Present and Future Drinking Water Security and Its Impacts on Maternities: A Multi-Scale Assessment of Sudan.

Adequate access to drinking water for hydration and hygiene depends on many factors. We developed the Drinking Water Security Index (DWSI) to assess relative multifactorial drinking water security at different spatial and temporal scales. DWSI is a function of four key indicators of drinking water security: water quality, water accessibility, water continuity, and water availability. We built DWSI with a total of 10 variables and applied the new index in Sudan to assess historical and future drinking water security at state, local, and maternity levels. Analyses at the state level found that the Red Sea and River Nile states are most vulnerable, with the lowest DWSI for both historical and future periods. The 1 km 2 pixel level analysis shows large differences in water security within the major states. Analyses at the maternity level showed that nearly 18.97 million people are affected by the 10% of maternities with the lowest DWSI, a number projected to increase by 60% by 2030. Current and future DWSI of maternities providing Emergency Obstetric and Newborn Care was assessed to identify those where urgent action is needed to ensure quality health care in water-secure conditions. This work provides useful information for stakeholders in the health and drinking water sectors in Sudan, to improve public health, reduce preventable mortality, and make the population more resilient to projected environmental changes.