GROUNDBREAKING RESEARCH SHOWS DRAMATIC REDUCTION IN CHILD STUNTING

The Maputo Sanitation (MapSan) Trial was the first rigorous, controlled study to examine the health impacts of high-quality shared sanitation. The intervention was delivered in Maputo, Mozambique by Water & Sanitation for Urban Populations (WSUP). The Trial demonstrated a 31% reduction in the prevalence of stunting among children born into intervention compounds, with access to high-quality shared toilets from birth, relative to the control group.

MapSan is one of the few studies assessing health impacts of sanitation interventions over a five-year period. The Trial offers valuable insights into improving child health in urban areas.

Read more about the interventions

Key outcomes of the study

High-quality shared toilets

The MapSan intervention provided low-income urban residents with access to high-quality shared sanitation in the form of pour-flush toilets connected to septic tanks.

Reduced enteric infections

The MapSan intervention reduced child exposure to key enteric pathogens like Shigella, ascaris, Trichuris and ETEC.

Reduced stunting

By reducing enteric infections, the intervention led to a dramatic decrease in child stunting, which has lifelong consequences on cognitive development and economic productivity.

Improved quality of life

The high-quality shared toilets delivered through MapSan reduced stress among users and improved their sense of dignity, privacy and security, with strong benefits for women and girls.

Sustainable community-led management model

MapSan’s intervention involved community-led management of shared toilets, providing a proven, replicable model for the long-term operation and maintenance of these facilities.

Filmed in 2018, this video explores the critical water and sanitation challenges in Mozambique, where nearly 80% of urban and peri-urban residents lack access to these essential services. With rapid urban migration straining infrastructure, WSUP has supported Maputo since 2009 by building up to 1000 shared sanitation facilities, improving conditions for over 10,000 people. The next priority is implementing the city’s sanitation masterplan to continue to extend services to underserved peri-urban areas.

Discover how non-sewered, high-quality, shared sanitation is dramatically reducing stunted growth among children and improving overall health outcomes in urban settings.

Explore the impact of the interventions

Research partners

The Mapsan journey

2015-2016
WSUP implements its sanitation intervention programme. Approximately 300 compounds in Maputo, Mozambique receive improved toilet facilities.
Further reading
2016
MapSan trial phase 1 takes place. A 12-month post intervention follow-up phase. No evidence is found that the intervention has an effect on the prevalence of any bacterial or protozoan infection. Intervention effects among children born into the study are also not observed in this phase.
Further reading
2017-2018
MapSan trial phase 2 takes place. A 24-month post intervention follow-up phase. No evidence is found that the intervention had an effect on the prevalence of any bacterial or protozoan infection. However, results suggest that intervention delays pathogen exposure and the accumulation of enteric infections during early childhood.
Further reading
2018
Researchers conduct a qualitative research study looking at causes and levels of psychosocial stress among users of traditional shared latrines and high-quality shared toilets in Maputo. Findings suggest that high-quality shared toilets can substantially reduce feelings of stress associated with fear of robbery, physical assault or sexual assault when using the toilet.
Further reading
2018
Survey data is collected covering MapSan trial participants behaviours. Results show that the presence of a compound chief improves soap and water availability and the adherence to a cleaning rota.
Further reading
2019
Researchers establish a link between improved sanitation and peoples mental wellbeing and perceived quality of life. Results show that quality of life outcomes are highly valued by toilet users and can be improved by sanitation interventions.
Further reading
2023
MapSan trial phase 3 takes place. A 60-month post intervention follow-up phase. Groundbreaking research shows a 31% reduction in the prevalence of stunting among children born into the intervention areas.
Further reading