Date of Conferral

2022

Degree

Ph.D.

School

Public Health

Advisor

Dr. Sriya Krishnamoorthy

Abstract

Despite remarkable progress in children’s survival since 1990, the global burden of the under-5 mortality rate (U5MR) remains immense. According to the World Health Organization, about 5.2 million children below 5 died in 2019, with 14,000 dying each day. Literature reveals that the lack and limitation of water, sanitation, and hygiene (WaSH) are linked to deaths in childhood. Cote d’Ivoire still lags behind expectations with 79 per 1000 live births in 2019 rather than 25 and below, so there is a need to uncover to what extent the U5MR is affected by WaSH. Through a cross-sectional design guided by the integrated behavioral model for water, sanitation, and hygiene and the health and human rights framework, this study examined the association between access to WaSH and U5MR using Cote d’Ivoire Demographic Health Surveys data sets: 2005-2020. Cox proportional hazards method was used to analyze the effect of WaSH variables on U5M. The results showed that the risk of U5MR is 22.4% higher among women with access to unimproved sanitation sources (HR:1.224, 95% CI: 1.044- 1.435). P=0.031compared with those with improved sanitation facilities. The risk of U5MR was 20.5% higher in women with unimproved water (HR:1.205, 95% CI: 1.000- 1.453). The risk of U5M among women was 77.3% (HR: 1.773,95% CI: 1.129- 2.784) higher in women with inadequate hygiene versus those with adequate hygiene. The likelihood of U5M is 49.1% higher (HR: 1.491 [95% CI: 1.021- 2.178] (p=0.039) among women from households with improved WaSH compared to counterparts with unimproved WaSH. Social change suggests educating and promoting access to improved WaSH to the targeted populations for preventive behaviors and minimizing the risk of U5MR.

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