Can clean drinking water and sanitation reduce child mortality in Senegal

(ProQuest: . denotes formulae omitted.)1 IntroductionChild mortality is an indicator commonly used when assessing child health and the overall level of development in a country. It is a public health priority for the West African nation of Senegal. In 2011, infant mortality rate for Senegal was 64.8 deaths per 1,000 children under the age of five (WBI, 2011). Although lower than the average rate of 108.6 deaths per 1,000 children for Sub-Saharan Africa, it is almost nine times higher than the North American average of 7.34 deaths per 1,000 children (WBI, 2011). Water and sanitation are also priority intervention areas for the Senegalese government. The Millennium Water and Sanitation Program (PEP AM) targeted specific objectives in the past for rural and urban areas to be reached by 2015.1 According to UNICEF, poor hygiene, lack of access to safe drinking water, and sanitation causing cholera and diarrheal diseases are responsible for the death of 1.5 billion children each year (UNICEF, 2007). In Senegal, child mortality related to unimproved water and sanitation is estimated at 15.13 % in rural areas only (African Development Bank Group, 2008). Water and sanitation, as a result, have been described as "the most effective public health intervention the international community has at its disposal" to reduce child mortality (Lancet editorial, 2007). Because of the great potential to improve child health through targeted interventions in the environment in a context where countries have limited resources to invest in better water and sanitation infrastructures, it is important to provide an evidence-based estimate on the benefits of these two factors.This paper will attempt to measure the effect of water and sanitation on child mortality in Senegal. A specific focus will be given to three policy variables, which are hand washing with soap, drinking water source, and sanitation facilities. The hypothesis is that having good hygiene practices, access to better source of drinking water, and improved sanitation systems reduce child mortality rates. The result of this study will have different implications depending on which variable has the highest impact on health. The benefit of improved sanitation and running water are well established and go beyond children's health. For example, water connections in households were found to improve well-being and social cohesion is communities where water is a source of conflict. (Devoto, Duflo, Dupas, Pariente, and Pons, 2012). Nevertheless, investment and running cost associated with new water connections or sanitation systems can be high. Consequently, any policy recommendation should be supported by strong evidence as to the health impact of water and sanitation.2 Literature ReviewThe effect of water and sanitation is studied in many developing nations across the globe, yet research in this area does not lead to robust conclusions as to which variable is associated with the most health benefits and under which circumstances. In Egypt, having access to municipal water has been associated with a decrease in neonatal and infant mortality. However, this study also found that the impact of modern sanitation was considerably larger, decreasing child mortality risk by 68% (Abou-Ali, 2003). Trussell and Hammerslough (1983) found that improved latrines decreased child mortality in Sri Lanka, but that the source of water supply was insignificant. In Malaysia, Ridder and Tunali (1999) did not find any impact of access to piped water and toilet facilities on child mortality.Fink, GA¼nther and Hill (2011) conducted one of the most comprehensive analyses on child health, water, and sanitation. They merged all the DHS dataseis available for seventy countries over the period 1986 to 2007. Even though the estimated effect of improved water and sanitation is smaller than estimations done by other studies, they still found a positive impact in the reduction of mortality, as well as a lower risk of diarrhea, and stunting. …