CoChat
Sign Up
Cited by 168Child Nutrition and Water AccessGlobal Maternal and Child HealthWater Resource Management and Quality

An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.

Open access
Cheng, June J, Schuster-Wallace, Corinne J, Watt, Susan, Newbold, Bruce K, Mente, Andrew·2012·Environmental Health
DOI 10.1186/1476-069x-11-4PMC PMC3293047
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? METHODS: Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). RESULTS: Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. CONCLUSIONS: Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/1476-069x-11-4

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Two global studies and one focused on sub-Saharan Africa found increased access to improved water and sanitation to be significantly associated with decreased maternal mortality.

    “Two global studies (with data from 193 [284] and 144 [286] countries) and one focused on sub-Saharan Africa [287] found increased access to improved water and sanitation to be significantly associated with decreased maternal mortality.”

    From Water, sanitation, and women’s empowerment: A systematic review and qualitative metasynthesis (2022) · cites this paper as [284]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Cheng, J. J., Schuster-Wallace, C. J., Watt, S., Newbold, B. K., & Mente, A.
Affiliations
  • McMaster University (CA)
  • United Nations University Institute for Water, Environment, and Health (CA)
  • Hamilton General Hospital (CA)
Corresponding author
Cheng, June J
ORCID
Venue
Environmental Health
Publisher
Springer Science and Business Media LLC
Published
2012-01-27
Volume
11
Issue
1
Pages
4-4
ISSN
1476-069X (ISSN-L)
DOI
10.1186/1476-069x-11-4
PMC
PMC3293047
OpenAlex
W2169242337
Cited by
168
References
31
Citations by year
2026: 6 · 2025: 8 · 2024: 12 · 2023: 14 · 2022: 12 · 2021: 10 · 2020: 12 · 2019: 13 · 2018: 11 · 2017: 17 · 2016: 12 · 2015: 13 · 2014: 19 · 2013: 8 · 2012: 1
FWCI
12.21
Type
journal article
Language
en
Open access
Licence
Locations
  • Environmental Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HARVEST (University of Saskatchewan) (submittedVersion, cc-by)
  • UNU Collections (United Nations University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Hamilton Health Sciences
  • McMaster University
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
Keywords
water access, sanitation access, infant mortality, child mortality, maternal mortality, under-five mortality, Millennium Development Goals, global health, country-level data, Millennium Development Goal 7, Millennium Development Goal 5
MeSH terms
Child, Preschool, Developing Countries, Female, Humans, Infant, Infant Mortality, Infant, Newborn, Maternal Mortality, Sanitation, Water Supply, Linear Models, Logistic Models, Odds Ratio, Developed Countries, Child Mortality

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review