Community Water and Sanitation Programs Boost Child Health and Local Groups

Jenn Hoskins
7th March, 2025

Community Water and Sanitation Programs Boost Child Health and Local Groups

The overlapping distributions of length-for-age Z-scores in intervention versus control children demonstrate that the community-driven WASH program did not improve child linear growth, reinforcing the study’s main finding of no effect on growth faltering despite sustained gains in WASH infrastructure and institutions.

Image adapted from: Quattrochi et al. / CC BY (Source)

Key Findings

  • In the Democratic Republic of Congo, a national clean water and sanitation program successfully provided better water sources and improved latrines to rural villages
  • Even with these infrastructure upgrades, the program did not significantly lower diarrhea rates or boost children's growth
  • The results indicate that alongside clean water and sanitation, additional health and nutrition initiatives are necessary to enhance child health outcomes
Access to clean water and adequate sanitation is fundamental for healthy childhood development. Diarrhea and growth faltering in early childhood are significant health challenges in many developing countries, leading to increased mortality and long-term cognitive impairments. Addressing these issues through improvements in water, sanitation, and hygiene (WASH) has been a key focus for global health initiatives. A recent study conducted by Georgetown University[1] sheds new light on the effectiveness of large-scale WASH programs in reducing these health problems. The study aimed to evaluate whether a national WASH program in the Democratic Republic of Congo (DRC) could decrease the prevalence of diarrhea and stunting among children under five years old. Diarrhea is a leading cause of mortality in young children, and stunting—a condition where children have reduced growth rates—is closely linked to cognitive and educational difficulties later in life[2]. By improving WASH infrastructure, the program hoped to mitigate these adverse health outcomes and promote better developmental prospects for millions of children. To assess the program's impact, researchers conducted a cluster-randomized controlled trial involving 332 rural villages across four provinces in the DRC. These villages were divided into 121 clusters, with 50 clusters receiving the WASH intervention and 71 serving as control groups. The intervention included funding for upgrading latrines and water sources, strengthening local institutions responsible for WASH, and running behavior change campaigns to encourage better hygiene practices. Data were collected from over 3,200 households between November 2022 and April 2023, approximately three and a half years after the intervention began. The results revealed that the WASH program successfully increased access to improved water and sanitation facilities. Households in the intervention villages were significantly more likely to use enhanced water sources and sanitation facilities compared to those in control villages. Additionally, the creation of new WASH institutions contributed to better local governance of water and sanitation resources. These improvements are consistent with earlier findings that highlight the substantial burden of disease attributable to unsafe WASH conditions[2]. However, despite these positive changes in infrastructure and institutional support, the study found no significant reduction in the prevalence of diarrhea or improvements in children's growth measurements. Diarrhea rates remained high, with 38% of children in the treatment group and 42% in the control group experiencing diarrhea in the past week. Similarly, there was no meaningful change in length-for-age Z-scores, a key indicator of child growth and development. Several factors may explain why the WASH improvements did not translate into better health outcomes. The study noted an 86% adherence rate to the intervention, meaning that not all planned upgrades and campaigns were fully implemented. Additionally, the absence of baseline health measures makes it difficult to assess the full impact of the program. High baseline rates of diarrhea suggest that other underlying issues, such as inadequate healthcare access or persistent environmental contamination, might have limited the program's effectiveness[3][4]. Moreover, previous research has shown that child development is influenced by a complex interplay of factors including nutrition, poverty, and the quality of the home environment[3][4]. While improving WASH infrastructure is crucial, it may not be sufficient on its own to address all the determinants of child health and development. Comprehensive approaches that integrate WASH with nutrition programs, healthcare services, and educational initiatives are likely necessary to achieve significant reductions in disease burden and to support optimal child development. The findings from Georgetown University's study emphasize the importance of not only implementing WASH interventions but also ensuring their effective and comprehensive integration with other health and social services. This aligns with earlier research indicating that multi-sectoral strategies are essential for tackling the multifaceted causes of child stunting and poor development[2][3][4]. In conclusion, while the national WASH program in the DRC succeeded in enhancing water and sanitation infrastructure and establishing local institutions, these efforts alone were insufficient to reduce diarrhea rates or improve child growth outcomes. This underscores the need for more holistic and integrated approaches to child health and development, combining WASH improvements with additional interventions targeting nutrition, healthcare access, and socio-economic factors.

EnvironmentHealth

References

Main Study

1) Effects of a community-driven water, sanitation, and hygiene intervention on diarrhea, child growth, and local institutions: A cluster-randomized controlled trial in rural Democratic Republic of Congo

Published 6th March, 2025

https://doi.org/10.1371/journal.pmed.1004524

Related Studies

2) Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes.

https://doi.org/10.1016/S0140-6736(23)00458-0

3) Developmental potential in the first 5 years for children in developing countries.

Journal: Lancet (London, England), Issue: Vol 369, Issue 9555, Jan 2007

4) Early childhood development coming of age: science through the life course.

https://doi.org/10.1016/S0140-6736(16)31389-7


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