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Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea
C G Victora1, P G Smith, J P Vaughan
1Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Brazil.
Insights
Lack of piped water significantly increases infant diarrhea deaths in Brazil. Improving water access is crucial for child survival and preventing diarrheal diseases.
Area of Science:
- Public Health
- Environmental Epidemiology
- Pediatrics
Background:
- Diarrheal diseases remain a leading cause of infant mortality globally.
- Socioeconomic and environmental factors are known contributors to diarrheal disease risk in infants.
- Understanding specific risk factors in diverse populations is essential for targeted interventions.
Purpose of the Study:
- To investigate the association between social and environmental variables and infant deaths due to diarrhea.
- To identify key modifiable risk factors for diarrheal mortality in infants in southern Brazil.
Main Methods:
- Population-based case-control study conducted in Porto Alegre and Pelotas, Brazil.
- Comparison of infants who died from diarrhea with neighborhood controls.
- Analysis of social and environmental variables including water access, sanitation, housing quality, and overcrowding.
Main Results:
- Initial analysis showed significant associations between diarrhea death risk and lack of piped water, absence of flush toilets, poor housing, and overcrowding.
- After adjusting for confounding variables, only the availability of piped water remained a statistically significant risk factor.
- Infants without easy access to piped water had a 4.8 times higher risk of death from diarrhea compared to those with water piped to their house.
Conclusions:
- The availability of piped water is a critical determinant of infant mortality from diarrhea in the studied Brazilian metropolitan areas.
- Interventions focused on improving household water access are likely to be highly effective in reducing infant deaths from diarrhea.
- While other factors like housing quality showed a near-significant association, water access emerged as the most robust protective factor.
Abstract:
In a population-based case-control study in the metropolitan areas of Porto Alegre and Pelotas in southern Brazil children dying in infancy from diarrhoea were compared to neighbourhood controls in terms of several social and environmental variables. Factors found to be significantly associated with an increased risk of death from diarrhoea included the non-availability of piped water, the absence of a flush toilet, residence in a poorly built house and household overcrowding. When adjustment was made for confounding variables and the mutual confounding effect of the environmental variables on each other, the only association that remained statistically significant was that with the availability of piped water. The association with poor housing was almost significant (p = 0.052). Compared to those with water piped to their house, those without easy access to piped water were found to be 4.8 times more likely to suffer infant death from diarrhoea (95% confidence interval 1.7 to 13.8) and those with water piped to their plot but not to their house had a 1.5 times greater risk (95% confidence interval 0.8 to 3.0).