Validity and Reliability of the Sanitation-related Quality of Life Index (sanqol-5) in Six Countries

Abstract

Sustainable Development Goal�6.2 measures sanitation progress by toilet type. However, improving people�s subjective sanitation experiences�such as feeling safe, avoiding disgust, maintaining privacy, reducing shame, and perceiving lower disease risk�is often overlooked. The SanQoL?5 index aggregates responses to five questions on these themes into a single 0�1 score. We evaluated its validity and reliability by surveying 6,165 individuals in rural and urban settings across six countries (Ethiopia, India, Kenya, Malawi, Mozambique, Zambia). There was strong construct validity: 87% of predicted associations between SanQoL?5 scores and toilet quality met expectations (P?<?0.05). Cross-cultural comparability was supported: only 9% of comparisons showed meaningful item bias across countries. Item-response theory models confirmed its structure, and convergent, discriminant, and known-groups validity were established. Overall, SanQoL?5 is a robust tool for sanitation impact evaluation, monitoring, needs assessment, and cost�benefit analysis.