A quarter of a million deaths linked to antimicrobial resistance could be prevented every year with clean water, study finds

20 June 2024
Washing hands, inside the girls toilet block, Lahan Municipality, Siraha, Nepal, July 2022.
Image: WaterAid/ Mani Karmacharya


A remarkable 247,800 deaths linked to antimicrobial resistance (AMR) could be prevented every year simply by providing safe drinking water, sanitation and hygiene in communities, finds new study. This includes simple, cost-effective interventions such as better hand hygiene and more regular cleaning and sterilisation of equipment.

Yet, almost 2 billion people in the world –one in four – don’t even have access to life-saving safe water[1]. This is fuelling a major public health threat, as infectious bacterial diseases spread from country to country and, in turn the need for drugs like antibiotics.  In total, the new study reveals that 750,000 deaths related to AMR could be prevented through a mixture of infection control methods, from water, sanitation and hygiene to available vaccinations.

The data, which comes from a newly published Lancet report, confirms that an estimated 7.7 million deaths globally are caused by bacterial infections – 1 in 8 of all global deaths. Out of these bacterial infection deaths, almost 5 million are associated with bacteria which no longer respond to the antibiotics, designed to kill them.

The evidence speaks for itself. Improvements in water, sanitation and hygiene, as well as other public health interventions, has led to a sharp decline in AMR-related deaths among children under five – as much as 50% between 2000 and 2013, Lancet stats reveal.

This is not only the best solution to combatting the AMR crisis, but also leads to billions of dollars of savings. Recent data from WaterAid highlighted that if infections developed in hospitals were to half across seven countries in sub-Saharan Africa, then a staggering $4.2 billion could be saved as a cost to the economy[2].

Sol Oyuela Executive Director, Global Policy and Campaigns at WaterAid said:

“1 in 8 of all global deaths are now linked to bacterial infections -  diseases that thrive in environments that lack clean water and hygiene and leads to millions of preventable deaths, especially among newborns and children under five. This devastation cannot go on.

“As this new data from Lancet shows, we cannot simply rely on expensive new drugs to fix this problem.  The tools to prevent this tragedy – water, sanitation and hygiene – are widely available and could save a quarter of a million lives every year.

“As leaders prepare to meet at UNGA this September, we are calling on health ministers to reverse the chronic global underinvestment in water, sanitation and hygiene and prioritise preventing the occurrence of infection in the first place - only then will we be able to stop AMR, a global silent killer, in its tracks.”

Healthcare facilities can’t be safe places without clean water, sanitation and hygiene, they can become breeding grounds for bacteria to thrive - leaving medical professionals unable to wash their hands between clients or sterilise equipment during births, and with little choice but to over-prescribe antibiotics to cure patient infections.

In the world’s least developed countries, every two seconds a woman gives birth in a healthcare facility with inadequate water and hygiene[3]. This is having devastating consequences across the world, particularly for vulnerable groups of people. Every 1 in 3 newborn deaths are caused by infections and half of those to sepsis – the immune system’s extreme and life-threatening response to infections which can damage the body’s own tissues and organs.  

But with the right facilities in place, the reality is life-changing.

For example, Joseph Siame, clinical officer at Busolwa has seen first-hand how antibiotic usage can fall drastically when health facilities gain access clean water and handwashing facilities. He said:"The antibiotic use is lower now because our clinic is clean so both mother and child leave without any infection. I haven’t used antibiotics in 5 months, because the environment is health friendly." 

Zelifa Nzoma, a nurse and midwife technician on a maternity ward floor in Nkhuzi Health Centre, Malawi, has also witnessed the life-changing impact clean water has on midwives and their patients. She said: “In the past two months, we have only had one case of sepsis that required the use of antibiotics. As someone working on the maternity ward, I see the change in how we administer antibiotics owing to the easy access to safe and clean water.”

The Lancet study comes ahead of the UN High Level Meeting on AMR this September, which will see global leaders gather to discuss the rising global threat of AMR. WaterAid is calling on health ministers across the world to:

1.    Champion a greater focus on safe water, sanitation and hygiene services as a preventive strategy for AMR.

2.    Integrate safe water, sanitation and hygiene services in public health programs and national AMR action plans. 

3.    Prioritise investment in clean water, sanitation and hygiene in healthcare facilities, communities, schools - the most immediate, cost-effective option for tackling antibiotic resistance - as a matter of urgency.


Notes to Editors:

For more information, please contact: Emma Sutton-Smith, News Manager, [email protected] or call our press line on 020 7793 4537.  

The Lancet Series on Antimicrobial Resistance: The need for sustainable access to effective antibiotics – find here.

WaterAid is an international not-for-profit determined to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. We work alongside communities in 22 countries to secure these three essentials that transform people’s lives. Since 1981, WaterAid has reached 28 million people with clean water and nearly 29 million people with decent toilets.  

For more information, visit our website wateraid.org/uk, follow us on Twitter @WaterAidPress, @WaterAidUK, @WaterAid, or find us on Facebook, LinkedIn or Instagram
•    703 million people in the world – almost one in ten – don’t have clean water close to home.1 
•    2.2 billion people in the world – more than one in four – don’t have safe water.2 
•    1.5 billion people in the world – almost one in five – don’t have a decent toilet of their own.3 
•    Almost 400,000 children under five die every year due to diseases caused by unsafe water, sanitation and hygiene. That's more than 1000 children a day, or almost one child every one and a half minutes.4  
•    Investing in safely managed water, sanitation and hygiene services provides up to 21 times more value than it costs.5