Where Washing Hands and Isolating Aren't Options
DHS data reveal how subnational inequalities may hinder COVID-19 mitigation in lower- and middle-income countries
Mitigating the Pandemic's Spread
With over three million COVID-19 cases around the world, governments are urging their citizens to wash their hands and to self-isolate in the case of symptoms. While such strategies can slow the pandemic’s spread, populations in many countries may not have the means to take these measures. Access to handwashing facilities and the number of people living in the same space vary greatly from community to community. Data from The Demographic and Health Surveys (DHS) Program help to illustrate these patterns across dozens of countries.
Handwashing
The first line of protection against infection is washing one’s hands with soap and water. But in many countries, households do not have access to a basic handwashing facility.
The DHS Program recently published a series of new indicators on the online dashboard, STATcompiler . Among the new indicators is the percentage of the household population with a basic handwashing facility – that is a location for household members to wash their hands with soap and water. The following maps explore this indicator in several sub-Saharan African and South Asian countries.
A father in Cambodia teaching his son how to wash his hands. © Fani Llaurado, WorldFish Cambodia
Availability of Basic Handwashing Facilities in Sub-Saharan Africa
In sub-Saharan Africa, the range of availability of handwashing facilities highlights the need for context-tailored solutions. Efforts to promote handwashing in Tanzania, where about 50% of the household population have access to basic handwashing facilities, should look very different from WASH (water, sanitation, and hygiene) solutions in Chad, where less than 7% have access. Click on a country in the map to see its data.
Disparities also vary within countries. The following three maps will explore subnational differences in Senegal, Nigeria, and Ethiopia.
Availability of Basic Handwashing Facilities in Senegal
On a national level, 25% of the household population in Senegal has access to basic handwashing facilities with soap and water. However, access fluctuates greatly between regions. In Dakar, for example, about 61% of people have access to a basic handwashing facility. On the other hand, only about 1% of people in Kedougou have access to one.
Availability of Basic Handwashing Facilities in Nigeria
States in Nigeria vary greatly in terms of access to soap and water. More than 90% of people in Anambra and Osun states have access to basic handwashing facilities. There are nine states, however, where fewer than 5% of the population has access.
Availability of Basic Handwashing Facilities in Ethiopia
Of the sub-Saharan African countries which recently conducted surveys with The DHS Program, Ethiopia has the most limited access to basic handwashing facilities. Nationally, only 7% of the household population has access to a handwashing facility with soap and water. While about 39% of the household population in Addis Ababa have access, the vast majority of people outside of the capital do not. About 11% of people in Ben-Gumuz have access, but fewer than 10% have access in the other nine provinces.
Availability of Basic Handwashing Facilities in South Asia
In this map, we compare subnational variations in basic handwashing facilities between three countries in South Asia. More than half of the household populations in Pakistan (69%) and India (60%) can access a handwashing facility with soap and water, compared with only 30% of the household population in Afghanistan. In most provinces of Afghanistan, less than 25% of people have access to a basic handwashing facility.
Notably, the Pakistani provinces with the lowest access to a handwashing facility (less than 50%) are found along the Afghanistan border.
In India, seven states clustered in the East have the lowest availability of basic handwashing facilities (less than 45%). These include Assam, Bihar, Chhattisgarh, Jharkhand, Odisha, Tripura, and West Bengal.
Isolation of the Sick
To contain the COVID-19 pandemic, governments are requiring social distancing and, in the case of symptoms, quarantine. These measures can help prevent the spread of COVID-19 in communities around the world, but communities with large households may not find these precautions practical.
To better understand a household's ability to isolate sick members, it helps to know the number of people per sleeping room. Households with many people per sleeping room may not be able to isolate family members with the virus.
A family in Nigeria. © 2018 KC Nwakalor, USAID Digital Development Communications
Sleeping Space in Sub-Saharan Africa
In sub-Saharan Africa, households in most countries have, on average, about 2 people per sleeping room. Only three countries (South Africa, Namibia, and Lesotho) have fewer. Ethiopia has the most people per sleeping room, at more than 3.
The following three maps explore subnational patterns in Senegal, Nigeria, and Ethiopia.
Sleeping Space in Senegal
As can be seen in the map and the chart (below), the majority of households in Senegal have between 1 and 2 people per sleeping room. However, more than a quarter of households (about 27%) have between 3 and 4 people sleeping per room.
There are some notable differences by region in Senegal. Households in Kaffrine, Matam, and Tambacounda regions have the largest number of people sharing sleeping rooms, with almost 3 people per room, on average.
Sleeping Space in Nigeria
Despite their demographic differences, Nigeria and Senegal have similar patterns in terms of sleeping space. Most households in Nigeria have between 1 and 2 people per room. Higher averages occur in the northwestern states and Lagos State.
As illustrated in the chart, 25% of Nigerian households have between 3 and 4 people sleeping per room.
Sleeping Space in Ethiopia
Among the countries which conducted surveys with The DHS Program since 2014, Ethiopia has the highest average number of people per sleeping room in sub-Saharan Africa. While in Senegal and Nigeria most households have between 1 and 2 people per sleeping room, the majority of households in Ethiopia have 3 or more people sharing sleeping space. Three in ten Ethiopian households have more than 5 people per sleeping room.
The map reveals subnational differences across Ethiopia. The eastern and central provinces have the highest numbers of people sharing sleeping rooms, whereas urban Addis Ababa has the lowest number of people per room (about 2).
Sleeping Space in South Asia
Moving eastward, sleeping patterns look slightly different in South Asia. In this region, we see higher national averages. Afghanistan, Pakistan, and India all have around 3 people per sleeping room.
In Afghanistan, more than half of households have at least 3 people per sleeping room. Nearly one in five households (17%) have 5 or more.
Pakistan has the highest average number of people per sleeping room. Here, 65% of households have 3 or more people per room. More than one-quarter of households (27%) have 5 or more people per room. Whereas both Afghanistan and India have regional variations in sleeping space, the number of people per sleeping room is high across all of Pakistan.
Between the three countries, India has the lowest average number of people per room. The majority of households in India (53%) have between 1 and 2 people per room.
More from The DHS Program
Both indicators, household access to basic handwashing facilities and the number of people sleeping per room, vary greatly by country and even subnational region. By looking beyond national data to explore inequalities between populations, governments and institutions can tailor COVID-19 mitigation strategies to local contexts.
The DHS Program collects thousands of population and health indicators in 90 countries worldwide. To explore other COVID-19 related indicators, visit the STATcompiler and select indicators "COVID-19 Prevention" and "COVID-19 Additional factors" tags. For more information, please read the recent blog on the topic.
To download and explore the spatial data used in this StoryMap, visit the Spatial Data Repository . There, you can access administrative boundary files, indicator data, modeled surfaces, and geospatial covariates.
