# Great strides, yet a long way to go: a comparative analysis of WASH conditions and associated sociodemographic factors from national hygiene surveys, 2014 and 2018

## TL;DR

Bangladesh improved rural WASH access from 2014 to 2018, but urban areas lagged, with wealth, household size, and housing type affecting access.

## Contribution

The study provides new insights into how sociodemographic factors influence WASH access in urban and rural Bangladesh over time.

## Key findings

- Rural sanitation improved significantly, while urban areas showed stagnation or decline in WASH access.
- Higher socio-economic status and self-owned housing were linked to better WASH outcomes.
- Urban households had better hygiene but worse water and sanitation access compared to rural areas.

## Abstract

Bangladesh faces substantial inequalities in water, sanitation, and hygiene (WASH), with disparities across sociodemographic groups and between urban and rural populations. Evidence on temporal changes in household WASH access and its determinants remains limited.

To assess changes in household WASH and examine the influence of sociodemographic factors on access, using data from two national hygiene surveys at national and urban–rural levels.

In this repeated cross-sectional study, differences in WASH outcomes between the 2014 National Hygiene Baseline Survey and the 2018 National Hygiene Survey were assessed using prevalence differences (PD), and associations with sociodemographic factors were examined using generalized estimating equations (GEE).

From 2014 to 2018, rural households maintained near-universal basic drinking water, while urban households showed a slight decline. Basic sanitation increased substantially in rural areas (PD = 27.8), driving national gains (PD = 25); urban changes were nonsignificant. Basic hygiene improved minimally across all levels. Higher socio-economic status was linked to better WASH outcomes, while larger households had poorer status. Rental housing was associated with unimproved drinking water (Coef.: 1.9) and lower basic sanitation (Coef.: −0.9) but better overall hygiene than self-owned homes. Urban households had lower access to basic drinking water and sanitation, yet better basic hygiene facilities than rural households.

Household WASH improved substantially, especially in rural sanitation and hygiene, while urban areas showed stagnation. Socio-economic status, household size, and housing tenure are key determinants, highlighting the need for targeted interventions to ensure equitable, universal WASH coverage.

Main findings: Rural areas saw significant improvements in sanitation and hygiene from 2014 to 2018, while urban areas faced stagnation or declines; sociodemographic factors like wealth, household size, and rental status influenced WASH access.Added knowledge: The study enhances our understanding of how sociodemographic factors, like wealth and housing tenure, impact WASH access, with a focus on addressing urban and rental household inequalities going forward.Global health impact for policy and action: The findings highlight the need for targeted policies to address WASH disparities, particularly in urban areas and among disadvantaged groups, to achieve universal coverage and meet global health targets.

Main findings: Rural areas saw significant improvements in sanitation and hygiene from 2014 to 2018, while urban areas faced stagnation or declines; sociodemographic factors like wealth, household size, and rental status influenced WASH access.

Added knowledge: The study enhances our understanding of how sociodemographic factors, like wealth and housing tenure, impact WASH access, with a focus on addressing urban and rental household inequalities going forward.

Global health impact for policy and action: The findings highlight the need for targeted policies to address WASH disparities, particularly in urban areas and among disadvantaged groups, to achieve universal coverage and meet global health targets.