Children in rural Kenya are more susceptible to disease and death the farther away they live from clean drinking water, according to Stanford researchers.

In a survey of families in Asembo – a small farming community at the edge of Lake Victoria that has high rates of chronic diarrhea, child malnutrition and child death – a research team from the Center on Food Security and the Environment found that most people live just over a quarter-mile from clean water sources. About 200 feet closer to home are ponds and springs contaminated with E. coli bacteria. Sixty-six percent of families primarily use this contaminated surface water for drinking.

A child in Asembo, Kenya sits next to her family's water storage containers.

A child in Asembo, Kenya sits next to her family's water storage containers. Photo Credit: Amy Pickering

While water is essential for farming, collecting it is time-consuming and physically exhausting in remote places like Asembo. Previous research has shown that when families must travel long distances for water, child health suffers. The harder it is to collect, the less of it a family will use. A shortage of water for cooking and drinking compromises children’s nutrition and hydration. And it limits hand washing and bathing, making children more susceptible to disease. Quality and availability of water also varies widely from source to source, and the time required to collect water can force families to use dirtier, unimproved water sources that are closer to home. 

In 2011, the FSE researchers partnered with the Centers for Disease Control Kenya Medical Research Institute (CDC-KEMRI), which was already conducting an extensive survey of household-level health indicators in the region. Combining resources with CDC-KEMRI allowed the team – led by FSE Director Rosamond Naylor, a professor of environmental earth system science, and Jenna Davis, an assistant professor of civil and environmental engineering – to use a robust set of data. The information covered about 3,000 households in a five kilometer radius and was collected on a bi-weekly basis for six months. In exploring the links between water, food and health in Asembo, FSE researchers first expanded the definition of water “access” to account for both physical distance and the quality of water sources.

Researchers take a child's measurements in Asembo, Kenya.

Researchers take a child's measurements in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers then mapped the distance of each household from its nearest water source, and recorded whether the source was improved (such as a deep borewell) or unimproved (surface water like a pond, spring or shallow well). To get the most precise possible data on local water quality, the research team collected samples from each household’s water source and sent them to a local hospital lab for testing. Surveyors then collected data on each household’s water management practices, including water treatment. They measured agricultural output, dietary diversity, and perceived food insecurity, then recorded the weight and height measurements of each child in the household. Respondents also reported the frequency of recent cases of diarrheal disease among children of the household.

Results of the initial survey highlight sobering realities about water access in Asembo. Households in the survey reported average per capita water consumption of only 31 liters per day, including water used for cooking, drinking, hygiene and agriculture. The average walk time to the nearest water source was approximately 15 minutes. The average distance to the nearest improved source was 428 meters, whereas the average distance to unimproved surface water was 374 meters. Water quality tests confirmed that these sources, used by the majority of families, were highly contaminated with E. coli bacteria, while improved water sources were significantly cleaner. Thirty percent of children showed stunted growth, and 11 percent were underweight for their age.

A researcher collects a sample of stored water at a household in Asembo, Kenya.

A researcher collects a sample of stored water at a household in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers found that close proximity to an abundant water source, regardless of quality, correlated with an increase in food production and diversity, as well as a lower hunger score. Having enough extra water for crop irrigation clearly improves children’s diets – particularly their access to the micronutrients essential for normal physical and cognitive development – and helps them resist disease. Households further from water sources reported lower and less diverse crop yields, as well as poorer child health indicators. Quality was also an important factor, as households with access to clean, improved water reported better child health outcomes than those relying on contaminated surface water.

The ultimate goal of the project, “Rural health and development at the food-water nexus” is to design interventions and policy incentives that help people absorb nutrients in environments where food and water are limited and disease is prevalent. In the next stage of the project, researchers will focus on links between water access and the progression of HIV, and will also investigate how improved diets from better water access can impact household income.

About the Stanford Research Team:

Jenna Davis is Associate Professor of Civil and Environmental Engineering, Higgins-Magid Faculty Senior Fellow at the Stanford Woods Institute for the Environment, and an affiliate of the Center on Food Security and the Environment.
Rosamond Naylor is the Director of the Center on Food Security and the Environment, Professor of Environmental Earth System Science, and the William Wrigley Senior Fellow at the Stanford Woods Institute.
Eran Bendavid is an infectious diseases physician and Assistant Professor of Medicine in the Division of General Internal Medicine, as well as an affiliate of the Center on Food Security and the Environment and the Stanford Health Policy center.
Amy Pickering is a lecturer in the School of Earth Sciences, and a research associate in Civil and Environmental Engineering, the Woods Institute for the Environment, and the Center on Food Security and the Environment.
Glwadys Gbetibouo is a postdoctoral scholar at the Center on Food Security and the Environment.
Katrina ole-MoiYoi is a Ph.D. student at the Center on Food Security and the Environment.

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