Sanitation Access and Child Survival: A 24-Year Global Panel Analysis, 2000–2023
DOI:
https://doi.org/10.65166/mv5k0e83Keywords:
sanitation access, child mortality, under-five mortality, infant mortality, neonatal mortality, WASH, panel data, World Development IndicatorsAbstract
Access to adequate sanitation remains an important environmental determinant of child survival, although its independent contribution is difficult to distinguish from improvements in drinking water and broader socioeconomic development. This study examined the relationship between basic sanitation access and child mortality across countries from 2000 to 2023 using World Development Indicators data. The analysis employed a longitudinal country-level panel comprising 4,287 country-year observations from 185 countries and economies, with a balanced-panel subsample of 155 countries. Under-five mortality was the primary outcome, while infant and neonatal mortality were examined as additional outcomes. Two-way fixed-effects regressions controlled for basic drinking-water access, GDP per capita, health expenditure, urbanization, country-specific characteristics, and common year effects, with standard errors clustered by country. Basic sanitation was strongly associated with lower under-five mortality when drinking-water access was excluded from the model (β = −0.775, p < .001). After water access was included, the sanitation coefficient declined to β = −0.288 (p = .070), indicating substantial overlap between sanitation and the broader WASH environment. Nevertheless, sanitation remained significantly associated with lower infant mortality (β = −0.231, p = .006) and neonatal mortality (β = −0.159, p < .001). In the balanced panel, sanitation was again significantly associated with under-five mortality (β = −0.409, p = .034). Safely managed sanitation did not exhibit an additional independent association with under-five mortality in the fully adjusted model. The findings indicate that sanitation contributes to child survival but operates within an interconnected system of water access and socioeconomic development. Policies aimed at reducing child mortality should therefore emphasize integrated WASH improvements rather than sanitation infrastructure in isolation.
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Copyright (c) 2026 Charmaine Castañeda, MS, Leah Quinto, Ramon George Atento, Margareth Mangubat (Author)
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