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International Health

June 26, 2020

Study Finds Widespread Inequalities in Access to Soap and Water, a Key COVID-19 Prevention Measure, in sub-Saharan Africa

Analysis shows two-thirds of households lack soap and water at home


A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that only a third of households in 16 sub-Saharan countries had soap and water readily available for handwashing at home. Handwashing with soap and water is one of the most effective interventions to prevent the spread of the coronavirus that causes COVID-19, which continues to spread across the region. Researchers also found that rural and poor households were disproportionally more likely to lack access to soap and water than urban and wealthier households.

The study was published June 3, 2020, in the International Journal for Equity in Health and was led by Safia Jiwani, MSPH ’16, a research associate in the Department of International Health at the Bloomberg School and Daniel Antiporta, a doctoral candidate in the Department of Epidemiology at the Bloomberg School.

The researchers noted that with social distancing measures difficult to implement in many lower-income settings where overcrowding and informal settlements can be common, access to basic hand hygiene needs, especially for the rural and poorest, is one of the only effective ways to prevent COVID-19.   

The analysis revealed access to soap and water varied widely across countries, from a low of 5% in Burundi to a high of 64% in Angola. The researchers found wide inequalities in access between the richest and poorest household, with a gap as high as 64 percentage points in South Africa. Urban-rural disparities were also wide, reaching up to 42 percentage points in Rwanda. A notable exception was in Angola where over 50% of both urban and rural households had access to soap and water at home. 

Researchers used publicly available data from the Demographic and Health Surveys of 16 countries in sub-Saharan Africa where surveys had been conducted since 2015 (Angola, Benin, Burundi, Chad, Ethiopia, Guinea, Malawi, Mali, Nigeria, Rwanda, Senegal, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe). The survey data allowed them to estimate the proportion of households that had soap and water readily available at a home where the household members routinely wash their hands.

The authors highlighted that several countries in the region had already put in place innovative structures such as community handwashing stations as an early response to the pandemic. They concluded that these measures should also be widely scaled up in rural areas and informal settlements in order to reach the most vulnerable populations.

Inequalities in access to water and soap matter for the COVID-19 response in sub-Saharan Africa was written by Safia S. Jiwani & Daniel A. Antiporta.