Association between water supply and early childhood development in Palestine: a descriptive analysis of demographic and health survey data

Abstract

BackgroundThe proportion of the Palestinian children who are not on track in their early development is higher than that among their peers in neighboring countries. This study aimed to assess and explain the association between unimproved water supply and early childhood development, and examine its implication for policy and programmes in Palestine. MethodsDemographic and health data obtained from nationally representative surveys were merged and analysed. Descriptive analysis was used to investigate the magnitude and patterns of inadequate access to domestic water supply (running water from household tap) and its association with early childhood development in Palestine. A causal mediation model was used to assess the pathways through which access to domestic water supply interacts with poverty and affects early childhood development. Data were analysed using the structural sequential method and the potential outcome framework, while confounders (such as age, sex, and mother's education) were controlled for using bootstrapping and propensity matching tests. Ecological data about multidimensional socioeconomic, health, and environmental conditions in 52 communities in the West Bank, Jerusalem, and Gaza were gathered. Data were analysed using Z score (level of dispersion) to develop a single summary measure capturing the multidimensional influence of water supply on children's wellbeing and development at the community level. FindingsFor one standard deviation increase in the access to unimproved water supply, a 0·308 increase was predicted for child underdevelopment due to indirect effect mediated by poverty, and a 0·084 increase due to direct effect. The ecological data indicated that the average Z score of unimproved water supply variables in the target communities could be indicative of possible low scores of early childhood development. InterpretationInadequate water supply might exacerbate the negative effects of poverty and inadequate family care on early childhood health and development. These findings suggest that holistic perspectives are needed in systems and interventions to monitor child wellbeing and development. FundingNone.