Determinants of Environmental Health Inequalities Among Urban and Rural Populations in Anambra State, South East Nigeria

Environmental health inequalities are shaped by socioeconomic, geographic, and governance factors that systematically disadvantage certain population groups. This study analyzed the determinants of environmental health inequalities between urban and rural populations in Anambra State, South East Nigeria, using an equity-focused analytical framework. Secondary data were obtained from the Nigeria Demographic and Health Survey, the National Water Supply and Sanitation Survey, and facility-based records from forty health centers. Primary data were generated through household surveys administered to 520 households across urban, peri-urban, and rural strata, and through twenty key informant interviews with local government and state health officials. A multilevel regression analysis was employed to identify predictors of environmental health outcome disparities. Results demonstrated that rural households had significantly lower access to improved water sources (forty-three percent versus eighty-one percent in urban areas) and improved sanitation (thirty-eight percent versus seventy-four percent). Educational attainment, household income quintile, and distance from local government headquarters were the strongest socioeconomic predictors of environmental health inequality. Governance quality, measured by LGA budget transparency scores, independently predicted WASH coverage outcomes. The urban-rural gap in environmental health outcomes was larger in Anambra State than national averages, indicating state-specific governance deficits. The study contributes an empirically grounded analysis of environmental health inequity and recommends equity-targeted resource allocation, progressive rural WASH investment, and community governance strengthening. Keywords: environmental health inequalities, urban rural, Anambra State, WASH access, equity.