{
  "abstract": "Placenta-related complications contribute substantially to maternal and perinatal mortality globally, with the greatest burden in low- and middle-income countries (LMICs). However, the potential influence of inadequate household water, sanitation and hygiene (WASH) on these outcomes remains poorly characterised. We investigated associations between household WASH conditions and selected placenta-related complications, including pre-eclampsia, small-for-gestational-age (SGA) and stillbirth, in The Gambia, Kenya and Mozambique. This secondary analysis was nested within PRECISE (PREgnancy Care Integrating Translational Science, Everywhere), a prospective observational cohort of 5,745 unselected pregnant women. Multivariable modified Poisson regression with robust standard errors was used to assess associations between household WASH exposures and pre-eclampsia, SGA or stillbirth. Missing exposure and covariate data were low (<5%) and handled using multiple imputation. Compared with water piped into the dwelling or plot, other improved water sources (adjusted relative risk [aRR] 1.18, 95% confidence interval [CI] 1.07–1.31, p = 0.002) and unimproved water sources (aRR 1.23, 95% CI 1.00–1.50, p = 0.049) were associated with a higher risk of any selected placenta-related complication. Unimproved sanitation facilities, compared with improved facilities, were also associated with increased risk (aRR 1.15, 95% CI 1.02–1.30, p = 0.019). The findings suggest that household‑level WASH conditions may be associated with selected placenta‑related complications through both direct and indirect pathways. Water sources, whether unimproved or improved, may be contaminated, and collection, transport, and storage further increase contamination risks while adding a physical burden to water collectors. Unsafe sanitation may also increase exposure to enteric pathogens. Given the observed associations, targeted WASH interventions warrant investigation as a potential strategy to reduce placenta-related complications and improve maternal and neonatal health outcomes in LMICs. Future research should explore the mechanisms linking WASH to pre-eclampsia, SGA, stillbirth and other placenta-related complications, and assess the effect of comprehensive WASH interventions.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom",
    "Centre for Maternal, Reproductive, Adolescent and Child Health, London School of Hygiene and Tropical Medicine, London, United Kingdom",
    "Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique",
    "Centre of Excellence in Women & Child Health, Aga Khan University, Nairobi, Kenya",
    "MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia",
    "Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique",
    "Department of Women and Children’s Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom",
    "Department of Obstetrics and Gynaecology and BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada",
    "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, United Kingdom"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 24,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Joseph Wells"
    },
    {
      "affs": [
        1
      ],
      "name": "Joseph Waiswa"
    },
    {
      "affs": [
        2
      ],
      "name": "Anifa Vala"
    },
    {
      "affs": [
        3
      ],
      "name": "Bahtisen Golla"
    },
    {
      "affs": [
        4
      ],
      "name": "Grace Mwashigadi"
    },
    {
      "affs": [
        5
      ],
      "name": "Hawanatu Jah"
    },
    {
      "affs": [
        6
      ],
      "name": "Marleen Temmerman"
    },
    {
      "affs": [
        7
      ],
      "name": "Robin Okello"
    },
    {
      "affs": [
        8
      ],
      "name": "Isaac Mwaniki"
    },
    {
      "name": "Herminio Cossa"
    },
    {
      "name": "Moses Mukhanya"
    },
    {
      "name": "Esperança Sevene"
    },
    {
      "name": "Yahaya Idris"
    },
    {
      "name": "Onesmus Wanje"
    },
    {
      "name": "Angela Koech"
    },
    {
      "name": "Anna Roca"
    },
    {
      "name": "Laura Braun"
    },
    {
      "name": "Marie-Laure Volvert"
    },
    {
      "name": "Fatima Touray"
    },
    {
      "name": "Umberto D’Alessandro"
    },
    {
      "name": "Peter von Dadelszen"
    },
    {
      "name": "Wendy Graham"
    },
    {
      "name": "Hannah Blencowe"
    },
    {
      "name": "the PRECISE and PRECISE-DYAD Networks"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a9g1pz59g15df.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pgph.0005004",
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  "issns": [
    "2767-3375"
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  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
    [
      "openalex",
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    ],
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      "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy/Pregnancy complications/Preeclampsia"
    ],
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      "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Stillbirths"
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    ],
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      "/People and places/Geographical locations/Africa/Kenya"
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  "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0005004&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-15",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/a9g1pz59g15df.ris",
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      "first_seen": "2026-10-30T12:17:23Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:women's health",
      "subfield": "reproductive-child"
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  ],
  "title": "Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique",
  "title_text": "Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:23Z",
  "url": "https://research.draconitic.com/paper/a9g1pz59g15df",
  "venue": "PLOS Global Public Health",
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