Impact of Water Supply and Sanitation on Diarrhoea Prevalence among Children under the Age of Five: Evidence from Cameroon

Publication Details

Yantio, DY, 2015, Impact of water supply and sanitation on diarrhoea prevalence among children under the age of five: evidence from Cameroon, 3ie Grantee Final Report. New Delhi: International Initiative for Impact Evaluation (3ie)

Link to Source
Debazou Y. Yantio
Institutional affiliations
None specified
Grant-holding institution
None specified
Sub-Saharan Africa (includes East and West Africa)
Water and Sanitation
None specified
Gender analysis
None specified
Gender analysis
Equity Focus
None specified
Evaluation design
Propensity Score Matching (PSM)
3ie Final Grantee Report
3ie Funding Window


In Cameroon, diarrhea is a leading cause of morbidity amongst children aged 5 and under, a situation that has been steady or worsening since 1991.

At country level, the situation of the access to improved sources of drinking water has deteriorated by 10 per cent between 1991 and 2004 despite the improvement witnessed in 1998. In 2006, only 29 per cent of urban households had access to the public network of piped water, i.e. two years before the privatisation in 2008. In that year, the same source estimated that probably 45 per cent of rural population accessed potable drinking water.

Concerning sanitation, there is no public service. The sanitation situation is alarming in towns and no better in rural areas.

Research questions

The main outcome of interest is diarrhoea incidence amongst children aged five years and under in Cameroon.

  • What is the impact of access to improved source of drinking water? 
  • What is the impact of access to improved sanitation facility? 
  • What is the impact of a combination of the two interventions?


Intervention design

This study does not examine a specific intervention or programme. Rather, it looks at the effects of the broad set of activities that could bring about access to improved drinking water sources and/or sanitation facilities.

Theory of change

Water, sanitation and hygiene improvements are the core interventions to break the transmission of disease from the environment to the human body, especially diarrhoeal diseases.

Evaluation design

a) The main identification strategy is established using propensity score matching

b) This study is based on Demographic and Health Survey data, which is designed to be representative at the X level. 

c) What are the relevant features of the study’s sampling, units of observation and treatment, and data collection methods? 

d) How are biases, contamination, and spillover addressed? 

e) Outcomes are disaggregated by wealth quintile.

Main findings

a) Access to improved sources of drinking water reduces diarrhoea prevalence by 10.59 per cent; (ii) Access to improved sanitation facilities reduces the prevalence of diarrhoea by 8.06 per cent to 31.26 per cent among children below the age of five, depending on the matching technique implemented. 

b) Richest households have higher probability to access improved sources of drinking water but bigger families have less. Concerning the access to improved sanitation facilities, the poorest household has a better chance to gain access, surprisingly.

Implications for implementers

It is necessary to further investigate and document the characteristics of piped water contamination by the frequent network breakages that is observed all over the country especially in Douala and Yaoundé; the information will help complete the theory of change in the water and sanitation sector developed by Waddington et al. (2009). Moreover, there is a need to investigate and document public and private measures undertaken to prevent the incidence of diarrhoea, including in households and workplaces.

Implications for policy and practice

It may be helpful to try to align national definitions of safe drinking water and sanitation with criteria used in the DHS and other large indicator surveys. Despite that water and sanitation stakeholders in the public sector and civil society are currently structuring themselves into various organizations to better coordinate their interventions, policy research on water and sanitation in the country is still almost inexistent, and needs to be strengthened.

Implications for further research

This work raises the importance of understanding the underlying regional context of secondary data sources. To this end, it would be helpful to survey the specific water and sanitation interventions implemented nationwide since 1991 by the government, local councils, community or grassroots-based organizations, foundations, prominent NGOs and private sector. Further, it is important to investigate the risk of contamination of the different sources of drinking water as observed across the country in order to segregate between improved and unimproved sources.

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