Spatial heterogeneity of neighborhood-level water and sanitation access in informal urban settlements: A cross-sectional case study in Beira, Mozambique

Abstract

Rapid urbanization, resulting in population growth within informal settlements, has worsened exclusion and inequality in access to water and sanitation (WASH) services in the poorest and most marginalized communities. In this study, we describe the heterogeneity in water service satisfaction and WASH access in low-income, peri-urban neighborhoods of Beira, Mozambique, and examine whether this heterogeneity can be explained by distance to water distribution mains. Using spatial statistics and regression analyses, we identify spatial heterogeneity in household WASH access, as well as consumer-reported satisfaction with water services (services, pressure, quality, and sufficient quantity). We find that as distance from the water main increased, both access to an improved water source at the household and satisfaction with water pressure decreases, and water supply intermittency increases, controlling for household density and socioeconomic status. The odds of a household having access to a water source at the household or on the compound decreases with every 100-meter increase in distance from a water main pipe (odds ratio [OR] 0.87, 95% confidence interval [CI]: 0.82, 0.92). Satisfaction with water services also decreases with every 100-meter increase in distance from a water main pipe (OR: 0.80; 95% CI: 0.69, 0.94). Days of availability in the past week decreases by a factor of 0.22 for every 100-meter increase in distance from the water main (95% CI: -0.29, -0.15). Findings from this study highlight the unequal household access to water and sanitation in urban informal settlements, even within low-income neighborhoods. Describing this heterogeneity of access to water services, sanitation, and satisfaction-and the factors influencing them-can inform stakeholders and guide the development of infrastructural solutions to reduce water access inequities within urban settings.

Fig 1.. Map of the study site in Mozambique.

Base layer maps were obtained from https://www.africageoportal.com, which is powered by Esri (http://www.esri.com). https://doi.org/10.1371/journal.pwat.0000022.g001

Fig 2.. Relative risk surface of consumer-reported water satisfaction and improved water and sanitation access at the household.

P-value contours in blue and white indicate areas with statistically different high or low density of survey responses. A ratio value of 1 indicates when the probability of either response at a specific location are equal. A higher ratio indicates a higher probability of having household access to improved water or unshared sanitation services or being at least sometimes satisfied with the water services. An adaptive bandwidth selection was used to select the optimum bandwidth for each individual relative risk surface. Base layer maps were obtained from https://www.africageoportal.com, which is powered by Esri (www.esri.com).