WATER SUPPLY AND SANITATION CONDITIONS IN RURAL SOUTHERN MOZAMBIQUE AND ITS ASSOCIATION WITH MORBIDITY AND MORTALITY INDICATORS, 2012–2015

Abstract

Water, sanitation and hygiene (WASH) are major health determinants, with an estimated total disease burden of 5.7% occurring worldwide.The situation of access to safe water and sanitation facilities and its impact on morbidity and mortality in southern Mozambique remains unknown. The aim of this study is to describe the current situation of safe water supply and sanitation facilities in the Manhica Health Research Centre (CISM) study area and evaluate its association with several morbidity and mortality indicators. We conducted a retrospective cohort study with 61,900 children living in the center study area followed up until 15 years of age during the period 2012-2015. Water and sanitation household data was obtained from the CISM demographic surveillance system in Manhica district, an area of around 2,380km2. Clinical data for all children under 15 was obtained from CISM round-the-clock morbidity surveillance system covering pediatric outpatient and hospital admission at the Manhica District Hospital and rural health posts. A negative binomial regression model using Wald test was performed to assess the incidence rate ratio for every morbi-mortality indicator. Preliminary data showed that 86% of the children lived at least once in a household with unimproved sanitation facilities, 27% with unimproved water source and 77% with the main water source located outside the household during 2012-2015.Unexpectedly, the incidence rate ratios to develop diarrhea for children using unimproved sanitation and water facilities were signifcantly protective. Only the use of rivers and lakes as water sources signifcantly increased the children's rate to develop diarrhea by 20%. Other morbidity indicators (malnutrition, parasitemia, anemia) did show a rate increase with the use of unimproved water and sanitation facilities. Spatial distribution and clustering for the water, sanitation and morbidity variables will be also analyzed.The possible explanation of the fndings will be discussed.This analysis will help to plan evidence-based interventions to improve access to safe drinking water and sanitation in rural southern Mozambique.