BACKGROUND: Despite continued national and international efforts, access to improved water and sanitation remains limited in many developing countries. The health consequences of lacking access to water and sanitation are severe, and particularly important for child development. METHODS: To investigate the associations between child health and access to water and sanitation, we merged all available Demographic and Health Surveys (DHS) with complete birth histories and water and sanitation information. The merged data set of 171 surveys includes information on 1.1 million children under the age of 5 years in 70 low- and middle-income countries over the period 1986-2007. We used logistic models to estimate the effect of water and sanitation access on infant and child mortality, diarrhoea and stunting. RESULTS: Access to improved sanitation was associated with lower mortality (OR = 0.77, 95% CI 0.68-0.86), a lower risk of child diarorhea (OR = 0.87, 95% CI 0.85-0.90) and a lower risk of mild or severe stunting (OR = 0.73, 95% CI 0.71-0.75). Access to improved water was associated with a lower risk of diarrhoea (OR = 0.91, 95% CI 0.88-0.94) and a lower risk of mild or severe stunting (OR = 0.92, 95% CI 0.89-0.94), but did not show any association with non-infant child mortality (OR = 0.97, 95% CI 0.88-1.04). CONCLUSIONS: Although our point estimates indicate somewhat smaller protective effects than some of the estimates reported in the existing literature, the results presented in this article strongly underline the large health consequences of lacking access to water and sanitation for children aged <5 years in low- and middle-income countries.
BACKGROUND: Despite continued national and international efforts, access to improved water and sanitation remains limited in many developing countries. The health consequences of lacking access to water and sanitation are severe, and particularly important for child development. METHODS: To investigate the associations between child health and access to water and sanitation, we merged all available Demographic and Health Surveys (DHS) with complete birth histories and water and sanitation information. The merged data set of 171 surveys includes information on 1.1 million children under the age of 5 years in 70 low- and middle-income countries over the period 1986-2007. We used logistic models to estimate the effect of water and sanitation access on infant and child mortality, diarrhoea and stunting. RESULTS: Access to improved sanitation was associated with lower mortality (OR = 0.77, 95% CI 0.68-0.86), a lower risk of child diarorhea (OR = 0.87, 95% CI 0.85-0.90) and a lower risk of mild or severe stunting (OR = 0.73, 95% CI 0.71-0.75). Access to improved water was associated with a lower risk of diarrhoea (OR = 0.91, 95% CI 0.88-0.94) and a lower risk of mild or severe stunting (OR = 0.92, 95% CI 0.89-0.94), but did not show any association with non-infantchild mortality (OR = 0.97, 95% CI 0.88-1.04). CONCLUSIONS: Although our point estimates indicate somewhat smaller protective effects than some of the estimates reported in the existing literature, the results presented in this article strongly underline the large health consequences of lacking access to water and sanitation for children aged <5 years in low- and middle-income countries.
Authors: Darlene Bhavnani; Jason E Goldstick; William Cevallos; Gabriel Trueba; Joseph N S Eisenberg Journal: Am J Trop Med Hyg Date: 2014-02-24 Impact factor: 2.345
Authors: Tarique Md Nurul Huda; Wolf-Peter Schmidt; Amy J Pickering; Zahid Hayat Mahmud; Mohammad Sirajul Islam; Md Sajjadur Rahman; Stephen P Luby; Adam Biran Journal: Am J Trop Med Hyg Date: 2018-02-08 Impact factor: 2.345
Authors: Stephen S Lim; Theo Vos; Abraham D Flaxman; Goodarz Danaei; Kenji Shibuya; Heather Adair-Rohani; Markus Amann; H Ross Anderson; Kathryn G Andrews; Martin Aryee; Charles Atkinson; Loraine J Bacchus; Adil N Bahalim; Kalpana Balakrishnan; John Balmes; Suzanne Barker-Collo; Amanda Baxter; Michelle L Bell; Jed D Blore; Fiona Blyth; Carissa Bonner; Guilherme Borges; Rupert Bourne; Michel Boussinesq; Michael Brauer; Peter Brooks; Nigel G Bruce; Bert Brunekreef; Claire Bryan-Hancock; Chiara Bucello; Rachelle Buchbinder; Fiona Bull; Richard T Burnett; Tim E Byers; Bianca Calabria; Jonathan Carapetis; Emily Carnahan; Zoe Chafe; Fiona Charlson; Honglei Chen; Jian Shen Chen; Andrew Tai-Ann Cheng; Jennifer Christine Child; Aaron Cohen; K Ellicott Colson; Benjamin C Cowie; Sarah Darby; Susan Darling; Adrian Davis; Louisa Degenhardt; Frank Dentener; Don C Des Jarlais; Karen Devries; Mukesh Dherani; Eric L Ding; E Ray Dorsey; Tim Driscoll; Karen Edmond; Suad Eltahir Ali; Rebecca E Engell; Patricia J Erwin; Saman Fahimi; Gail Falder; Farshad Farzadfar; Alize Ferrari; Mariel M Finucane; Seth Flaxman; Francis Gerry R Fowkes; Greg Freedman; Michael K Freeman; Emmanuela Gakidou; Santu Ghosh; Edward Giovannucci; Gerhard Gmel; Kathryn Graham; Rebecca Grainger; Bridget Grant; David Gunnell; Hialy R Gutierrez; Wayne Hall; Hans W Hoek; Anthony Hogan; H Dean Hosgood; Damian Hoy; Howard Hu; Bryan J Hubbell; Sally J Hutchings; Sydney E Ibeanusi; Gemma L Jacklyn; Rashmi Jasrasaria; Jost B Jonas; Haidong Kan; John A Kanis; Nicholas Kassebaum; Norito Kawakami; Young-Ho Khang; Shahab Khatibzadeh; Jon-Paul Khoo; Cindy Kok; Francine Laden; Ratilal Lalloo; Qing Lan; Tim Lathlean; Janet L Leasher; James Leigh; Yang Li; John Kent Lin; Steven E Lipshultz; Stephanie London; Rafael Lozano; Yuan Lu; Joelle Mak; Reza Malekzadeh; Leslie Mallinger; Wagner Marcenes; Lyn March; Robin Marks; Randall Martin; Paul McGale; John McGrath; Sumi Mehta; George A Mensah; Tony R Merriman; Renata Micha; Catherine Michaud; Vinod Mishra; Khayriyyah Mohd Hanafiah; Ali A Mokdad; Lidia Morawska; Dariush Mozaffarian; Tasha Murphy; Mohsen Naghavi; Bruce Neal; Paul K Nelson; Joan Miquel Nolla; Rosana Norman; Casey Olives; Saad B Omer; Jessica Orchard; Richard Osborne; Bart Ostro; Andrew Page; Kiran D Pandey; Charles D H Parry; Erin Passmore; Jayadeep Patra; Neil Pearce; Pamela M Pelizzari; Max Petzold; Michael R Phillips; Dan Pope; C Arden Pope; John Powles; Mayuree Rao; Homie Razavi; Eva A Rehfuess; Jürgen T Rehm; Beate Ritz; Frederick P Rivara; Thomas Roberts; Carolyn Robinson; Jose A Rodriguez-Portales; Isabelle Romieu; Robin Room; Lisa C Rosenfeld; Ananya Roy; Lesley Rushton; Joshua A Salomon; Uchechukwu Sampson; Lidia Sanchez-Riera; Ella Sanman; Amir Sapkota; Soraya Seedat; Peilin Shi; Kevin Shield; Rupak Shivakoti; Gitanjali M Singh; David A Sleet; Emma Smith; Kirk R Smith; Nicolas J C Stapelberg; Kyle Steenland; Heidi Stöckl; Lars Jacob Stovner; Kurt Straif; Lahn Straney; George D Thurston; Jimmy H Tran; Rita Van Dingenen; Aaron van Donkelaar; J Lennert Veerman; Lakshmi Vijayakumar; Robert Weintraub; Myrna M Weissman; Richard A White; Harvey Whiteford; Steven T Wiersma; James D Wilkinson; Hywel C Williams; Warwick Williams; Nicholas Wilson; Anthony D Woolf; Paul Yip; Jan M Zielinski; Alan D Lopez; Christopher J L Murray; Majid Ezzati; Mohammad A AlMazroa; Ziad A Memish Journal: Lancet Date: 2012-12-15 Impact factor: 79.321