Newborn and Infant Health
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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)
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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
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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
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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
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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
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Sierra Leone Case:
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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
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 postcaesarean wound sepsis from 60% to less than 10%
within 3 months. 20
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/childhealth/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
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