Context

Mozambique, a south-eastern African nation along the Indian Ocean, is experiencing rapid urbanisation which poses significant challenges for its 33 million residents.

While its bustling capital, Maputo, reflects the country’s potential, over half the population lives in urban slums, with 63% lacking safely managed sanitation and 37% without access to basic drinking water.

With an urbanisation rate of 4.2% annually, the demand for adequate water and sanitation services is growing rapidly.

Lack of access to adequate sanitation impacts health, dignity, and economic growth, particularly in the country’s poorest communities.

Life in the informal settlements of Maputo is marked by a critical lack of access to basic sanitation, with over half the population lacking safely managed sanitation facilities. This leads to unhygienic sanitation practices, which cause the spread of preventable diseases, posing serious public health risks.

Overcrowded living conditions, poor waste management, and limited access to clean drinking water further exacerbate these challenges. Many residents face poverty, limited healthcare, and vulnerability to flooding and climate change.

Around 44% of Mozambique’s population is under the age of 14, making it essential to invest in and protect the health of the youth. Addressing these issues, especially the urgent need for improved sanitation, is crucial not only for improving health, dignity, and quality of life for the most marginalised communities, but also for ensuring Mozambique’s sustainable development in the future.

Enteric infections (infections impacting the digestive system) are a major health concern for children, particularly those living in low-income countries like Mozambique. Poor environmental conditions have contributed to the frequent detection of multiple enteric pathogens in stool samples during the first year of life. This period also sees the highest incidence of diarrhoea, a leading cause of child mortality in low- and middle-income countries, and which is closely linked to stunted growth.

Water, sanitation, and hygiene (WASH) interventions are designed to reduce diarrhoea and improve child growth by interrupting the transmission of faecal-oral pathogens. However, WASH intervention trials have shown inconsistent and often limited impacts on child health outcomes.

The MapSan trial was the first rigorous study of its kind— a non-randomised controlled study designed to evaluate the health impacts of high-quality shared sanitation.

Years of research has provided evidence of improved child health, particularly through a reduction in enteric infections and diarrhoeal diseases—two of the leading threats to young children in overcrowded, urban settings.

Before MapSan, there was little robust evidence on how shared sanitation solutions could improve health, especially child health, in informal urban environments. The Mapsan trial was conceived to help bridge this evidence gap. By assessing the impact of WSUP’s innovative non-sewered, high-quality sanitation intervention in Maputo, the trial represents a critical contribution to the evidence base for urban WASH interventions and how these can address the needs of underserved communities.