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January 9, 2004

Inadequate Water and Sanitation Adversely Affect Child Growth

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, “Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community” is published in the January 10, 2004, issue of The Lancet.

Lead author of the study, William Checkley, MD, PhD, an associate in the Department of International Health at the School, 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 further 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 the 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 cm shorter and had 54 percent more diarrheal incidents than those children with the best conditions. A height deficit of 0.9 cm 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 cm 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.

Dr. Checkley said, “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. 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 Institutes of Allergy and Infectious Diseases, and the charitable RG-ER fund.

Robert H. Gilman, Robert E. Black, Leonardo D. Epstein, Lilia Cabrera, Charles R. Sterling, and Lawrence H. Moulton co-authored the study.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Kenna Brigham or Tim Parsons at 410-955-6878 or