The realization of the scale, magnitude, and complexity of the water and sanitation problem at the global level has compelled international agencies and national governments to increase their resolve to face the challenge. There is extensive evidence on the independent effects of urbanicity (rural-urban environment) and wealth status on access to water and sanitation services in sub-Saharan Africa. However, our understanding of the joint effect of urbanicity and wealth on access to water and sanitation services across spatio-temporal scales is nascent. In this study, a pooled regression analysis of the compositional and contextual factors that systematically vary with access to water and sanitation services over a 25-year time period in fifteen countries across sub-Saharan Africa (SSA) was carried out. On the whole, substantial improvements have been made in providing access to improved water sources in SSA from 1990 to 2015 unlike access to sanitation facilities over the same period. Households were 28.2 percent and 125.2 percent more likely to have access to improved water sources in 2000-2005 and 2010-2015 respectively, than in 1990-1995. Urban rich households were 329 percent more likely to have access to improved water sources compared with the urban poor. Although access to improved sanitation facilities increased from 69 percent in 1990-1995 and 74 percent in 2000-2005 it declined significantly to 53 percent in 2010-2015. Urban rich households were 227 percent more likely to have access to improved sanitation facilities compared with urban poor households. These results were mediated and attenuated by biosocial, socio-cultural and contextual factors and underscore the fact that the challenge of access to water and sanitation in sub-Saharan Africa is not merely scientific and technical but interwoven with environment, culture, economics and human behaviour necessitating the need for interdisciplinary research and policy interventions.

Access to clean cooking fuels is critical for human health and features, prominently in the UN Sustainable Development Goals. However, our understanding of the probabilities of access to clean cooking across sub-Saharan Africa (SSA) is emergent. A pooled regression analysis of the compositional and contextual factors that cumulatively influence access to clean cooking fuels in 31 SSA countries, between 2010 and 2016, was carried out. Household access to clean cooking fuels across the 31 countries was just 10%. Access of urban households to clean cooking fuels was 26% and it was 2% for rural households. Higher probabilities of access were observed for households that were rich and highly educated compared with households that were either rich but with low education or poor but highly educated. Middle households with heads educated to secondary level or higher in both urban and rural areas almost have the same chance with the rich households with uneducated heads or educated to primary level regarding access to clean cooking fuels. The average probability of poor households with heads educated to secondary level or higher is twice that of poor households with uneducated heads or educated to primary level. The average probability of access to clean cooking of rich households with heads educated to secondary or higher level is ten times higher than for poor households with uneducated heads. These findings are mediated and attenuated by compositional and contextual factors, giving credence to the fact that the challenge of access to clean cooking fuels in SSA is multifaceted and requires interdisciplinary research and policy interventions encompassing health, environment, culture, and economics.

Background and aims: Understanding the importance of using personal protective equipment (PPE) and the influence of work‐post (working distance to main dust source—crusher) in stone quarries is vital for designing tailored interventions in minimizing workers' exposure to silica dust. Nonetheless, studies on silica dust and disease symptoms in Ghana are nascent. This study assessed how work‐post and use of required PPE jointly influence exposure to silica dust and disease symptoms in Ghana.Methods: Generalized linear models (complementary log‐log regression) were fitted to cross‐sectional survey data of 524 stone quarry workers in Ghana to assess the joint effect of work‐post and PPE usage on self‐reported disease symptoms while controlling for relevant compositional and contextual factors.Results: Stone quarry workers who work between 1‐100 m and beyond 100 m from the crusher with the required PPE were 90% and 87% respectively less likely to report eye irritation compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE. Individuals who work between 1‐100 m and beyond 100 m from the crusher with the required PPE were 94% and 95% respectively less likely to report breathing difficulty compared with the reference group. Workers who work between 1‐100 m and beyond 100 m from the crusher with the required PPE were 97% and 99% respectively less likely to report coughing compared with the reference group. Workers who work between 1‐100 m and beyond 100 m from the crusher with the required PPE were 93% and 97% respectively less likely to report common cold compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE.Conclusion: There are adverse health implications for people who work in silica dust polluted environments, suggesting the need for a national safety and health policy to target them.