Water system unreliability and diarrhea incidence among children in Guatemala
This article examines the effect of water system unreliability on diarrhea incidence among children aged 0–5 in Guatemala.
We use secondary data from a nationally representative sample of 7579 children to estimate the effects of uninterrupted and interrupted water services on diarrhea incidence. The national scope of this study imposes some methodological challenges due to unobserved geographical heterogeneity. To address this issue, we estimate mixed-effects logit models that control for unobserved heterogeneity by estimating random effects of selected covariates that can vary across geographical areas (i.e. water system reliability).
Compared to children without access to piped water, children with uninterrupted water services have a lower probability of diarrhea incidence by approximately 33 percentage points. Conversely, there is no differential effect between children without access and those with at least one day of service interruptions in the previous month. Results also confirm negative effects of age, female gender, spanish language, and garbage disposal on diarrhea incidence.
Public health benefits of piped water are realized through uninterrupted provision of service, not merely access. Policy implications are discussed.
KeywordsGuatemala Diarrheal incidence Morbidity Tap water Service interruptions
Compliance with ethical standards
Conflict of interest
We certify that there is no external funding for this research nor does any participant benefit from the results of the study.
Research involving human participants and/or animals
Our research utilizes secondary data that was previously collected in Guatemala.
Our research utilizes secondary data and thus does not require informed consent.
- Cairncross S, Valdmanis V (2006) Water supply, sanitation, and hygiene promotion. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M (eds) Disease Control Priorities in Developing Countries, 2nd edn. The International Bank for Reconstruction and Development/The World Bank, Washington (DC). Chapter 41. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11755/Co-published by Oxford University Press, New York
- Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, Molbak K, Valentiner-Branth P, Lanata CF, Black RE (2008) The childhood malnutrition and infection network. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol 37(4):816–830. https://doi.org/10.1093/ije/dyn099 CrossRefPubMedPubMedCentralGoogle Scholar
- Edwards J (2002) Education and Poverty in Guatemala, World Bank Guatemala Poverty Assessment Program (GUAPA) Technical Paper No. 3Google Scholar
- Evans B, Bartram J, Hunter P, Williams AR, Geere J, Majuru B, Bates L, Fisher M, Overbo A, Schmidt W (2013) Public health and social benefits of at-house water supplies. University of Leeds, Leeds, pp 1–61Google Scholar
- Jeandron A, Saidi JM, Kapama A, Burhole M, Birembano F, Vandevelde T, Gasparrini A, Armstong B, Cairncross S, Ensink JHJ (2015) Water supply Interruptions and suspected cholera incidence: a time-series regression in the Democratic Republic of the Congo. PLOS Med 12(10):e1001893. https://doi.org/10.1371/journal.pmed.1001893 CrossRefPubMedPubMedCentralGoogle Scholar
- Matsinhe NP, Juizo DL, Persson KM (2014) The effect of intermittent supply and household storage in the quality of drinking water in Maputo. J Water Manag Res 70:51–60Google Scholar
- Prüss-Üstün A, Bos R, Gore F, Bartram J (2008) Safe water, better health: Costs, benefits, and sustainability of interventions to protect and promote health. World Health Organization, GenevaGoogle Scholar
- SEGEPLAN (2015) Informe Final del cumplimiento de los objetivos de desarrollo del milenio. Secretaría de Planificación y Programación de la Presidencia (SEGEPLAN), GuatemalaGoogle Scholar
- Thompson J, Porras I, Tumwine J, Mujwahuzi M, Katui-Katua M, Johnstone N, Wood L (2000) Drawers of water ii: thirty years of change in domestic water use and environmental health in East Africa. International Institute for Environment and Development. Russell Press, NottinghamGoogle Scholar
- UNICEF (2015) https://data.unicef.org/topic/child-health/diarrhoeal-disease/. Accessed 5 February 2017
- Vásquez WF (2016b) La gestión de los servicios comunitarios de agua potable en Guatemala. In: Sánchez Medero G, Sánchez Medero R (eds) Guatemala: Gobierno, Gobernabilidad, Poder Local y Recursos Naturales. Tirant Humanidades, ValenciaGoogle Scholar
- Waddington H, Snilstveit B, White H, Fewtrell L (2009) Water, sanitation and hygiene interventions to combat childhood diarrhea in developing countries. International Initiative for Impact Evaluation, New DelhiGoogle Scholar
- World Health Organization (2015a) Global Burden of Disease: Disease burden estimates for 2000–2015. http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html. Accessed 7 February 2015
- World Health Organization (2015b) Country profiles on neonatal and child health. http://www.who.int/maternal_child_adolescent/epidemiology/profiles/neonatal_child/gtm.pdf. Accessed 5 February 2017
- World Health Organization (2015c) “Maternal, newborn, and child health score cards,” http://www.who.int/maternal_child_adolescent/documents/countries/indicators/gtm.pdf?ua=1. Accessed February 5, 2017