In sub-Saharan Africa (SSA), limited water infrastructure investment limits agricultural production and rural income growth, restricting households’ access to improved nutrition. Fully one-quarter of the SSA population is malnourished. Moreover, 40 percent of SSA households lack access to an improved domestic water source (e.g., household connections and public standpipes) and the majority survive on less than 25 liters per person per day for all domestic needs. This situation leaves people vulnerable to infectious diseases.

Identifying intervention points and constructive policy responses requires an understanding of how and to what extent freshwater supplies and nutrition jointly influence health outcomes. However, there is little rigorous empirical work that integrates water infrastructure planning, nutrition an infectious disease in ways that lead to actionable insights.

This project’s researchers will explore how access to clean water and a nutritional diet affect the progression of tuberculosis and HIV infection – two of the leading causes of morbidity and mortality in SSA. Progression of these illnesses is thought to be more rapid among individuals whose immune systems are compromised by malnutrition. Illness, in turn, leads to reduced dietary intake and poor absorption of nutrient, creating a vicious cycle that worsens the impact of both malnutrition and infectious diseases.

The project aims to identify the how and why access to domestic and productive water supplies and associated nutritional benefits affect the progression of HIV and TB among adults living in rural Africa.