Exploring the links between water, sanitation and hygiene and disability; Results from a case-control study in Guatemala.

OBJECTIVE: To assess the Water, Sanitation and Hygiene (WASH) access and appropriateness of people with disabilities compared to those without, in Guatemala. METHODS: A case-control study was conducted, nested within a national survey. The study included 707 people with disabilities, and 465 age- and sex-matched controls without disabilities. Participants reported on WASH access at the household and individual level. A sub-set of 121 cases and 104 controls completed a newly designed, in-depth WASH questionnaire. RESULTS: Households including people with disabilities were more likely to use an improved sanitation facility compared to control households (age-sex-adjusted OR: 1.7, 95% CI 1.3-2.5), but otherwise there were no differences in WASH access at the household level. At the individual level, people with disabilities reported greater difficulties in relation to sanitation (mean score 26.2, SD 26.5) and hygiene access and quality (mean 30.7, SD 24.2) compared to those without disabilities (15.5, 21.7, p<0.001; 22.4, 19.1, p<0.01). There were no differences in different aspects of water collection between people with and without disabilities in this context where over 85% of participants had water piped into their dwelling. Among people with disabilities, older adults were more likely to experience difficulties in hygiene and sanitation than younger people with disabilities. CONCLUSIONS: People with disabilities in Guatemala experience greater difficulties in accessing sanitation facilities and practicing hygienic behaviours than their peers without disabilities. More data collection is needed using detailed tools to detect these differences, highlight which interventions are needed, and to allow assessment of their effectiveness.