Influence of sanitation facilities on diarrhea prevalence among children aged below 5 years in flood-prone areas of Bangladesh: A multilevel analysis

Abstract

Abstract Although the improvement of sanitation facilities has been a major contributor to improving public health, it is not guaranteed to prevent negative health outcomes. This is especially true in areas affected by severe natural disasters, such as flooding or extreme rainfall. Previous studies have focused on the association between catastrophic natural disasters and negative health outcomes. However, studies focusing on disaster-prone areas are limited. This study focused on the impact of flood risks and examined whether the improvement of sanitation facilities would be sufficient to suppress the prevalence of diarrhea in flood-prone areas. To this end, we used data from the Bangladesh Demographic and Health Survey and geodata of flood-prone areas. Results showed that the severely and low flood-prone areas had significant positive and negative associations with diarrhea prevalence, respectively. However, interactions between unimproved sanitation and moderately flood-prone areas as well as between diffused sanitation facilities and severely flood-prone areas had significant negative associations with diarrhea prevalence. These findings indicate that improved sanitation may not positively contribute to the prevention of diarrhea in these areas. Instead of installing sanitation facilities that concentrate feces in one area in flood-prone regions, the urgent need for alternative sanitation technologies should be addressed.