Analyzing child health and water, sanitation, hygiene facilities in Punjab, Pakistan: A multilevel and spatial approach

The health and well-being of children can be achieved through access to clean water, proper sanitation, and hygiene practices. The current study investigates the effect of water, sanitation, and hygiene (WASH) on health outcomes using the multiple indicator cluster surveys (MICS) data. The household-level and district-level determinants of child health are analyzed using logistic regression models and multilevel logistic regression models. The results indicate that there are significant relationships between water availability, sanitation facilities, hygiene practices, and health outcomes. Access to clean water, an increase in sanitation facilities, and proper hygiene have a significant positive relationship with child health. Better access to clean water enhances children's well-being. The level of parental education, household head dynamics, and WASH indicators at the district level also have a significant relationship with child health. The bivariate Local Moran's I analysis of child health and WASH facilities shows positive spatial autocorrelation (0.441). It also identifies the districts with significant high–high and low–low clustering patterns. This study contributes to achieving SDGs 3 and 6 to develop policies, programs, and future-based solutions to promote the health and well-being of children in Punjab and other similar areas.