An Analysis of Access to Improved Drinking Water and Sanitation and Distance to the Water Source in a Newly Independent Country, Timor-Leste: Assessing Geographical and Socioeconomic Disparities

Background: Lack of access to water, sanitation and hygiene (WASH) is of great concern globally as an estimated 748 million people worldwide are without an improved source of drinking water and 2.5 billion people are without adequate access to improved sanitation. Serious disparities exist and the unequal distribution has been recognized globally. However, it is important to further examine the distributions on a national and sub-national scale to understand disparities in access. In Timor-Leste, the determinants of disparities in access to improved drinking water and sanitation systems are poorly understood. Therefore, this present study sought to examine geographical and socioeconomic disparities in access to improved drinking water, distance to water and sanitation in the country. Methods: This study analyzed 11,463 households and 13,137 women observations from the Timor-Leste Demographic and Health Survey (TLDHS) 2009-2010. Analyses were performed separately for household and individual level. Sampling weights were used to account for complex sampling of the population of interest. Weighted descriptive statistics were computed to display the frequency distribution of outcome variables. Weighted bivariate logistic regression analysis was performed to assess associations between each independent variable (type of residence, municipalities, region, wealth index, education level and literacy) and each outcome variable (improved drinking water source, improved sanitation facility and travel times of 30 minutes or less to the water source). Weighted multivariate logistic regression analysis was performed to examine the associations between independent variables and the outcome variable. This study also utilized spatial data to map out the distribution of drinking water source, sanitation type and distance to the water source in 13 municipalities of Timor-Leste. Results: Significant predictors in weighted multivariate logistic regression analysis included urban/rural status, region and wealth index for disparities in access to improved drinking water and only wealth index for disparities in access to improved sanitation. Overall, disparities seem to be starker for sanitation than they are for water due to larger values of odds ratio for sanitation outcome, especially when looking across wealth index predictor at both the household and individual level of analysis. Conclusion: Policies and programming aiming to address disparities should encompass WASH interventions with emphasis on a poverty reduction approach by targeting the poorest population. Future longitudinal model and/or randomized trials are needed to examine the trends and to enable causal inferences