Combining clean water, decent toilets and child health measures could save 700,000 children a year, research finds

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Doctor in consultation with child and elderly woman

Combining clean water, decent household toilets and good hygiene with routine childhood vaccinations and nutrition support could potentially save the lives of as many as 697,000 young children annually, and prevent billions of harmful bouts of diarrhoeal illness and pneumonia in under-fives each year, new research from WaterAid and PATH has found.

Nearly half a million children die each year from diarrhoeal illness, more than half of them directly related to dirty water, poor sanitation and poor hygiene. Those who survive multiple bouts of diarrhoea are left weakened and sometimes stunted, their long-term development and education compromised. But major health gains are possible if decision-makers coordinate, integrate and invest in child health and water, sanitation and hygiene measures.

Produced by WaterAid and PATH’s Defeat Diarrheal Disease (Defeat DD) Initiative, this new analysis is published in the report Coordinate, Integrate, Invest: how joint child health and water, sanitation and hygiene (WASH) interventions can deliver for your country’s future.

Modelling has found that rotavirus vaccination – used to immunise children against the most common cause of diarrheal disease – combined with hygiene promotion could lead to nearly twice the reduction in child illnesses, and nearly five times the reduction in child deaths, than rotavirus vaccination alone.

Ensuring 100% coverage with water, sanitation and hygiene, rotavirus vaccination and nutritional interventions such as breastfeeding promotion and zinc supplements could potentially reduce illness by nearly two thirds (63%) and almost halve the number of child deaths (49%) from diarrhoea and pneumonia, the analysis estimates.

An integrated approach combining vaccination and hygiene promotion has been successfully trialled in Nepal by the Ministry of Health with support from WaterAid.

Rosie Wheen, WaterAid Australia Chief Executive, said:

“If children are to grow and thrive, they need clean water, good sanitation and good hygiene alongside good healthcare, vaccinations and good nutrition. Each year, nearly 300,000 young children die of diarrhoea directly linked to dirty water, poor toilets and poor hygiene, and the greatest tragedy of all is that we know how to address this. This study adds to the evidence that the lives of hundreds of thousands of young children could be saved each year if these pillars of development were combined with other health interventions.

“As the World Health Assembly in Geneva approaches, WaterAid is calling on world leaders to ensure that whenever they are investing in health and nutrition, they are also investing in water, sanitation and hygiene. They can save so many lives by combining these efforts.”

Eileen Quinn, Director of PATH’s Defeat Diarrhoeal Disease Initiative, said:

“Diarrhoeal disease is the second leading killer disease of children under five around the world, and even when children survive, they may be left with irreversible physical and cognitive effects. This study provides even stronger evidence that when we combine vaccinations and essential nutritional support with water, sanitation and hygiene, we can prevent illness, save children’s lives and help them to grow and reach their potential. The reason to act is clear; leaders and policy-makers need to coordinate and integrate their efforts, and invest in our children’s health and well-being.”

It’s not just a matter of health – it’s also a matter of wealth. For every US$1 invested in water and sanitation globally, there is a US$4.3 return in the form of reduced healthcare costs.

Countries in Sub-Saharan Africa and South Asia that have not tackled child stunting are facing punishing economic losses of up to 9-10% of GDP per capita, due to the potential lost in children who are stunted. Combining actions on health, nutrition and water, sanitation and hygiene could help to create a more productive workforce and economic growth, lifting countries out of poverty.

The report also highlights examples of where countries are making good progress with integrating health, nutrition, water and sanitation efforts. In Madagascar, for example, the government is using this kind of coordination to tackle high rates of malnutrition. In Nepal, promoting good hygiene during health clinic visits for rotavirus vaccinations is improving parents’ knowledge and actions around food safety, handwashing and safe disposal of children’s faeces, while also improving immunisation coverage and helping to reach those families hardest to reach because of remote locations and poverty.

WaterAid and Defeat DD are calling on governments and donors to align child health and water, sanitation and hygiene programmes, policies and financing to address this unnecessary health crisis more effectively and more efficiently. These investments create a positive cycle that builds human capital, strengthens economies, reduces future healthcare costs and contributes to national development.