An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality

Bruce K Newbold,Corinne J Schuster-Wallace,Andrew Mente,Susan Watt,June J Cheng

doi:10.1186/1476-069x-11-4

Abstract

BackgroundWater and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality?MethodsData for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR).ResultsUnder-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The 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 = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR.ConclusionsOur analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies.

Highlights

Water and sanitation access are known to be related to newborn, child, and maternal health
In our analyses, increased access to improved water sources was significantly associated with decreased under-five mortality rate, decreased odds of under-five mortality due to diarrhea, decreased infant mortality rate (IMR), and decreased odds of maternal mortality ratio (MMR) in our analyses
After adjustments for Gross National Income (GNI), fertility per woman, MMR, and region of the world as potential confounders, this decrease continued to be significant at p < 0.001, 1.17 (95%CI 1.08-1.26) deaths per 1000

Summary

Introduction

Water and sanitation access are known to be related to newborn, child, and maternal health. A World Health Organization (WHO) report found that almost one tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources [1]. Another estimate reports that 4.0% of all deaths and 5.7% of total disability-adjusted life years can be attributed to water, sanitation, and hygiene [2]. Water quality and Worldwide, 1.4 million children die each year from preventable diarrheal diseases and some 88% of diarrhea cases are related to unsafe water, inadequate sanitation, or insufficient hygiene [2,5]. Children bear 54% of the burden of illness from environmental exposure to chemicals–estimated to be 4.9 million deaths in total worldwide–some of which is caused by exposure through contaminated water [3]

Methods

Results

Discussion

Conclusion