Access to improved water sources and sanitation reduces a nation’s infant mortality rate. One study found that the infant mortality rate decreases by 1.14 deaths per 1000 live births with increased access to an improved water source. The rate decreases by 1.66 with increased access to improved sanitation. 1 Simple hygiene practices during antenatal care, labor, and birth can reduce the risk of infections, sepsis, and death for infants and mothers by up to 25 percent. 2 Handwashing, food hygiene, and household hygiene combined reduces infant diarrhea by more than 33 percent. 3, 4 Safe excreta disposal can reduce the risk of infant diarrhea by up to 37 percent. 4, Handwashing with soap by both birth attendants and mothers results in a 41 percent reduction of neonatal mortality. 5
Child Health (2-5 years)
Diarrhea is a leading cause of death in children under five years old.6 Fifty percent of global malnutrition is associated with diseases such as diarrhea and intestinal worms due to a lack of safe drinking water, sanitation, and hygiene. 25 percent of stunting cases can be attributed to five or more episodes of diarrhea before the age of two. 7, 8 In 2013, approximately 1,600 children died each day due to diarrhea, or about 580,000 children total.9 Decreasing the one-way walking time to collect water by fifteen minutes is associated with a 41 percent reduction in diarrheal disease and an 11 percent relative reduction in under-five child mortality. 10 Regular handwashing by children during their first 30 months of age results in important gains in global developmental quotients such as height, weight, and social skills. 11
Maternal Health
Access to an improved nearby water source can decrease maternal mortality by reducing the risk of intestinal worms and thus anemia and diarrheal diseases, which can cause nutritional deficiencies and hepatitis. 12 Infections that can be directly linked to unhygienic conditions during labor and birth, at home or in facilities, and to poor hygiene practices after birth lead to 8 percent of global maternal deaths, and approximately 10-15 percent of maternal deaths in developing countries. 13, 14, 15 The causes of maternal death are mostly preventable including sepsis, which causes 11 percent of maternal deaths.16 Sepsis can be caused by unhygienic conditions and poor infection control practices during delivery. 17 About 18.5 percent of births in Bangladesh and 9.6 percent of births in India that occur in homes lack access to improved water and/or sanitation.18
Sierra Leone Case:
o Post-caesarean section wound sepsis stood at 60% at a hospital that lacked sufficient water and lighting, prolonging hospital stay up to 1 month in some cases. 20 o The maternity and neonatal unit were reconstructed and
staff were trained in basic WASH principles and wound care. Results led to a dramatic reduction in post- caesarean wound sepsis from 60% to less than 10% within 3 months. 20
1 Cheng JJ, Schuster-Wallace CJ, Watt S, Newbold BK, Mente A. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environ Health 2012; 11: 4. 2 Blencowe H, Cousens S, Mullany LC, et al. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect. BMC Public Health 2011; 11 Suppl 3: S11. 3 Waddington H, Snilstveit B. Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea. J Dev Eff 2009; 1: 295–335. 4 Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane database Syst Rev 2008: CD004265. 5 Rhee, V., et al. (2008). Impact of maternal and birth attendant hand-washing on neonatal mortality in Southern Nepal. Archives of Pediatrics & Adolescent Medicine 162(7): 603-608. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587156/ 6 Children: Reducing mortality. (2014, September 1). Retrieved from http://www.who.int/mediacentre/factsheets/fs178/en/ 7 Pruss-Ustun A, Bos R, Gore F, Bartram J. Safer water, better health, World Health Organization, 2008. 8 Walker CLF, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381: 1405–16. 9 COVERAGE OF RECOMMENDED TREATMENT. (2014, November). Retrieved from http://data.unicef.org/child- health/diarrhoeal-disease 10 Davis, J. & Pickering, J. (2012). Freshwater availability and water fetching distance affect child health in sub-Saharan Africa. Environmental Science and Technology 46(4):2391-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22242546 11 Bowen, A., Agboatwalla, M.. Luby, S., Tobery, T., Ayers, T., & Hoekstra, R. (2012). Association between handwashing promotion and child development in Karachi, Pakistan. Archives of Pediatrics & Adolescent Medicine 166(11):1-8. Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=1360890#tab1 12 Cheng JJ, Schuster-Wallace CJ, Watt S, Newbold BK, Mente A. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environ Health 2012; 11: 4. 13 Goodburn E, Campbell O. Reducing maternal mortality in the developing world: sector-wide approaches may be the key. BMJ 2001; 322: 917–20. 14 Gravett CA, Gravett MG, Martin ET, et al. Serious and life-threatening pregnancy-related infections: opportunities to reduce the global burden. PLoS Med 2012; 9: e1001324. 15 Simavi. Getting It Right: Imporving maternal health through water sanitation & hygiene, 2012. 16 Say L et al. 2014. 17 Seale, A., Mwaniki, M., Newton, C., & Berkley, J. (2009). Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa. Lancet Infectious Diseases 9(7), 428-438. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2856817/ 18 Benova L, Cumming O, Gordon BA, Magoma M, Campbell OM (2014) Where there is no toilet: water and sanitation environments of domestic and facility births in Tanzania. PLoS ONE 9: e106738. doi: 10.1371/journal.pone.0106738 20 Velleman Y, Mason E, Graham W, Benova L, Chopra M, et al. (2014) From Joint Thinking to Joint Action: A Call to Action on Improving Water, Sanitation, and Hygiene for Maternal and Newborn Health. PLoS Med 11(12): e1001771. doi:10.1371/journal.pmed.1001771