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

8 May 2018
Children, Health
Image: WaterAid/Ernest Randriarimalala

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.

To read the report please click here.

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.

Margaret Batty, director of global policy and campaigns at WaterAid, 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.


For photos from Zambia click here.

For photos from Madagascar click here.

For photos from Nepal click here.

For photos from Cambodia click here.

For more information, please contact:

WaterAid in London:
Carolynne Wheeler, News Manager
[email protected] or +44 (0)207 793 4485

WaterAid in the US:
Emily Haile, Senior Communications and Media Manager
[email protected]

PATH in the US:
Eileen Quinn, Director, PATH’s Defeat Diarrhoeal Disease Initiative
[email protected] or +1 202 765 4240.

Or call WaterAid’s after-hours press line on +44 (0)7887 521 552 or email [email protected]

Notes to Editors:

WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. The international not-for-profit organisation works in 34 countries to change the lives of the poorest and most marginalised people. Since 1981, WaterAid has reached 25.8 million people with clean water and 25.1 million people with decent toilets. For more information, visit, follow @wateraid or @WaterAidPress on Twitter, or find WaterAid UK on Facebook at

  • 844 million people in the world – one in nine – do not have clean water close to home.[1]
  • 2.3 billion people in the world – almost one in three – do not have a decent toilet of their own.[2]
  • Around 289,000 children under five die every year from diarrhoeal diseases caused by poor water and sanitation.That's almost 800 children a day, or one child every two minutes.[3]
  • Every £1 invested in water and toilets returns an average of £4 in increased productivity.[4]
  • Just £24 can provide one person with clean water.[5]
  • To find out if countries are keeping their promises on water and sanitation, see the online database

PATH's Defeat Diarrheal Disease Initiative works to raise awareness of the burden of diarrheal disease and help increase access to the solutions by coordinating advocacy across the health, nutrition, and WASH sectors to promote integrated policies and practices.

[1] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines

[2] WHO/UNICEF Joint Monitoring Programme (JMP) Progress on drinking water, sanitation and hygiene: 2017 update and SDG Baselines


[4] World Health organization (2012) Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage