WASH’ Nutrition

Figure 13: Effect of improvements in drinking water and sanitation on diarrhea disease risk
UNIMPROVED SOURCE OF DRINKING-WATER
HIGH
11%
23%
IMPROVED POINT SOURCE
OF DRINKING-WATER
14%
BASIC PIPED WATER ON
PREMISES
73%
28%
38%
45%
RISK TO HEATH
PIPED WATER,
SYSTEMATICALLY
MANAGED
WATER EFFICIENTLY
TREATED AND SAFELY
STORED IN THE
HOUSEHOLD
LOW
UNIMPROVED SANITATION FACILITIES
HIGH
16%
69%
IMPROVED SANITATION
WITHOUT SEWER
CONNECTIONS
63%
28%
GROUPED: IMPROVED
SANITATION (INCLUDING
SEWER CONNECTIONS)
RISK TO HEATH
COMMUNITY SANITTAION OR SEWER
CONNECTIONS
LOW
Source: WHO, 2014
Current research also confirms that water, sanitation and hygiene interventions prevent intestinal parasitic infections and
other diseases associated with poor nutritional status. 78 For example, access to and use of facilities for the safe disposal of
human excreta have been shown to reduce the risk of soil-transmitted nematode infections by 34% and use of treated water
by 54%. 79 Children under five in households that received plain soap and hand washing promotion had a 50% lower incidence
of pneumonia than in control groups. 80 Approximately 42% of the global malaria burden could be prevented by environmental
management, including removing stagnant or slowly moving fresh water and drainage. 81
The etiology of EED remains unclear. Nutritional deficiencies, specially zinc and vitamin A deficiencies, imbalances of gut
microbiome, Helicobacter pilori presence and bacterial overgrowth, mycotoxins or HIV infection, seems to contribute to the
multicausality of EED. EED has been associated with linear growth faltering in several studies and it is currently proposed as
the primary causal pathway from poor sanitation and hygiene to stunting, rather than diarrhea or soil-transmitted helminths. 82
78 - Pruss-Ustun A et al (2008) “The impact of the environment on health by country: a meta-synthesis”
79 - Strunz et al, 2014
80 - Luby, 2005
81 - WHO (2016) “Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks”
82 - Baby wash and the 1000 days, a practical package for stunting reduction, ACF-Spain, 2017
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WASH’Nutrition
A practical guidebook