Domestic drinking water supplies prone to interruptions and low per capita domestic water availability have been frequently reported among African households. Despite expanded international monitoring indicators that now include metrics of water availability, the range of methods used for measuring and monitoring availability remains unclear in Africa. Few household surveys have historically assessed water continuity and per capita availability, and both pose measurement challenges. This paper aims to examine the methods used to measure availability and synthesise evidence on African domestic water availability by systematically reviewing the literature from 2000–2019. Structured searches were conducted in five databases: Web of Science Core Collection, Scopus, GEOBASE, Compendex and PubMed/Medline. A total of 47 of 2406 reports met all inclusion criteria. Included studies were based on empirical research which reported the household’s perspective on a water availability measure. Most studies had methodological problems such as small sample sizes, non-representative sampling and incomplete reporting of methods and measures of uncertainty. Measurement of drinking water availability is primarily reliant on quantifying litres/capita/day (LPCD). Only four (9%) of the included studies reported an average water availability over the international benchmark of 50 LPCD. This pattern of water insufficiency is broadly consistent with previous studies of domestic water availability in Africa. The review highlights the need for high-quality and representative studies to better understand the uncertainties and differences in household water availability across Africa, and the methods used to measure it.

Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.

Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.

Commercial geospatial data resources are frequently used to understand healthcare utilisation. Although there is widespread evidence of a digital divide for other digital resources and infra-structure, it is unclear how commercial geospatial data resources are distributed relative to health need. To examine the distribution of commercial geospatial data resources relative to health needs, we assembled coverage and quality metrics for commercial geocoding, neighbourhood characterisation, and travel time calculation resources for 183 countries. We developed a country-level, composite index of commercial geospatial data quality/availability and examined its distribution relative to age-standardised all-cause and cause specific (for three main causes of death) mortality using two inequality metrics, the slope index of inequality and relative concentration index. In two sub-national case studies, we also examined geocoding success rates versus area deprivation by district in Eastern Region, Ghana and Lagos State, Nigeria. Internationally, commercial geospatial data resources were inversely related to all-cause mortality. This relationship was more pronounced when examining mortality due to communicable diseases. Commercial geospatial data resources for calculating patient travel times were more equitably distributed relative to health need than resources for characterising neighbourhoods or geocoding patient addresses. Countries such as South Africa have comparatively high commercial geospatial data availability despite high mortality, whilst countries such as South Korea have comparatively low data availability and low mortality. Sub-nationally, evidence was mixed as to whether geocoding success was lowest in more deprived districts. To our knowledge, this is the first global analysis of commercial geospatial data resources in relation to health outcomes. In countries such as South Africa where there is high mortality but also comparatively rich commercial geospatial data, these data resources are a potential resource for examining healthcare utilisation that requires further evaluation. In countries such as Sierra Leone where there is high mortality but minimal commercial geospatial data, alternative approaches such as open data use are needed in quantifying patient travel times, geocoding patient addresses, and characterising patients’ neighbourhoods.

Disposable diaper use is widespread in many low- and middle-income countries whilst waste collection services are scarce. Despite the potential environmental and public health impacts of disposable diaper consumption by households lacking waste services, an international system for monitoring such consumption is lacking. This study therefore aims to develop and evaluate a method for estimating disposable diaper use based on secondary data, specifically nationally representative household expenditure surveys. Disposable diaper expenditure reported via household expenditure surveys for Nigeria (from 2018–19), Kenya (2015–16) and Ghana (2016–17) was used to estimate national disposable diaper consumption among households lacking waste collection services. To assess plausibility of reported expenditure, consumption-smoothing was examined, and Receiver Operating Curve analysis was used to infer mean toilet-training age. In Ghana, Kenya and Nigeria, households lacking appropriately managed waste services consumed an estimated 19 million, 210 million and 285 million disposable diapers per year (292 child/year, 433 child/year and 59 child/year among nappy-consuming households), respectively. Mean toilet-training ages were 24 to 30 months. Disposable diaper purchasing patterns showed evidence of consumption-smoothing among poorer households. Where commodity coding allows, household expenditure surveys can be used to construct internationally comparable indicators depicting disposable diaper consumption among households lacking waste services. Such indicators could be used to advocate for accelerated diaper product innovation, and target areas with high disposable diaper consumption but low waste service coverage.

Studies have reported widespread disposable diaper (DD) consumption in parts of urban Africa, increasing municipal waste generation and with mismanaged DD waste impacting water quality. However, the DD manufacturing and distribution systems behind this trend are little studied, yet understanding these underlying systems is critical in informing efforts to promote extended producer responsibility. This study therefore aims to assess DD brand preferences and trends in international trade in absorbent hygiene products in two case study Sub-Saharan countries. A cross-sectional survey was undertaken of 440 carers of children aged 0–36 months attending health facilities in Greater Accra, Ghana and Kisumu, Kenya. Survey analysis was supplemented by analysis of international trade in absorbent hygiene products for both countries from 2000–2021. Trade data showed DD imports to Ghana and Kenya increased from 2000–17 particularly from China, but declined thereafter. This coincided with Chinese foreign direct investment establishing DD production facilities within both countries in 2018–19, and increased DD exports from Kenya and Ghana to surrounding countries. Meanwhile, 93.0% and 94.2% of survey respondents in Greater Accra and Kisumu respectively reported using DD. In Greater Accra and Kisumu respectively, 62.4% and 45.3% of survey participants reported using the brand produced by these new domestic manufacturing facilities, with 29.8% and 40.9% using imported brands. In Greater Accra, approximately half of reported imported brands were unregistered with the regulator. Given its market dominance, we therefore recommend engagement with the leading manufacturer to identify product or waste management innovations to address water pollution from DD waste. We also recommend similar engagement with imported brand manufacturers and greater DD import regulation in Ghana, given lack of imported brand registration.