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The newspaper of The Johns Hopkins University February 9, 2004 | Vol. 33 No. 21
Inadequate Water and Sanitation Adversely Affect Child Growth

By Kenna Brigham
School of Public Health

Peruvian children with inadequate water supplies and sanitation were found to be shorter and had more episodes of diarrhea, according to research from the Johns Hopkins Bloomberg School of Public Health and other institutions. Past studies have shown that improvements to water supply and sanitation benefit health and improve life expectancy in industrialized countries, but the effect on long-term growth is less clear. The study is published in the Jan. 10 issue of The Lancet.

Lead author William Checkley, an associate in the school's Department of International Health, said, "The public health challenges of unsafe water and inadequate sanitation have plagued humanity for centuries and will continue to do so unless governments make water and sanitation infrastructure improvements one of their first priorities. The poor in most of the developing world either pay more for their access to water or have to travel farther distances to obtain water."

Between April 1995 and December 1998, researchers recruited 230 children at birth from Pampas de San Juan, a community in Lima, Peru, to assess the effects of water and sanitation on linear growth, diarrheal disease and prevalence of parasites. Follow-up with the children was done once a day for diarrhea and once a month for height measurements. Household water and sanitation levels were obtained at the initial recruitment of the children.

Children at 2 years of age with the worst conditions for water source, water storage and sanitation were found to be 1 centimeter shorter and had 54 percent more diarrheal incidents than those children with the best conditions. A height deficit of 0.9 centimeter was also associated with a lack of adequate sewage disposal. The researchers found that a better water source alone did not provide full health benefits. Those children with a water connection but without adequate sewage disposal were 1.8 centimeter shorter than children in households with sewage. These results suggest that more reliable water sources would discourage water storage, which puts the water at risk of being contaminated, and consequently decrease diarrheal occurrences and improve growth in children.

"Better water supply alone does not guarantee full health benefits; our findings underscore the importance of adequate sanitation facilities in developing countries to reduce childhood malnutrition and diarrhea," Checkley said. "We must not fail to recognize that access to safe water and adequate sanitation is not a privilege but a basic human right."

The study was funded by the National Research Service Award of the National Institutes of Child Health and Development, an ICTDR grant of the National Institute of Allergy and Infectious Diseases and the charitable RG-ER fund.

Co-authors of the study from Johns Hopkins were Robert H. Gilman, Robert E. Black and Lawrence H. Moulton.


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