Vaccination and better hygiene could save 700,000 lives annually

8 May 2018
Individuals, Hygiene, Health
Nurse administers an anti-diarrhea vaccine to a baby at Mwanza Clinic in Monze District, Zambia.
Image: WaterAid/PATH/Chileshe Chanda
Even if we give vaccinations against diarrhea to children, they still get sick if they drink dirty water and ignore other hygiene practices.
Lennie N'gun, Nurse, Mwanza Clinic in Monze District, Zambia. (pictured above)

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 children annually, and prevent billions of cases of diarrheal illness and pneumonia in children under-five, new research from WaterAid and PATH has found.

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

72-year Heng with her granddaughter, 2-year-old Chinh, who is often sick. “My granddaughter drank a lot of water, and became sick with diarrhoea and fever.” The family almost never use soap for handwashing. “I don’t have money for soap.”
WaterAid/PATH/Philong Sovan

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 immunize children against the most common cause of diarrheal disease – combined with hygiene promotion could reduce child illnesses twofold, and reduce child deaths nearly five times the 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 diarrhea and pneumonia, according to the report.

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

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

Diarrheal 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.

A side-by-side comparison of water from the river and water from the newly installed tap in Andranomiady village, Madagascar.
A side-by-side comparison of water from the river and water from the newly installed tap. WaterAid/PATH/Ernest Randriarimalala

Lisa Schechtman, Director of Policy and Advocacy at WaterAid, said:

Clean water, sanitation and hygiene are among the most important and efficient investments a government can make. The American public consistently selects clean water as its top priority for U.S. global health investments, while the integration of water, sanitation and hygiene with health services has had bipartisan support for more than a decade. When foreign aid funding is threatened, this research is critical because it reminds us how impactful clean water can be in the health of millions of children worldwide.

It’s not just a matter of health – it’s also a matter of wealth. For every U.S. $1 invested in water and sanitation globally, there is a U.S. $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 countries that are making progress with integrating health, nutrition, water and sanitation efforts. In Madagascar, the government is using this kind of coordination to tackle high rates of malnutrition. In Nepal, promoting good hygiene during vaccination visits provides vital education for parents around food safety, handwashing and waste management.

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 efficiently. These investments create a positive cycle that builds human capital, strengthens economies, reduces future healthcare costs and contributes to national development.

In the U.S., the recent transformation of USAID provides a critical opportunity for the Agency to improve accountability to health outcomes of WASH pursuant to the Water for the World Act of 2014; WaterAid calls on USAID Administrator Mark Green to focus on the reduction of child mortality through improved integration of WASH and health and on Congress to continue its robust support of both programs in fiscal year 2019 and beyond, including by providing $410 million in funding for WASH.

Congress must now focus on preserving investments in foreign aid, including in child health and water, sanitation and hygiene. Keeping children healthy worldwide benefits everyone, at home and abroad, through improved economies, public health, and security. We must now follow the evidence, and jointly invest in health and nutrition with water, sanitation and hygiene to get the most for taxpayer dollars and lay the groundwork for a stronger world.
Lisa Schechtman, Director of Policy and Advocacy, WaterAid

To find out if countries are keeping their promises on water and sanitation, see the online database 


About PATH
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.