Safely managed drinking water service use and child diarrhoea based on evidence from 24 countries.

Universal access to safe drinking water is called for under Sustainable Development Target 6.1 (SDG 6.1). Yet quantitative evidence on disease reductions associated with achieving SDG 6.1 and the service dimensions that most effectively reduce diarrhoeal diseases remains limited and inconsistent. Here, using multiple indicator cluster survey data from 24 low- and middle-income countries, we show that household use of safely managed drinking water services (SMDWS) reduces diarrhoea risks in children under 5 years old compared with use of services not fulfilling all of the SMDWS criteria. Drinking water availability when needed and absence of faecal contamination at the point of use showed consistent protective associations with child diarrhoea. We observed less evidence of the protective effect of an improved drinking water source, access on premises and absence of faecal contamination at the point of collection. Our findings reaffirm the importance of SMDWS in protecting against child diarrhoea, while highlighting uncertainties in estimates of the magnitude of the disease burden, which could be prevented by achieving SDG 6.1.