Environmental interventions in developing countries: interactions and their implications

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.