WATER, WASTE, AND WELL-BEING - A MULTICOUNTRY STUDY

Data collected in the late 1980s from eight countries in Sub-Saharan A frica (Burundi, Ghana, Togo, and Uganda), Asia/North Africa (Sri Lanka and Morocco), and the Americas (Bolivia and Guatemala) were combined and analyzed to test whether incremental health effects regarding diar rhea and nutritional status result from incremental improvements in wa ter and sanitation conditions. Rural (n = 11,992) and urban (n = 4,888 ) samples were analyzed separately. Optimal (i.e., on the premises) an d intermediate (improved public water) water supplies were compared wi th unimproved water conditions. Optimal (flush toilets or water-seal l atrines) and intermediate (latrines) sanitation levels were compared w ith unimproved sanitation. Nationally representative (random) samples of ever-married women aged 15-49 years, with or without children, were interviewed in all countries, and children aged 3-36 months with avai lable weight and height data were included in the analyses, Multiple l inear regression controlled for household, maternal, and child-level v ariables; in addition, dummy variables were included for each country. Improvements in sanitation resulted in less diarrhea and in taller an d heavier children with each of the three levels of water supply, Incr emental benefits in sanitation were associated with less diarrhea and with additional increases in the weights and heights of children. The effects of improved sanitation were greater among urban dwellers than among rural dwellers. Health benefits from improved water were less pr onounced than those for sanitation. Benefits from improved water occur red only when sanitation was improved and only when optimal water was present, These findings suggest that public health interventions shoul d balance epidemiologic data with the cost of services and the demand for water. There should be efforts to develop compatible technologies so that incremental improvements in service can be made.