American Journal of Epidemiology Vol. 141, No. 2: 135-144
Copyright © 1995 by The Johns Hopkins University School of Hygiene and Public Health
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Environmental Interventions in Developing Countries: Interactions and Their Implications
1University of Texas Health Science Center at Houston, School of Public Health, MPH Program at EI Paso 901 Education Building, UTEP, EI Paso, TX 79968
2Chief, Water and Sanitation Division The World Bank, S4-143 1818 H Street NW, Washington, DC 20433
University of Texas Health Science Center at Houston, School of Public Health, MPH Program at EI Paso, 901 Education Building, UTEP, EI Paso, TX 79968. (Reprint requests to Dr. James VanDerslice at this address.)
This study assesses the effect of drinking water quality on diarrheal disease in good and poor sanitary conditions using a random sample of 2,355 Filipino infants over the first year of life. The study provides powerful confirmation of the importance of environmental factors on diarrhea: The effects of water quality, household sanitation, and community sanitation are strong, consistent, and statistically significant. The positive impact of improved water quality is greatest for families living under good sanitary conditions, with the effect statistically significant when sanitation is measured at the community level but not significant when sanitation is measured at the household level. Improving drinking water quality would have no effect in neighborhoods with very poor environmental sanitation; however, in areas with better community sanitation, reducing the concentration of fecal coliforms by two orders of magnitude would lead to a 40 percent reduction in diarrhea. Providing private excreta disposal would be expected to reduce diarrhea by 42 percent, while eliminating excreta around the house would lead to a 30 percent reduction in diarrhea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved. They also imply that it is not epidemiologic but behavioral, institutional, and economic factors that should correctly determine the priority of interventions.
developing countries; diarrhea, infantile; sanitation; water supply
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