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. 2017 Mar 7;7(3):e013201.
doi: 10.1136/bmjopen-2016-013201.

Does household access to improved water and sanitation in infancy and childhood predict better vocabulary test performance in Ethiopian, Indian, Peruvian and Vietnamese cohort studies?

Kirk A Dearden  1 , Alana T Brennan  2   3   4 , Jere R Behrman  5 , Whitney Schott  6 , Benjamin T Crookston  7 , Debbie L Humphries  8 , Mary E Penny  9 , Lia C H Fernald  10 ; Young Lives Determinants and Consequences of Child Growth Project Team
Affiliations

Does household access to improved water and sanitation in infancy and childhood predict better vocabulary test performance in Ethiopian, Indian, Peruvian and Vietnamese cohort studies?

Kirk A Dearden et al. BMJ Open. .

Abstract

Objective: Test associations between household water and sanitation (W&S) and children's concurrent and subsequent Peabody Picture Vocabulary Test (PPVT) scores.

Design: Prospective cohort study.

Setting: Ethiopia, India, Peru, Vietnam.

Participants: 7269 children.

Primary outcome measures: PPVT scores at 5 and 8 years. Key exposure variables were related to W&S, and collected at 1, 5 and 8 years, including 'improved' water (eg, piped, public tap or standpipe) and 'improved' toilets (eg, collection, storage, treatment and recycling of human excreta).

Results: Access to improved water at 1 year was associated with higher language scores at 5 years (3/4 unadjusted associations) and 8 years (4/4 unadjusted associations). Ethiopian children with access to improved water at 1 year had test scores that were 0.26 SD (95% CI 0.17 to 0.36) higher at 5 years than children without access. Access to improved water at 5 years was associated with higher concurrent PPVT scores (in 3/4 unadjusted associations), but not later scores (in 1/4 unadjusted associations). 5-year-old Peruvian children with access to improved water had better concurrent performance on the PPVT (0.44 SD, 95% CI 0.30 to 0.59) than children without access to improved water. Toilet access at 1 year was also associated with better PPVT scores at 5 years (3/4 unadjusted associations) and sometimes associated with test results at 8 years (2/4 unadjusted associations). Toilet access at 5 years was associated with concurrent PPVT scores (3/4 unadjusted associations). More than half of all associations in unadjusted models (water and toilets) persisted in adjusted models, particularly for toilets in India, Peru and Vietnam.

Conclusions: Access to 'improved' water and toilets had independent associations with children's PPVT scores that often persisted with adjustment for covariates. Our findings suggest that effects of W&S may go beyond subacute and acute infections and physical growth to include children's language performance, a critical component of cognitive development.

Keywords: PPVT; child development; cognition; lower and middle income countries; sanitation; water.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Conceptual framework for water and sanitation and receptive vocabulary.
See this image and copyright information in PMC

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