A new study from the University of Notre Dame, published in the journal Children, links access to safe drinking water with lower stunting in Mozambique. The researchers analysed nationally representative health data from more than 3,500 children collected in the 2022–23 Mozambique Demographic and Health Surveys, which were conducted by the National Institute of Statistics with the Ministry of Health and technical support from ICF International.
Applying rigorous econometric methods, the team examined two WASH indicators—the source of drinking water and the type of toilet facility—both separately and in combination. The principal result was that improved access to safe drinking water reduced the odds of stunting by about 20%, making water the most effective WASH intervention for child growth in these data. After accounting for household and child factors such as wealth, region and religion, improved sanitation did not show an independent effect on stunting. Neither improved water nor sanitation showed a consistent association with wasting.
The study places these findings in a global context: nearly 2 billion people lack access to safe drinking water and 3.6 billion lack safe sanitation. In Mozambique recent data show 56% of the population has access to basic drinking water and 31% to basic sanitation, and undernutrition is estimated to cost the country more than 11% of GDP.
- Prioritise clean water by expanding safely managed and basic water services and strengthen water-quality monitoring in high-stunting regions.
- Continue sanitation improvements for broader health and dignity benefits, while recognising they may not produce rapid gains in child growth.
- Track progress with clear indicators on WASH access, water quality, disease burden and child growth metrics.
By identifying whether water or sanitation investments have stronger impacts on stunting or wasting, policymakers in Mozambique and similar low- and middle-income settings can better allocate resources to reduce child malnutrition.
Difficult words
- stunting — Low height for age from chronic undernutrition
- wasting — Low weight for height from recent weight loss
- sanitation — Systems that manage human waste and hygienic services
- econometric — Using statistical methods to analyse economic data
- undernutrition — Poor nutrition that harms growth and overall health
- safely managed — Water services protected and reliably available at household level
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Discussion questions
- Do you agree that Mozambique should prioritise expanding safe drinking water to reduce stunting? Explain your reasons.
- The article says sanitation may not produce rapid gains in child growth but has broader health and dignity benefits. What other benefits of sanitation do you think are important?
- Which indicators should policymakers track to measure progress on WASH and child nutrition, and why would each be useful?
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