CEE Seminar Healthier guts and taller kids: new results from the world’s longest-running, largest controlled trial of urban sanitation

The Maputo Sanitation (MapSan) trial began over a decade ago to estimate the effects of urban sanitation upgrades on child health in Maputo, Mozambique. In a long-term follow-up, we found that children living from birth in households served by new sanitation facilities experienced reduced exposure to enteric pathogens (adjusted prevalence ratio across 22 gut pathogens [aPR] 0·88, 95% CI: 0·83-0·93) compared with controls lacking upgrades, with high reductions in enteric bacteria and helminths. Children in intervention compounds grew significantly taller (adjusted mean height-for-age z-score [HAZ] difference +0·31; 95% CI: 0·097, 0·51) and had a substantially lower prevalence of stunting (aPR: 0·69; 95% CI: 0·54, 0·89) than control children lacking good sanitation. Findings strongly suggest that better urban sanitation can deliver on improved health outcomes in kids. But can such strategies scale in an era of declining global health investment?