Disease Burden Inequities & Pro-Poor Targeting

University of Florida/Rick Rheingans


This study, carried out by LSHTM in partnership with the University of Florida, sought to estimate inequities in sanitation-related disease burden and the potential impacts of pro-poor targeting. As such, it modelled the distribution of sanitation-related health burden and health benefits by wealth quintile, and looked at the spatial distribution of these for 10 low-income countries in sub-Saharan Africa and South Asia.

The results of this modelling exercise, which is based on existing information sources, suggest the following: 

  • The health burden of poor sanitation falls disproportionately on children living in the poorest households
  • This increased health burden is the result of both greater exposure to infection and increased susceptibility among children in these households
  • The increased exposure among these children is a function of their increased likelihood of having no access to a private facility, having to use shared facilities and being more likely to live in an area with a high density of people without sanitation
  • Children in poor households are more likely to be susceptible (resulting from lower nutritional status) to diarrhoeal diseases and suffer higher mortality
  • Improvements in sanitation for households in the poorest quintile may bring significantly greater health benefits than improvements in the richest quintiles
  • The sanitation-related burden differs between rural and urban settings, but children in poor households in both settings consistently suffer disproportionately
  • While rural populations generally have lower levels of access, the sanitation associated risk may be greater for the urban poor due to the increased likelihood of these households being in areas with a high density of people without sanitation.


SHARE contributes to achieving universal access to effective, sustainable and equitable sanitation and hygiene by generating evidence to improve policy and practice worldwide.