Benefits trickling away: the health impact of extending access to piped water and sanitation in urban Yemen

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThis article investigates the impact of piped water supply and sanitation on health outcomes in urban Yemen using a combination of quasi-experimental methods and results from microbiological water tests. Variations in project roll-out allow separate identification of water and sanitation impacts. Results indicate that access to piped water supply worsens health outcomes when water rationing is frequent, which appears to be linked to a build-up of pollution in the network. When water supply is continuous no clear health benefits are found compared to traditional urban water supply through water vendors. Connections to piped sewers can lead to health improvements, conditional on regular water supply. The findings suggest that investments in piped water supply should not be made when availability and reliability of water cannot be guaranteed.

Developmental Drivers of Nutritional Change: A Cross-Country Analysis

“…17 Interestingly, the three infrastructure variables-piped water, flush toilets, and electricity-all show very weak relationships, suggesting their relationship to nutrition is not very robust. Although we suspect that these weak relationships partly stem from the fact that these factors really are less important drivers of nutritional change, it could well be that piped water and flush toilets are very poor proxies for water and sanitation quality (Klasen, Tobias, Kristina, & Johannes, 2012;Smith & Haddad, 2002). Table 5 shows two regressions which confirm this pattern of bivariate results in a multivariate context (because of sample size constraints, the country trend effects in these regressions are dropped).…”

Enhancing arsenic mitigation in Bangladesh: Findings from institutional, psychological, and technical investigations

“…Piped water systems are a new phenomenon in rural Bangladesh, and there is so far little documented experience on either the financial sustainability of such systems, or the quality of water they are able to deliver. Experiences from other countries suggests that intermittently operated piped water schemes are vulnerable to fecal contamination, and do not necessarily deliver water which is safer than point sources (Klasen et al, 2012).…”

Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens

“…However, this overall estimate included non-interventions that were previously ineligible, such as hospital-based case-control studies [84][85][86]. Sixteen studies were found that measured the effect of a sanitation intervention [21,22,24,49,50,55,[73][74][75][76][77][78][79][80][81][82]. In a sub-analysis, these intervention studies were found to reduce diarrheal disease by 23% (OR = 0.77, 95% CI 0.66, 0.91).…”

“…However, this estimate still includes school-based interventions, which likely follow unique transmission dynamics, and three sewerage studies that possibly drive the observed overall effect of sanitation interventions. In this update, eight new eligible sanitation studies were identified and added to the 11 studies from Wolf et al 2014 [19,21,22,24,[48][49][50][51][52][53]55,58,[77][78][79][87][88][89][90]. Four estimates were extracted from Interventions that led to sanitation coverage of <75% reduced diarrhea by an average of 24% (RR = 0.76, 95% CI = 0.51, 1.13), and those that led to coverage >75% reduced diarrhea by 45% (RR = 0.55, 95% CI 0.34, 0.91).…”

“…But one study with a small confidence interval around a large effect magnitude (RR = 0.31, 95% CI 0.28, 0.34) appears to drive this estimate [21]. The other two sewerage interventions found no effect on diarrhea, but their interpretations are limited by sample size (23 children in the intervention group of Pradhan et al 2002 [22]) and study design (Klasen et al estimated the effect of sewerage by comparing a water plus sewerage intervention to a water intervention, in two geographic regions that had opposite results [77]). The studies that found the largest effect of sanitation on diarrhea were on sewerage (64% reduction), followed by those on interventions including more than sanitation alone (26%), and national survey or DHS data (15%) (Figure 1).…”