Reduced burden of childhood diarrheal diseases through increased access to water and sanitation in India: A modeling analysis

Arindam Nandi, Itamar Megiddo, Ashvin Ashok, Amit Verma and Ramanan Laxminarayan

Social Science & Medicine, 2017, vol. 180, issue C, 181-192

Abstract: Each year, more than 300,000 children in India under the age of five years die from diarrheal diseases. Clean piped water and improved sanitation are known to be effective in reducing the mortality and morbidity burden of diarrhea but are not yet available to close to half of the Indian population. In this paper, we estimate the health benefits (reduced cases of diarrheal incidence and deaths averted) and economic benefits (measured by out-of-pocket treatment expenditure averted and value of insurance gained) of scaling up the coverage of piped water and improved sanitation among Indian households to a near-universal 95% level. We use IndiaSim, a previously validated, agent-based microsimulation platform to model disease progression and individual demographic and healthcare-seeking behavior in India, and use an iterative, stochastic procedure to simulate health and economic outcomes over time. We find that scaling up access to piped water and improved sanitation could avert 43,352 (95% uncertainty range [UR] 42,201–44,504) diarrheal episodes and 68 (95% UR 62–74) diarrheal deaths per 100,000 under-5 children per year, compared with the baseline. We estimate a saving of (in 2013 US$) $357,788 (95% $345,509–$370,067) in out-of-pocket diarrhea treatment expenditure, and $1646 (95% UR $1603–$1689) in incremental value of insurance per 100,000 under-5 children per year over baseline. The health and financial benefits are highly progressive, i.e. they reach poorer households more. Thus, scaling up access to piped water and improved sanitation can lead to large and equitable reductions in the burden of childhood diarrheal diseases in India.

Keywords: India; Water; Sanitation; Childhood diarrhea; Agent-based model; Cost effectiveness; Financial risk protection (search for similar items in EconPapers)
Date: 2017
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (7)

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0277953616304853
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:180:y:2017:i:c:p:181-192

Ordering information: This journal article can be ordered from
http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
http://www.elsevier. ... _01_ooc_1&version=01

DOI: 10.1016/j.socscimed.2016.08.049

Access Statistics for this article

Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian

More articles in Social Science & Medicine from Elsevier
Bibliographic data for series maintained by Catherine Liu ().