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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.

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Fig. 1

Data source: 2014 Living Standards Measurement Survey (ENCOVI), Guatemala

Fig. 2

Data source: 2014 Living Standards Measurement Survey (ENCOVI), Guatemala


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Correspondence to Jennifer Trudeau.

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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.

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Our research utilizes secondary data and thus does not require informed consent.

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Trudeau, J., Aksan, AM. & Vásquez, W.F. Water system unreliability and diarrhea incidence among children in Guatemala. Int J Public Health 63, 241–250 (2018).

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  • Guatemala
  • Diarrheal incidence
  • Morbidity
  • Tap water
  • Service interruptions