29. Available from: https://www.researchgate.net/publication/227490445_Water_sanitation_and_human_development_in_urban_fringe_settlements_in_Nigeria
16. 16- Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis C, CH Fung I, et al. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiology. 2010;39[1]:i193–i205. Available from: https://doi.org/10.1093/ije/dyq035
17. 17- Geruso M, Spears D. Neighborhood Sanitation and Infant Mortality. American Economic Journal: Applied Economics. 2018; 10[2]:125–62. Available from: https://doi.org/10.1257/app.20150431
18. 18- Bhalotra S, Valente C, Soest A.The puzzle of Muslim advantage in child survival in India. Journal of Health Economics.2014;29[2]:191-204. Available from: https://doi.org/10.1016/j.jhealeco.2009.11.002
19. 19- Hammer J, Spears D. Village sanitation and child health: Effects and external validity in a randomized field experiment in rural India. J Health Econ. 2016;48:135-48. Available from: https://doi.org/10.1016/j.jhealeco.2016.03.003
20. 20- Lin A,Arnold B, Afreen S,Goto R, Nurul Huda TM, Haque R, et al. Household Environmental Conditions Are Associated with Enteropathy and Impaired Growth in Rural Bangladesh. Am J Trop Med. 2013;89[1]:130-7. Available from: https://doi.org/10.4269/ajtmh.12-0629
21. 21- Coffey D, Geruso D, Spears D. Sanitation, disease externalities and anaemia: evidence from Nepal. TheEconomicJournal. 2017[cited 2019 Dec 6]; 128[3]:1395-1432. Available from: https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/ecoj.12491
22. 22- Spears D, Lamba S. Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from India’s Total Sanitation Campaign. Journal of Human Resources, University of Wisconsin Press. 2016[cited 2019 Sep 27];51:298-327. Available from: http://jhr.uwpress.org/content/51/2/298
23. 23- Novotný J, Ficek F, K.W.Hill J, Kumar A. Social determinants of environmental health: A case of sanitation in rural Jharkhand. Sci Total Environ. 2018; 643(1):762-74. Available from: https://doi.org/10.1016/j.scitotenv.2018.06.239
24. 24- Kibria GMA, Burrowes V, Choudhury A, Sharmeen A, Ghosh S, Mahmud A, et al. Determinants of early neonatal mortality in Afghanistan: an analysis of the Demographic and Health Survey 2015. Globalization and Health. 2018;14. Available from: https://doi.org/10.1186/s12992-018-0363-8
25. 25- Hala AB. The effect of water and sanitation on child mortality in Egypt. Göteborg University[internet].2003[cited november 15 2019;112:29. Available from: http://hdl.handle. net/2077/2828.
26. 26- Gebremariam W. The Effects Of Water Supply And Sanitation On Childhood Mortality In Urban Eritrea. Cambridge University Press. 2000;32[2]: 207-27. Available from: https://doi.org/10.1017/S0021932000002078.
27. 27- Rabindran SG, Khanb S,Timmins C. The impact of piped water provision on infant mortality in Brazil: A quantile panel data approach. Journal of Development Economics. 2010[cited 2019 Dec 5];92[2]:188-200. Available from:https://www.nber.org/papers/w14365
28. 28- K'Akumu OA. Water, sanitation conditions and implications for child survival in Kenya: a review of statistical evidence from the 1999 census of population. Water Practice and Technology. 2016;11[1]:48-57. Available from:https://doi.org/10.2166/wpt.2016.007
29. 29-USAID, CSO, MoPH, DHS. Afghanistan 2015 Demographic and Health Survey Key Findings[internet]. Kabul: Central Statistics Organization [COS];2017[cited 2019 Nov 27]. Available from:https://dhsprogram.com/pubs/pdf/SR236/SR236.pdf.
30. 30-USAID, CSO, MoPH, DHS. Afghanistan 2015 demographic and health survey[Internet]. Kabul: Central Statistics Organization [COS];2017[cited 2019 Nov 28]. Available from: https://www.nsia.gov.af: 8080/wp-content/uploads/2019/04/AFDHS_2015.pdf.
31. 31- D. Semba R, De Pee S, Sun K, M. Best C, Sari M ,W. Bloem M. Paternal Smoking and Increased Risk of Infant and Under-5 Child Mortality in Indonesia. Am J Public Health[internet].2008[cited 2019 Nov 29]; 98(10):1824-6. Available from:https://ajph.aphapublications.org/doi/10.2105/AJPH.2007.119289
32. 32- Ridder G, Tunali I. Stratified partial likelihood estimation. Journal of Econometrics.1999;92[2]:193-232. Availeble from:https://doi.org/10.1016/S0304-4076[98]00090-6.
33. 33- Fink G, Günther I, Hill K. The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Inter J Epidemiology.2011;40[5]:1196-204. Available from: https://doi.org/10.1093/ije/dyr102.
34. 34- Finlay JE, Özaltin E, Canning D. The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries. BMJ Open. 2011;1[2]:1-24. Available from:http://dx.doi.org/10.1136/bmjopen-2011-000226.