Measuring Disparities in Sanitation Access: Does the Measure Matter?

Initiatives to monitor progress in health interventions like sanitation are increasingly focused on disparities in access. This journal paper by Rheingans et al. (2013), published in Tropical Medicine and International Health, explores three methodological challenges to monitoring changes in sanitation coverage across socio-economic and demographic determinants: confounding by wealth indices including water and sanitation assets, use of individual urban and rural settings versus national wealth indices, and child-level versus household-level analyses. It concludes that standard asset indices provide a reasonably robust measure of disparities in improved sanitation, although overestimation is possible. Separate setting wealth quintiles reveal important disparities in urban areas, but analysis of setting quintiles using a national index is sufficient. Estimates and disparities in household-level coverage of improved sanitation can underestimate coverage for children under five.