Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community

William Checkley*, Robert H. Gilman, Robert E. Black, Leonardo D. Epstein, Lilia Cabrera, Charles R. Sterling, Lawrence H. Moulton

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

192 Scopus citations


Background: Inadequate water and sanitation adversely affect the health of children in developing countries. We aimed to assess the effects of water and sanitation on childhood health in a birth cohort of Peruvian children. Methods: We followed up children once a day for diarrhoea and once a month for anthropometry, and obtained data for household water and sanitation at baseline. Findings: At 24 months of age, children with the worst conditions for water source, water storage, and sanitation were 1.0 cm (95% CI 0.1-0.8) shorter and had 54% (-1 to 240) more diarrhoeal episodes than did those with the best conditions. Children from households with small storage containers had 28% (1-63) more diarrhoeal episodes than did children from households with large containers. Lack of adequate sewage disposal explained a height deficit of 0.9 cm (0.2-1.7) at 24 months of age. Better water source alone did not accomplish full health benefits. In 24-month-old children from households with a water connection, those in households without adequate sewage disposal and with small storage containers were 1.8 cm (0.1-3.6) shorter than children in households with sewage and with large storage containers. Interpretation: Our findings show that nutritional status is a useful endpoint for water and sanitation interventions and underscores the need to improve sanitation in developing countries. Improved and more reliable water sources should discourage water storage at risk of becoming contaminated, decrease diarrhoeal incidence, and improve linear growth in children.

Original languageEnglish
Pages (from-to)112-118
Number of pages7
JournalThe Lancet
Issue number9403
StatePublished - 10 Jan 2004
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by a National Research Service Award of the National Institutes of Child Health and Development (F31-HD08488) awarded to W Checkley, an ICTDR grant of the National Institutes of Allergy and Infectious Diseases awarded to The Johns Hopkins School of Public Health (U01-A135894), and by the charitable RG-ER fund, concerned with childhood health in developing countries. We thank M D Chestnut for her substantive contributions to this manuscript, and J B Phu and D Sara for their technical assistance.


  • Anthropometry
  • Article
  • Cohort analysis
  • Community care
  • Container
  • Controlled study
  • Developing country
  • Diarrhea
  • Health care
  • Human
  • Infant
  • Major clinical study
  • Newborn
  • Nutritional status
  • Patient care
  • Preschool child
  • Priority journal
  • Risk factor
  • Sanitation
  • Sewage disposal
  • Water contamination
  • Water supply


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