Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania: A Community-Based, Cross-Sectional Analysis

Abstract

Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18–0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27–0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24–0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52–0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65–1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.

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

“…This study revealed that improved sanitation was associated with a 16% reduction in the risk of diarrhea occurrence among under-five children after matching control and treated children. This finding is in agreement with other studies conducted elsewhere [ 17 , 18 , 21 , 22 , 24 , 27 , 28 , 40 ]. A systematic and meta-analysis conducted by Wolf J et al found that improved sanitation interventions can reduce the occurrence of diarrheal diseases by 24% among children in LMICs [ 22 ].…”

“…A study conducted in rural Ethiopia reported that children from households who had no access to toilet facilities were 1.50 to 4.8 times more likely to having of diarrhea compared to children from households who had access to toilet facilities [ 18 , 24 , 27 , 40 ]. Also, a study conducted in rural Tanzania revealed that improved waste management reduced diarrhea risk by 63% among children [ 28 ]. However, previous studies were largely observational and used conventional regression models to investigate the association between access to improved sanitation and diarrhea.…”

“…The provision of an improved drinking water source and sanitation reduced diarrhea risk by 52% and 24%, respectively, in LMICs [ 22 ]. However, most of the previous studies investigated the association between water source and sanitation and diarrhea used the conventional logistic regression model [ 14 , 18 , 22 , 24 – 28 ]. Unlike the conventional logistic regression model, the use of propensity score matched analysis offers a better option compared to conventional logistic regression analyses in controlling for the confounding that may exist in analyzing associations between independent variables and the outcome variable.…”

Evaluation of the effectiveness of some local plant extracts in improving the quality of unsafe water consumed in developing countries

“…These deficiencies unfortunately have serious health consequences such as deaths due to diarrhea caused by the consumption of unsafe water; and economic consequences due to the lack of access to water and sanitation. (Fuente et al, 2020;McClelland et al, 2022). The treatment of raw water before consumption is essential for the preservation of the health and the wellbeing of the populations (Sharma and Bhattacharya, 2017).…”

Community perception of the autodissemination of pyriproxyfen for controlling malaria vectors in south-eastern Tanzania

“…Members of the community indicated that malaria mosquitoes breed in poorly designed toilets and septic tanks, and they strongly advocated for better toilets to control them. While improved toilets are important for preventing waterborne diseases like cholera [ 64 ], it is often non-malaria transmitting mosquitoes, such as Culex quinquefasciatus , that prefer breeding and resting in toilets [ 65 , 66 ]. The misconception that malaria-transmitting mosquitoes breed in toilets clearly highlight continued community’s engagement coupled with education on malariology.…”