Safe Water, Sanitation Reduce Child and Maternal Deaths

Larry Hand

February 16, 2012

February 16, 2012 — Researchers have quantified globally that increasing access to safe water and adequate sanitation lowers infant, child, and maternal death rates, according to an article published online January 27 in Environmental Health.

June J. Cheng, MD, from the Public Health and Preventive Medicine Residency Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, and the United Nations University Institute for Water, Environment and Health, both in Hamilton, Ontario, Canada, and colleagues analyzed data from 193 countries and divided the information into 4 tiers of access to water and sanitation.

After adjustment for potential confounders including gross national income, fertility per woman, maternal mortality ratio (MMR), and region in the world, the researchers estimated that in 2008, as access to water improved for each tier, 1.17 fewer deaths per 1000 (95% confidence interval [CI], 1.08 - 1.26 deaths; P < .001) occurred in children younger than 5 years and 1.14 fewer infant deaths per 1000 occurred (95% CI, 1.05 - 1.23 deaths; P = .001) from the bottom to top tier. For each tier, as access to sanitation improved, 1.66 fewer deaths per 1000 (95% CI, 1.11 - 1.32 deaths; P < .001) occurred in children younger than 5 years, including infants.

In terms of maternal deaths, "[t]he estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39–0.86), P = .008," explain the authors. Similarly, "[t]he corresponding odds ratio for sanitation was 0.52 (95%CI 0.32–0.85), P = .009, both suggesting that better water and sanitation were associated with decreased MMR."

According to the World Health Organization, improving water supply and sanitation, along with better management of water resources, could alleviate almost a tenth of the global disease burden. The researchers cite another report that concludes that 4% of all deaths can be linked to unsafe water and sanitation and poor hygiene.

The United Nations Millennium Development Goals (MDGs) include reducing child mortality by two thirds (MDG 4), improving maternal health by 75% (MDG 5), and reducing by half the number of people without access to drinking water and adequate sanitation (MDG 7), all by 2015.

"Our analyses show interesting and statistically significant relationships between access to water and sanitation and maternal, infant, and child mortality," the researchers conclude. "With this knowledge, plans for development should include improving water and sanitation access. This will allow fuller achievement in MDGs four and five — improving child and maternal health."

The sources of information for this paper included the World Health Organization Statistical Information System, the United Nations Children's Fund Childinfo, and World Bank Open Data.

The authors have disclosed no relevant financial relationships.

Environ Health. Published online January 27, 2012. Full text

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