Can more children benefit from cleaner water?

Muhammad Zahir Hassan Nabil

Children are one of the most vulnerable populations suffering from the lack of pure drinkable water across the world.

Photo: GMB Akash / icddr,b

Only one percent of the world’s water is accessible freshwater. Poor levels of access to clean drinking water are one of main reasons why the majority of children die from diarrhoea, cites the World Health Organization (WHO).

World Water Day this year reminds us that damaged ecosystems affect the quantity and quality of water available for human consumption.

Infographic: WHO,  UNICEF

The repercussions of contaminated water are not just limited to deaths of children. Research has indicated that waterborne and diarrhoeal diseases, often resulting from contaminated water, haveprofound negative effect on children’s health and growth.

On the other hand, children may thrive better with improvements in water quality and other relevant interventions including nutrition, suggests a new study with icddr,b with collaborators from Stanford University, University of California Berkeley, University of California Davis and Johns Hopkins Bloomberg School of Public Health.

Recently published in the Lancet Child & Adolescent Health, the study provided combined and individual interventions on water, sanitation, handwashing (WASH) and nutrition for over 5000 pregnant mothers and their children right from birth until two years of age.

Children receiving the combined intervention (improved water quality, handwashing, sanitation, and/or nutrition) for about two years have shown benefit in motor, language and behavioural aspects of development than those receiving no intervention.

“Our findings have indicated that children who received WASH and nutrition interventions have better gross-motor abilities, language development, communication skills and personal-social behaviour,” says Dr Fahmida Tofail, scientist at icddr,b nutrition and clinical services division and first author of the study.

“Benefit in different areas of child development from this integrated WASH and nutrition intervention possibly followed a complex pathway - where the children experienced less illnesses, better immunity, improved nutritional status and their mothers faced less troubles and suffered less depression. This may have resulted in better interaction between the children and their mothers,” explains Dr Tofail.

Frequent illnesses hurt growth and development of children. Photo: Shumon Ahmed / icddr,b

“At the same time, these healthier children had more time to explore their surroundings and altogether these may have contributed to their brain development,” she adds.

The intervention also included community health promoters who frequently visited the intervention households with behaviour change communication materials focusing on WASH, food, nutrition and breastfeeding for mothers and children.

When the children were aged about two, the study assessed their communication, gross motor and personal social development in order to understand children’s impulse control, ability to initiate action, ability to sustain attention and their persistence and working memory. At this point the group receiving combined WASH and nutrition intervention demonstrated higher scores, indicating better child development than the control group that did not receive any intervention.

Professor Stephen Luby, senior author of the study from Stanford University, observes that interventions designed to improve water quality, sanitation, handwashing practices, or nutrition provide multiple benefits to children.

“Children who live in cleaner households are healthier, and our findings suggest that this cleaner environment and improved health may also contribute to improved child development. Providing clean drinking water to children save lives and helps communities to thrive,” adds Prof Luby, who is one of the first epidemiologists to examine WASH interventions and child growth and development in resource-limited settings.


Water quality: Addressing the inadequacies

Regrettably, at least 2 billion people worldwide use a drinking water source contaminated with faeces, notes WHO. People in low- and middle-income countries (LMICs) experience more difficulties with children particularly at risk from water-related diseases.

Many water sources are constantly contaminated. Photo: Emdadul Islam Bitu / icddr,b

Around 38% of health care facilities in LMICs lack an improved water source, 19% do not have improved sanitation, and 35% lack water and soap for handwashing. Diarrhoeal diseases claim the lives of around 340,000 children under five every year across the world, mentions WHO and UN.

The new evidence from this icddr,b study, suggesting the beneficial effect of safe water, sanitation and nutrition on child development, reiterates the appeal to make water cleaner and more accessible, particularly for the health and wellbeing of children. Although many children survive from waterborne diseases, they may not attain the anticipated development due to frequent illnesses due to contaminated water, which is often coupled with poor hygiene and sanitation systems.

Infographic: World Water Day

Bangladesh is among the countries with inadequate wastewater treatment as only 17% of wastewater across Bangladesh is treated appropriately, while in Dhaka city around 98% wastewater is unsafely managed, according to the 2017 UN World Water Development report.

This shortfall in wastewater treatment must be addressed by relevant authorities so that water sources are properly replenished and people have access to relatively purer drinking water.