Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: a propensity score matched analysis

Abstract

Background Diarrhea, the second leading cause of child morbidity and mortality worldwide, is responsible for more than 90% of deaths in children under 5 years of age in low and middle-income countries (LMICs). The high burden of diarrhea is mainly attributable to the limited access to improved water and sanitation. However, the impacts of improved sanitation and drinking water in preventing diarrheal diseases are not well understood. Therefore, this study estimated both the independent and joint effects of improved sanitation and water on diarrhea occurrence among rural under-five children in LMICs. Methods The current study utilized secondary data from the Demographic and Health Survey (DHS) datasets conducted between 2016 and 2021 in 27 LMICs. A total weighted sample of 330,866 under-five children was included in the study. We employed propensity score matching analysis (PSMA) to examine the effects of accessing improved water and sanitation on childhood diarrheal disease reduction. Results The prevalence of diarrhea among children under 5 years of age in rural LMICs was 11.02% (95% CI; 10.91%, 11.31%). The probability of developing diarrhea among under-five children from households with improved sanitation and water was 16.6% (Average Treatment Effect on the Treated (ATT) = − 0.166) and 7.4% (ATT = − 0.074) times less likely among those from households with unimproved sanitation and water, respectively. Access to improved water and sanitation is significantly associated with a 24.5% (ATT = − 0.245) reduction of diarrheal disease among under-five children. Conclusions Improved sanitation and drinking water source reduced the risk of diarrhea among under-five children in LMIC. The effects of both interventions (improved water and sanitation) had a larger impact on the reduction of diarrheal disease than the improvements to water or sanitation alone. Therefore, achieving Sustainable Development Goal 6 (SDG 6) is key to reducing diarrhea among rural under-five children.

Measuring water poverty based on SDG 6

“…A plausible mechanism would be that as water poverty increases, the prevalence of diarrhea also increases. Previous evidence suggests that access to quality water and sanitation reduces the risk of diarrhea (WHO 2014, Cha et al, 2015, WHO, 2019, Ko & Sakai, 2022, Merid et al, 2023. From the policy perspective, this is quite important, since diarrhea is the second most prevalent cause of morbidity and hospitalization among children in Ecuador (S anchez et al, 2023).…”

Water woes: the institutional challenges in achieving SDG 6

“…These issues extend beyond mere statistics and observations; they underline broken commitments, poor governance, and reluctance to work together in championing sustainable solutions. If we don't quadruple our current progress rate for SDG6, billions will still lack access to clean water and sanitation by 2030 [13]. Yet, there is little evidence that any acceleration in effort is occurring or emerging [14].…”

Prevalence and Antimicrobial Resistance of Campylobacter Species and Associated Factors Among Under-Five Children with Diarrhea at Randomly Selected Public Health Facilities in Mekelle, Tigray, Ethiopia

“… 1 Diarrheal illness is a major health problem in the world, principally in low- and middle-income countries. 2 , 3 It is the second most important infectious cause of death, accounting for 9.2% of deaths in under-five children across the globe. 1 , 4 Of these, 90% of the death rate among under-five children due to diarrhea happens in low- and middle-income countries, 5 and 46% in African continents.…”