Drinking water accessibility and quantity in low and middle-income countries: A systematic review

Background: Increasing the quantity of water available for consumption and hygiene is recognized to be among the most efficient interventions to reduce the risk of water-related infectious diseases in low and middle-income countries. Such impacts are often associated with water supply accessibility (e.g. distance or collection time) and used to justify investment in improving access. Objective: To assess the relationship between the water source location and the quantity of water available in households from low and middle-income countries by identifying the effects of interventions aiming to improve access, and to compare the indicators and measures used to collect information. Methods: We systematically searched seven databases (i.e. Cairn, Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Women's Studies International) along with grey literature for articles reporting indicators and measures of accessibility and quantity. We found 6492 records, of which 20 studies were retained that met the review's inclusion criteria. Results: Most studies were conducted in rural settings and provided suggestive findings to describe an inverse relationship between accessibility and quantity. Overall, a wide range of indicators and measures were used to assess water accessibility and quantity in the selected studies along with their association. The lack of consistency raised concerns regarding comparability and reliability of these methods. Conclusions: The review findings support the hypothesis that the quantity of water available in households is a function of the source location, but the inconsistency in study outcomes highlights the need to further investigate the strength and effects of the relationship.