Potential Impact of Water, Sanitation and Hygiene Interventions on Childhood Diarrhea in Honduras Using Counterfactual Simulation

Abstract

Acute diarrhea disease remains a major cause of morbidity and mortality in children under five years of age in Honduras and is closely related to water, sanitation and hygiene (WASH) conditions. To estimate the counterfactual causal effect of improvements in WASH on the prevalence of childhood diarrhea, a representative sample of 7,500 children adjusted to the distributions reported by ENDESA/MICS 2019 was simulated. Doubly robust estimators (IIPW) were used to estimate average causal effects, and five counterfactual intervention scenarios were analyzed, as well as heterogeneity by wealth quintile, area of residence, and age group. Simulated coverage of improved water was 88.1%, improved sanitation 76.3%, and basic hygiene 81.2%, with a prevalence of diarrhea of 4.1%. The estimated ATE showed decreases of -1.79 percentage points (pp) for improved water (95% CI: -3.63, 0.05), -1.93 pp for sanitation (95% CI: -3.72, -0.14) and -1.66 pp for hygiene (95% CI: -3.02, -0.30). The comprehensive WASH package was shown to have the greatest potential for reduction (0.74 pp), translating to 7.4 cases prevented per 1,000 children, with greater benefits in the poorest quintiles and in the 12–23 month group. Taken together, the findings indicate that integrated and targeted WASH interventions have the potential to significantly reduce the burden of childhood diarrhea in Honduras.