Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique
9 affiliations
- 1Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 2Centre for Maternal, Reproductive, Adolescent and Child Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- 3Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
- 4Centre of Excellence in Women & Child Health, Aga Khan University, Nairobi, Kenya
- 5MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- 6Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- 7Department 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
- 8Department of Obstetrics and Gynaecology and BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
- 9Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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.
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BibTeX
@article{wells2026evaluating,
title = {{Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique}},
author = {Joseph Wells and Joseph Waiswa and Anifa Vala and Bahtisen Golla and Grace Mwashigadi and Hawanatu Jah and Marleen Temmerman and Robin Okello and Isaac Mwaniki and Herminio Cossa and Moses Mukhanya and Esperança Sevene and Yahaya Idris and Onesmus Wanje and Angela Koech and Anna Roca and Laura Braun and Marie-Laure Volvert and Fatima Touray and Umberto D’Alessandro and Peter von Dadelszen and Wendy Graham and Hannah Blencowe and the PRECISE and PRECISE-DYAD Networks},
journal = {PLOS Global Public Health},
year = {2026},
month = oct,
doi = {10.1371/journal.pgph.0005004},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005004},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluating the association between household water, sanitation and hygiene (WASH) and selected placenta-related complications in The Gambia, Kenya and Mozambique
AU - Joseph Wells
AU - Joseph Waiswa
AU - Anifa Vala
AU - Bahtisen Golla
AU - Grace Mwashigadi
AU - Hawanatu Jah
AU - Marleen Temmerman
AU - Robin Okello
AU - Isaac Mwaniki
AU - Herminio Cossa
AU - Moses Mukhanya
AU - Esperança Sevene
AU - Yahaya Idris
AU - Onesmus Wanje
AU - Angela Koech
AU - Anna Roca
AU - Laura Braun
AU - Marie-Laure Volvert
AU - Fatima Touray
AU - Umberto D’Alessandro
AU - Peter von Dadelszen
AU - Wendy Graham
AU - Hannah Blencowe
AU - the PRECISE and PRECISE-DYAD Networks
PY - 2026
DA - 2026/10/15
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005004
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005004
AB - 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.
SN - 2767-3375
ER -