This paper presents the findings of a longitudinal study that measures the public health impact of a multiple intervention rural water and sanitation programme termed the One Million Initiative in Central Mozambique. Data from a 2008 multiple indicator panel survey baseline is compared with results from the 2010 midline using a random selection of 1,600 households divided over 80 clusters (control and intervention communities). The study reports the impact using two statistical methods: 1) statistical analysis of double differencing; and 2) calculation of DALYs (disability adjusted life years). The results indicate a self-reported reduction from 30 per cent to 14 per cent in cases of waterborne diseases between 2008 and 2010 in the intervention areas. Regression analysis suggests that 3.1 percentage points of this 16 point decline can be attributed to interventions under the programme. Furthermore the paper noted a 2 per cent reduction in DALYs between 2008 and 2010 in the target communities.

Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372-81 <http://dx.doi.org/10.2105/AJPH.2007.124610≯.

American Waterworks Association (AWWA)/American Public Health Association (APHA) (2013) Standard Methods for the Examination of Drinking Water and Wastewater, 22nd edn, Washington, DC: AWWA/APHA.

Barahona, C. (2010) Randomised Control Trials for the Impact Evaluation of Development Initiatives: A Statistician's Point of View, ILAC Working Paper 13, Rome, Italy: Institutional Learning and Change Initiative.

Bramberger, M. and White, W. (2007) ‘Using strong evaluation designs in developing countries: experience and challenges’, Journal of Multidisciplinary Evaluation 4(8): 58-73.

Elbers, C., Godfrey, S., Gunning, J.W., van der Velden, M. and Vigh, M. (2012) Effectiveness of Water and Sanitation Interventions: the One Million Initiative in Mozambique, Tinbergen Institute Discussion Paper 12-069/2, Rotterdam/Amsterdam: Tinbergen Institute.

Esrey, S.A., Potash, J.B., Roberts, L. and Schiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69(5): 609-21.

Fewtrell, L., Kaufmann, R., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Fewtrell, L., Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, WHO Environmental Burden of Disease Series No. 15, Geneva: World Health Organization.

Godfrey, S., Labhasetwar, P. and Datta, S. (2010) ‘Case controlled cohort health indicator study of an integrated fluorosis mitigation programme in India’, Ingenieria Hidraulica en Mexico 25(1).

Godfrey, S., Labhasetwar, P., Chakma, T., Water, S., Swami, A. and Bartram, J. (2011) ‘Assessing and managing fluorosis risk in children and adults in rural Madhya Pradesh, India’, Journal of Water, Sanitation and Hygiene in Developing Countries 1(2): 136-43 <http://dx.doi.org/10.2166/washdev.2011.101≯.

Independent Evaluation Group (IEG) (2008) What Works in Water Supply and Sanitation: Lessons from Impact Evaluation, Washington, DC: World Bank.

IOB - Policy and Operations Evaluation Department (2011) More than Water: Impact Evaluation of Drinking Water Supply and Sanitation Interventions in Rural Mozambique, The Hague: IOB.

Khush, R., London, A., Colford, J., Aarnold, B., Balakrishnan, K. and Ramaswamy, P. (2009) Evaluating the Sustainability and Impact of Water, Sanitation and Hygiene Interventions, unpublished final report. OECD (2011) Paris Declaration and Accra Agenda for Action, Paris: OECD.

Waddington, H. and Snilstveit, B. (2009) ‘Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea’, Journal of Development Effectiveness 1(3): 295-335 <http://dx.doi.org/10.1080/19439340903141175≯.

Waddington, H., Sniltsveit, B., White, H. and Fewtrell, L. (2009) Water, Sanitation and Hygiene Interventions to Combat Childhood Disease in Developing Countries, International Initiative for Impact Evaluation (3ie) Synthetic Review, No. 1, London: 3ie.

WHO/UNICEF (2012) Rapid Assessment of Drinking Water Quality (RADWQ): A Handbook for Implementation [pdf], <www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf≯ [accessed 3 December 2013]. www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf

Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372-81 <http://dx.doi.org/10.2105/AJPH.2007.124610≯.

American Waterworks Association (AWWA)/American Public Health Association (APHA) (2013) Standard Methods for the Examination of Drinking Water and Wastewater, 22nd edn, Washington, DC: AWWA/APHA.

Barahona, C. (2010) Randomised Control Trials for the Impact Evaluation of Development Initiatives: A Statistician's Point of View, ILAC Working Paper 13, Rome, Italy: Institutional Learning and Change Initiative.

Bramberger, M. and White, W. (2007) ‘Using strong evaluation designs in developing countries: experience and challenges’, Journal of Multidisciplinary Evaluation 4(8): 58-73.

Elbers, C., Godfrey, S., Gunning, J.W., van der Velden, M. and Vigh, M. (2012) Effectiveness of Water and Sanitation Interventions: the One Million Initiative in Mozambique, Tinbergen Institute Discussion Paper 12-069/2, Rotterdam/Amsterdam: Tinbergen Institute.

Esrey, S.A., Potash, J.B., Roberts, L. and Schiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69(5): 609-21.

Fewtrell, L., Kaufmann, R., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Fewtrell, L., Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, WHO Environmental Burden of Disease Series No. 15, Geneva: World Health Organization.

Godfrey, S., Labhasetwar, P. and Datta, S. (2010) ‘Case controlled cohort health indicator study of an integrated fluorosis mitigation programme in India’, Ingenieria Hidraulica en Mexico 25(1).

Godfrey, S., Labhasetwar, P., Chakma, T., Water, S., Swami, A. and Bartram, J. (2011) ‘Assessing and managing fluorosis risk in children and adults in rural Madhya Pradesh, India’, Journal of Water, Sanitation and Hygiene in Developing Countries 1(2): 136-43 <http://dx.doi.org/10.2166/washdev.2011.101≯.

Independent Evaluation Group (IEG) (2008) What Works in Water Supply and Sanitation: Lessons from Impact Evaluation, Washington, DC: World Bank.

IOB - Policy and Operations Evaluation Department (2011) More than Water: Impact Evaluation of Drinking Water Supply and Sanitation Interventions in Rural Mozambique, The Hague: IOB.

Khush, R., London, A., Colford, J., Aarnold, B., Balakrishnan, K. and Ramaswamy, P. (2009) Evaluating the Sustainability and Impact of Water, Sanitation and Hygiene Interventions, unpublished final report. OECD (2011) Paris Declaration and Accra Agenda for Action, Paris: OECD.

Waddington, H. and Snilstveit, B. (2009) ‘Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea’, Journal of Development Effectiveness 1(3): 295-335 <http://dx.doi.org/10.1080/19439340903141175≯.

Waddington, H., Sniltsveit, B., White, H. and Fewtrell, L. (2009) Water, Sanitation and Hygiene Interventions to Combat Childhood Disease in Developing Countries, International Initiative for Impact Evaluation (3ie) Synthetic Review, No. 1, London: 3ie.

WHO/UNICEF (2012) Rapid Assessment of Drinking Water Quality (RADWQ): A Handbook for Implementation [pdf], <www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf≯ [accessed 3 December 2013]. www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf

Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372-81 <http://dx.doi.org/10.2105/AJPH.2007.124610≯.

American Waterworks Association (AWWA)/American Public Health Association (APHA) (2013) Standard Methods for the Examination of Drinking Water and Wastewater, 22nd edn, Washington, DC: AWWA/APHA.

Barahona, C. (2010) Randomised Control Trials for the Impact Evaluation of Development Initiatives: A Statistician's Point of View, ILAC Working Paper 13, Rome, Italy: Institutional Learning and Change Initiative.

Bramberger, M. and White, W. (2007) ‘Using strong evaluation designs in developing countries: experience and challenges’, Journal of Multidisciplinary Evaluation 4(8): 58-73.

Elbers, C., Godfrey, S., Gunning, J.W., van der Velden, M. and Vigh, M. (2012) Effectiveness of Water and Sanitation Interventions: the One Million Initiative in Mozambique, Tinbergen Institute Discussion Paper 12-069/2, Rotterdam/Amsterdam: Tinbergen Institute.

Esrey, S.A., Potash, J.B., Roberts, L. and Schiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69(5): 609-21.

Fewtrell, L., Kaufmann, R., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Fewtrell, L., Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, WHO Environmental Burden of Disease Series No. 15, Geneva: World Health Organization.

Godfrey, S., Labhasetwar, P. and Datta, S. (2010) ‘Case controlled cohort health indicator study of an integrated fluorosis mitigation programme in India’, Ingenieria Hidraulica en Mexico 25(1).

Godfrey, S., Labhasetwar, P., Chakma, T., Water, S., Swami, A. and Bartram, J. (2011) ‘Assessing and managing fluorosis risk in children and adults in rural Madhya Pradesh, India’, Journal of Water, Sanitation and Hygiene in Developing Countries 1(2): 136-43 <http://dx.doi.org/10.2166/washdev.2011.101≯.

Independent Evaluation Group (IEG) (2008) What Works in Water Supply and Sanitation: Lessons from Impact Evaluation, Washington, DC: World Bank.

IOB - Policy and Operations Evaluation Department (2011) More than Water: Impact Evaluation of Drinking Water Supply and Sanitation Interventions in Rural Mozambique, The Hague: IOB.

Khush, R., London, A., Colford, J., Aarnold, B., Balakrishnan, K. and Ramaswamy, P. (2009) Evaluating the Sustainability and Impact of Water, Sanitation and Hygiene Interventions, unpublished final report. OECD (2011) Paris Declaration and Accra Agenda for Action, Paris: OECD.

Waddington, H. and Snilstveit, B. (2009) ‘Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea’, Journal of Development Effectiveness 1(3): 295-335 <http://dx.doi.org/10.1080/19439340903141175≯.

Waddington, H., Sniltsveit, B., White, H. and Fewtrell, L. (2009) Water, Sanitation and Hygiene Interventions to Combat Childhood Disease in Developing Countries, International Initiative for Impact Evaluation (3ie) Synthetic Review, No. 1, London: 3ie.

WHO/UNICEF (2012) Rapid Assessment of Drinking Water Quality (RADWQ): A Handbook for Implementation [pdf], <www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf≯ [accessed 3 December 2013]. www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf

Aiello, A.E., Coulborn, R.M., Perez, V. and Larson, E.L. (2008) ‘Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis’, American Journal of Public Health 98(8): 1372-81 <http://dx.doi.org/10.2105/AJPH.2007.124610≯.

American Waterworks Association (AWWA)/American Public Health Association (APHA) (2013) Standard Methods for the Examination of Drinking Water and Wastewater, 22nd edn, Washington, DC: AWWA/APHA.

Barahona, C. (2010) Randomised Control Trials for the Impact Evaluation of Development Initiatives: A Statistician's Point of View, ILAC Working Paper 13, Rome, Italy: Institutional Learning and Change Initiative.

Bramberger, M. and White, W. (2007) ‘Using strong evaluation designs in developing countries: experience and challenges’, Journal of Multidisciplinary Evaluation 4(8): 58-73.

Elbers, C., Godfrey, S., Gunning, J.W., van der Velden, M. and Vigh, M. (2012) Effectiveness of Water and Sanitation Interventions: the One Million Initiative in Mozambique, Tinbergen Institute Discussion Paper 12-069/2, Rotterdam/Amsterdam: Tinbergen Institute.

Esrey, S.A., Potash, J.B., Roberts, L. and Schiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69(5): 609-21.

Fewtrell, L., Kaufmann, R., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Fewtrell, L., Prüss-Üstün, A., Bos, R., Gore, F. and Bartram, J. (2007) Water, Sanitation and Hygiene: Quantifying the Health Impact at National and Local Levels in Countries with Incomplete Water Supply and Sanitation Coverage, WHO Environmental Burden of Disease Series No. 15, Geneva: World Health Organization.

Godfrey, S., Labhasetwar, P. and Datta, S. (2010) ‘Case controlled cohort health indicator study of an integrated fluorosis mitigation programme in India’, Ingenieria Hidraulica en Mexico 25(1).

Godfrey, S., Labhasetwar, P., Chakma, T., Water, S., Swami, A. and Bartram, J. (2011) ‘Assessing and managing fluorosis risk in children and adults in rural Madhya Pradesh, India’, Journal of Water, Sanitation and Hygiene in Developing Countries 1(2): 136-43 <http://dx.doi.org/10.2166/washdev.2011.101≯.

Independent Evaluation Group (IEG) (2008) What Works in Water Supply and Sanitation: Lessons from Impact Evaluation, Washington, DC: World Bank.

IOB - Policy and Operations Evaluation Department (2011) More than Water: Impact Evaluation of Drinking Water Supply and Sanitation Interventions in Rural Mozambique, The Hague: IOB.

Khush, R., London, A., Colford, J., Aarnold, B., Balakrishnan, K. and Ramaswamy, P. (2009) Evaluating the Sustainability and Impact of Water, Sanitation and Hygiene Interventions, unpublished final report. OECD (2011) Paris Declaration and Accra Agenda for Action, Paris: OECD.

Waddington, H. and Snilstveit, B. (2009) ‘Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea’, Journal of Development Effectiveness 1(3): 295-335 <http://dx.doi.org/10.1080/19439340903141175≯.

Waddington, H., Sniltsveit, B., White, H. and Fewtrell, L. (2009) Water, Sanitation and Hygiene Interventions to Combat Childhood Disease in Developing Countries, International Initiative for Impact Evaluation (3ie) Synthetic Review, No. 1, London: 3ie.

WHO/UNICEF (2012) Rapid Assessment of Drinking Water Quality (RADWQ): A Handbook for Implementation [pdf], <www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf≯ [accessed 3 December 2013]. www.wssinfo.org/fileadmin/user_upload/resources/RADWQHandbookv1final.pdf

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Venkataramanan, Vidya

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Arnold, Benjamin F.

Benjamin-Chung, Jade

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