Water and Children

Image 1: Map showing the varying risks for childhood stunting across the globe

Acute diarrheal infections are one of the most devastating diseases impacting children in resource poor nations.  Although direct impacts such as administering oral medication may be helpful in the short run, interventions in the non-health sector such as securing clean water may have a much more sustainable impact. The United Nations’ new objectives under the Sustainable Development Goals (SDG’s) have started to highlight the importance of a holistic approach to addressing public health issues in regions such as sub-Saharan Africa. Across the world, an estimated 2.4 billion people do not have access to safe water sources and over 800,000 children die from diseases related to poor sanitation conditions each year.

I’ve mentioned that diarrheal diseases have the highest impact on young children but you may be wondering in what ways? Besides being one of the leading causes of morbidity, diarrheal diseases can cause significant stunting, micronutrient malnutrition, impaired cognition and environmental enteropathy, also known as intestinal inflammation. These developmental outcomes in children usually lead to early onset of mortality as adults.

Image 2: Graphic highlighting intestinal inflammation due to environmental pathogens such as contaminated fecal matter.

In a study examining the benefits of WASH in western Kenya, a cluster-randomized trial was conducted on rural villagers with unimproved sanitation facilities. After establishing a control group, the researchers appointed six intervention groups that would receive latrines, water treatment, and/or training sessions on hand-washing in addition to soap supply. The fully delineated groups were: 1. Hand-washing 2. Latrines 3. Water Treatment 4. Hand-washing and latrines 5. Water treatment and latrines 6. Hand-washing, latrines, and water treatment. In addition, households with infants were given micronutrient supplements.

Unfortunately, the results were not as expected. Throughout the two years that this study was conducted in western Kenya, community adherence to intervention practices fell tremendously. By the end of the two years, only 20% of households were utilizing hand-washing facilities and 40% were using latrines. However, household adherence to supplement usage remained comparably high. This particular study did not find that WASH interventions improved water quality, hand-washing, and sanitation practices. Consequently, the interventions did not improve incidences of diarrhea in children under the age of two, nor did it improve hygienic behavior in children. However, the study suggests that within the two year span in which micronutrient supplements were handed out, children met development projections and avoided childhood stunting.

I wanted to highlight this study to show that material interventions can only go so far. If the community does not utilize the resources correctly - or at all - then the expected health outcomes cannot be realized. In addition, this study did not focus on community engagement or community based health management, which could be one of the reasons why adherence rates were so low. One thing I would like to emphasize is that just because the WASH interventions did not yield the desired outcomes does not mean that short term solutions such as dietary supplements and oral medication should be given priority amongst global public health initiatives. In the long run, addressing problems such as clean water, hand-washing, open-defecation, and other sanitary deficits may be a better, more sustainable, approach to addressing the prevalence of diarrheal diseases in children.