Water, sanitation and the risk of chronic diseases in old age: Results from the Ghana WHO SAGE 2

Abstract

Background: The associations of water and sanitation with population health have been well-documented. However, the specific effects of water and sanitation on chronic diseases in old age are least explored. This study examines the associations between water, sanitation and chronic diseases among older people in Ghana and whether these associations are moderated by sex and spatial variation. Methods: Data from the WHO-SAGE Wave 2 involving adults aged ≥ 50 years were analyzed. Chronis diseases were assessed based on the self-reported diagnosis by a healthcare professional. The exposures included water sources, type of toilet, and sharing of toilet facilities. Generalized logistic regression models estimated the effects of water and sanitation indicators on chronic diseases.  Results: Overall, 18.8% of the sample reported at least one chronic disease. Compared to men and those in rural areas, women and urban residents respectively were more likely to report chronic disease (p < 0.001). After full adjustments, logistic regressions showed that the use of unimproved sanitation (OR = 1.732, CI: 1.377–5.418) and sharing of sanitation facilities (OR = 1.624, CI: 1.095–1.320) were associated with higher odds of chronic diseases. However, the use of water did not reach significance (p = 0.125). We found a significant interaction effect for type of toilet × sex (OR = 3.498, CI: 1.744–16.442), source of water × residence (OR = 5.935, CI: 1.320–26.685), and type of toilet × spatial variation (OR = 1.998, CI: 1.462–8.642).  Conclusions: The use of unimproved sanitation facilities and the sharing of toilet facilities are associated with the occurrence of chronic diseases among older people. Policy and public health interventions targeted at improving the health and well-being of older people should conspicuously include better access and improved sanitation services.