Water, sanitation and agriculture linkages: impact on health and nutrition outcomes in peri-urban Gujarat, India

In the rural and peri-urban settings, where agriculture is one of the main sources of livelihood, the multi-purpose character of irrigation and drainage infrastructure creates several interlinks between water, sanitation (WATSAN) and agriculture. These interlinkages have health and nutrition impacts. This study looks at the determinants of household water quality and child health outcomes among households in areas where communities are using different irrigation water types. Using econometric models based on an original survey done for this research, we analyze household water quality, longitudinal diarrhea prevalence, malnutrition and parasitic prevalence among children under 5 years in the study area. The survey conducted collected information on anthropometric measures, stool sample testing for the presence of parasites and a biweekly follow up survey to collect information on diarrhea among under 5 children. In addition, assessment of the microbial quality of stored drinking water and source drinking water were done. The number of Escherichia coli (E.coli) colony-forming units per 100ml water was used as an indicator of fecal contamination and the results demonstrate that the microbiological water quality was poor, with water at both point of use (80 %) and point of source (73 %) cannot be considered potable. Drinking water quality was positively impacted by proper storage and water treatment practice such as reverse osmosis. Safe water storage and point-of-use water treatment should be the focus of intervention to ensure the quality of water being consumed. Hygiene and sanitation indicators had mixed impacts on the quality of drinking water, and the impacts were largely driven by hygiene behavior rather than infrastructures. Community open defecation and high village-household density deteriorate household stored water quality. Household improved toilet had no significant effect on water quality but lead to 8 percent reduction in diarrheal incidence. Stunting, an important indicator of chronic malnutrition, was affected by household improved toilet and open defecation in the community. Efforts to improve the sanitation infrastructure will prevent poor health outcomes. The mean longitudinal prevalence of diarrhea per person years is 1.6. Among the variables having a significant impact on diarrhea were wastewater irrigation, household stored water quality, and sanitation infrastructure. We found that the under 5 children of farmers using wastewater in irrigation have a statistically significant higher incidence risk ratio of 2.19, a two times increase in the diarrheal incidence in comparison to canal water irrigators. With the unprecedented population growth, measures should be undertaken to scale up the existing sewage treatment plants and exploring alternative ways as river bed filtration for wastewater treatment. The study observed that as the stored water quality deteriorates, the diarrheal incidence risk ratio increases significantly. Stunting rates in the study were high with 52 % stunted under 5 children. Stunted kids had a significantly higher incidence of diarrhea and vice versa increased diarrheal incidence increased stunting with a marginal effect of 7 percent at a significance level of p