Exploring the sanitation success, sanitation technology and diarrhoeal mortality nexus in Sub-Saharan Africa

Previous research on the determinants of sanitation success has largely focused on economic, environmental, political and social factors at the expense of technological factors. Therefore, this paper explores the relationship between improved sanitation technologies and sanitation success, and further investigates the impact of improved sanitation technologies on diarrhoeal mortality in 46 Sub-Saharan African (SSA) countries. Cross-country regression analyses were done using publicly available data. The dependent variables 'proportion of 2015 population that gained access to sanitation since 2000' (GAINACC), 'access to improved sanitation as a percentage of the 2015 population' (ACCSAN) and diarrhoeal mortality rates were regressed against six different types of improved sanitation technologies commonly used in SSA. Significant relationships were observed between GAINACC and flush toilets connected to septic tanks in the rural sample (p < 0.001). In addition, significant relationships were obtained between ACCSAN and coverage of flush toilets connected to piped sewer, septic tanks and pit latrines for all samples (all p-values < 0.05). The findings also showed negative significant relationships between all flush toilets and diarrhoeal mortality rates (all p-values < 0.05). These results suggest that successful countries in SSA had higher access to flush toilets than other improved sanitation technologies and diarrhoeal mortality was lower in areas with higher coverages of flush toilets than those without. These results imply that investment in flush toilets, where possible, must be encouraged. However, sanitation success must be accompanied with an improvement in human health. These findings provide important information that could inform new strategies for achieving the Sustainable Development Goals (SDGs) and help in the drive to improved sanitation and health.